With more than a quarter of Colorado children overweight or obese, schools are increasingly being asked to do their part to reverse the trend. A small number of Colorado school districts have responded with an approach that they believe is one piece of the puzzle: measuring students’ Body Mass Index or BMI.scale

While 21 states require and several others recommend that school districts collect data on students’ BMI, Colorado is not one of them. The absence of a state mandate means that districts like Denver, Poudre and a handful of others, are in the minority when it comes to such efforts.

In a sense, they are both pioneers and guinea pigs, taking the plunge with a practice that can provide valuable data but at the same time highlights the tricky task of talking about weight.

Several influential health organizations, including the Institute of Medicine, recommend that schools measure BMI, which is one way to determine if students are overweight or obese. Besides helping track overall trends, the results can arm parents with valuable information they may not get otherwise, particularly if they lack access to routine health care.

In Colorado, Denver Public Schools leads the way when it comes to BMI measurement, which is calculated using a person’s height and weight.

Not only was the district an early adopter of the practice, launching its program in 2007, it’s one of the few districts that reaches such a large proportion of students. Last year, the district collected BMI data for more than three-quarters of its students.

“In general, school districts just don’t provide this level of service,” said Donna Shocks, manager of nursing and student health services for DPS. “They don’t have the capacity, and then there’s the cost.”

Overall, it appears there are fewer than 10 districts that make a concerted effort to collect the data on a regular basis at multiple schools. In addition to Denver and Poudre, these include Cherry Creek, Steamboat Springs, South Routt, Hayden and Canon City. Individual schools in various districts sometimes conduct BMI screenings as well.

Collecting BMI may seem like an additional burden when districts are strapped for cash and time, but advocates believe there are compelling reasons to keep an eye on the weight of their students. In part, it’s because students who are obese are at higher risk for health conditions that can negatively impact school performance, such as sleep apnea, asthma and depression. Also, collecting school- or district-level data can help administrators craft initiatives to address the problem.

Nicole Turner-Ravana, a former district wellness coordinator and now a nutrition coordinator in Poudre, said BMI data showed principals, “OK, we do have an issue,” and validated the need for school wellness efforts.

About 23-25 percent of students were overweight or obese, according to the district’s BMI results.

“It mirrored what the state of Colorado was seeing,” said Turner-Ravana. “Typically, the lower-income schools have higher rates.”

Keeping feathers unruffled

BMI screening may have ardent champions in the public health community, but even after a decade of use in some states, it raises a raft of thorny issues. It’s indicative in the language used by anyone charged with running a BMI program. Besides repeated references to “privacy” and “confidentiality,” you’ll hear worries about kids feeling targeted, singled out or bullied, and parents reacting angrily to unwanted news.

Weight status based on BMI
Obese
BMI at or above the 95th percentile
Overweight
BMI at or above the 85th percentile and under the 95th percentile
Healthy weight
BMI at or above the 5th and under the 85th percentile
Underweight
BMI under the 5th percentile

In Poudre, where BMI collection began at some schools in 2007, organizers saw the effort as a way to collect aggregate data and track trends rather than alert families about possible problems. In other words, the purpose was surveillance not screening.

Organizers didn’t want students to sense undue attention to their weight or become the victims of teasing. In fact, at some grade levels, the scale’s digital display screen was turned around so students couldn’t see the weight reading. If students asked what it was, school staff or volunteers would write it down on a slip of paper.

“We would never say it out loud. That was a really strict policy that we had,” said Jessica Hinterberg, former obesity prevention coordinator for CanDo, a local anti-obesity organization that worked with the district to collect BMI data.

Renee Porter, obesity nurse coordinator at Children’s Hospital Colorado, believes schools should inform parents about BMI results to help educate them about potential weight issues. She said many parents of children who are overweight or obese mistakenly believe their children are in a normal weight range.

“You lose some opportunities by not sending out that letter,” she said, citing a common notification method among states that have adopted universal BMI screenings for students.

While agreeing that such letters have to be delicately worded, Porter said states that have long measured BMI in schools, such as Massachusetts and Arkansas, have created versions that don’t offend. But Denver Public Schools administrators say sending home letters never played well.

“We ditched that pretty quick,” said Shocks.

DPS contacts parents if their children fall into the obese, overweight or underweight categories, but not if their children are in the healthy weight range. No matter how they worded the letters, parents assumed the district was calling their children fat, said Shocks. Now, school nurses try to set up face-to-face meetings to discuss the results. If that doesn’t work, they talk with them over the phone or at school events.

“We find that to be much more effective than sending letters,” said Shocks. “That was a hard lesson that we learned.”

The value of BMI screening

Porter believes school-based BMI screenings provide universal access to an important health indicator. And since all kids are being screened regardless of weight or size, there’s no stigma attached.

As for the prospect of a student being teased or bullied because of a BMI measurement, some advocates note that children who are obese are already being bullied because of their weight. The screening could prompt interventions that could improve their health and ultimately their social lives.

Porter said she has had many young patients with significant weight problems, but their primary care doctors never brought the issue up to parents.

So, whose responsibility is it to sound the alarm about a child’s potential weight problem? It can be a knotty question even for school health leaders.

“I would say it’s probably the parents’ role, but the reality is we work in an inner city school district,” said Shocks, adding that increasing access to good health is part of the district’s mission.

How it’s done

Typically, BMI data is either collected at the same time as state-mandated hearing and vision screenings or during fitness testing in physical education class. However they’re conducted, parents can usually opt their children out of the screenings if they choose.

Until this year, Poudre School District conducted BMI screenings in conjunction with hearing and vision screenings, but not at every school. Each year, up to 12 of the district’s 50 schools participated.

Starting next spring, the district will collect BMI data during physical education class as part of an overall fitness assessment called FitnessGram. The program, which costs around $600 the first year and $150 in subsequent years, also yields information on aerobic capacity, flexibility, endurance and muscle strength. The results are accessible to parents and students online via a private login.

“This program works with our Colorado state standards,” said Conrad Crist, the district’s P.E. curriculum facilitator and a high school p.e. teacher.  “It allows the district to see trends and guide curriculum, guide instruction.”

While FitnessGram will be used in fourth- to 12th-grade, only sixth- to 12th-graders will have the BMI measurements taken, said Crist. FitnessGram will send progress report e-mails to parents with suggestions if their children fall into the red “needs Improvement zone” instead of the green “healthy fitness zone.”

Poudre is not the only Colorado district to use FitnessGram. Next door in the Thompson School District, the health and wellness-focused B.F. Kitchen Elementary has been using the program since 2008. In addition to tracking school-level BMI data, FitnessGram reports are sent home with student report cards. In addition, 13 schools in Cherry Creek use FitnessGram thanks to grant funding from the Denver Broncos.

In Denver, BMI was added to the hearing and vision screening process six years ago in response to the rise in childhood obesity. Now, there is one BMI specialist on all four district screening teams. DPS spends about $100,000 a year to pay the four BMI screeners.

Last year, the district collected BMI data on about 66,000 of its 84,000 students, including children in kindergarten through third grade, fifth-graders, seventh-graders, ninth-graders, preschoolers, special education students and those new to the district.

“Without those mandated screenings, I don’t know if I would have taken the plunge,” said Shocks.