Every now and then, someone suggests that in order to improve the health of our kids, we should stand them on the scales.
Usually, it sparks a debate, but this time, the response was swift, and it was unanimous.
As a part of their proposal for every child in Australia to have access to a suitably qualified school nurse, the Australian College of Nursing also recommended ‘normalising’ weighing of children in schools, and running weight intervention programs in schools.
Now, we love school nurses- and all nurses. Sschool nurses are an excellent resource in a school. They have time, capacity and expertise in implementing programs that have the potential to improve health and wellbeing in ways that classroom teachers don’t. Our experience in meeting with school nurses is that they are very open to the new research that we are able to present about weight and health, practical suggestions for more supportive language, and our body image programs. So while we welcomed the policy proposal for all children to have access to a school nurse, the latest research suggests that this should be about supporting health, regardless of the size of the child, not about weight.
When we were asked to comment on this in the media, The Embrace Collective Co-Executive Director Taryn Brumfitt did an excellent job of communicating the reasons why we should not go back to a time when weighing kids in schools was ‘normal’.
And people on our socials agreed. With force.
On her @bodyimagemovement account, Taryn did a quick poll – and 98% of 1000 respondents agreed that we shouldn’t be weighing kids in schools. Story after story of the damage that was caused by being weighed- mostly from women, and mostly aged 30-60 added depth to the numbers, as hundreds of people wrote comments on our social media:
- “I was weighed in school in grade 4 and it was humiliating- it was the first time I started to compare my body to others
- “I’m 32 and remember vividly being weighed in front of the entire class during P.E in Year 7. It was terrible. I also remember the teacher asking me to stand up in front of the class with another student who was slimmer, and she told the class I was an example of ‘eating the food pyramid incorrectly”.
- “Being weighed in PE at school in front of the whole class 10-15 years ago 100% contributed to me developing an eating disorder”
- “Weighing kids at school? WHY? Are we bringing back the cane as well?”
The lived experience voices were clear, but so is the evidence. There is so much new research that is coming out in this space that outlines the ineffective, and potentially harmful impact of weighing kids in schools. It is nice to think that this could be done in non-stigmatising ways, but given the broader cultural context around weight, the shame that kids feel is likely to persist regardless of the manner in which the measurements are taken.
In particular, the latest research indicates that:
- Weighing young people does not reduce weight
- Weighing young people does not improve their health, and
- There is significant potential for inadvertent harm.
Weighing kids does not reduce weight
Data from large BMI screening and reporting programs implemented throughout the past 10 years in the US clearly shows the ineffectiveness of existing BMI screening programs. In 2014, almost half of the states in the USA had a policy mandating weighing kids in schools, and a quarter reported this weight to parents (Ruggieri & Bass, 2015). Several states have now ceased this practice (Poole et al., 2023). A simulation study revealed that if BMI screening and reporting programs were implemented in 15 US states, it would cost $210 million (from 2023-2033), yet was not projected to prevent any cases of child obesity or significantly change obesity prevalence (Poole et al., 2023). De-implementation of BMI screening practices in schools has now been recommended and is underway in the US (Poole et al., 2023).
In addition, Californian research has revealed that BMI screening and reporting among students in 5th, 7th and 9th grade did not result in a reduction in weight (Madsen, 2011). Other research in New York (Almond et al., 2016) and other states, as summarised in systematic reviews, finds that weighing students does not lead to weight loss (Thompson & Madsen, 2017).
There is a misconception that we need to make young people feel dissatisfied with their bodies to motivate them to engage in health behaviours, and maintain a ‘healthy’ or stable weight over time. However, longitudinal data from the USA has found that when young people are dissatisfied with their body, they are more likely to gain weight over a 5-year and 10-year period (Loth et al., 2015).
Weighing kids does not improve health
Research also shows that when young people are told that their BMI is in the overweight or obese range, they are less likely to engage in health behaviours. Data from a large US study of adolescents who had bodies in the ‘overweight’ and ‘obese’ range, but who did not know about it, were more likely to eat vegetables, be physically active, be on a sports team, sleep an average of at least 8 hours per school night and less likely to be trying to lose weight than those who knew they were in a higher weight category (Hahn et al., 2018). Weight misperception, or not knowing that you are in the ‘overweight’ or ‘obese’ category, seems to be protective in terms of supporting people to maintain weight and engage in healthy behaviours. This has also been found among adolescents in Taiwan (Hsu et al., 2016).
The latest research is revealing that, it is the extent to which people feel shame about their bodies, or are discriminated against on the basis of weight and size, that is associated with health issues, independent of actual BMI (Sutin et al., 2015; Nagpal et al., 2021). Weight stigma also contributes to weight gain over time (eg., Major et al., 2014; Prunty et al., 2023). A meta-analysis has also confirmed that people who experience weight stigma are also significantly more likely to experience psychological distress (Alimoradi et al., 2020).
There is significant potential for inadvertent harm
Anti-obesity public health advertisements and public health interventions have been found to cause harm, as they have increased weight stigma and risk factors for eating disorders (Bristow et al., 2022; Richmond, 2020). Public health practitioners, parents and students often express concerns about the possibility of BMI screening leading to weight teasing, the triggering of eating disorders and psychological distress (Hayes, 2016; Portilla, 2011; Tatum et al., 2021). Each of these poses significant implications for young people’s physical and mental health.
Studies from over a decade ago have found that between 85% and 92% of adolescents report weight-based teasing in school (Puhl et al., 2011) and that children and adolescents who experienced weight-based teasing have lower self esteem and increased depression, and feel self-conscious, angry and unappreciated by their peers, compared to those who were not teased for their weight (Li & Rukavina, 2012; Lampard et al., 2014). Students who are teased are more likely to be dissatisfied with their weight and to engage in dieting, which are two key risk factors for eating disorders (Lampard et al., 2014; Paxton et al., 2006). Weight teasing is named as a specific trigger for the development of anorexia nervosa in a study of the admission reports for residential eating disorder programs (Lin et al., 2023). Teachers recognise that weight teasing is an issue, but also have significant levels of negative attitudes towards young people in larger bodies (Nutter et al., 2019).
Eating disorder diagnoses have doubled in 5-12 year old children and increased significantly in adolescents over the past five years (Morris et al., 2022). The full socio-economic cost of eating disorders has been estimated at $67 billion AUD annually (Paying the Price ). It is time for policy makers and governments to consider the de-implementation of the potentially harmful practices and messaging that have been embedded in school settings in efforts to reduce obesity, and adopt size-inclusive public policy in order to reduce eating disorder onset and enhance wellbeing (Hunger et al., 2020).
Curriculum Context
After significant advocacy, significant changes have just been made to the Australian Curriculum to remove education about, and lessons involving measurement of student’s bodies, calculation of BMI, and a focus on restrictive dieting. These changes were implemented as a safety consideration due to the number of reported instances in which these sorts of lessons were triggering for young people vulnerable to eating disorders, based on empirical and anecdotal evidence. You can read more about the changes here.
Conclusion
If our goal is to improve the health and wellbeing of young people, we should not be weighing students and conducting ‘obesity management’ in schools. The evidence clearly shows that these actions do not lead to reductions in weight or increases in health behaviour, and yet these practices come with risk of significant harm to young people’s mental health.
If the intention is to improve health, there is no need to focus on weight.
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Dr Zali Yager Bio
References
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