District 205 Forced to Review its Practice of Testing for Body Fat in Elementary School

Angela Gemini will never forget the day her fifth-grade son came home from Hawthorne School last fall and told her he was at “some risk” for obesity and/or obesity-related health issues.

 “I have an extremely slim, tall, physically active fifth-grader,” Gemini said.  “He eats nutritionally and is healthy. He never has and never will have an obesity problem.”

Gemini immediately logged on to the Center for Disease Control Web site and, using height and weight information provided by the school, calculated her son’s body mass index [BMI]. It said clearly, "This child has a healthy weight."

“I talked to my son and told him that he had nothing to fear. But for the first time he was worried about his health,” Gemini said. “He didn’t want to get cancer or diabetes. He was using words like 'obesity,' 'unhealthy,' 'not physically fit.'

“I started talking to other parents and found out other kids were coming home crying, depressed and self-critical,” she recalled.

Gemini spent weeks going back and forth with school administrators, then district staff, trying to understand exactly what happened at Hawthorne to make this year’s annual fitness challenge different than in years past. What she discovered was that dozens of parents through the years have complained to District 205 administration about BMI testing, but nothing ever became of it—until now.

 “Administrators are aware of parents’ concerns at Hawthorne,” said Melea Smith, District 205 director of communications and public relations.

 Assistant Superintendent for Curriculum and Instruction Karen Sullivan, and Connie Chester, curriculum coordinator for K-12 world language/unified arts and physical education, have already met with members of the district physical education team and are planning to talk with Hawthorne parents at their Jan. 18 PTA meeting, she said.

“We take all issues related to the implementation of curriculum very seriously,” Chester said. “In an effort to be both responsive and thorough, we feel that we need to examine the existing curriculum, evaluate current procedures and carefully review best practice.”

 Better communication among educators and with parents will definitely be part of the conversation, she said.

Two Sides to Every Issue

On one side is a group of concerned and passionate parents looking out for the best interests of their children, Smith said. On the other is a group of passionate and professional teachers, curriculum experts and administrators whose goal is “to develop students who take personal responsibility for their own health and physical fitness for a lifetime.”

Both sides agree that childhood obesity is a national epidemic with dire health consequences. At question is the use of BMI testing, student fitness plans and the weighing in of fourth- and fifth-grade students in the district’s elementary schools and how that testing is administered and communicated.

BMI, the ratio of weight to height squared, has long been one measurement tool pediatricians have used to screen for obesity, overweight, healthy weight or under weight issues in children and young adults. The CDC recommends a child’s pediatrician conduct an annual height and weight assessment starting at the age of 2.

 District 205 started BMI testing in 1986 in all eight elementary schools.

“At that time health aides took students’ height and weight,” Chester said. “And in some cases, parents assisted.”

The district uses a health-related fitness assessment created by The Cooper Institute, a preventive medicine nonprofit founded by Dr. Kenneth H. Cooper, known as the “Father of Aerobics,” and sold and supported by Human Kinetics.

The assessment, called a FITNESSGRAM, measures five components of health-related physical fitness: aerobic capacity (1-mile run/walk/pacer), BMI and muscular strength (push ups), endurance (curl ups) and flexibility (trunk lifts and sit-and-reach). PE instructors at each school administer and communicate the assessment to students in the fall.

In the spring, parents of elementary school students receive the information as part of their students’ progress reports. And, yes, PE teachers consider the results of the FITNESSGRAM as one of the criteria in determining the learning target, “Demonstrates appropriate health-related fitness,” in fourth and fifth grade.

 The Institute of Medicine supports annual school-based screening. “BMI is an acceptable measure, and schools are a logical measurement site because they reach virtually all youth,” the institute reports.

 But most health organizations, including the CDC, believe there is still not enough evidence to recommend school-based BMI measurement programs as an effective strategy for preventing or reducing childhood obesity.  

“Decision makers need to consider the pros and cons,” according to the CDC Web site.  “If implemented, these programs should be part of a comprehensive approach to address obesity.”

Within the physical education profession, many favor BMI testing. One Elmhurst PE instructor wrote, “I agree that BMI is not a perfect test.  There is a margin of error because muscle mass and bone structure is not taken into account. But, it is an appropriate test for elementary students.  We, as parents and teachers, need to make sure the students understand the limitations of the test, and how it can be used to make us aware of our health status.”

 Smith said the district is always looking for ways to improve its curriculum, including its policies and procedures.

 “I’m sure [their] review will result in better alignment of best practice from school to school and better parent communication regarding what we are doing and why we are doing it,” Smith said. “We are trying to reach middle ground. “We are listening.”

Hawthorne Parents Weigh In

Parents at Hawthorne are shining a light upon the issue of BMI testing. Gemini said she was even more surprised when her son came home a week later with an assignment to write out a fitness plan to improve his BMI.

“Now, everyone knows that the only way to improve the ratio is to grow in height or to lower your weight,” she said. “A child may have a high BMI for age and sex, but to determine if excess fat is a problem, a health care provider would need to perform further assessments.”

These assessments, according to the CDC, might include skin fold thickness measurements, evaluations of diet, physical activity and family history, and other health screenings.

“I strongly believe any type of weight-BMI assessment should be done by a qualified health care provider of my choosing in conjunction with the other relevant factors, including body type and muscle mass," Gemeni said. "And certainly not during PE class with their peers present, even if the weigh-ins are supposed to be private.”

But what upset Gemini the most, she said, was that the school never communicated the BMI testing process directly to her. Instead, she heard about it through her son. Furthermore, she said, teachers are using the assessment to determine a child’s rating on the progress report.

“Reporting a number in a vacuum, absent proper communication and counseling, runs the risk of being inaccurate and is harmful to the children, especially at this sensitive time in their lives,” she wrote in an e-mail to officials at Hawthorne.  “Focusing on weight and numbers, at school no less, on pre-teens, is not consistent with promoting healthy body image or health in general.”

Gemini said she has heard of 10-year-old girls counting calories and asking for treadmills for Christmas.

“I want District 205 to stop BMI testing at school,” she said. “The school is there to educate, not to physically evaluate my child. BMI testing is dangerous and irresponsible, but to include it in the grading process goes from silly to ridiculous.”

Gemini said she plans to “opt out” of BMI testing and to “direct my child’s school not to weigh my child or discuss with him these issues without me present.”

Susan Bonner has children in District 205 elementary, middle and high schools. She said her older two children never mentioned BMI testing to her, or at least no one came home upset.

"I remember my daughter saying, however, ‘The flexible kids don't seem as strong, and the strong kids don't seem as flexible.’ ” Bonner said. “This year my youngest child came home and asked me what ‘at risk’ meant. I told her that it meant you were ‘in danger’ of something. She burst into tears and said ‘Well I have to tell you, I’m in danger of being obese and getting diabetes!’ "

Bonner said her daughter had been measured and weighed at school and that she was embarrassed and humiliated in the process. She made an appointment with her pediatrician, who assured her that her daughter’s weight was in the normal range for her height and certainly not “at risk" for obesity or any other disease.

“I think if we all look back on our upbringing, the fourth- and fifth-grade years were ones in which we tended to pack on the pounds before puberty,” Bonner said. “We seem to be judging kids when they are least likely to be in the normal zone. However, my biggest concern is that if you are telling young girls they are at risk for obesity (when they are in the normal BMI range), we are just setting our children up for eating disorders in middle school or high school.” 

 Bonner said she has failed to see the positive outcome of BMI testing.

“I feel it should be handled like vision screening.” she said. “If there is a concern flagged at school, the child should be referred to another authority. Can you imagine if during vision testing children were told they were at risk for blindness?”

Lisa Barnhart, another Hawthorne mom, would like to see the district take BMI testing out of the schools, as well as out of the grading process.

“I am in full support of teaching children how to develop healthy habits in all aspects of their life,” she wrote in an e-mail. “The fact that they are graded based on improvement of their BMI seems very wrong to me.”

Teri Litavsky said her daughter, now a senior at York, on occasion still recalls with her friends how unpleasant and embarrassing their weighing-in experience was at Hawthorne. But when her fourth-grade daughter came home earlier this year crying because she was told she was “fat,” she realized there has to be a better solution to addressing children’s health beyond BMI testing.

“The district’s approach to children’s health seems well intentioned,” Litavsky said. “But it desperately needs re-evaluation.”