Body Mass Index Screening Programs Research Articles

Communicating With Head Start Families About Children's Weight Status: A Phenomenological Approach

BackgroundTo support the early identification of childhood obesity, Head Start (HS) implemented a body mass index screening program. This program provides opportunities for HS to communicate with families about children's weight status. Limited research is available describing the methods used to communicate this information. ObjectiveExplore common experiences of HS health/nutrition managers (HNM) when communicating information to families about children's weight status. Study Design, Settings, and ParticipantsTwenty-eight in-depth telephone interviews with HNM across North Carolina (n = 15) and Ohio (n = 13). Study Design/AnalysisPhenomenology guided the study design and analysis. The themes focused on HNM's lived experiences with their body mass index screening program. Interviews were recorded and transcribed verbatim. ResultsFour emergent themes identified: (1) strategies for communicating weight status to families; (2) family response to communication strategies; (3) educational, staff support, and counseling opportunities for families; and (4) challenges engaging families in childhood obesity prevention efforts. Conclusions and ImplicationsHead Start programs acknowledged the importance of communicating children's weight status; however, there are inconsistencies in methods used and information communicated across programs. Head Start programs have community partners who support obesity prevention efforts; however, these partnerships may be underused. More research is needed to explore effective and sensitive communication methods for HS families regarding children's weight status.

Parents' Perceptions of and Responses to School-Based Body Mass Index Screening Programs-A Systematic Review.

Evidence for the effectiveness of state-mandated body mass index (BMI) screening programs in the United States has been inconclusive, and potential unintended consequences of the programs have been debated. The present review aims to understand parents' perceptions of and responses to school-based BMI screening, and to highlight racial/ethnic differences. We systematically identified studies published January 2003-May 2019 examining parent and/or youth perceptions of and/or responses to US school-based BMI screening. A total of 16 studies were included in the review. Studies suggested that while parents largely found BMI screening helpful, they held concerns regarding stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school-based screening. Furthermore, parents did not frequently follow-up with health care providers, although they reported some healthy behavior changes. Our review highlights existing parent perceptions of school-based BMI screening including the potential for healthy behavior change and important concerns regarding weight-stigma and disturbed eating attitudes/behaviors. Additionally, racial/ethnic differences in screening preferences and experiences were found. Limitations of existing literature included a need to understand youths' experiences and a lack of standardized, reliable outcomes research. Implications for future research and the role of parents, schools, and providers are discussed.

P96 Your Child is Overweight, Now What? Understanding How North Carolina Head Start Staff Communicate with Families about Childhood Obesity

Background Children (3-5 years) enrolled in Head Start (HS) are at increased risk for obesity. In an effort to prevent childhood obesity, HS implemented a Body Mass Index screening program in 2012. This program provides opportunities for HS to engage families by communicating information about children's weight status; however, limited research is available to describe the barriers and facilitators HS staff face when communicating this information to families. Objective Explore common experiences of HS Health/Nutrition Managers when communicating information to families about their child's weight status. Study Design, Setting, Participants Researchers conducted 15 in-depth telephone interviews with Managers across North Carolina. Measurable Outcome/Analysis Phenomenology was used to guide study design and analysis. Interviews were recorded and transcribed verbatim. Researchers identified significant statements through open-coding and grouped them into themes focusing “what” and “how” participants experienced the phenomenon. Results Researchers identified 3 themes: Process of Communication; Barriers to Communication; and Communication Supports. Programs used different methods to communicate about children's weight (eg, letters, meetings, no communication). Parent reactions to children's weight status often dictated communication methods chosen; negative reactions often resulted in limited communication. Managers perceived parents’ backgrounds (socioeconomic status, education) and the “shame” associated with having an overweight/obese child as communication barriers. HS (eg, consulting dietitian) and community-based (eg, WIC) educational/counseling opportunities for families were identified as supportive of Manager efforts to communicate about children's weight status. Conclusions Participating HS programs acknowledged the importance of communicating with parents about their children's weight status. However, findings also indicated parents’ personal feelings about their child's weight status may influence the type of communication they receive and their willingness to utilize other educational/counseling opportunities. More research is needed to explore parents’ perceptions of HS communication methods, as well as effective strategies for supporting and educating parents about healthy weight in childhood. Funding East Carolina University Graduate Student Thesis Award.

Are Body Mass Index Screening Programs in Schools Enough? Body Mass Index Notification, Follow-up, and School Nurse Role.

Childhood and adolescent obesity are epidemic in the United States. Because of this crisis, schools in our nation have been challenged to develop strategies to decrease the number of overweight and obese youth, with many states passing legislation requiring body mass index (BMI) monitoring by the school. This may be done as a screening or surveillance program depending on the state, with some states requiring notification to parents. As school nurses are often the only health professional in the school, they are typically the employee tasked with leading the BMI screening programs. School nurses, both in states requiring and in states without requirements for BMI screening programs, must be knowledgeable about evidence-based programs and strategies that have promise in reversing the obesity epidemic. Indeed, school nurses are in a position to be an active participant in the fight against the obesity and overweight crisis.

Association of Neighborhood Geographic Spatial Factors With Rates of Childhood Obesity

Childhood obesity is a principal public health concern. Understanding the geographic distribution of childhood obesity can inform the design and delivery of interventions. To better understand the causes of spatial dependence in rates of childhood obesity across neighborhoods. This cohort study used data from a legislatively mandated body mass index screening program for public school children in Arkansas from the 2003-2004 through 2014-2015 academic years. Spatial autoregressive moving average (SARMA) models for panel data were used to estimate spatial dependency in childhood obesity at 2 levels of spatial aggregation. Data were analyzed from August 2017 to February 2018. The SARMA models included geographic fixed effects to capture time-invariant differences in neighborhood characteristics along with controls for the mean age of children and the proportion of children by race/ethnicity, school meal status, and sex. The proportion of obese schoolchildren in Arkansas neighborhoods by year, defined at larger (census tract) and smaller (census block group) spatial scales. The geographic aggregations were based on 935 800 children with a mean (SD) age of 132 (39) months. Of these children, 51% were male; 65% were white, 21% were black, 10% were Hispanic, 2% were Asian, and the remainder were of other or unidentified race/ethnicity. In models without geographic fixed effects, there was evidence of positive and significant spatial autocorrelation in obesity rates across tracts (ρ = 0.511; 95% CI, 0.469-0.553) and block groups (ρ = 0.569; 95% CI, 0.543-0.595). When geographic fixed effects were included, spatial autocorrelation diminished at the census tract level (ρ = 0.271; 95% CI, 0.147-0.396) and disappeared at the census block group level (ρ = -0.075; 95% CI, -0.264 to 0.114). Because block groups are smaller than tracts, children in neighboring block groups were more likely to attend the same schools and interact through neighborhood play. Thus, geographic-based social networks were more likely to span block group boundaries. The lack of evidence of spatial autocorrelation in block group-level models suggests that social contagion may be less important than differences in neighborhood context across space. Caution should be used in interpreting significant spatial autocorrelation as evidence of social contagion in obesity.

Understanding Parents' Perceptions of School-Based BMI Screening and BMI Report Cards Using Perceptual Mapping: Implications for School Nurses.

Half of U.S. states measure students' body mass index (BMI), with many communicating that information to parents through a "BMI report card" or notification letter. School nurses are usually responsible for implementing these programs and communicating results to parents. The purpose of this study was to understand parents' perceptions of BMI screening programs to help inform school nurses about messages that are most helpful to use in report cards to motivate parents to follow-up with a health-care provider or to make behavioral changes for their child. Using a cluster analysis and perceptual mapping methods, a commercial marketing technique that creates three-dimensional graphic maps, we identified four unique clusters of parents based on their core attitudes and beliefs related to BMI screenings and report cards. Based on vector modeling techniques, key message strategies were developed that can be used by school nurses to enhance parent response to a BMI report card.

Do Schools That Screen for Body Mass Index Have Recommended Safeguards in Place?

The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences.

BMI Health Report Cards: Parents' Perceptions and Reactions.

In 2003, Arkansas became the first state to require body mass index (BMI) testing in public schools to raise awareness of the growing obesity epidemic among children and adolescents. Limited information exists regarding the effectiveness of school-based BMI screening programs. The purpose of this study was to determine if BMI health report cards affected parents' knowledge or actions regarding their child's health and to determine the accuracy of parents' perceptions of their child as underweight, normal weight, or overweight according to their child's BMI. A questionnaire was developed with the help of physical educators, pediatricians, and exercise scientists to determine parents' perceptions and behaviors regarding BMI report cards. The questionnaire was distributed to parents/guardians of children who sought medical care at two pediatrician's offices in Arkansas. Based on responses to survey questions, parents are not making changes to their child's diet and exercise habits if their child is classified as "at risk" or "overweight." However, parents did report that BMI health report cards are influencing their knowledge about their child's health. The majority of parents in the study (approximately 66%) did not accurately perceive their child's BMI category.

Food environment and childhood obesity: the effect of dollar stores.

In this paper we examine the effect of dollar stores on children’s Body Mass Index (BMI). We use a dataset compiled by the Arkansas Center for Health Improvement that reflects a BMI screening program for public school children in the state of Arkansas. We combine propensity score matching with difference-in-differences methods to deal with time-invariant as well time-varying unobserved factors. We find no evidence that the presence of dollar stores within a reasonably close proximity of the child’s residence increases BMI. In fact, we see an increase in BMI when dollar stores leave a child’s neighborhood. Given the proliferation of dollar stores in rural and low-income urban areas, the question of whether dollar stores are contributing to high rates of childhood obesity is policy relevant. However, our results provide some evidence that exposure to dollar stores is not a causal factor.

African-American Parents' Knowledge and Perceptions About BMI Measurements, School-Based BMI Screening Programs, and BMI Report Cards: Results from a Qualitative Investigation and Implications for School-to-Parent Communication.

School-based body mass index (BMI) screenings can help parents make informed decisions about their child's health, but schools have questioned parents' understanding and attitudes about BMI measures and report cards. Although researchers have investigated minority parents' perceptions of their child's weight, no research has explored minority parents' knowledge and perceptions related to BMI measurements, school-based BMI screening programs, and BMI report cards. To address this gap, focus groups were conducted (n = 20) with female Black or African-American parents/guardians from a large urban school district. Participants were asked to share their perceptions before and after receiving education about BMI measurements and screening programs. Pre-education: Many participants had heard of BMI, thought it was similar to body fat, believed screenings were intended to track students' weights and monitor eating habits, and were concerned that screenings could cause their child embarrassment. Post-education: Most participants did not object to screenings, but said they would have without education about why and how BMI measurements are taken. They also voiced concerns about lack of prior notice, confidentiality, and the need for schools to serve healthier food. Some of these findings support those of other qualitative studies of parents' concerns about BMI screenings, but no previous studies have compared parents' perceptions of screening programs pre-/post-education. The results reinforce that schools' efforts to explain what BMI measurements are as well as why and how they are taken can increase parents' confidence in the schools and level of comfort with BMI screening programs and report cards.

A comprehensive review of school-based body mass index screening programs and their implications for school health: do the controversies accurately reflect the research?

Whereas legislation for body mass index (BMI) surveillance and screening programs has passed in 25 states, the programs are often subject to ethical debates about confidentiality and privacy, school-to-parent communication, and safety and self-esteem issues for students. Despite this debate, no comprehensive analysis has been completed that compares and contrasts how these issues differentially affect schools, parents, and students. A keyword search from electronic databases and a review of state legislation related to BMI surveillance and screening were used to identify relevant literature and data focused on surveillance and screening policies, BMI report cards, and parental perceptions of BMI screenings and their child's weight status [corrected]. This article addresses the gap of previous literature by outlining the ethical considerations and implications that BMI screening programs and report cards have for schools, parents, and students, and links these with outcome studies to address whether these controversies are supported by research. Despite the controversies surrounding these programs, this review shows that they can be valuable for all parties and demonstrates BMI screening programs to be vital to the development of robust school-based obesity prevention programs and promotion of healthy lifestyles in schools.

IMPACT: A multi-level family and school intervention targeting obesity in urban youth

IMPACT (Ideas Moving Parents and Adolescents to Change Together) is a 3-group randomized, multi-level trial comparing the efficacy of two distinct behavioral interventions and a control condition on body mass index (BMI) in middle school urban youth who are overweight/obese. Interventions include: (1) SystemCHANGE™ (SC), a promising new behavior change approach that focuses on system redesign of the family environment and daily routines; (2) HealthyCHANGE (HC), a cognitive–behavioral and Motivational Interviewing (MI)-consistent approach to behavior change that focuses on increasing intrinsic motivation, self-monitoring, goal setting, and problem solving; and (3) diet and physical education counseling (attention control). In addition, about half of the participants are enrolled in a K-8 public school that offers an innovative community-sponsored fitness program, augmented by study-supported navigators. In addition to the primary interventions effects, the study assesses the moderating effect of the school environment on BMI, blood pressure, cardiovascular risk factors, and quality of life.The sample consists of 360 children entering 6th grade from a large urban school district in the Midwest, identified through an existing BMI screening program. The intervention period is 36months, and measures are obtained at baseline, 12, 24, and 36months. Using intent-to-treat analyses across the 36-month intervention window, we hypothesize that both SC and HC will have a greater impact on BMI and other health outcomes compared to health education alone, and that the enriched school environment will enhance these effects. This manuscript describes IMPACT's study design and methods.

Parent Reactions to a School‐Based Body Mass Index Screening Program

This study assessed parent reactions to school-based body mass index (BMI) screening. After a K-8 BMI screening program, parents were sent a letter detailing their child's BMI results. Approximately 50 parents were randomly selected for interview from each of 4 child weight-classification groups (overweight, at risk of overweight, normal weight, underweight) to assess parent recall of the letter, reactions to BMI screening, and actions taken in response to the child's BMI results. Most parents found the BMI screening letter easy to read and had poor recall of numerical information (eg, the child's BMI percentile) but good recall of the child's weight classification (eg, normal weight or overweight). Most parents, and ethnic-minority parents in particular, supported school-based BMI screening. Parents of children whose weight was outside of the normal range were more likely to recall receiving the letter and talking to the child and the child's doctor about it. Parents who recalled their child as being overweight were more likely to report changing the child's diet and activity level. Most parents, and ethnic-minority parents in particular, wanted their child to participate in an after-school exercise program. An overweight condition in parents, but not children, was associated with an interest in family-based cooking and exercise classes. Most parents, and ethnic-minority parents in particular, viewed school-based BMI screening and after-school exercise programs favorably. Parents reported taking action in response to a BMI result outside of the normal range. Parents who were overweight themselves were particularly interested in family cooking and exercise classes.

Body Mass Index Measurement in Schools*

School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth. An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided expertise on an earlier version of this article. The panel comprised experts in public health, education, school counseling, school medical care, and a parent organization. This article describes the purposes of BMI measurement programs, examines current practices, reviews existing research, summarizes the recommendations of experts, identifies concerns, and provides guidance including a list of safeguards and ideas for future research. The implementation of school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted; however, considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI screening programs are a promising practice for addressing obesity. Based on the available information, BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools. Schools that initiate BMI measurement programs should evaluate the effects of the program on BMI results and on weight-related knowledge, attitudes, and behaviors of youth and their families; they also should adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.

Parents of Elementary School Students Weigh in on Height, Weight, and Body Mass Index Screening at School

School-based body mass index (BMI) screening and parent notification programs have been recommended as a childhood overweight prevention strategy. However, there are little empirical data available to guide decision making about the acceptability and safety of programs. A pilot study was conducted using a quasiexperimental research design. In fall 2004, children in 4 suburban elementary schools (kindergarten to sixth grade) in the St Paul/Minneapolis, MN, metropolitan area completed height/weight screening. The following spring, parents in 2 schools received letters containing height/weight and BMI results. A self-administered post-only survey examined parents' opinions and beliefs regarding school-based BMI screening and parent notification programs (response rate: 790/1133 = 70%). The chi2 test of significance was used to examine differences in program support by treatment condition, child's weight status, and sociodemographic characteristics. Among all parents, 78% believed it was important for schools to assess student's height/weight annually and wanted to receive height, weight, and BMI information yearly. Among parents receiving the letter, 95% read most/all of the letter. Most parents (80%) and children (83%) reported comfort with the information in the letter. Parents of overweight children were more likely to report parental discomfort as well as child discomfort with letter content. There was considerable parental support for school-based BMI screening and parent notification programs. Programs may be a useful overweight prevention tool for children. However, continued attention to how best to support parents and children affected by overweight is required.

School-Based Body Mass Index Screening Program

School-Based Body Mass Index Screening Program

Developing School-Based BMI Screening and Parent Notification Programs: Findings From Focus Groups With Parents of Elementary School Students

School-based body mass index (BMI) screening and parent notification programs have been advanced as an obesity prevention strategy. However, little is known about how to develop and implement programs. This qualitative study explored the opinions and beliefs of parents of elementary school students concerning school-based BMI screening programs, notification methods, message content, and health information needs related to promoting healthy weight for school-aged children. Ten focus groups were conducted with 71 participants. Parents were generally supportive of school-based BMI screening. However, they wanted assurance that student privacy and respect would be maintained during measurement and that BMI results would be provided to parents in a neutral manner that avoided weight labeling. They also believed that aggregate results should be disseminated to the larger school community to support healthy change in the nutrition and physical activity environments of schools. Implications for practitioners and researchers are discussed.