Earlier this year, a state assemblyman proposed legislation that
would require schools in New York to include a health update with each
student’s report card. This confidential “health report” would include
your child’s body-mass index (BMI), a ratio of an individual’s
weight-to-height, which is used to assess thickness or thinness. The
legislation was recommended on the belief that parents need to be more
aware of health concerns impacting their children and especially more
involved in recognizing and managing problematic weight gain among our
school-aged population.
The legislation hasn’t passed into law yet and surprisingly much of
the reaction to it was negative. Evidently, those who oppose this
recommendation believe that most parents are aware of their child’s
weight or that it is too damaging to a child’s self esteem to know the
truth about how he or she measures up to the medical standards.
Neither of these positions can be backed up by my experience as a
pediatrician or by current research in the field. Studies conducted by
my Bassett colleagues have shown that parents may not recognize their
child’s obesity. In 2000, researcher Barbara A. Dennison, M.D.,
reported that the prevalence of childhood obesity in New York was more
than twice the national rate in the 1970s. More than 35 percent of the
children studied were found to be overweight. In her studies, she also
found that most parents of overweight children did not consider their
child to be overweight. For example, 68 percent of parents of obese
children, reported that their child’s weight was ‘OK, just right,’ and
eight percent even reported their child was ‘underweight.’
Obviously, if we care about the health of these children, parents
need to recognize that a problem exists. Ideally, health risks should
be identified and addressed by a child’s personal health care provider
in collaboration with parents. Unfortunately, in our rural communities,
many children, especially adolescents, do not get regular physicals
that adequately assess health status.
Parents rely upon schools to keep them aware of other issues related
to a child’s development and well being, so why shouldn’t schools
measure and report a student’s body mass index?
I do not believe that a child’s BMI or other confidential health
information should be part of one’s academic record. Perhaps it would
be better to issue a health report in a separate statement and, along
with it parents should receive suggestions to help them address their
child’s obesity or other medical problems. After all, a child cannot
tackle weight management without a parent’s participation.
Also, schools have a role in creating solutions to help children
avoid weight gain. It is their responsibility to provide a healthy
environment with more physical activity, greater emphasis on
nutritional choices in food services, and limited access to soda and
snack machines.
Obesity is a serious health threat. The medical community is not
studying obesity because we are concerned by the appearance of
overweight Americans. The health problems that result from excess
weight are well documented and include high blood pressure, heart
disease, type 2 diabetes and orthopedic problems. The costs of these
diseases and injuries are great in financial terms and in quality of
life.
There is good evidence to suggest that many of these medical
conditions can be alleviated by a reduction of 10 percent of the excess
weight. For most children who are moderately overweight and not yet
experiencing serious health problems, a handful of changes can make the
difference. These simple steps include:
• Changing the way you eat to decrease fats and sugar and to increase fruits and vegetables
• Increasing physical activity, especially family activity
• Decreasing your child’s inactivity – parents must ensure that their children cut down on TV, video and on-line computer time.
If the above habits are sustained, a lifetime of better health may result.
The surgeon general has established recommendations for managing
weight loss in children. These guidelines include allowing overweight
children to grow into their weight by maintaining, rather than losing,
pounds during growing years. Additionally, a physician should supervise
any weight management program undertaken by children or teens, and
weight loss should be gradual even for those youngsters who are
extremely overweight.
Ultimately, I am optimistic that the national trends on obesity can
be reversed, but it will take time. Heightened public awareness of the
health consequences of obesity has started us on this course. Change
requires individual recognition and personal commitment. Children need
the involvement of their parents to combat the factors that lead to
weight gain. Wholesome eating and active living results in healthy
lives for our children into their adulthood.
Chris L. Kjolhede, M.D., M.P.H., is an attending physician in pediatrics and a research scientist at Bassett Healthcare.
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