1. Kendrin Sonneville, ScD, RD Assistant Professor Intended Outcomes and Unintended Consequences: Do BMI Report Cards Fail?

2. Eating Disorders Eating disorders are a major public health problem among youth – What environmental triggers could be contributing to eating disorders? – What is happening in schools?

3. BMI Measurement Policies National Association of State Boards of Education. State School Health Policy Database. http://nasbe.org/healthy_schools/hs/bytopics.php?topicid=4100&catExpand=acdnbtm_catD BMI surveillance required BMI screening required BMI measurement recommended

4. School-Based BMI Measurement Programs School-based BMI measurement programs were designed to address obesity among youth Several concerns about these programs have been raised – Ineffective? – Harmful? 4

5. BMI MEASUREMENT PROGRAMS BMI SurveillanceBMI Screening (“BMI Report Cards”) Description Weigh/measure all students AnonymousParents notified Goal Track obesity rates from year to year Motivate obese youth/families to make behavioral changes Assumptions Weighing youth at schools is harmless Youth is not aware of obesity status Awareness of obesity status is essential for healthy behavior Youth and families will have the necessary knowledge/resources

6. BMI MEASUREMENT PROGRAMS BMI SurveillanceBMI Screening (“BMI Report Cards”) Description Weigh/measure all students AnonymousParents notified Goal Track obesity rates from year to year Motivate obese youth/families to make behavioral changes Assumptions Weighing youth at schools is harmless Youth is not aware of obesity status Awareness of obesity status is essential for healthy behavior Youth and families will have the necessary knowledge/resources

7. BMI MEASUREMENT PROGRAMS BMI SurveillanceBMI Screening (“BMI Report Cards”) Description Weigh/measure all students AnonymousParents notified Goal Track obesity rates from year to year Motivate obese youth/families to make behavioral changes Assumptions Weighing youth at schools is harmless Youth is not aware of obesity status Awareness of obesity status is essential for healthy behavior Youth and families will have the necessary knowledge/resources

8. BMI MEASUREMENT PROGRAMS BMI SurveillanceBMI Screening (“BMI Report Cards”) Description Weigh/measure all students AnonymousParents notified Goal Track obesity rates from year to year Motivate obese youth/families to make behavioral changes Assumptions Weighing youth at schools is harmless Youth is not aware of obesity status Awareness of obesity status is essential for healthy behavior Youth and families will have the necessary knowledge/resources

9. BMI MEASUREMENT PROGRAMS BMI SurveillanceBMI Screening (“BMI Report Cards”) Description Weigh/measure all students AnonymousParents notified Goal Track obesity rates from year to year Motivate obese youth/families to make behavioral changes Assumptions Weighing youth at schools is harmless Youth is not aware of obesity status Awareness of obesity status is essential for healthy behavior Youth and families will have the necessary knowledge/resources

10. BMI MEASUREMENT PROGRAMS BMI SurveillanceBMI Screening (“BMI Report Cards”) Description Weigh/measure all students AnonymousParents notified Goal Track obesity rates from year to year Motivate obese youth/families to make behavioral changes Assumptions Weighing youth at schools is harmless Youth is not aware of obesity status Awareness of obesity status is essential for healthy behavior Youth and families will have the necessary knowledge/resources

11. Do BMI report cards fail? Assumption: Weighing youth at school is harmless

12. Do BMI report cards fail? Assumption: Weighing youth at school is harmless

13. Do BMI report cards fail? Assumption: Weighing youth at school is harmless Reality: Weight concerns and body dissatisfaction are already extremely high In Arkansas, overweight students report being embarrassed by BMI measurement Weighing students may worsen weight stigma

14. Do BMI report cards fail? Assumption: Youth is not aware of obesity status

15. Do BMI report cards fail? Assumption: Youth is not aware of obesity status Reality: BMI is routinely measured at the doctor’s office When measured at a doctor’s office, other factors can be taken into account when BMI is interpreted

16. Do BMI report cards fail? Assumption: Awareness of obesity status is essential for healthy behavior

17. Do BMI report cards fail? Assumption: Awareness of obesity status is essential for healthy behavior Reality: Overweight youth who are aware that they are overweight: Are more likely to skip meals, use diet pills, and smoke cigarettes for weight control

18. Do BMI report cards fail? Assumption: Awareness of obesity status is essential for healthy behavior Reality: Overweight youth who are aware that they are overweight: Are more likely to skip meals, use diet pills, and smoke cigarettes for weight control

19. Do BMI report cards fail? Assumption: Awareness of obesity status is essential for healthy behavior Reality: Overweight youth who are aware that they are overweight: Are more likely to skip meals, use diet pills, and smoke cigarettes for weight control Gain more weight

20. Do BMI report cards fail? Assumption: Youth and families will have the necessary knowledge and resources

21. Do BMI report cards fail? Assumption: Youth and families will have the necessary knowledge and resources Reality: Meaningful strategies not provided Resources are extremely limited Weight is not a behavior Youth may adopt harmful behaviors

22. Do BMI report cards fail? Assumption: Youth and families will have the necessary knowledge and resources Reality: Meaningful strategies not provided Resources are extremely limited Weight is not a behavior Youth may adopt harmful behaviors

23. Creating a healthy and safe school environment should be a top priority There is no evidence that BMI measurement programs reduce obesity BMI measurement programs could worsen weight stigma and increase eating disorders The effects of BMI measurement programs must be evaluated