The Arkansas state legislature stirred up a mixture of praise and criticism in 2005 when lawmakers passed a bill requiring school-based body mass index testing for children. Despite a tripling of childhood obesity since the late 1970s, many parents chaffed at the idea of routinely screening children as young as 6 years old for obesity. Six years after passage of the Arkansas bill, more schools have embraced the body mass index, or BMI, tool as a component of school fitness testing, and the American Academy of Pediatrics now recommends yearly BMI screening for children. Some parents remain unconvinced, however, about the need for obesity screening during childhood.
Screening and Self-Esteem
Most adults feel angst if the bathroom scales show we've gained just a couple of pounds. So how does BMI screening affect a child's psyche and self esteem? Some parents have expressed concern that focusing on obesity during childhood might spark unhealthy dieting behaviors in children or might lead to weight-based teasing and bullying. In order to address these concerns, researchers involved in the Arkansas BMI initiative tracked behaviors such as dieting, use of diet pills and obesity-related teasing. As of 2010, the researchers noted no increase in these behaviors. Curiously, reports of weight-related teasing declined after the implementation of school BMI screening.
Misdiagnosis of Obesity
Probably the most criticized aspect of BMI testing is the possibility that BMI will false diagnose athletic, muscular children as overweight. This is because BMI only considers two factors -- height and weight -- to determine potential obesity.
Inadequate Referral Programs
One of the challenges of public health is weighing the need for screening programs against the ability to provide effective treatment if a problem is detected. In the case of BMI screening for children, there simply aren't enough weight loss and fitness programs to meet the needs of the 23 million overweight and obese children in the United States.
Parental Confusion
Interpretation of BMI is more complicated in childhood than in adulthood. An adult's BMI is simply calculated based on body weight and height; the resulting number determines obesity risk. In children, however, the raw BMI number isn't used to diagnose obesity. Instead, a child's calculated BMI is plotted on a growth chart that takes into account the child's age. If a child's BMI plots above the 85th percentile on the growth chart, he is diagnosed as overweight. Because multiple steps are involved, parents are often confused about what their child's BMI percentage really means.
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