November 12, 2009

Generation BMI

Photo: hoyasmeg

There are all kinds of phrases designating the time period in which we were born. Generation X, Gen Y and specifics aside, I'm somewhere between Baby Boomer and Millennial (a proper lady never voluntarily reveals her age - and neither do I). And even though this generation coming up has been known as the "iGeneration" for growing up in the shadow of the Internet, I have begun to think that maybe we should be referring to them as "Generation BMI" given the intense focus on childhood obesity and the well-meaning attempts at reining that in.

This particular bee in my bonnet got buzzing when some area towns began flirting with the notion of the schools measuring each student's BMI and sending the results home to their parents. These are the same schools which have slashed recess and phys ed programs, but I digress. I'm not about to touch that third rail know as "school funding". I'm also in the camp of thinking that medical issues are better dealt with through pediatricians but understand that not every child might have access to one. My specific concern is the negative emotional message these adolescents might be receiving while we're trying to correct a physical issue (obesity) - which may or may not actually be a problem because they haven't finished growing yet.

Based on personal experience, I was always a slim child until adolescence came along and hit me with the lumpy stick. My two siblings, who were always very trim, just kept growing in proper proportion to their weight and height (damn them!) - but not me. It's not good to feel different at this stage of life. I don't know about you but I remember adolescence as a frantic, hormone swill of a time filled with extreme self-conscious behavior and constant anxiety over fitting in. That was pretty much the extent of my world but in that regard, I think I was a pretty typical pre-teen. It was bad enough that I was conscious of my growing weight but God forbid anyone else take notice too. (Cue nervous mother.) So it didn't help matters when my well-meaning mother got me a girdle after I turned twelve and insisted I wear it.

Talk about humiliation! I became obsessed about my weight and appearance, although thankfully never fell into any kind of serious eating disorder other than general overeating to help soothe my hurt feelings (oh, the irony!). A year later I experienced the growth spurt that my mother thought was never going to happen and "evened out" quite nicely, thank you very much, but now with the very heavy baggage of what I believed was conditional acceptance based on appearance. LaGuadia Sky Caps would need a payloader to carry these bags from the curb.

I recognize the need to tackle this obesity problem but wonder if doing it through the schools is such a great idea - especially during adolescence. While researching whether or not BMI screening in schools was as helpful a tool as it was intended to be, I came across this article which pretty much nailed what I was thinking - especially in the "Potential Harm" section and beyond.

It stated that while more research needed to be done, the only study regarding a parent's reaction to receiving a BMI report of their child being overweight was to restrict the child's caloric intake - which could prove damaging to a child who has not gone through puberty yet. This could lead to stunted growth and behavioral issues such as sneak eating, hiding food, overeating and eventual yo-yo dieting; all of which ultimately increase the risk of obesity.

Another issue that can arise is the stigma of a child being labeled "fat". A BMI reading of overweight can be devastating for a child whose main purpose in his or her early life is to "fit in". There is an awareness in children very early on that being overweight is socially unacceptable - the health risks surrounding that are the least of their concerns. "Few problems in childhood have as significant an impact on emotional well-being as being overweight". As such, overweight children are at increased risk for lower self-esteem, depression and isolation.

Lower self-esteem in this instance is a bit of a double-edged sword. While labeling a child as overweight can undermine his or her self-acceptance as well as that of others, not addressing it at all can lead to increased weight over a prolonged period, which is just a continuation of the problem. A child needs a good sense of self to set the stage for achievement in school, personal interactions and the world beyond. I've heard of schools no longer printing the honor roll in the newspapers to preserve the self-esteem of the kids who didn't make it and yet there seems not to be the same concern with BMI screenings. Is this the Jekyll and Hyde of political correctness? Do some self-esteem issues trump others?

Body dissatisfaction is one of the greatest risk factors involved in the onset of eating disorders. While the correlation between BMI and body dissatisfaction begins in childhood and is small, the size of the correlation increases with age. Peer and parent pressure along with the constant media bombardment of the "perfect body image" already serve to undermine a child's satisfaction with his or her own body. BMI, while intended to be helpful, may be having the opposite effect.

There are very few bandwagons that I don't jump on but this is one of them. While I acknowledge the problem of childhood obesity I also cringe at the idea of telling a not-yet-done-growing child that they are overweight when in fact, their height possibly just hasn't caught up to their weight and left to its own devices, will self-correct. Physical health risks may have been averted but what of the emotional damage? There must be a balance somewhere but I haven't found it yet. And it's not just the schools getting into the BMI business that worries me (even though that's where an "overweight" reading is likely to spread like wildfire) - it's even how some pediatricians approach the topic. How about a little sensitivity for starters. How about the doctor taking the parent aside and talking about it amongst adults instead of right in front of the child? Or how would you respond to the doctor's nurse asking, "Any concerns about his/her weight, Mom?" just after weighing the child in - but still within earshot of that child? My response? "Ask me when he/she is done growing".

I know a lot needs to be done in terms of making our kids healthier and preparing them well for adulthood. We need to make sure they get enough exercise and are eating healthy foods as often as possible - and in a world of fast food and video games, that can be a real challenge. But by properly addressing their physical needs, we also need to keep their psychological health intact as well. We need to bring up the best generation we can.

So what do you think is the right balance to strike here? To BMI or not to BMI before puberty - that is the question.


  1. You know, I get sick and tired of the schools' being sainted for caring about the kids' BMI. Let's be honest. Considering the poverty levels in America, most public schools have a whole lot of kids eating free and reduced price lunches at school. In most schools, these kids also have breakfast. That means two out of three meals kids eat are in the school. So how do they figure they can serve breaded and fried garbage to our kids twice a day, then come back and blame us because they're fat?

  2. Agreed, Kate.

    I'd like to see more energy put into teaching kids healthy eating habits and activity rather than telling them a number says they're overweight. Leave the BMI ratings for High School and older.

  3. BMI is NOT an accurate test of health! If my child's school did this, you bet my hind would be in that office raising a fuss. A very loud fuss. You absolutely do not have any right to damage my child's sense of self-worth over a stupid, arbitrary measure of "health"!

  4. I apologize for the back-to-back commenting but in my furious rage I forgot to link.

    The BMI Project

    It's well worth your time to look.

  5. Great post! You mentioned a lot of the probs with schools doing this when they cut Phys ed & don't even serve healthy meals.. they are not even helping & they want to do BMI!

    When I was a kid, they actually had us stand in line & get weight in front of everyone! I was fat as a kid & this was my worst nightmare. Like I was not depressed & self conscious about it enough already & teased my kids already & then they did this. It still sits in my mind all these years later & that is a dang lot of years! I am not a lady I guess cause I am willing to say my age which is almost 52. That is alot of years of still feeling that weigh in back then!

    AND, one of my biggest gripes, the parents that complain & then do nothing in the home to help & in fact are heavy or obese themselves....

  6. The following in no way sides with the schools measuring BMI. I'm just illustrating the other side a bit.

    They still had mandatory Phys. Ed. all the way through high school. They didn't quite sell it though, because I hate exercising and I hate most sports. I still exercise when I can, but that took a while to get to; like, after I was married...6 years after high school had ended. Interesting thing, though, through my junior year in high school I was in Illinois and they had the mandatory Phys. Ed. classes. When my parents moved (read: were transferred) to Texas for my senior year, what's the one class I did't have to take? You guessed it, PE. So, does what region you live in dictate accessibility or mandatoriness?


  7. I will take the unpopular stance here (adjusting my armor). I would be leading the charge if the BMI information were made public. But in our district, nobody sees the number but the school nurse and the kid's parent. The letter arrives in the mailbox with a disclaimer about muscle mass, etc. All it is is information which the parent should have anyway, hopefully through their children's checkups.

    I realize the jury's still out as to the real total of ultimate harm that over-fat may cause, but as a prediabetic, I am a convert to trying to maintain a more or less normal BMI.

    If I were a wishing fairy, one of my first wishes would be to separate weight from self-esteem. Being overfat doesn't mean you're lazy or awful, it just means you have the kind of body that likes to put on fat. When you have that kind of body, there are things you can do to help-- like playing outside and going easy on the juices and poptarts.

    Remember, this information is between the nurse, the kid, and the kids' parents. It is not silk-screened on a t-shirt. I think it's kind of odd that there's all this heated emphasis on protecting kids from this information when it's just information. Knowledge is power.

  8. Oh that is outrageous. It's not the school's place to check if your kid is fat or not. Frankly, I think BMI's are meaningless and do more harm than good. We have a such a skewed view of weight that such a test simply cannot be trusted.

  9. Our school hasn't cut recess or gym, but does send home a BMI reading -- in the same letter they tell us the results of our kids' vision tests. I don't think the kids see what's in those letters unless we parents choose to share.

    My issue is with BMI itself. When a professional athelete has something like a 3% body fat and a BMI that's obese (and yes, there is one. At least one.), there's an obvious flaw with BMI. There is no way that particular man is obese.

    We need another, better scale by which to judge -- ourselves and our kids. And yes, more emphasis on healthy eating and activity would be nice.

  10. Great question. I am not a fan of the BMI as an indicator of fitness for anyone. As we know, muscle is denser than fat, professional athletes could be considered obese by this standard.

    Let's work on reinstating physical education programs and recess instead.

  11. I agree that schools shouldn’t test kids’ BMI for multiple reasons. First, most kids (I know, not all) are weighed by their doctor at least annually, and he/she as a medical professional is more equipped to determine if the child’s really obese or just hasn’t hit a growth spurt yet. But on top of that, there’s been so much talk recently about BMI not being a good indicator of health anyhow. Many athletes would be considered obese if we just looked at BMI because they’re all muscle, which weighs more. Also, what’s the point? If a child is truly obese, will a random number make that much of a difference to a family who hasn’t had a problem with it yet? On top of that all, being weighed in front of other kids—and having to face the inevitable “What was your number?”—is mortifying no matter how fat or skinny you are.

    That said, I do think there are kids out there who aren’t “just a little husky.” I know one who is in elementary school and is obese, has high cholesterol, and high blood pressure. Really. When our 10-year-olds are getting these medical conditions, there’s reason to worry. Their long-term health (a recent study said kids who have high cholesterol are at an increased risk for a heart attack as a teen, not a thirtysomething!) is at risk. The number of people with type 2 diabetes is getting larger—and for the first time in decades it’s an epidemic in kids, too.

  12. Honestly? There are a lot of parents who maybe think that restricting calories before puberty is a mistake. If something is in place to alert them to the idea that it isnt so much about "restricting" calories as eating the right number of them in the first place, it could save kids a lot of physical and emotional stress down the road.

  13. Great post and comments. I agree that BMI at this stage in life is not relevant (and would argue it's relevancy in general). Schools should be introducing more wellness programs into their curriculum: one that includes teaching about proper diet and exercise. And while everyone can see who the visibly overweight kids are, I daresay that the percentage of unhealthy thin kids is just as high, due to unhealthy eating and dieting. Especially due to the various peer pressures you face at that age.

  14. I understand that obesity is a huge problem, but seriously do not think that testing a child's BMI is the way to go.

    Perhaps burning down all the fast-food joints would be a better place to start.

    (Disclaimer - not that I am advocating this, of course.... it was merely a suggestion!)

  15. BMI is a tool, one which can be used correctly or incorrectly, like so many others. it should never be the only measure of whether a child needs to work on weight.

    In my experience, unfortunately, I was one of the ones that got "chubby" at the onset of puberty, which meant I stored estrogen (excess weight can do that) which ground my growth spurt to a halt.

    Translation: I have not grown any taller since the age of 12, when I grew wider at menarche.

    This whole topic of childhood obesity needs to be handled with sensitivity and grace, by parents who love the child, a pediatrician who cares and approaches it from the health standpoint, a school that supports a healthy lifestyle (recess, PE, healthy food in the cafeteria), and a society that promotes health over fashion and beauty.

    Hmm, tall order.

  16. I think the emphasis in schools needs to be on healthy eating, exercise, and education. It will all work out with this approach!

  17. I like the approach of this - Being a chubby teen I really hated having my weight talked about in front of me like I wasn't there.
    It would have done me much more good to teach me healthy eating habits. I was a reallya ctive kid, I jsut ate WAY too much. All I knew was that I was fat, but didnt' ahve any way to fix it. Occasionally my Mom would help me go on a diet, but as soon as I stopped I'd gain it back because I didn't know what to do when the diet was over.
    BMI is not a good indication of health, and I think that it would be dangerous to a child to label them as fat before they're done growing.
    I think teaching ALL kids healthy eating and activities would go much firther to helping kids figure out what they need. Most of them (and me back then too I think) would have leveled off to a healthy weight in the end once we grew up and levelled off...
    I would be more interested to know if kids with high BMI vame from families with hig BMIs. THAT would be an instance where things needed to be taken further...but to just measure BMI, state fault and walk away does not address the problem.
    Not at all...

  18. Hmmm...

    A few thoughts.

    1) Kate, the schools feed their kids breaded, fried garbage because the federal stipend for school lunches is $2.25 per child. And while they could probably give the kids a nice salad, their parents have not taught the kids to eat salad at home, so the kids won't eat it. At $2.25 a kid, you can't afford to hire a chef to make healthy food more kid-palatable.

    2) BMI is garbage, for all the reasons cited by others here.

    3) Really? The problem is that kids don't run around anymore. We can blame that on a couple of things: Our culture of irrational fear means that we don't send out kids out to play in the neighborhood anymore, because we're convinced that some psychopath is waiting around every corner to snatch our little darlings; communities refuse to properly fund school systems, so they have to cut physical education, so even when these kids *do* go outside, they haven't learned the rules to the games that we all grew up with; and No Child Left Untested has our school systems in such a tizzy about proficiency tests that our children are getting assigned hours o homework every night and they don't have TIME to go out and play after school.

    Oh, and just for good measure, I'll blame video games.

  19. I don't have any objection to measuring the BMI of children in school on condition that parents are only contacted if their child is obese. This is because I feel that BMI has it's inaccuracies, as well as the fact that they're still growing, but obesity may indicate a problem.
    This said, I would like to see schools spending more money on school dinners, so that they only offer healthy meals with plenty of fruit and veg.
    And assuming that schools are going to have to spend some money to provide these BMI values, I would suggest that they spend the money on school lunches instead.

  20. It is nonsense! Like you said they have taken away phys ed and most recess time. The lunch lines are filled with pizza, cookies and fried chicken sandwiches. What child is going to chose broccoli and grilled chicken over those other options! I was overweight the majority of my life until last year when I made a commitment to get healthy. I WISH I would have learned more about nutrition and fitness while I was in school so I would not have been so lost when I started the “healthy lifestyle” journey on my own. Ugh- and to think about how much this would affect those children’s self confidence makes me VERY sad…

  21. I agree that it would be a lot more effective for schools to support adequate phys ed and nutrition (and stop contributing to the problem with junky food in school lunches), rather than singling out kids with high BMI.

    Lots of great points people are making, I'm really enjoying the discussion!

  22. I'm reading so much on obesity and our society. We want to blame the individuals and yet turn a blind eye to the way the food industy is producing food -and encouraging the consumption of bad food.

    We need turn a hard eye back on the sources of what children are eating.

    BMI is just a number. And numbers, in this case, are not the canaries in the coal mine.

  23. i remember when my son's BMI was "over the chart", and it's like.. he was a tall fit lil boy for his age, and how DARE the doctor, who had to be over 300 herself, sitting on a stool you couldn't even see was telling me my child was obese. you don't see ab definition on an 8 yr old if he's obese lady... sorry.

    i wish those "normalcy" charts would just go away! they base health and life insurance rates on them, and it's bs in my opinion.

  24. I say not to BMI before puberty. I agree with your though on the possibility of a child's height just hasn't caught up with their weight yet and that in the end it will self correct in most cases.

    I think schools need to focus more on what they are serving at lunch and other meals they may be providing. There is a ton of room for improvement on their end in that area.

  25. I don't have a black and white position on this, but I've got one foot in the school's circle here.

    Childhood obesity is on the rise because they are developing more unhealthy habits than before. More & more studies are suggesting an awful lot of dangerous/deadly consequences for these kids' futures. Many of us in the weight loss blogging community come from a childhood of being overweight and have to unscramble our brains from years of bad eating and fitness habits that usually started at home.

    Parents should be free to parent. But life for a child is not experienced in a vacuum. Parents aren't perfect. Neither are schools. But because schools usually have these kids in their care and custody during the majority of their waking hours, it is unrealistic to expect that there shouldn't be some flow of communication between the schools who are charged with looking after the best interest of the kids and the parents.

    It is not simply a health issue between a physician and family. If that were the case, I wouldn't have gotten glasses until years later (and would have continued to have bad grades....who knows how this would have impacted my future education and career) because my folks certainly didn't notice I was squinting and had bad eyesight. I was embarrassed about the glasses and teased, but it was for the best.

    Parents aren't perfect and never will be. Therefore, schools should play a role in a child's physical and educational development. I can't envision a functional system where they aren't involved.

    This would include dealing with childhood obesity. While I agree that the BMI is a flawed gauge, it's at least a start, a tool toward what should be a common goal. Of course, education about good eating and physical fitness should be included. And all schools should get rid of soda and junk food vending machines and serve healthier meals.

    And while getting a letter may be embarrassing for an obese child, I hardly think it is the worst type of embarrassment he or she is going through. It's not like obesity is a hidden condition, as the other kids who tease that child about it demonstrate. A letter isn't going to make it worse.

  26. BMI is a highly questionable measure of health even for adults. When you try to apply it to kids, it's going to be even more of a mess. My little brother was a skinny kid, a fat roly poly adolescent, and now he's a 6'1" beanpole. My mom wisely never got on to him about his weight during his teen years because she knew he was just going to grow the way he was going to grow. I would be very angry if a school butted in with comments on my child's weight when they know nothing about my family's genetics and eating/exercise habits.

  27. As others have said:

    • Teach healthy eating
    • Model healthy eating by getting rid of the sugar vending machines
    • Model healthy eating by serving nutritious, tasty meals
    • Teach lifelong activity skills
    • Bring back physical education
    • Teach parents about healthy, inexpensive eating and physical activity through community events, PTO, etc.

    Haranguing kids about their weight won't do it.

  28. Looks like plenty of other folks have said what I say..

    #1: BMI is stupid and not a measure of true health.
    #2: A growing kid doesn't need the pressure
    #3: If you're going to torture kids with this, at least pick up the ball and teach them *how* to be healthy. Starting with cafeteria reform.

    If that was my pediatrician you were talking about I'd be picking a new one in no time flat. And letting the old one have it. Unless it's been a consistent problem, or a sudden huge swing, i doubt it's an issue. And use some tact. Kids are pretty darn smart.

  29. Wholeheartedly agree with what Fab Kate said!!!!
    Schools feed out kids crap, cut out phys ed and recess, and then complain when the kids are heavy, unhealthy, and/or have no attention span.
    Also, if schools want to PROMOTE bullying, this whole BMI thing is a GREAT way to do it!
    I was a "normal-sized kid. After I hit puberty, many people, including teachers, made inappropriate comments about my body and my weight. Guess what? I was bulimic by the time I got to college, and anorexic in grad school.
    Schools need to leave kids' bodies alone,

  30. I don't think this is a good idea. Like a lot of the commenters, i think more focus should be on teaching kids healthy habits (and parents) and get better physical activity programs in schools. Checking a kids BMI and telling them they are "overweight" probably isn't going to help the kid much. Might make it worse.

  31. What a fabulous post! Thank you, Gigi, for bringing this issue to the forefront.

  32. At the high school where I work, students can take phy ed online! Sure, part of it involves setting up and participating in a fitness plan, but no one checks to see if they actually do it.

  33. Peripatetic said it, but I would also like to reiterate is the importance of calories. Sure eating healthy is an important concept and inevitably leads to less calories, but it took me 35 years to realise that more important than anything was watching the number of calories I eat. In other words, not eating too much. Our society is focused on big portions and this is what made me a bigger kid growing up and into my adult years.

    I am not suggesting that kids need to count calories, only that if we focus on teaching them the importance of not eating too many calories we would be way ahead.

  34. thanks for this post. i have three kids, two at a healthy weight and one overweight. our school does BMI testing and sends the reports home WITH THE KIDS to give to their parents. my overweight child knows he's big, he's head and shoulders taller than his peers and also quite a bit heavier. as his parents we are concerned. we have seen doctors, we have discussed and encouraged diet and exercise. but we feel like having this become the issue that defines our relationship with our son is not the way to go. it's not a quick fix. it's a long term change and we are working on it - with our son.

    wish the school took as much interest in notifying us of his achievements. good test scores, honor roll and the like. none of those get a mention.

  35. I would like to commend you on bringing up B.M.I. and how it has its faults in present day society. I would really appreciate feedback for class project. thank you.

    In my opinion words like "obesity" and "Overweight" are made up to make people feel bad about who they are. They are hurtful and have no real relevance on how healthy a person really is. Further using B.M.I. as a tool to tell us if we are under, over or at exact weight we should be is very dangerous.
    For reasons which i cant explain we are starting to see B.M.I. numbers sent home with a child's report card. One of the Biggest problems i have with B.M.I. is that it suggests that we can put kids in certain categories with numbers as its boundaries. I agree with you that this is very dangerous and can lead to further problems in life. Mainly a child's mental well being and their views of what being healthy is. Which in some cases could lead to yo yo dieting and eating disorders. In my research i have learned that B.M.I. does not take account for a persons muscular, bone or fat distribution. Not taking these factors into account result in individuals with good muscle tone, strong bones and low fat to be placed in the high B.M.I. level. Further B.M.I is over 200 year old mathematical problem with no medical backing.

    We are starting to see how genetics play a role in adolescence variation in weight, height and B.M.I from early childhood to adolescence.
    In this study: 23 twin pairs with data available for both height and weight at a given age, from birth through 19 years of age. Study showed how environmental factors Heritability for body weight, height, and B.M.I. was low at birth but increased over time, accounting for close to more of the variance in body weight and B.M.I. after 5 months of age in both sexes. The findings in this study showed that we need to worry less about B.M.I. and more about genetic factors that predispose us to obesity.
    In conclusion we are seeing how B.M.I. can lack validity when it comes to quality of life. And furthermore we see that children to adolescence have no control on their body image. Genetics play such a huge role that it pushes our body back to where it wants to be. So no matter your weight, we see that being physically active and practicing healthy eating habits will prolong quality of life over issues of losing weight. When it comes down to it, its about being happy with who you are inside, no changes that come with weight loss will make you happy.

    1) U.S. National Library of Medicine "Health at Every Size, Shift toward a new paradigm of weight loss", 2005; 7(3):B Published online 2005 July 12

    2) U.S. National Library of Medicine "Genetics and Environmental Contributions to weight, height, and B.M.I from birth to 19 years of age, Internet study of twin pairs", 2012; 7(2): e30153. Published online 2012


Thanks for commenting, Cranky Fitness readers are the BEST!

Subscribe to comments via RSS

(Note: Older Comment Threads Are Moderated)