Schools Take On the Task

In 2014 the Colorado Department of Education published the Colorado Healthy Weight Toolkit, which is something of a model to which others might aspire. Once again, we look to the very conscientious state for guidance in what they call Growth Screening, defined as “measuring height and weight to calculate Body Mass Index” (BMI). The toolkit includes the messages that parents receive about this process, including a form to be returned if they don’t want their children’s BMI measured.

The literature explains that by state law, schools are required to screen for only two impairments:

While vision and hearing screenings are required, growth screenings are recommended by the Colorado Department of Public Health and Environment as another tool to evaluate the health of each child. Results are confidential. The growth screenings will take place in a private setting, supervised by the school nurse.

On the list of safeguards, the first item is a reminder that parental consent is necessary. Staff should be properly trained to carry out the measurement program and keep appropriate records. Accurate equipment should be obtained, and student privacy assured. The guidebook’s seventh rule reminds the people in charge that they should “regularly evaluate the program and its intended outcomes and unintended consequences,” a precept that is sometimes not followed carefully enough.

Many characteristics are specified for the correct type of scale. It should have no wheels and be otherwise stable. It should be in a private location, and the child’s weight should not be spoken aloud, but only written down. Any “stature device,” ruler, or other height-measuring attachment is not to be used for that purpose. Height is to be measured separately, with a different instrument, the stadiometer. It comes with its own list of procedural requirements, to assure that each individual reading is accurate, and to acquire meaningful statistics.

Another agency weighs in

The Arkansas Center for Health Improvement, like similar departments in other states, presents its measurement protocol in one of its training manuals, which probably all derive from the same sources. The preparation involves such matters as privacy, good equipment, proper form, and not wearing sweaters, jackets, hats or shoes while being weighed or measured.

From another state, Missouri, here is only the first and shortest of a three-paragraph explanation:

The student should stand on the footplate, or at the base of the measuring device, without shoes and positioned with heels close together, legs straight, arms at sides, and shoulders relaxed. The student should be instructed to look straight ahead and stand fully erect without moving their heels. The heels should not rise off the floor. When possible, the head, back, buttocks and heels should touch the wall. All hair ornaments, buns, braids, etc. should be removed to obtain an accurate measurement against the crown of the head.

To make a long story short, the process involved in BMI assessment can be tedious, embarrassing, and even frightening to children. It is a job for trained personnel, and if trained personnel are unavailable for whatever reason, it is a lot of responsibility to put on school employees who might be totally unfamiliar with medical procedures.

Your responses and feedback are welcome!

Source: “Colorado Healthy Weight Toolkit,” CDE.state.co.us, 12/01/14
Source: “BMI Screening Program: Eight & Weight Measurement Training Manual,” Arkansas.gov, 2019
Source: “Guidelines for Growth Screening in Missouri Schools,” MO.gov, 2005
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Schools and Expectations

The rules for qualification as a disabled person in the education system were laid down by the Individuals with Disabilities Education Act (IDEA) of 2004, which recognized 13 categories of disability, including Other Health Impairment. To come in under the heading of Other Health Impairment, two criteria needed to be met: there had to be “limited strength, vitality, or alertness as related to the educational environment” and “the condition must adversely affect the student’s educational performance.”

What did this document say about obesity? IDEA explained that its list was not all-inclusive, and on some questions did not take a firm stand:

The list does not include or negate the general condition of childhood obesity; however, the conditions of asthma, diabetes, and morbid obesity are explicitly recognized (as of 2009).

Students who are obese whose condition adversely impacts their educational performance, should be eligible for special education services. If a student is obese and has a significant physical fitness or motor skill deficiency, they have the potential to meet the minimum criteria for obesity as a disability…

What kinds of special educations services was the Act talking about? The subject was clarified by the U.S. Department of Education’s Office for Civil Rights (OCR), which was given jurisdiction over Section 504 of the Rehabilitation Act of 1973. In 2010 the agency published guidelines defining the OCR’s main responsibilities as “investigating complaints, conducting compliance reviews, and providing technical assistance.” The intentions were carefully explained:

It is not a plan designed to enhance a student’s performance. It is a plan to provide fairness and equal access to education… A student is entitled to a Section 504 Accommodation Plan if they have been identified and the evaluation shows that the individual has a mental or physical impairment that substantially limits one or more major life activities. This determination is made by a team of knowledgeable individuals, including the parents, who are familiar of the student and his/her disability.

The purpose of Section 504 was to protect individuals with disabilities from being discriminated against. Exceptions might be made for a student whose obesity “substantially impairs the major life activity of mobility.” As examples, the authors suggested seating modifications (including in restrooms), and the opportunity for privacy in restrooms. The student could be allowed extra time to arrive at classrooms, and/or given elevator privileges. The furniture in classrooms could be rearranged. Classes could be moved to different rooms.

There could be dietary modifications or adjusted meal schedules. If the student travels by bus, that situation should be checked for safety. Attendance policies could be more forgiving. The physical education requirements could be relaxed. There might be counseling, or a peer support group. Students with disabilities could be encouraged to take part in clubs and activities.

A certain type of person would perceive all this as shameful coddling of kids who eat too much and play too many video games. But bear in mind, these accommodations are meant to make life bearable not only for a morbidly obese child but for a wheelchair-bound child or a child on crutches. The list of suggested interventions came with a rather significant caveat:

These guidelines might not reflect the opinion of the Office for Civil Rights and/or current court cases. Civil Rights laws and regulations change periodically and will change interpretations of various rules and regulations.

(To be continued… )

Your responses and feedback are welcome!

Source: “Childhood Obesity: Classification as an IDEA Disability,” SagamorePub.com, 2016
Source: “Guidelines for Educators and Administrators for Implementing Section 504 of the Rehabilitation Act of 1973—Subpart D,” MemberClicks.net, 2010
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How Much Should Schools Care?

Several years ago, a major hospital chain conducted an opinion survey in which 90% of the people responded that they wanted schools to play a role in reducing obesity. Regarding what that role should be, how many different pictures were in their minds? More physical education classes? Less junk food in the vending machines? Weigh and measure the students and send alarming letters to their parents? The survey did go further, and learned that 64% of the positive respondents were also in favor of the role being “major.”

In 1997, in a book called Schools & Health: Our Nation’s Investment, the National Center for Biotechnology Information published its viewpoint on the confidentiality of student academic and health records. When speaking of difficulties, they did not beat around the bush:

Providing health care in an educational setting requires consideration of separate and sometimes conflicting standards about clients’ rights to obtain health care and requirements for educators and health care providers to protect the privacy of their clients’ records.

Students are of two important subcategories — legal minors and legal adults — and different procedures are involved in the record-keeping.

Although client health and social service records may belong to the agency where the data are collected, the individual (parent or guardian, in the case of a minor) maintains the right of control over the information in the records.

That is as it should be, but no bureaucracy is error-free. No doubt there are some horror stories of mishandled records. When things go right, the student or parent signs a consent form, so that various agencies can see the records and coordinate their efforts on behalf of the patient. This is desirable for many reasons, like the prevention of medication conflicts. Most clients, or the parents responsible for them, are okay with that provision, but…

[…] this may be problematic when there is an issue related to mental health, drug use, or a sexually related condition. Further, some parents and guardians express concern for the consequences if such information — or information about health problems discovered at the school, such as asthma or seizures — might be obtained by their insurer.

Most people don’t set out to deceive their insurance company, but there is no point in letting them know every detail of a child’s condition before a diagnosis is confirmed or before there is a chance to sanely assess the situation. Obesity is not identical to a mental health or drug use issue, or a sexually related problem, but there might be valid reasons to control the flow of information to other parties. With insurers so eager to find disqualifying “pre-existing conditions,” confidentiality is important.

In the discussion of screening processes, the recommendation is to use “a relatively simple test to identify those who may have a particular problem.” Customary testing methods should be reviewed, and their relevance attested to. Financial resources and other factors will decide how to apportion the attention “between population-based screenings and targeted interventions for high-risk groups.” Here is the crux of the matter:

Unfortunately, screening programs are ineffective unless procedures are in place for ensuring follow-up of identified problems.

(To be continued…)

Your responses and feedback are welcome!

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

What Should Schools Care About?

At the turn of the millennium, schools were being pressured to bring up academic test scores, no matter what. Meanwhile, the National Association of State Boards of Education (NASBE) had written:

Health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.

In those few words, the raw material can be found for an infinite amount of disagreement. Parents, politicians, teachers, school administrators, and many other interest groups have a stake in prescribing the mission of schools in America. Who gets to define physical health? Who gets to define mental health or — most volatile of all — social health? These monumental questions resist consensus and compromise.

In that quotation, see where it mentions health and fitness for both students and staff? Before going in more serious directions, this is a good opportunity to mention what Emily Richmond wrote several years later, when conditions had started to change, of her time as a reporter on the education beat:

I did some quality control spot checks at various campuses after the junk food ban was passed. I found that bottled water and graham crackers had indeed replaced the sports drinks and chocolate bars — with one notable exception: the machines in the faculty lounges were fully stocked with the familiar array of candy, chips and sugary sodas. That the ban didn’t extend to the adults on campus illustrates the larger challenge facing schools, families, and communities as a whole.

That larger challenge encompasses, on a regular basis, such issues as hypocrisy, as well as the reluctance to include or ignore particular bits of science, depending on the participants’ bias.

In 2004, the Centers for Disease Control published “The Role of Schools in Preventing Childhood Obesity,” whose nine pages included 10 strategies to improve student nutrition and increase the opportunities for physical activity. The document stressed the need for each school in the country to have a Coordinated School Health Program, including a coordinator and a school health council.

School strategies for reducing obesity

Administrators were encouraged to use the CDC’s School Health Index to list measures already in place, and note the elements that were missing but needed. Each state was tasked with determining whether junk food and sugar-sweetened beverages could be sold in schools. They needed to decide how much physical activity kids ought to engage in, and figure out how to induce them to do it. They needed to think about whether it was appropriate to encourage such programs as safe walk-to-school routes.

Great emphasis was put on improved meals. The “Role of Schools” paper is energy exchange formula-oriented, all about nutrition and activity; and does not include the words “weigh” or “scale,” and only mentions Body Mass Index in the context of defining overweight to discuss the national percentage of overweight kids. Other statistics were grim, too. Richmond mentioned that the rate of absenteeism was 20% higher among the children who were headed for obesity. She also wrote,

Kaiser Permanente conducted a nationwide survey and found that 90 percent of respondents believed schools should “play a role in reducing obesity in their community” and 64 percent supported it being “a major role.”

Your responses and feedback are welcome!

Source: “The Role of Schools in Preventing Childhood Obesity,” CDC.gov, 2004
Source: “Should Schools Be Responsible for Childhood Obesity Prevention?,” TheAtlantic.com, 07/15/13
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Schools and Obesity Tracking

The previous post asked, “Should Schools Stay in Their Lane?” What exactly is their lane, or area of competency and responsibility? This turns out to be a very complicated question. What ought schools to be doing about obesity, and on whose say-so? What happens if they go too far or don’t go far enough? How much of a child’s personal life is none of the schools’ business anyway? It is a sprawling area of inquiry, so we will look at some of the societal institutions that contribute input.

What gets recorded?

For the convenience of anyone who wishes to refresh their Body Mass Index knowledge, here are several previous posts that cover this topic:

• What Is This BMI?
• Doubts About BMI
• Edmonton Obesity Staging System As BMI Alternative
• BMI Takes Another Hit

For now, this is the measurement standard most widely used. One reason for not wanting to change is that switching to a different system would make longitudinal studies more difficult. When statistics are to be compared, the more alike they are, the better. Still, in some quarters BMI is falling out of favor.

Leaving aside the pros and cons of various methods, why do local, state, and federal agencies concern themselves with weighing and measuring school kids?

Extra weight is likely to correlate with other things that should have an eye kept on them — things like hypertension, type 2 diabetes, cardiovascular disease, and on and on. Some parents and legislators believe that very close attention should be paid by the school system, while others do not believe that the schools should be concerned with matters of physical health at all. The debate around that has only become more heated since COVID-19.

A 2017 document from Colorado’s Department of Public Health & Environment reflects years of objective study and increasing consciousness. At the time of publication, the state identified nearly one in five high school students as overweight or obese, and more than one in four children, which is an even worse ratio. And Colorado was one of the top three states!

The S-word

Back in 2013, the state had boldly declared tackling obesity as a “winnable battle.” A couple of years later the state government announced that…

[…] healthy eating, active living and obesity prevention have been designated as a flagship priority in the plan, Shaping a State of Health (2015-2019)…

STATEWIDE GOAL: Reverse the upward obesity trend by aligning efforts to develop a culture of health… Intensify efforts to create conditions to achieve healthy weight across the lifespan… Increase statewide capacity for coordinated obesity surveillance.

And that S-word, surveillance, is where a lot of people pull the brake cord and jump off the anti-obesity train. They feel that kids are already scrutinized far too closely for their own and their families’ good. A lot of Americans want no part of a system that includes screening, referrals, and record-keeping. They regard this observation, and what appears to them as an obsessive and excessive concern, as repugnant, and are against it on principle.

They have also accrued evidence that it doesn’t necessarily help. Some studies show that when certain kinds of attention are paid to body weight, eating disorders are likely to increase.

(To be continued…)

Your responses and feedback are welcome!

Source: “Overweight and Obesity in Colorado,” Dphe.state.co.us, 2017
Image by Elizabeth Lloyd/CC BY 2.0

Should Schools Stay in Their Lane?

Should schools mind their own business? To what areas of life should that business be limited? There has never been universal agreement on where the norm ought to be. In 1993, the American Academy of Pediatrics suggested seven appropriate goals for policy and practice in the area of school health:

1. Ensure access to primary health care.
2. Provide a system for dealing with crisis medical situations.
3. Provide mandated screening and immunization monitoring.
4. Provide systems for identification and solution of students’ health and educational problems.
5. Provide comprehensive and appropriate health education.
6. Provide a healthful and safe school environment that facilitates learning.
7. Provide a system of evaluation of the effectiveness of the school health program.

Over the years, the federal government stepped up with some major moves. The Elementary and Secondary Education Act (ESEA) of 1965 had laid out the basic tenets of governmental involvement in education. It was organized in such a way that states could opt into financial benefits by fulfilling the “requirements outlined in certain sections, or titles, of the act.” Later, as a Harvard University publication explained:

The 2001 No Child Left Behind Act (NCLB) marked a new level of federal oversight by requiring states to set more rigorous student evaluation standards and, through testing, demonstrate “adequate yearly progress” in how those standards were met. Flaws in the law quickly surfaced.

Then in 2004 came the Individuals with Disabilities Education Act, or IDEA 2004, whose Child Find Mandate applies to all children residing in a state, and says that “schools are required to identify and evaluate all children who may have disabilities,” from birth to age 21. It also specifies that “The law does not require children to be ‘labeled’ or classified by their disability.”

On the other hand, a certain amount of record-keeping and statistical calculation has to be done in any project of this kind. The citizens who pay for the program need to be shown that it yields good results, and charts are how we do this. In the course of doing legitimate accountability chores, bad judgment and error can creep in. Despite good intentions, undesirable classification and labeling of children seem to occur anyway. This is one of the issues that many parents and professionals are concerned about.

(To be continued…)

Your responses and feedback are welcome!

Source: “Schools & Health: Our Nation’s Investment,” NIH.gov, 1997
Source: “When it Comes to Education, the Federal Government is in Charge of… Um, What?.” Harvard.edu, Fall 2017
Source: “Do Schools Have Any Legal Obligation to Identify and Test Students?,” WrightsLaw.com, 06/03/2008
Image by Rick Obst/CC BY 2.0