Journal Issue: Childhood Obesity Volume 16 Number 1 Spring 2006
School Health Services
School health services can play a central role in addressing obesity-related issues among students by providing screening, health information, and referrals to students. Services and settings vary widely, ranging from traditional, school-based basic core services to comprehensive primary care either in school-based health centers or in off-campus health centers.103
School-based health centers offer students primary care, including diagnostic and treatment services.104 Their number is growing rapidly, from some 200 in 1990 to about 1,500 today.105 A 2002 national survey found 61 percent of the centers in urban settings, 37 percent in elementary schools, and 36 percent in high schools. More than half of the students in schools with such health centers are African American or Hispanic.106 The centers are typically open twenty-nine hours a week, and 39 percent are open during the summer. Survey participants cited nutrition as their most important prevention-related service.107 The centers are an untapped resource for preventing obesity, because the students they serve are at high risk of obesity, tend to be underinsured, and may not receive health services elsewhere.108
Height, weight, and BMI screening and reporting. School health services are an ideal way to collect height, weight, or body mass index (BMI) information about children. These measurements are traditionally taken in a physician's office, and some observers think they should not be taken in schools.109 But an estimated 9.2 million U.S. children and youth lack health insurance and therefore may not get regular medical care.110 Because nearly all children attend school, these preventive screening measures would be available to all families at no cost. And collecting height and weight measures is already an established practice in schools. In 2000, 26 percent of states required schools to screen students for height and weight or body mass; of these, 61 percent required them to notify parents of the results. Among school districts, 38 percent required such screening, of which 81 percent required parental notification.111 Taking these measures annually and converting them to an age- and gender-specific BMI percentile for each child makes it possible to monitor individual children over time. It also provides an opportunity for early intervention in obesity prevention.
A newer strategy is parental notification by health “report cards.”112 Family involvement in obesity interventions is considered integral, and sharing children's weight through report cards may help raise family awareness of children's weight status and health risk.113 Concerns about this practice include privacy issues, the problem of labeling and stigmatizing certain children, risks that parents will place children on diets without consulting a physician, and risks of causing eating disorders.114 Some also question whether BMI reporting can be effective if a school has an unhealthful food environment and lacks a good PE program.115
The Institute of Medicine endorses BMI reporting. It also recommends that schools measure each student's weight, height, and gender- and age-specific BMI percentile each year and make the information available to parents and also to the students when age-appropriate.116 The institute acknowledges concerns about BMI reporting and emphasizes that student data must be collected and reported validly and appropriately, with attention to privacy concerns and with information on referrals available if follow-up health services are needed.
Three school districts—Cambridge, Massachusetts; Allentown, Pennsylvania; and Citrus County, Florida—have adopted school-based BMI reporting measures.117 They send home each year a health report that includes the child's BMI percentage and a description of his or her risk category. The first study of this school-based practice, conducted with elementary school children and their parents in Cambridge, was promising.118 Parents of overweight children who received health reports were more aware of their child's weight status and were more likely to consider looking into medical help, dieting, and physical activities for their child than parents who received general or no health information.
Arkansas also recently created a comprehensive program to combat childhood obesity. Major provisions include: conducting annual BMI screenings for all public school students, with results reported to parents; restricting access to vending machines in public elementary schools; disclosing schools' contracts with food and beverage companies; creating district advisory committees made up of parents, teachers, and local community leaders; and establishing a Child Health Advisory Committee to recommend additional physical activity and nutrition standards for public schools.119 In 2004 Illinois required the state's Department of Health to collect height and weight measurements as part of the mandatory health exam for students. In 2005 West Virginia, Tennessee, and New York enacted legislation requiring student BMI reports.120