BMI Screenings totally depress me

[MHDNURSE]

So I just completed my BMI screening for first grade. 29% are "overweight" and 19% are obese. So roughly half the first grade is not normal weight. I had no "underweight" kids. It just makes me so sad. I have a 1st grader who weighs 200 pounds, her entire family is morbidly obese and there is nothing I can do, other than send home that referral paper. They know she is fat. They are fat. It is really sad.

I do my health classes, they get healthy food at school, gym class, lots of wiggle breaks. Other than that, there is nothing else I can do. Just makes me sad for these kids and families.

[akulahawkRN, ADN, RN, EMT-P]

Body Mass Index is flawed in a very particular way. For most people, that aren't particularly athletic, it is generally useful. That being said, people that are fairly athletic can be significantly heavier than a non-athletic person of the same physical dimensions. BMI only considers height and weight. It does not consider actual body composition. Someone that's 5' 8" tall who weighs 230 lbs will have a BMI of approximately 34. Age and sex do not factor in this. That person could easily be a couch potato and have a very high body fat content or could easily be an athlete with a body fat content of 15%. One person will truly look fat and start having health problems while the other will look very fit with few health problems, if any. It's possible for a person to have a high body fat content and yet look "ok" by BMI.

BMI is a good screening tool but it does not replace clinical judgment.

[JenTheSchoolRN, BSN, RN]

I screen for it in grades 7 and 10 because I am required to do so by my state. I send a letter home that I doing so.

But I do not send home what I call "fat letters." My state dropped that requirement, thankfully. BMI is a tool, but standalone it is very flawed. I do have some students in the obese category and even some paperwork on counseling and diet student has received from doctor. But there are other factors at play.

I also am well aware of body imaging. I had a 7th grade student that does fall into the obese BMI category come and see me this week. She had a headache and I uncovered that it was due to her not eating in 24 hours. She went on a "liquid" diet to lose weight. I took her that was not good for her or her body and that she was beautiful , but that if she wanted to make some healthy choices together we could do that. Then we had a snack together. This kid will be on my radar for the year.

Side Note: I, myself, fall into the "obese" category with the basic BMI formula, even though the size of clothing I wear makes me feel more overweight than obese (size 14). I work out regularly, try my best to eat well (but do love sweets) and have never been "skinny" in my life. I love walking when the weather is good. My health is excellent currently. BMI tells only a small part of a larger story.

[OhioBPH]

I think that over-eating disorders like binging, compulsive eating, or obsessive eating are often overlooked because as a nation we thinkit's about will power. Disordered eating is a problem for people of all shapes and sizes. And although anorexia and bulemia can have severe health effects, all of these things require our attention at encouraging healthy eating, lifestyle, and body image.

And BMI screening is not the best palce for it, especially in the school setting. It sucks that so many states require it.

[ruby_jane, BSN, RN]

Body Mass Index is flawed in a very particular way.BMI is a good screening tool but it does not replace clinical judgment.

I think we're all in agreement. But we all also have to (by mandate of our districts, in one way or another) calculate a BMI on a kid sometime in their academic career. I had one world weary newcomer tell me she knew what acanthosis was and that I was the fourth nurse in five years to notice.

[LikeTheDeadSea, MSN, RN]

I hate BMI. I'm a size 2/4 and pretty tall. Regularly referred to as being lean. If I fluctuate 5lbs up, I fall into overweight. Lots of muscle mass on this frame; lifting stuff is my favorite hobby. I know my elementary school darlings aren't typically in this kind of scenario, but just knowing what my numbers look like makes me agitated at the whole system.

[Amethya]

As some of the Texas SN say, I do the AN, as it's mandated in Texas, and I get a lot of these kids and all I can do is send a letter and hope that one parent actually follows up. I do it during my screenings and the ones who were positive, I do the BMI.

My TD1's little sister is starting to have the AN mark and I mentioned to mother, but she claims that the little girl just wants to eat sweets and won't listen to her. I know why though, it's because they don't limit their sugar intake and diet and that's why she refuses to try to eat healthier, she's just following their example.

[OldDude]

BMI is BS...it doesn't take a highly trained medical specialist to look at someone and tell if they're too fat. I fall into the obese category and don't have to do any calculations to realize that; just pay attention to how my belt gets shorter!!

[Amethya]

As some of the Texas SN say, I do the AN, as it's mandated in Texas, and I get a lot of these kids and all I can do is send a letter and hope that one parent actually follows up. I do it during my screenings and the ones who were positive, I do the BMI.

My TD1's little sister is starting to have the AN mark and I mentioned to mother, but she claims that the little girl just wants to eat sweets and won't listen to her. I know why though, it's because they don't limit their sugar intake and diet and that's why she refuses to try to eat healthier, she's just following their example.

Actually good news is that today my little TD1 kid came with a chef salad instead of mcdonalds for lunch! It was low carb lunch and I was so happy for him! His mother prepared it for him.

[NurseCard, ADN]

Interesting that I've never heard a thing from any school nurses about

my daughter. Guess it does vary by state. I live in Kentucky where

obesity is extremely common. Maybe if school nurses here were made

to send letters to parents, strongly encourage healthier eating in

kids...

I mean, my daughter is overweight. I'm sure she falls into the obese

category. She's always been overweight. To look at her.. she's tall,

she's a big girl... perhaps to most people she looks like she is a

healthy weight, but I know she isn't.

And then we have my son, who I DO get talked-to by his

school nurse very often... because he is UNDERWEIGHT.

He has ADHD and takes a lot of medicine for it, plus he is

very active, plays basketball.. we can't keep weight on

him.

I get talked to about him, but not about my daughter.

Never. Ever.

[Jedrnurse, BSN, RN]

I'm 6'4" and last year I had a fifth grader who outweighed me. I don't know how many Mondays I'd ask the kiddos about what they did over the weekend and they said "nothing" or "played video games". If this is typical weekend, Lord knows that they don't do anything after school during the week. Add that to ridiculously awful lunches sent by parents...

[Farawyn]

I'm 6'4" and last year I had a fifth grader who outweighed me. I don't know how many Mondays I'd ask the kiddos about what they did over the weekend and they said "nothing" or "played video games". If this is typical weekend, Lord knows that they don't do anything after school during the week. Add that to ridiculously awful lunches sent by parents...

How's the high school life treating you, Jed?

[K9lover, ASN, RN]

It has gotten bad and just appears to be accepted as normal course of events. I have jail patients who weigh over 300 lbs (some 400) and they are not yet 30 years-old.

We see them for diabetes and HTN. I tell them they are far too young for these health problems and they tell me 'it runs in my family', I tell them it runs in their generation and it does. Childhood obesity is going to turn into adult obesity.

I think one of the biggest barriers is that we are overly sensitive as a society in not bringing it out in the open more due to being labeled as 'judging' people on appearance. Just because obesity is a more obvious condition than say alcohol/drugs etc...we are not doing anyone favors by not addressing it and when I suggest to a 20-something that they will have huge health consequences if they do not turn the situation around. The vast majority is more calories taken in than burned; it is not a battle I had to fight; I had other issues. It will become worse, the inmates I see are always complaining they go @ 11 hours between dinner and breakfast, factoring 8 hours sleep I tell them they will not starve having 3-4 hours at night that they are not fed but h*ll, when did we become a society where people think that going 3 hours without eating is a hardship? We are a food-obsessed society, look at commercials, billboards and ads on the net. It is a bonus if meals taste good but we do not eat out of hunger and do not stop when sated. That all being said I am surprised your comment was not removed for using the word 'fat'; the one time I was dinged on allnurses was a comment along the lines of putting down the fork. Of course I know there is more to it than that but it is a start. No one ever got sober by continuing to drink while they addressed the underlying issues and no one will take off weight if they continue to eat 3000 calories a day while looking at underlying issues. They all at one time only had 10 pounds to lose, once they have a hundred pounds to lose they tend to sink into that 'cannot change' mode.