Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, April 09, 2007

BMI Measurements in Schools

An article in yesterday's Philadelphia Inquirer discusses the latest incursion of the schools -- via the legislature -- into my job.

Apparently America is getting fatter. Apparently it is children as well as adults who are packing on the pounds as fast food is supersized and physical activity recedes into the X-box console. And apparently the schools don't have enough to do teaching the basic academic skills of reading, math and science; witness how many people believe the chiropracters who tell them germs are only a theory and immunization is dangerous. Apparently the danger of overweight is so great and its presence so subtle that parents and doctors can no longer be trusted to notice what their children look like.

Fortunately, the government (of Pennsylvania, at any rate) has stepped in and now requires schools to weigh and measure students at school and, using a simple arithmetic formula to arrive at a single number of completely unproven clinical significance in this age group, to enlighten parents about their child's BMI percentile.

Realistically, what are parents supposed to do with this information? I'll tell you what they do: they call me.

"I got a note from Johnny's school saying that he's 'at risk for overweight.' What does that mean?" they ask.

I peruse the child's growth chart and note that he's been tracking beautifully along the 50th percentile ever since he's come under my care at the age of three.

"Nothing," I answer, and proceed to waste ten minutes of my time (and the parent's) discussing the normal growth of children, the hazards of overweight and the greater hazard of trying to predict which child will wind up seriously obese and which is about to begin a growth spurt during which he will stretch out and his BMI recede from the "danger" zone. Granted that discussions about healthy diet, snacking and substantial levels of physical activity are important ones to have, but they take place EVERY YEAR WHEN I SEE THE CHILD FOR HIS CHECKUP.

All I can hope is that mandated BMI measurements in school rapidly go the way of required scoliosis screening which, in the wake of convincing evidence of its uselessness, is disappearing all too gradually. Perhaps they can upgrade the science curriculum to fill all the extra time they will have freed up.


At Mon Apr 09, 07:27:00 AM, Blogger MedStudentGod (MSG) said...

I think that the legislators just want to feel important enough to mandate policies over health care. This is a very weak, but obviously annoying, tool for them to get some satisfaction.

I'm sure the school nurse will be able to give the parents plenty of concern before calling you with her free government handouts that scare more than educate.

At Mon Apr 09, 08:42:00 AM, Blogger Bookhorde said...

I was just googling for childhood obesitry links when I remembered I hadn't read you blog yet. Coincidence.

At Mon Apr 09, 07:23:00 PM, Blogger oshee said...

Kudos to you Dr Dino. As a mom, I am often struck by the insanity of my friends' worries over their healthy children. Sending home notices of poor BMI scores for CHILDREN could fuel this to insanity. Children's bodies most certainly change in relation to growth spurts. I've noticed it in each of my five kids.
My children have a wonderful pediatrician who I think is equally appreciative that I understand MY children each are growing normally for him/herself.
This year, the school nurse sent home a permission slip for scoliosis screening. I checked "do not screen my child" and sent it back. Maybe there is a place for it for children who do not see a pediatrician regularly, but I didn't see the point in wasting my child's or the nurses time.

Thank you for the reassurance that I'm on the right track with my kids.

At Tue Apr 10, 10:05:00 AM, Anonymous Anonymous said...

As far as it goes, I agree with you that BMI testing in schools is a waste of time and money.

But most of the people I know with children do not have a physician or regular health check ups. The schools their children attend do not have a school nurse (altho some of them have a few hours a week of a visiting nurse aide (not even an RN)). They do not have either health insurance or health care. They will probably NOT call a doctor to find out what 'at risk for obesity' means for their children.

Personally, I'd rather see health care (not insurance!) provided by our elected officials. BMI testing is just another empty show, which will do little to help anything.

At Tue Apr 10, 12:30:00 PM, Anonymous Anonymous said...

Just personal anedoctal experience, but with both my kids, they were absolute chubsters and then the older one skinnied up after about three and is now a lanky seven-year old. The two-year old is still a fine exempar of roundness, and is all the more adorable for it. Yes, she's above 50%. She's two, and she likes food. She also likes to pick up leaves and rocks, chase pigeons, and make noise. None of these features are big time indicators for adulthood traits. Oh, and she likes to destroy things. I probably should find out what syndrome that's connected with, but I already know. It's highly scientific, well-documented, and temporary -- the terrible twos.


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