School-based Body Mass Index Screening Research Articles

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.

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.

The Fit Study: Design and rationale for a cluster randomized trial of school-based BMI screening and reporting

BackgroundIn the U.S., 25 states conduct body mass index (BMI) screening in schools, just under half of which report results to parents. While some experts recommend the practice, evidence demonstrating its efficacy to reduce obesity is lacking, and concerns about weight-related stigma have been raised. Methods/designThe Fit Study is a 3-arm cluster-randomized trial assessing the effectiveness of school-based BMI screening and reporting in reducing pediatric obesity and identifying unintended consequences. Seventy-nine elementary and middle schools across California were randomized to 1 of 3 Arms: 1) BMI screening and reporting; 2) BMI screening only; or 3) no BMI screening or reporting. In Arm 1 schools, students were further randomized to receive reports with BMI results alone or both BMI and fitness test results. Over 3 consecutive years, staff in schools in Arms 1 and 2 will measure students' BMI (grades 3–8) and additional aspects of fitness (grades 5–8), and students in grades 4–8 in all Arms will complete surveys to assess weight-based stigmatization. Change in BMI z-score will be compared between Arm 1 and Arm 2 to determine the impact of BMI reporting on weight status, with sub-analyses stratified by report type (BMI results alone versus BMI plus fitness results) and by race/ethnicity. The potential for BMI reports to lead to weight-based stigma will be assessed by comparing student survey results among the 3 study Arms. DiscussionThis study will provide evidence on both the benefit and potential unintended harms of school-based BMI screening and reporting.

The Report Card on BMI Report Cards.

Half of states in the USA have legislation requiring that schools conduct body mass index (BMI) screening among students; just under half of these states report results to parents. The effectiveness of school-based BMI screening and reporting in reducing childhood obesity is not established and the practice has raised concerns about the potential for increased weight-based stigmatization. Recent experimental studies of BMI screening and reporting have not demonstrated a positive impact on students' weight status. However, the language and formatting of BMI reports used in studies to date have been suboptimal and have likely limited the potential effectiveness of the practice. This article reviews the recent literature on school-based BMI screening and reporting and highlights important areas for future inquiry. The present review suggests that evidence to date is not sufficient to support definitive conclusions about the value of school-based BMI screening and reporting as a childhood obesity prevention tool.

Effects of Enhancing School-Based Body Mass Index Screening Reports with Parent Education on Report Utility and Parental Intent To Modify Obesity Risk Factors

School-based body mass index screenings (SBMIS) have been controversial. We aimed to determine if parents would indicate improved utility with SBMIS when the report included parent education and whether parental intent to modify obesity risk factors would vary with report type or child weight. A cluster-controlled trial was conducted with 31 elementary schools randomized to distribute a standard SBMIS report or the standard report plus education (SBMIS+). A random subsample of parents completed a mailed survey (731 SBMIS, 738 SBMIS+). Using a two-stage cluster sampling design, logistic regression models with school-level random effect were used to assess differences between conditions and by weight category. Parents in the SBMIS+ condition vs. the standard condition were more likely to indicate that the report provided useful information (not significant) and an intent to help their child get enough sleep (p < 0.001). Parents of children who were overweight or obese were less likely than parents of children who were not to indicate that the report provided useful information about their child's weight status (p < 0.001) or access to resources (p < 0.05). However, these parents were more likely to plan a visit to healthcare provider (p < 0.001) and to intend to limit sugar-sweetened beverages (p < 0.05). Parental education can enhance the utility of the SBMIS report and parental intention to modify at least one obesity risk factor. SBMIS reports prompted parents of children with overweight and obesity to seek clinical care and limit sugar-sweetened drinks.

Massachusetts Pediatricians' Views Toward Body Mass Index Screening in Schools: Continued Controversy.

Objective Evaluate Massachusetts pediatricians' views toward school-based body mass index screening since its implementation. Methods Survey of 286 members of the Massachusetts Chapter of the American Academy of Pediatrics on attitudes toward screening and perceived impact on clinical practice. Results Overall, 36.3% supported screening, with suburban or rural pediatricians significantly less likely (vs urban) to indicate support. Less than 10% of pediatricians agreed or strongly agreed that screening improved communication with schools (4.2%), communication with families (8.9%), or helped them care for patients (7.0%), with suburban or rural pediatricians significantly less likely to agree. Most pediatricians reported contact from patients regarding screening (59.4%) and identifying concerns from patients regarding screening during office visits (60.4%), including bullying and self-esteem. Suburban or rural pediatricians were significantly more likely to report patient contact and concerns related to screening. Conclusions Support for school-based body mass index screening is low among Massachusetts pediatricians, particularly among suburban and rural pediatricians.

Critical Elements of a School Report to Parents on Body Mass Index.

School-based body mass index (BMI) screening and reporting could have a positive impact on student health, but best practices for writing a report are unknown. Building on previous qualitative work, 8 focus groups were conducted with a diverse group of California parents (n = 79) to elicit feedback on report content and design. Results indicate that parents want a visually appealing, picture-heavy report that clearly defines BMI, avoids stigmatizing language, and includes recommendations for appropriate actions whole families can take. Next steps involve using the final report in a statewide, randomized trial to determine the effectiveness of school-based BMI screening and reporting in reducing childhood obesity.

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.

School-Based Body Mass Index Screening and Parental Notification in Late Adolescence: Evidence From Arkansas's Act 1220

PurposeIn 2003, Arkansas enacted Act 1220, one of the first comprehensive legislative initiatives aimed at addressing childhood obesity. One important provision of Act 1220 mandated that all children attending public schools be screened for their body mass index (BMI) and the information sent home to their parents. Since then, eight other states have adopted similar school-based BMI screening and notification policies. Despite their widespread adoption and implementation, there is a dearth of empirical studies evaluating such policies, particularly for adolescents. The aim of this study was to evaluate whether adolescents, who had been previously screened in early adolescence, experienced changes in their health outcomes if they continued to receive screening and reporting throughout late adolescence (11th and 12th grades). MethodsSecondary data from the Centers for Disease Control's Youth Risk Behavior Survey were analyzed using the method of difference-in-differences. Changes in outcomes between 10th and 12th grade were compared between a group of students who received screenings throughout 11th and 12th grades versus a later comparison group who were exempt from screening and reporting requirements in 11th and 12th grades. ResultsBMI screening and parental notification during late adolescence, given prior screening and notification in early adolescence, was not significantly related to BMI-for-age z-scores, the probability of being in a lower weight classification or exercise and dietary intake behaviors. ConclusionsExposing 11th and 12th graders to BMI screening and reporting, given that they had been exposed in prior grades, was not associated with adolescents' health outcomes.

Child's Weight Status and Parent's Response to a School-Based Body Mass Index Screening and Parent Notification Program.

This study examined the response of parents of elementary school-aged children to a school-based body mass index (BMI) screening and parent notification program conducted in one Minnesota school district in 2010-2011 and whether parent's response was moderated by child's weight status. Randomly selected parents (N = 122) of second- and fourth-grade students completed a mailed self-administered anonymous survey. Child's weight status was determined using measured height and weight. Most parents read the BMI notification letter and considered it helpful, independent of child's weight status. Parents of overweight children were significantly more likely than parents of normal weight children to report healthy lifestyle changes. This low-intensity intervention has the potential to support children, especially overweight children, and their parents to make healthy lifestyle changes. Future studies should investigate whether parent's response contributes to improved short- and long-term health outcomes for children.

The Massachusetts school-based body mass index experiment: gleaning implementation lessons for future childhood obesity reduction efforts.

In 2009, Massachusetts (MA) Department of Public Health (DPH) implemented new regulations that required public schools in the state to measure height and weight, determine body mass index (BMI), and notify parents of children in grades 1, 4, 7, and 10 of their child's weight status. After 3 years of implementation, MA DPH recently abandoned parental notification of school-based BMI screening results citing several concerns including flaws in the ability to monitor the way that the BMI screening results were communicated from the schools to parents/guardians and some reports of breaches in confidentiality of students' measurements. In this article, we review implementation issues that could have impacted the success of the MA DPH regulation as well as lessons to be learned and potentially applied to future childhood obesity efforts.

Student and Parental Perceptions of School-Based Body Mass Index Screening and Notification

To address the childhood obesity epidemic, school-based body mass index (BMI) screening and surveillance is proposed or mandated in 30 states. We examined parent and student perceptions of school-based measuring and reporting in an ethnically diverse school district in Madras, Oregon, USA. Four broad themes emerged from focus groups held separately with parents and students. Students generally expressed a neutral opinion of BMI measurement. Parents felt that they held primary responsibility for their child’s weight. Parents and students perceived BMI notification as important; however, BMI reporting did not widely serve as an impetus for physician involvement or self-reported behavior change. Perceived barriers to behavior change included the lack of a supportive environment, poor access to healthcare, cultural issues, lack of concern over childhood overweight or a minimizing of health risks associated with overweight and poor understanding of the BMI graph and accompanied reporting of health information. Notification letters had limited effectiveness in this community.

School-based BMI and body composition screening and parent notification in California: methods and messages.

School-based body mass index (BMI) or body composition screening is increasing, but little is known about the process of parent notification. Since 2001, California has required annual screening of body composition via the FITNESSGRAM, with optional notification. This study sought to identify the prevalence of parental notification when screening is required but notification is optional, and the methods and messages used. Researchers conducted phone interviews with 851 school districts (89%) in California and reviewed notification materials from 54 districts. As of 2008, 53% of California districts notified parents of screening results. Many districts (24%) did not know the reason for their notification policy. Most districts notified parents via a letter mailed home (70%) or sent home with the child (18%). Whereas 79% of sample letters provided students' BMI, only 12% provided an explanation of BMI, and only half provided tips on what parents should do if concerned about their child's results. In California, where body composition screening is required but parent notification is not, approximately half of school districts elect to notify parents of results, most commonly via letter. Most letters do not explain BMI or percent body fat scores, nor do they suggest what parents should do for a child identified as at-risk. Further research to identify interpretable and actionable notification messages for parents will be critical if school-based BMI and body composition screening and notification is to reduce childhood obesity.

Understanding Pediatricians' Views Toward School‐Based BMI Screening in Massachusetts: A Pilot Study

Massachusetts (MA) mandated body mass index (BMI) screening in schools in 2010. However, little is known about pediatricians' views on school-based screening or how the pediatricians' perspectives might affect the school-based screening process. We assessed MA pediatricians' knowledge, attitudes, beliefs, and practices concerning BMI screening. An anonymous Web-based survey was completed by 286 members of the MA Chapter of the American Academy of Pediatrics who provided primary care (40% response rate). Support for school-based BMI screening was mixed. While 16.1% strongly supported it, 12.2% strongly opposed it. About one fifth (20.2%) believed school-based screening would improve communication between schools and pediatricians; 23.0% believed school-based screening would help with patient care. More (32.2%) believed screening in schools would facilitate communication with families. In contrast, pediatricians embraced BMI screening in practice: 91.6% calculated and 85.7% plotted BMI at every well child visit. Pediatricians in urban practices, particularly inner city, had more positive attitudes toward BMI screening in schools, even when adjusting for respondent demographics, practice setting, and proportion of patients in the practice who were overweight/obese (p < .001). These data suggest MA pediatricians use BMI screening and support its clinical utility. However, support for school-based BMI screening was mixed. Urban-based pediatricians in this sample held more positive beliefs about screening in schools. Although active collaboration between schools and pediatricians would likely help to ensure that the screenings have a positive impact on child health regardless of location, it may be easier for urban-based schools and pediatricians to be successful in developing partnerships.

State-Mandated School-Based BMI Screening and Parent Notification

To address childhood obesity, several states and local school districts across the United States have adopted body mass index (BMI) measurement initiatives. This descriptive case study explored psychosocial, environmental, and behavioral factors among parents of sixth-grade students who received BMI Health Letters (BMIHLs) in one Florida County. A nonexperimental postintervention design was employed to gather quantitative data via self-report Likert-type questionnaire. Participants were parents/guardians of sixth-grade students attending one Hillsborough County public middle school (n = 76). Results indicate three main findings: (a) most parents in this study (67.4%) who discussed the BMIHL with their child reported their child as "very" or "somewhat" uncomfortable with the discussion; (b) some parents of normal weight (NW) children responded by taking their child to a medical professional to control their weight; and (c) more parents of at risk of overweight/overweight (AR/OW) children (vs. NW) reported greater concern about their child's weight, using food restriction and physical activity to control their child's weight, and giving negative weight-related comments/behaviors. This case study illustrates the importance of adapting and tailoring state mandated BMIHLs for parents based on child's BMI status.

School-Based Body Mass Index Screening and Parent Notification

To assess the impact of body mass index (BMI) screening with parental notification on weight status for California public school students. A natural experiment wherein nearly all California school districts conducted annual BMI screening in the fifth, seventh, and ninth grades, but parental notification of BMI screening results was optional. Data from mandatory fitness testing in California public schools for 2001 through 2008. A total of 6 967 120 fifth-, seventh-, and ninth-grade youth (73% of enrolled students). School-based BMI screening with optional parent notification. Body mass index z score was the main outcome in adjusted mixed-effects linear regression models, assessing whether notifying parents of their child's BMI in a given year predicted BMI z score 2 years hence. Rates of parental notification of BMI screening results increased from 35% in 2001 to 52% in 2008. Body mass index notification in fifth and/or seventh grade had no impact on subsequent BMI z scores (95% confidence interval, -0.03 to 0.01) compared with no notification. No differences in the impact of notification were seen by race/ethnicity. Results did not vary with sensitivity analyses. These findings suggest that while BMI screening itself could have benefits, parental notification in its current form may not reduce pediatric obesity. Until effective methods of notification are identified, schools should consider directing resources to policies and programs proven to improve student health.

Parental Perceptions of the Rural School’s Role in Addressing Childhood Obesity

This study employed cross-sectional, descriptive design with convenience sampling to explore rural parent perceptions of child obesity, use of Body Mass Index (BMI) in schools, preferences for receipt of BMI information and, the rural school's role in obesity prevention/treatment. The survey "Parental Perceptions of BMI and Obesity in the School-Age Child" was used. Of the 183 surveys distributed, 65 were returned (35.5%). Fifty-five percentage of parents were in agreement of school-based BMI screening. Fifty-four percentage of parents selected a combination of ways to receive BMI information (letter from school nurse, face-to-face conference with nurse, or via report card). Few parents (6.2%) were reluctant to schools addressing obesity. Significant relationships were identified between non-White, overweight parents who had overweight children (n = 3). They were more likely to disagree with removal of junk food, increasing physical activity, and recommending weight loss. Recommendations to involve parents in BMI screening are presented.

School Health Initiatives and Childhood Obesity: BMI Screening and Reporting

The prevalence of childhood obesity has reached an epidemic status especially in the United States. Agencies such as the Institute of Medicine, Surgeon General's Office, and the American Academy of Pediatrics have called for action. Schools have been provided with guidelines to address obesity prevention. School-based body mass index screening and parent reporting programs have received a significant amount of attention in the literature. Intended to raise awareness for parents and provide a first step toward intervention for children who are overweight, there is to date limited outcomes of their success. However, one state, Arkansas, with mandated screening has reported success in that following screening in its schools, obesity rates were not increased. A significant concern with screening in schools is its potential harm to children around teasing, body image sensitivity, and possible unhealthy dieting. These controversial issues are explored, and recommendations are suggested for nursing's role in obesity prevention especially in schools.