Yes, BMI Report Cards Are Bulls#*t

grade on curveI’ve had a number of requests recently from parents who are dealing with their kids getting weighed in at school, including one school that is doing it now and after the holidays to “inform parents and kids if dangerous holiday weight gain is happening” so I wanted to re-post this.   If you’re not familiar with this practice, kids are weighed in and then their Body Mass Index (BMI) is sent home in a letter to parents letting them know if their child’s BMI is “too high” or “too low” (or, ostensibly juuuuust right) and suggesting to some that they see a medical professional to help their child get to a “healthy weight.” Let’s look at some of the many, many reasons that this is a bad idea.

First of all, there is absolutely no research to suggest that this practice improves the health of children. In fact, according to research from the University of Minnesota “None of the behaviors being used by adolescents (in 1999) for weight-control purposes predicted weight loss[in 2006]…Of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors.”

In the last decade hospitalizations for eating disorders for kids under 12 are up 119%.  Kids.  Under.  Twelve.  Kids are plenty focused on their weight – they don’t need their gym teacher to get involved. Even Dr. Yoni Freedhoff, who is a self-described obesity researcher, said “I don’t think that it’s the role of the school to be the schoolyard bully. These six- and seven- and eight-year-olds who are going to get letters sent home, they’re not suffering from an epidemic loss of willpower. We’re not dealing with that here…Simply putting it on the kids is putting them at increased risk for bullying and increased risk for pressures at home.”

A focus on weight as a substitute for health does a disservice to kids of all sizes because of the “healthy weight” fallacy.  When we try to make body size a middle man for health we tell fat kids that their healthy habits don’t support their health unless they make them thin (which is not what the evidence suggests), and we tell thin kids that they are healthy because of their size and regardless of their habits (which is also not what the evidence suggests.)

The use of BMI is another issue here. BMI is always problematic as a health measurement predominantly because it’s, well, not a health measurement – as a simple ratio of weight and height BMI doesn’t take into account any actual health measurements, body composition or anything other than weight and height.  So again, even if someone believes that being fat is bad, BMI would still not be a good tool to use.

It’s even more problematic with kids than with adults because it completely fails to acknowledge not just a natural diversity of body sizes and body compositions, but also natural fluctuations in kids’ weight. If a kid gets their BMI report card taken when they’ve put on weight before a growth spurt, and their parents take them to a doctor who puts them on an diet and restricts their calories, how does that affect the kid’s growth and health? Since dieting hardly ever works, these programs are using other measures of success, one of which is an INCREASE in kids who are indicating that they are concerned about their weight.  Just to be clear, they are suggesting that creating a preoccupation with weight is a good thing for kids.  There is, as you might expect, no research to support this as a path to either thinness or health in kids.

Even if someone believes that all fat kids would be healthier thin, we do not know how to get it done; and saying repeatedly that we do is just a lie that has been repeated so often that people believe it’s the truth. Dr.Freedhoff has called these “non-evidence based interventions.” The CDC has admitted that there isn’t sufficient evidence to recommend these BMI Screening programs.  There is not a single statistically significant controlled study where even a simple majority of kids were able to change their weight long-term.  Anything that is prescribed to kids for weight control is experimental medicine at best, and at worst it’s an intervention that’s been demonstrated by research to fail – and it’s typically prescribed without the consent to the child or the parent, violating the ethical principles of evidence-based medicine and informed consent. Basically, we’re experimenting on kids without their, or their parent’s, consent.

Can you imagine the uproar if kids who were actually sick were shamed for being sick, prescribed treatments that studies had shown to not work, often making the sickness worse, lied to that “everyone who tries hard enough” gets cured on these treatments, and then were blamed and shamed when the treatments didn’t work.  To be very clear, body size is neither a disease nor a diagnosis but if the medical establishment is going to treat it that way then the least they could do is practice ethical medicine.

Parents are typically allowed to opt-out but many are saying that they were not notified in advance and so kids were forced to submit to a weigh in at school that their parents would have vigorously opposed.

All of this is another dangerous example of people substituting what they think is “common sense” for actual evidence-based health interventions.  Let’s be clear about what’s happening here – lawmakers have decided that kids’ body size is such a big “problem” that they should just start “doing something about it” and what they should do is the first thing that comes into their heads – even if there is no evidence basis for it, even if evidence exists suggesting that it’s actually dangerous and likely to cause harm, they believe that their “common sense” is a better guide than science when dealing with the health of kids.  Yikes.

This entire thing is completely unnecessary. We could have a complete discussion about health and healthy habits for kids without even once bringing up weight.  There aren’t different healthy habits based on body size, and so there is no need to pull weight into the conversation, let alone force kids to participate in weigh-ins. We can work to create programs that help kids love and appreciate their bodies, we can help kids develop healthy relationships with their bodies, and food, and movement. We can work to be fiercely anti-shame in all of the messages that we give kids about their bodies.  We can do better than a useless at best, seriously harmful at worst, BMI report card.  Let’s.

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24 thoughts on “Yes, BMI Report Cards Are Bulls#*t

  1. Thank you for posting this. It outrages me beyond my normal outrage. Kids are defenseless in “The War on Obesity” and parents aren’t even being given an opportunity to protect them.

    Any dietitian worth his or her salt knows that one weight at one point in time in a child’s life doesn’t predict anything. Dietitians (or good pediatricians) will plot kids’ along a growth chart to see if they are on a steady growth trajectory – no matter where they are on (or off) that chart. It is really only huge deviations above or below that steady trajectory that might show cause for concern, such as illness or a sudden lack of access to food or feeding practices that need some guidance.

    Why the schools think it is their place to get involved in the child’s health care is beyond me. I hope more parents will stand up and fight this BS.

    1. Normally we take our kids to the pediatrician and they are able to track the growth patterns, since they have the history of them. A school “report card” that is a one time thing can’t be that accurate. Also this whole “holiday weight gain” is crap.

      1. Yes, doctors and WIC workers already track height and weight.

        And doctors who aren’t obsessed with the horrors of being FAAAAAAAAAAAT know that nearly all children fill out, then shoot up, then fill out again, and so on. Freaking out about the filled-out stage is like fussing and fretting in order to get the moon to come up at night. It’ll shine when it shines.

        I’ve been letting the kids eat as much of their Halloween candy as they want as long as they eat filling, nourishing food first and eat their candy slowly. Their stomachs will tell them when it’s time to be done. As for those articles solemnly computing how hyoooooooge the kids would get if they ate the entire pillowcaseful all at once…who even does that?!

        1. “As for those articles solemnly computing how hyoooooooge the kids would get if they ate the entire pillowcaseful all at once…who even does that?!”

          That’s one of those bogus things fatphobes need to believe we’re doing to justify the way they treat us, lest real fat people start blocking the view of their straw fat bogeyman.

          1. I made myself sick ONCE by eating too much candy in a sitting. I think I ate about one cereal-bowl-full. Mom had put out a bag of hard candies for Christmas, and I ate the lot one day. Mom and Dad were busy and all the other kids were out, and I was bored.

            Seriously, even the greediest kid can’t truly eat too much at once. You see it on movies and TV shows, but it doesn’t happen that way in real life, because they DO get sick sooner than that, and even if they’re not smart enough to listen to their body and stop eating, they’ll throw it up, anyway, and then the sugar and fat and calories are gone, and no harm done, and a learning experience, and they probably won’t do that again.

            At least, that’s how it worked for me.

  2. And meanwhile, schools are reducing or eliminating recess. I guess it’s easier to shame kids than to teach them healthy lifestyle habits?

    1. Because starving yourself thin, giving up nutrients, as well as calories, is MUCH healthier than exercising and using up any “excess” calories, right?

      Oh, and don’t forget to put all those hyper-active kids on Ritalin, so they’ll sit still through eight solid hours of classes, with the only break being a lunchtime full of shame and guilt. We can’t have them running around, now, can we? Well, except in P.E. class, where we make absolutely no accommodations for individual mobility issues or current health. Ashthma? Multiple Sclerosis? Cancer? Get off your lazy butt and run around the track, and don’t you DARE break into a walk, instead of a run, even if you DID fall down and twist both your ankles.

      Yeah, I have issues with public schools.

  3. This was done at my childs school, when he was 10, he was so worried about it when it knew it was happening that he didn’t want to go to school,I requested them not to do it, explained why ( he is on the austistic spectrum and get very upset about somethings , his weight being one,) they went ahead with it anyway, his is almost fifteen now, and still struggling with the weight issues the school projects on to him, as if he doesn’t have enough self doubt already, here in England the government has it all wrong when it comes to kids and what they deem to be an”obesity epidemic” I really hate that phrase, and it helps nothing .

  4. I’m disturbed they’re still doing this. It’s like the more wrong that BMI joke is proven, the harder the anti-obesity brigade doubles down on it. Let’s not forget that this is a ratio created to determine *averages* and nothing else, its twisting into a measurement of health was done by an insurance company, and the only time it was ever reviewed, it was by lobbyists from weight loss companies, who I’m sure had no ulterior motive whatsoever when they decided it would be healthier and more normal for the average to weigh less.

    But I’m with GlenysO. It’s especially aggrivating they’re turning away from adult fatties and targeting children. It’s just like a bully to run away and look for an easier and more legally vulnerable target the very second his current punching bag shows the first hint of fighting back.

  5. They are turning away from adult fatties and targeting children because they want to destroy the next generation of fatties.This is a sexual war between the thinnies , beauties and the fatties.They don’t care about rational scientific facts.If they are allowed they will extend the report cards to every state in the country and encourage bullies to harass children so they will be psychologically scarred for life.This is animal law or the law of the wild. You have to fight them in kind and at least hold them to a stalemate. If you lose completely you will cease to be.

    1. Oh, yeah, and don’t forget all the shame that is piled on anyone whose idea of beauty varies from the “ideal,” (aka most popular fetish) of a thin person. Poor Fat Appreciators and people who actually DO care more about character than body type, and would love a thin, fat, or in-between person equally, if they had the right personality.

      That’s just NOT ACCEPTABLE! Nooooooo! You are only allowed to love the people we say you’re allowed to love. Only the airbrushed, pictures on the ads are acceptable for you to love. How DARE anyone love outside the established “norm”? Our fetish is right, and all others are perverted and despicable!

      Nobody should be fetishized for their size, big or small, and nobody should be shamed for preferring a size outside the established community fetish, and nobody should be shamed for not giving a hoot about the established community fetish, but thin people who love fat people are shamed ALL THE TIME.

  6. I’m just waiting for this to play out:

    Scene: Lunchtime at the elementary school cafeteria.

    Teacher: Johnny, why aren’t you eating lunch? Did you forget your lunch, or your lunch money? You know the school wants every child to eat a healthy lunch, so that they can concentrate in the afternoon. If you have no lunch, we can provide you with a cheese sandwich and a fruit cup.

    Johnny: No thanks, Teacher! I failed my BMI class, and you know, I HAVE to get into college or I’ll be serving french fries at a fast food joint for the rest of my life, because only college-educated people know anything, or can get real work, so I’m not allowed to fail any of my classes! So I’ve given up eating until my next weigh in. If I lose enough by then, I can eat again.

    Teacher: But, Johnny! You’re built like a little line-backer! You ARE a little linebacker on the Juniors Football League. You’re all muscle and pituitary gland!

    Johnny: But I FAILED BMI! Teacher, you SAID I was too heavy, and had to lose weight. Well, I’m going to lose weight, if it KILLS ME! Because I HAVE to go to college, and I HAVE to get thin so I can be HEALTHY! And MY HEAD HURTS! And I feel SICK! And I… Why are there spots floating in the air? …

    Teacher: Oh, is that all? Well, carry on, then. If you’ve learned your lesson about being too big, and are showing true will-power and healthy behaviors about size, then that’s all right. I’ll give you five bonus points to your grade every day you don’t eat. You’ll get an A plus! Wait till I tell the principal about your SUCCESS! You’ve increased your concern about your weight, which is just the goal we set for this program. Bravo, Johnny!

    Excuse me. I now have to go gag myself with a celery stick.

    1. Well, uni ain’t what it’s cracked up to be. I have 2 BA’s and can’t get a job doing fries or sweeping floors.

    2. It’s already happening at an adult level. True story: Two guys in the same military unit, same height, same general frame, both with a BMI that was “too high.” If your BMI is “too high,” you have to get it “down to the right level” or face drastic consequences to your career (and income, and insurance before Obamacare). One guy fought with real swords in his free time, moved like a big cat, and could lift his entire family. He was built like a cement bunker, is what I’m sayin’. He had the figure of a strongman of the old days, including a gut that was there for storing energy. But his BMI was “too high,” so he had to literally stop doing anything more strenuous than a short walk for weeks, lose condition, and also eat hardly anything. Wasted, flabby, and weak, he was then “down at the right level.” He looked awful and felt like crap, but he was officially healthy.

      The other guy was an amateur bodybuilder who did nothing with all that carefully defatted muscle but pose. He got a pass.

      But it’s all about our health, yup yup!

      1. This is horrifying, and unfortunately makes only too much sense in our current madness.

        I am partially of Dutch ancestry, and I lived in Holland for 6 months in my early 20s. Now that I’m almost 60, I realize that I have precisely the build I saw on many Dutch women then. As my sister puts it, I am *stout* — a word I really like since it can mean “strong” and “sturdy” as well as fat. I am broad side to side and broad front to back. I vividly remember the many Dutch women with exactly this build I saw bicycling everywhere, walking for miles in the woods, etc. — they were healthy, they were vigorous, they were the size their genetics programmed them to be. And so am I.

        1. I know just what you mean. I spent some time living in Holland, and spent so much time walking, riding bikes, and being generally active, as did every person I knew. And yeah, there were plenty of “stout,” and certainly fit, people there.

  7. Here’s one of the stupidest things I’ve ever heard: my dad was worried about giving celery to the guinea pigs because popular myth says that it is a negative calorie food (eg. you burn more energy than get out of it). There is no scientific basis for this, and I haven’t found anything for it outside of diet sites.

    And guinea pigs only weigh about 2 pounds!

    1. Huh? Was he afraid the guinea pigs would lose weight, if they ate celery?

      But… “We can ALL stand to lose some weight,” amirite? And aren’t those cute little fur-balls a bit too “round” to be “healthy”?

      Tongue firmly in cheek, here, of course. Really, though, I don’t get why he would be afraid to feed celery to an herbivore.

  8. A friend pointed me to this blog and I just can’t stop reading the archives! Great job, Ragen!

    Let me offer you a comment from the “other side” about those stupid BMI charts. When I was a kid, I was very slender. They didn’t have BMI in the 80’s, but there were similar weight/height charts. The doctor was concerned. At my height, I had dropped off the chart! He recommended to my mother that I be allowed to eat as much as I wanted. Her response was “She gets plenty to eat! She’ll grow out of it.” In my first year of high school, I overslept and skipped breakfast in order to make the bus. Then I passed out before lunch and ended up in the school nurse’s office. She called my mother, lectured her about eating disorders. Too skinny! No one is that skinny without being sick! My mother’s response was “That’s not the problem! She’ll grow out of it.” There were several incidents like this, of adults who thought my weight was an indicator of something gone terribly, terribly wrong and if only I would just eat more, I’d be fine. Have a milkshake! You need to put some meat on your bones! Why are you eating a salad? You don’t need to diet!

    Mom was right. By the time I had finished college, I had grown out of it. Puberty can do that….. The point is, I was healthy at that low of a weight. I was healthy at the “normal” weight. And I’m healthy at my current, higher weight. All these people were really hung up about that low weight, except for the person whose opinion mattered to me most. Mom just helped me find clothes that fit and took in ones that didn’t without a comment. Go Mom!

  9. About a year and a half ago, I took my 14-yr-old son to the doctor for an ear infection, and found it interesting that his BMI was 17.2 (56 inches and 77 lbs), which is also off the chart. The fact is that he has been little and skinny his whole life, except for a period in his pre-teen years when he developed a little bit of round belly right before he started growing. So yeah, BMI is useless for kids.

    As a side note, while in nursing school we had to do a community project that included getting weights on kids. They were not allowed to see their weight. I believe this practice still continues, as some kids who come into the ER still turn around backwards. I think I’m going to set the weight to kilograms when I’m at work from now on. Same for adults, because honestly, it never makes anybody feel good and it’s not like we do counseling on weight loss or diet in the ER.

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