Effect of School-Based Body Mass Index Reporting in California Public Schools

Abstract

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.

Recent trends in overweight and obesity in adolescents aged 12 to 15 years across 21 countries

“…31 For example, parents receive their children's BMI report when it is measured, which is a widely applied effort to reduce childhood overweight and obesity. 31,32 However, evidence shows that this effort has no effect in reducing paediatric overweight and obesity. 31,32 Evidencebased interventions should be prioritized.…”

“…31,32 However, evidence shows that this effort has no effect in reducing paediatric overweight and obesity. 31,32 Evidencebased interventions should be prioritized. Importantly, to effectively address the upward trends and high prevalence of paediatric overweight and obesity, comprehensive policies and programs that combine efforts from the children themselves, their families, schools, community groups and governments will be required.…”

Weight-Based Disparities in Youth Mental Health: Scope, Social Underpinnings, and Policy Implications

“…However, programs emphasizing weight loss are more commonly utilized in school settings than evidence-based programs that promote healthy eating and physical activity, despite their potential to reinforce and strengthen weight stigma (Kenney et al, 2017). For example, although associated with decreased weight satisfaction and increased peer weight talk (Madsen et al, 2021), weight assessment and monitoring practices are widespread in schools. Indeed, half of all U.S. states have legislation requiring schools to monitor student BMI (Ruggieri & Bass, 2015).…”

Critical Evaluation of the Case for Pausing California’s School-based Fitness Testing

“…In a rigorous test of the hypothesis that school-based BMI screening is associated with adverse students outcomes, Madsen et al 90 conducted a randomized clinical trial in which 79 elementary and middle schools were randomly assigned to either undergo BMI screening or have no screening for three successive years.…”