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Health & Fitness

Weight Discrimination and In-School BMI Measurement

You may have seen my name in this article originally posted in the Chicago Tribune, discussing our school district's use of Fitnessgram, "a fitness assessment and reporting program for youth." This program requires that students have their BMI calculated in school, and each student is privately shown the result; a report is also sent home to parents. There has been significant community discussion on the subject, largely centered around concern for students' health and concern for students' privacy and self-esteem.

One medical expert in obesity, speaking in favor of the measure at a recent school board meeting, horrified me by saying that he became an anti-obesity activist when one of his young patients wanted to lose weight because "she wanted A friend." While the doctor relayed this story with real compassion, his example illustrates my concerns exactly: the problem he describes is not with the child's weight, but with weight discrimination.

Weight loss (while it may be indicated medically) is not an acceptable solution for discrimination. This young woman’s experience is not uncommon: a recent study in the UK showed that children as young as four rejected a heavy character in a story, and that the harshness of their rejection increases with age. The majority of children in the study thought the "fat" character was "less likely to win a race, do good school work, be happy with the way he looks, get invited to parties, and more likely to be naughty at school."

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I want to bring weight bias to the forefront of this discussion. Numerous studies have shown that children and adults whose bodies do not meet our exacting cultural standards face discrimination in the workplace, at school, and even in the doctor's office. The Yale Rudd Center has a research division dedicated to studying weight bias and stigma and the serious negative effects it has on the lives of children and adults. Confusing weight bias with pro-health policies is a common problem in the field of public health which can be seen in advertising in Georgia, more subtly in New York City, and which has been the subject of diet books for children. (You heard me - diet books for children.)

An excellent example of weight bias was created by art professor Haley Morris-Cafiero in her photography project Wait Watchers. She elaborates on her experiences with weight discrimination in Pictures of People Who Mock Me. I also encourage readers to listen to the video panel discussion, Fat Stigma Starts Young, which discusses cases where school programs intended to improve student’s health fostered an environment of discrimination instead.

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What does weight bias have to do with measuring BMI in a school setting? Instead of focusing on offering all children the tools they need to take care of themselves, BMI is contextualized as a "healthy zone" which students use to "set goals." In other words, it shifts the focus from appropriate self-care to body shape, thus supporting the beliefs that drive weight bias. In a vacuum, BMI is "just a number," or "just information," but unfortunately middle schools do not operate in a vacuum - they are a pressure-cooker for societal attitudes. Schools need to be mindful of the risk involved in providing fuel for weight bias, via an easily-shared, easily-compared number.

It's difficult to really understand the effect of weight bias unless you have a personal connection to it. I've written before about the blog Dog-lbs.com. While much of Lori's writing journals her personal success in improving her health, she also documents the times when total strangers publicly taunt her, or review the health of the food in her shopping cart or discuss her exercise habits. I talked to her about what I was writing today, and I've asked her to write about her own experiences. One important theme of her blog "...success is measured in more than a number on the scale."  You can read what she wrote by scrolling to the bottom of my original post on Chicagonow.com - fair warning, Lori is brutally honest when it comes to her experiences, and what she writes may be triggering to some readers.

All children need to learn to take care of themselves—that is the point of our educational system. We need to ensure that school policies, especially health policies, are carefully crafted to minimize potential risks and support the well-being of every child.

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