A Reflection on BMI | Part 2 – BMI Report Cards

A Reflection on BMI: Part 2 BMI Report Cards
By Laura Cipullo Whole Nutrition Services Team

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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.

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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?

 

For more information on this subject, check out the Academy of Eating Disorder’s stand on BMI reporting in schools and Examiner’s take on Fitnessgrams.

From Supersized to Downsized

Photo Credit: KRoark via Compfight cc
Photo Credit: KRoark via Compfight cc

From Supersized to Downsized
By Laura Cipullo and the Whole Nutrition Services Team

 

7-Eleven proudly offers a 44-ounce “Super Big Gulp”. KFC has something called the 64-ounce soda bucket – an entire gallon of liquid that is sold as a single portion. According to Reader’s Digest, this is the caloric equivalent of a KFC Honey BBQ sandwich, a house side salad with ranch dressing, macaroni and cheese, and half an apple turnover (roughly 780 calories and 217 grams of sugar). When did drinking an entire gallon of soda in one sitting become commonplace and acceptable?

 

Outrageous soda sizes like these and others prompted former Mayor Bloomberg’s health board to pass a law in March of 2013 prohibiting the sale of sweetened beverages larger than 16 ounces in New York City. This “soda ban”, as it was widely known, was immediately met with criticism, especially from the American Beverage Association and fast-food restaurants. Critics argued that drinking gallons of soda is a personal choice and the government shouldn’t be allowed to regulate that choice. After much deliberation, the Supreme Court ruled against the ban and by August of the same year, New Yorkers were free to eat, drink and be merry – but at what cost?

 

These issues were debated at the very first MOFAD Roundtable event, a new program from the Museum of Food and Drink (MOFAD) which aims to bring together experts and advocates to debate current controversial food issues. The event took place on December 5 and featured the following diverse panel of experts:

 

  • Joel Berg, Executive Director, New York City Coalition Against Hunger
  • Nicholas Freudenberg, Faculty Director, NYC Food Policy Center at Hunter College
  • Parke Wilde, Associate Professor, Friedman School of Nutrition Science and Policy, Tufts University
  • J. Justin Wilson, Senior Research Analyst, The Center For Consumer Freedom
  • Lisa Young, Adjunct Professor, Department of Nutrition, Food Studies, and Public Health, New York University

 

Nicholas Freudenberg, Faculty Director of the NYC Food Policy Center at Hunter College moderated the discussion and started off with the following facts: Over the past 20 years, sugary beverages have contributed to a 60% increase in overweight among 6-11 year olds and teens consume half their calories from sugary drinks. In very recent years, the soda trend has diminished slightly but it is still predicted that this generation will live less years than the previous one. So what is the solution? Is it more education? Unfortunately, pro-ban panelists argued, by itself, health education does little to change behavior; we need to do more and the soda ban is a good place to start. While critics argue that removing a choice created a “nanny” state and even went as far as calling the mayor “Nanny Bloomberg”, aren’t “Nanny Pepsi” and “Nanny Coke” doing the same thing? Wouldn’t a real nanny offering a gallon of sugary soda to a child on a regular basis be charged with negligence?

Pro-ban panelists also raised a good point in saying that when people think that limiting the power of government influence increases individual power, what it really does is increase the power of big business. “Obesity is directly related to larger portion sizes,” explained Lisa Young, a professor at New York University and author of The Portion Teller Plan, “It’s time to reset the environment; we need an environment that promotes healthy choices.” Pro-ban panelists also argued that the ban is not really a ban at all – people can still buy four smaller cups if they are really craving more soda. Rather, it’s the idea of not giving people the option of mindlessly drinking 64-ounces in one sitting. If someone is genuinely thirsty after the first 16 ounces, they have to actively make the decision to purchase more.

Photo Credit: poolie via Compfight cc
Photo Credit: poolie via Compfight cc

Choice was a big issue with anti-ban panelist J. Justin Wilson, Senior Research Analyst for The Center For Consumer Freedom, arguing that the government trying to remove our choice is only sending a message that people aren’t smart enough to make healthy decisions on their own. “With these policies, we’re removing all personal responsibility for one’s health,” he said, “and dramatically changing one’s weight requires a whole lifestyle change.” Joel Berg, Executive Director for New York City Coalition Against Hunger countered that it’s the “economic environment that’s preventing personal responsibility. When you’re poor, you don’t have a personal choice. Soda is cheaper.” Young also raised a good point in saying that with $190 billion in healthcare costs, are the choices being offered to us really choices at all? Is a choice of a 32-oz, a 44-oz, and a 51-oz at the movie theatre really a choice? None of those are healthy choices in her book.

With an issue like this, one that scares people into thinking their personal choice is taken away in the “land of the free”, there is no easy answer. In the end, it is certainly up to the individual to make healthy choices but when there are so many unhealthy ones being thrown our way, our judgment may certainly be clouded. A soda ban would have at least removed the mindless gulp of a gallon’s worth of sugary water just because it was there. Here at EALM (Eating and Living Moderately Blog) we strongly encourage our readers to make mindful choices and recognize the consequences of these choices.

 

What do you think?