A Reflection on BMI: Part 2 BMI Report Cards
By Laura Cipullo Whole Nutrition Services Team
Just to recap what we learned in Part I, BMI is a measurement based on an individual’s height and weight. It is used on a scale to reflect one’s status as underweight, normal and underweight. While using measurements is essential for statistical reasons and diagnostic tools, BMI is being utilized as a marker of health rather than focusing on behaviors and a cluster of measurements. We have said it before and will say it again; BMI is only one measurement and it’s not always reflective of a person’s state of health.
After collecting all of this information on BMI, does this change how we look at it for our growing children and adolescents?
Adolescent bodies, the time of development just after childhood, are growing at a rapid pace. Mentally and physically. Teens deal with an increased level of hormones in their bodies, which contribute to the many different growth spurts they will endure. They struggle with self-identity and the desire for independence. This combination often causes teens to be deeply self-conscious, which can inhibit decision-making. It could cause them to become defiant and often times unresponsive to parental guidance.
Puberty arrives at different times, stages and intervals for every child but usually happens around age 11-14. On average, teens experience a 20-25% growth increase during this time—35 pounds for girls and 45 pounds for boys. In an average one-year spurt, girls grow roughly 3.5 inches and boys about 4 inches. Using a measurement such as BMI, which is already so marginalized to determine the health status of a rapidly changing youth seems counterproductive.
Over the past few years, you may have heard of BMI Report Cards or, as they are more harshly referred to, “Fat Letters.” They are letters sent home from schools reporting on a child’s BMI and suggesting to seek out a physician if results are above normal. Needless to say, parents did not respond well to this. It caused a national outrage. In 2004, Arkansas was the first state to send BMI report cards home to parents and/or guardians. Children and adolescents with a BMI indicating they were “overweight” were suggested to consult a health care professional. Today, the program is implemented in over a quarter of United States school districts.
A cover story from the New York Post last week chronicled (with pictures!) this same concern. Click here to read the article in full and see the letter that a young girl was sent home with from the NY Department of Education. Unfortunately, this is happening with more regularity in New York City schools than the article chronicled. It isn’t just front cover news; a friend of ours recently received “obese” range marks for two of her three children who are nowhere near overweight. Now it becomes clear that we cannot possible classify these kids as overweight or underweight without taking into consideration other factors such as fat distribution, family history and the child’s behavior. This leads us to a very important question—if BMI calculates the relationship between height and weight, in a time when height and weight are rapidly changing at different paces and intervals, how can we justify using this as a determinant of adolescent health?
Knowing everything that we know about BMI, is this really something that will be beneficial for children and adolescents? Shouldn’t we be focusing on their habits through this time to pave the way for a lifelong positive relationship with health and food?
Perhaps even more important, we should be considering how these letters impact the children receiving them. We know that adolescence is the time that individuals are molded into adults. So what happens when a child is told they are fat? A recent article published by the LA Times discusses a study at UCLA that researched this question. Their data reflects “10-year-old girls who are told they are too fat by people that are close to them are more likely to be obese at 19 than girls who were never told they were too fat.” (LA Times, Deborah Netburn) The research goes on to emphasize the danger of “Weight Labeling” at this age. With our understanding of adolescent development, it’s easy to see why.
The major flaw with BMI calculations continues to be that it cannot tell you an individual’s habits. Those high in muscle weight are considered overweight, petite individuals are underweight and normal range individuals could be harboring unhealthy eating habits. BMI is limiting. It doesn’t ask the big questions; have you started menstruating? Are you feeling pressure to experiment with drugs, alcohol, cigarettes, or sex? How often do you think about food? Are you eating a balanced diet? These are the thoughts and habits that, overtime, determine the health of an individual.
Has your child received a BMI report card known as a Fitness Gram? What are your feelings concerning weight stigmas and children?