IMPORTANCE Annually, US schools screen millions of students' body mass index (BMI) and report the results to parents, with little experimental evidence on potential benefits and harms.OBJECTIVE To determine the impact of school-based BMI reporting on weight status and adverse outcomes (weight stigmatization and weight-related perceptions and behaviors) among a diverse student population. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized clinical trial. The Fit Study (2014)(2015)(2016)(2017) randomized 79 California schools to BMI screening and reporting (group 1), BMI screening only (group 2), or control (no BMI screening or reporting [group 3]) in grades 3 to 8. The setting was California elementary and middle schools. Students in grades 3 to 7 at baseline participated for up to 3 years. A modified intent-to-treat protocol was used. Data analysis was conducted from April 13, 2017, to March 26, 2020.INTERVENTIONS School staff assessed BMI each spring among students in groups 1 and 2. Parents of students in group 1 were sent a BMI report each fall for up to 2 years. MAIN OUTCOMES AND MEASURESChanges in BMI z score and in adverse outcomes (based on surveys conducted each fall among students in grades 4 to 8) from baseline to 1 and 2 years of follow-up.RESULTS A total of 28 641 students (14 645 [51.1%] male) in grades 3 to 7 at baseline participated in the study for up to 3 years. Among 6534 of 16 622 students with a baseline BMI in the 85th percentile or higher (39.3%), BMI reporting had no effect on BMI z score change (−0.003; 95% CI, −0.02 to 0.01 at 1 year and 0.01; 95% CI, −0.02 to 0.03 at 2 years). Weight dissatisfaction increased more among students having BMI screened at school (8694 students in groups 1 and 2) than among control participants (5674 students in group 3). Results of the effect of BMI reporting on other adverse outcomes were mixed: compared with the control (group 3), among students weighed at school (groups 1 and 2), weight satisfaction declined more after 2 years (−0.11; 95% CI, −0.18 to −0.05), and peer weight talk increased more after 1 year (0.05; 95% CI, 0.01-0.09); however, concerning weight control behaviors declined more after 1 year (−0.06; 95% CI, −0.10 to −0.02).CONCLUSIONS AND RELEVANCE Body mass index reports alone do not improve children's weight status and may decrease weight satisfaction. To improve student health, schools should consider investing resources in evidence-based interventions.
This study was funded by NIH/NHLBI R01HD074759. The funder had no role in any of the following activities: design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Kristine Madsen had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Kristine Madsen and Shalika Gupta conducted all analyses contained in this manuscript. Nancy Fang Liu, BA, Benjamin King, MPP, and Ana Ibarra-Castro, BA, contributed substantial efforts on data collection and data entry while working as paid Research Assistants on this study at the
Objectives Sober living houses are alcohol- and drug-free recovery residences that help individuals with substance use disorders maintain long-term abstinence. Given the prevalence of co-occurring mental disorders among individuals entering substance use treatment, it is likely that many residents entering sober living houses are also contending with psychiatric symptoms, and it is unclear how these symptoms may affect their sobriety. This study sought to describe the prevalence and trajectories of different types of symptoms among sober living house residents and examine how these symptoms affect substance use outcomes. Methods 300 residents (241 men and 59 women, with a mean age of 38.5 years) were interviewed upon entry and re-interviewed at 6-, 12-, and 18-month follow-ups. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI). General estimating equations were used to test changes in BSI global psychological distress and clinical symptom scales (depression, hostility, somatization, and phobic anxiety) over time and to test the relationship between scale scores and substance use in longitudinal models controlling for demographics, length of stay, and psychiatric service utilization. Results Psychiatric symptoms were common. At baseline, the majority (51%) of participants endorsed 20 or more symptoms. Overall psychological distress and symptoms of depression and phobic anxiety significantly improved over time. Rates of abstinence and days of use among those who reported using substances also improved over time. Overall distress and all symptoms dimensions measured were associated with a decreased likelihood of abstinence. Symptoms of somatization were associated with an increase in the number of days substances were used among those who reported use. Conclusions Psychological symptoms among sober living house residents improve over time, but they are risk factors for relapse, suggesting that additional support provided to residents with psychiatric symptoms could improve substance use outcomes.
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