Obesity, Schools and Personnel, Continued

It is not that easy to find definitive reports of what actually goes on in schools, rather than guidelines and other literature of the aspirational type. Of course, the past year and a half have been a circus, and not the fun kind. There seems to be a great deal of uncertainty about what to expect in the coming school term. It looks like COVID-19 will be the major medical issue for the foreseeable future, overshadowing other health-related concerns like spotting dangerous tendencies toward obesity and its co-morbidities.

News about anti-discrimination laws, as they relate to obesity, is generally about adults in the context of employment. Late in 2020, for instance, it was reported that…

[…] the Washington State Supreme Court has ruled that obese individuals are members of a protected class under Washington’s Law Against Discrimination.

The piece included no mention of children or schools. A contemporaneous article published by the Minnesota Journal of Law & Inequality bore the promising title, “A Disability Studies Perspective on the Legal Boundaries of Fat and Disability,” but again, revealed nothing about young people or the K-12 school system.

In June of 2021, just to throw a monkey wrench into an already complicated situation, there was a newly re-aroused conflict over these issues. In the United Kingdom, Fiona Simpson reported on the possibility of psychological damage from the now widely accepted practice of weighing kids at school.

The country’s National Child Measurement Programme (NCMP) had been on hold during the COVID months, but is being reinstated. A child is weighed twice in her or his grade-school career, and alerts the parents of signs of encroaching childhood obesity. Simpson quotes charity director Tom Quinn:

Many eating disorder clinicians working in children and young people’s eating disorder services have told us how the programme has triggered restricted eating patterns, which has then developed into an eating disorder requiring specialist care. At a time when we know that the pandemic has had a devastating impact on people with eating disorders, with children and young people seeking treatment at record highs and with waiting times longer than ever, this is absolutely the wrong move.

The Women and Equalities Committee has objections, and wants the government to take a second look before re-implementing the program which could prevent a child from developing a positive body image. Their report said,

Academics stated that clinicians consider being weighed in front of people or making a child’s family aware they need to lose weight or have a high body mass index (BMI) as a trigger for eating disorders.

Parental interest, opinion, and activism have been mobilized.

Your responses and feedback are welcome!

Source: “Is Obesity a Protected Status Under Washington’s Law Against Discrimination?,” Sapphire-Law.com, 12/09/20
Source: “A Disability Studies Perspective on the Legal Boundaries of Fat and Disability,” LawAndInequality.org, February 2021
Source: “Weighing Children at School Increases Eating Disorder Risk, Charities Warn,” Cypnow.com, 06/25/21
Image by U.S. Dept. of Agriculture/CC BY 2.0

Obesity, Schools and Personnel

For the bureaucrats in charge of deciding who should be considered disabled for Social Security purposes, the task is not easy. In 2019 a document was issued to provide “guidance on how we establish that a person has a medically determinable impairment (MDI) of obesity and how we evaluate obesity in disability claims.” Apparently, a lot depends on variables leading to case-by-case decisions. The clearest part says,

When deciding whether a person has an MDI of obesity, we consider the person’s weight over time. We consider the person to have an MDI of obesity as long as his or her weight, measured waist size, or BMI shows a consistent pattern of obesity.

In 2019, the Centers for Disease Control said,

Care coordination in schools involves school nurses organizing the care of students by sharing information and maintaining communication among those concerned with the needs and care of students with chronic health conditions (e.g., asthma, diabetes, epilepsy).

Since type 2 diabetes and obesity are very closely related, this would seem to make weight checks necessary, even if not specifically for the purpose of identifying obesity. The 2010 document issued by another governmental department suggested accommodations that might be made for students who could not deal with school without help, and Childhood Obesity News discussed a few of these.

Some of the more obvious adjustments that can be made for a morbidly obese child or teen include suitable seating and usable restrooms. Other suggestions include counseling for the affected child, and for the rest, education about medical conditions. A really ambitious program might include peer counseling, and there are many other ways in which schools can help kids with this particular problem — including the traditional routes of nutrition and exercise.

In 2019, the American Academy of Pediatrics recommended that every school, of any size, should have at least one registered nurse on duty when school is in session. At the time, only about 39% percent of schools employed a full-time nurse. In only about 10% of schools was a staff physician available. Furthermore,

According to a 2018 study in the Journal of School Nursing, more than half of school nurses cover more than one school building, and about 38 percent cover three or more schools.

All that was, of course, pre-pandemic. If and when conditions return to normal, it is uncertain how this will shake out. As before, each state will be different. In many places, absent a nurse, a teacher or administrative assistant is designated as the person who dispenses medications, provides first aid, or decides whether emergency services should be called in. In some places, teachers and staff need to be certified for cardiopulmonary resuscitation and/or other life-saving procedures. With all the time and energy that will be needed to deal with COVID-related matters, it appears that working in schools in any capacity will be stressful for adults.

Your responses and feedback are welcome!

Source: “Policy Interpretation Ruling — SSR 19-2p: Titles II and XVI: Evaluating Cases Involving Obesity,” SSA.gov, 05/20/19
Source: “Care Coordination,” CDC.gov, 05/29/19
Source: “Guidelines for Educators and Administrators for Implementing Section 504 of the Rehabilitation Act of 1973 — Subpart D,” MemberClicks.net, 2010
Source: “What You Should Know About School Nurses,” ConsumerReports.org, 08/13/19
Image by Wil Pharma/CC BY 2.0

Schools Trying Their Best

Information gathered in the early 1990s about the education system was included in a report called “A Closer Look,” which concentrated on the services that school districts nationwide were willing and able to provide. Almost every jurisdiction did First Aid, and administration of prescription meds to students. In the obesity area, “Other commonly provided services include such health screenings as height, weight, vision, and hearing…” Also related to obesity, just slightly more than half of the school districts concerned themselves about nutrition counseling.

In 1997, via the National Academy Press, the Institute of Medicine published Schools and Health: Our Nation’s Investment. The Committee on Comprehensive School Health Programs in grades K-12 had worked three years on this massive book. The object was to create a set of programs that would serve, in a systematic way, the needs of “health education, health promotion and disease prevention, and access to health and social services at the school site.”

The ideal

Returning to what the experts decided in 1997 to recommend with regard to obesity in schools, they began with screening. It was felt that all teens should have their blood pressure checked annually, and if the numbers look dangerous, they should be tested again twice within the same month, to get an idea of what is going on. At least once, their total blood cholesterol level should be determined.

Other tests would be desirable for kids whose parents or grandparents suffered from certain obesity-related conditions, and there are some very specific recommendations about which tests should be done, and when. The issue of unknown family history presents another set of problems. This is one of the many burdens carried by adopted and foster children. When someone asks whether there is heart disease in the family, they don’t know.

Other advice concerns checking adolescents for eating disorders, including via interviews about body image perceptions, dieting patterns, self-induced vomiting, use of diuretics or laxatives, and so on. Now, what about teens with a body mass index at or above the 95th percentile? They definitely need an in-depth assessment. Meanwhile:

Adolescents with a BMI between the 85th and 94th percentiles are at risk for becoming overweight. A dietary and health assessment to determine psychosocial morbidity and risk for future cardiovascular disease should be performed on these youth…

The authors go on to list the various red flags that indicate a need for watchfulness. One introductory paragraph of the book contained unintentional and unforeseeable irony:

Whereas earlier generations of school health programs were predominantly concerned with stemming the threat of infectious disease, these problems have now to a large extent been ameliorated and replaced with the “new social morbidities” — injuries, violence, substance abuse, risky sexual behaviors, psychological and emotional disorders, and problems due to poverty — and many students’ lack of access to reliable health information and health care.

Of course, all these other problems exist, and it is too true that many students suffer from shortages of both health care and information. But the disturbing part is that today, because of COVID-19, we are back to a predominant concern with infectious disease. Even in places where the physical school has been in session, routines have been disrupted and priorities have shifted. Everybody is just doing the best they can with what they have.

Your responses and feedback are welcome!

Source: “Schools & Health: Our Nation’s Investment,” NIH.gov, 1997
Source: “Schools and Health: Our Nation’s Investment,” NAP.edu, 1997
Image by Fotos_PDX/CC BY 2.0

Obesity and Establishments — Whose Opinion Counts?

There is always controversy around schools and what they ought to be doing about various problems. Obesity prevention is a prime example. Many Americans have the sincere and worthy desire to give each child every possible advantage in life. Others are like, “Hey! Teacher! Leave them kids alone!”

The existence of Section 504 of 1973’s Rehabilitation Act inspired a mass of commentary, such as “Guidelines for Educators and Administrators,” published in 2010. This very comprehensive manual identified 18 major life activities which, if impaired, could define a child as having a disability. This, in turn, would signal the need for the institution to offer a service or accommodation to help put the child on equal footing with peers. It does not explicitly say so here, but several of the difficulties could apply in the case of obesity: caring for one’s self, walking, breathing, sleeping, standing, working, helping, eating, bending, and the operation of a bodily function.

Down to specifics

Page 31 offers a list of red flags that might indicate the need for action. If the child does not qualify for special education services under the IDEA, they might through Section 504. There are many other possible reasons for the school to take an interest and intervene, like persistent parental concern, or if the child is being expelled from school, or is in a substance use rehab program. One item says the school should be concerned “when a disability of any kind is known or suspected,” which covers a lot of ground.

This would include, it is to be hoped, the circumstance where a young person might need extra help because of obesity. The authorities are even reminded to take disabilities into consideration when a school is being built or remodeled.

What are accommodations?

The possibilities are many. The strategies come in batches: environmental, organizational. behavioral, presentation, methodology, curriculum. There is an exhaustive list of the kinds of small adjustments that good teachers delight in using and in originating. They would doubtless do a lot more of this sort of thing if they had fewer students and more support.

In an ideal learning environment, each child gets as much attention as the scion of a royal family, from a teacher who loves both the job and the child. Of course, nowadays, there are COVID-related issues in schools, and many different opinions on what should be done, and when, and how, and by whom. Even though obesity and COVID are bosom buddies, it must be admitted that since COVID came along, obesity has lost a large share of the attention it had been accustomed to.

Privacy can be a stumbling block

One of the ongoing problems is that, in order to give the appropriate care, schools need information. A treatment action plan is especially vital if the child has asthma, epilepsy, or diabetes. When accommodations need to be made, parents are expected to do things like fill out a form that asks a lot of nosey questions, and maybe to have a doctor fill out a form, too. With some folks, this just doesn’t sit right. Idealism and the urge to do good run up against other barriers in real life. A parent may deeply resent having a child go on record as “disabled” because the secretary in the principal’s office thinks the kid breathes funny.

Or, just to take an extreme example, say your kid is a serial bully who finally got thoroughly trounced by another child, and in your heart you know she deserved it. The last thing you need is the school calling you in on suspicion of abuse, to explain why your kid has bruises. It is, after all, possible to see why people don’t necessarily want the education system prying into every last detail of their business. The friction between parental rights and society’s demands will always make the handling of matters like obesity fraught with problems.

Your responses and feedback are welcome!

Source: “Guidelines for Educators and Administrators for Implementing Section 504 of the Rehabilitation Act of 1973,” MemberClicks.net, 2010
Image by Steven Depolo/CC BY 2.0

Obesity and Schools — Who’s In Charge?