The Other 60 Percent

A few districts lead the way in tracking body mass index

With more than a quarter of Colorado children overweight or obese, schools are increasingly being asked to do their part to reverse the trend. A small number of Colorado school districts have responded with an approach that they believe is one piece of the puzzle: measuring students’ Body Mass Index or BMI.scale

While 21 states require and several others recommend that school districts collect data on students’ BMI, Colorado is not one of them. The absence of a state mandate means that districts like Denver, Poudre and a handful of others, are in the minority when it comes to such efforts.

In a sense, they are both pioneers and guinea pigs, taking the plunge with a practice that can provide valuable data but at the same time highlights the tricky task of talking about weight.

Several influential health organizations, including the Institute of Medicine, recommend that schools measure BMI, which is one way to determine if students are overweight or obese. Besides helping track overall trends, the results can arm parents with valuable information they may not get otherwise, particularly if they lack access to routine health care.

In Colorado, Denver Public Schools leads the way when it comes to BMI measurement, which is calculated using a person’s height and weight.

Not only was the district an early adopter of the practice, launching its program in 2007, it’s one of the few districts that reaches such a large proportion of students. Last year, the district collected BMI data for more than three-quarters of its students.

“In general, school districts just don’t provide this level of service,” said Donna Shocks, manager of nursing and student health services for DPS. “They don’t have the capacity, and then there’s the cost.”

Overall, it appears there are fewer than 10 districts that make a concerted effort to collect the data on a regular basis at multiple schools. In addition to Denver and Poudre, these include Cherry Creek, Steamboat Springs, South Routt, Hayden and Canon City. Individual schools in various districts sometimes conduct BMI screenings as well.

Collecting BMI may seem like an additional burden when districts are strapped for cash and time, but advocates believe there are compelling reasons to keep an eye on the weight of their students. In part, it’s because students who are obese are at higher risk for health conditions that can negatively impact school performance, such as sleep apnea, asthma and depression. Also, collecting school- or district-level data can help administrators craft initiatives to address the problem.

Nicole Turner-Ravana, a former district wellness coordinator and now a nutrition coordinator in Poudre, said BMI data showed principals, “OK, we do have an issue,” and validated the need for school wellness efforts.

About 23-25 percent of students were overweight or obese, according to the district’s BMI results.

“It mirrored what the state of Colorado was seeing,” said Turner-Ravana. “Typically, the lower-income schools have higher rates.”

Keeping feathers unruffled

BMI screening may have ardent champions in the public health community, but even after a decade of use in some states, it raises a raft of thorny issues. It’s indicative in the language used by anyone charged with running a BMI program. Besides repeated references to “privacy” and “confidentiality,” you’ll hear worries about kids feeling targeted, singled out or bullied, and parents reacting angrily to unwanted news.

Weight status based on BMI
BMI at or above the 95th percentile
BMI at or above the 85th percentile and under the 95th percentile
Healthy weight
BMI at or above the 5th and under the 85th percentile
BMI under the 5th percentile

In Poudre, where BMI collection began at some schools in 2007, organizers saw the effort as a way to collect aggregate data and track trends rather than alert families about possible problems. In other words, the purpose was surveillance not screening.

Organizers didn’t want students to sense undue attention to their weight or become the victims of teasing. In fact, at some grade levels, the scale’s digital display screen was turned around so students couldn’t see the weight reading. If students asked what it was, school staff or volunteers would write it down on a slip of paper.

“We would never say it out loud. That was a really strict policy that we had,” said Jessica Hinterberg, former obesity prevention coordinator for CanDo, a local anti-obesity organization that worked with the district to collect BMI data.

Renee Porter, obesity nurse coordinator at Children’s Hospital Colorado, believes schools should inform parents about BMI results to help educate them about potential weight issues. She said many parents of children who are overweight or obese mistakenly believe their children are in a normal weight range.

“You lose some opportunities by not sending out that letter,” she said, citing a common notification method among states that have adopted universal BMI screenings for students.

While agreeing that such letters have to be delicately worded, Porter said states that have long measured BMI in schools, such as Massachusetts and Arkansas, have created versions that don’t offend. But Denver Public Schools administrators say sending home letters never played well.

“We ditched that pretty quick,” said Shocks.

DPS contacts parents if their children fall into the obese, overweight or underweight categories, but not if their children are in the healthy weight range. No matter how they worded the letters, parents assumed the district was calling their children fat, said Shocks. Now, school nurses try to set up face-to-face meetings to discuss the results. If that doesn’t work, they talk with them over the phone or at school events.

“We find that to be much more effective than sending letters,” said Shocks. “That was a hard lesson that we learned.”

The value of BMI screening

Porter believes school-based BMI screenings provide universal access to an important health indicator. And since all kids are being screened regardless of weight or size, there’s no stigma attached.

As for the prospect of a student being teased or bullied because of a BMI measurement, some advocates note that children who are obese are already being bullied because of their weight. The screening could prompt interventions that could improve their health and ultimately their social lives.

Porter said she has had many young patients with significant weight problems, but their primary care doctors never brought the issue up to parents.

So, whose responsibility is it to sound the alarm about a child’s potential weight problem? It can be a knotty question even for school health leaders.

“I would say it’s probably the parents’ role, but the reality is we work in an inner city school district,” said Shocks, adding that increasing access to good health is part of the district’s mission.

How it’s done

Typically, BMI data is either collected at the same time as state-mandated hearing and vision screenings or during fitness testing in physical education class. However they’re conducted, parents can usually opt their children out of the screenings if they choose.

Until this year, Poudre School District conducted BMI screenings in conjunction with hearing and vision screenings, but not at every school. Each year, up to 12 of the district’s 50 schools participated.

Starting next spring, the district will collect BMI data during physical education class as part of an overall fitness assessment called FitnessGram. The program, which costs around $600 the first year and $150 in subsequent years, also yields information on aerobic capacity, flexibility, endurance and muscle strength. The results are accessible to parents and students online via a private login.

“This program works with our Colorado state standards,” said Conrad Crist, the district’s P.E. curriculum facilitator and a high school p.e. teacher.  “It allows the district to see trends and guide curriculum, guide instruction.”

While FitnessGram will be used in fourth- to 12th-grade, only sixth- to 12th-graders will have the BMI measurements taken, said Crist. FitnessGram will send progress report e-mails to parents with suggestions if their children fall into the red “needs Improvement zone” instead of the green “healthy fitness zone.”

Poudre is not the only Colorado district to use FitnessGram. Next door in the Thompson School District, the health and wellness-focused B.F. Kitchen Elementary has been using the program since 2008. In addition to tracking school-level BMI data, FitnessGram reports are sent home with student report cards. In addition, 13 schools in Cherry Creek use FitnessGram thanks to grant funding from the Denver Broncos.

In Denver, BMI was added to the hearing and vision screening process six years ago in response to the rise in childhood obesity. Now, there is one BMI specialist on all four district screening teams. DPS spends about $100,000 a year to pay the four BMI screeners.

Last year, the district collected BMI data on about 66,000 of its 84,000 students, including children in kindergarten through third grade, fifth-graders, seventh-graders, ninth-graders, preschoolers, special education students and those new to the district.

“Without those mandated screenings, I don’t know if I would have taken the plunge,” said Shocks.

after parkland

‘We’re not kidding about this,’ says one teen leader of Memphis march on gun violence

PHOTO: Dylan Peers McCoy
Students in Indianapolis participate in the National School Walkout on March 14. This Saturday, students in the Memphis area will join a related March for Our Lives.

Memphis students were on spring break when this month’s national school walkout against gun violence happened, but 13-year-old Simran Bains is not going to miss her chance to publicly speak her mind.

PHOTO: Simran Bains
Eighth-grader Simran Bains is a student leader at Schilling Farms Middle School in Collierville.

An eighth-grader at Schilling Farms Middle School in Collierville, which is on the outskirts of Memphis, Simran is one of more than a dozen teenagers planning this Saturday’s March for Our Lives in Memphis.

She believes the student drive to protest gun violence following last month’s shooting of 17 people in Parkland, Florida, will not end anytime soon. Saturday’s march is part of a national movement organized by Parkland students to keep the conversation going about gun violence.

“I think this moment is different,” Simran said. “For every school shooting I can remember, it’s the same cycle. People are sad and shocked, but nothing ever changes.”

Students and other supporters will walk to the National Civil Rights Museum from Clayborn Temple, the historic assembling area for civil rights marches of the 1960s.

We spoke with Simran about what this march means to her and what she hopes Memphis learns from it. (This interview has been lightly edited for clarity and length.)

Why are you participating in Saturday’s march?

For me, I’ve always been a little louder than my peers. I’ve always been one to go on a tangent or two. When I heard about the march from a friend, it really stood out to me because it’s being organized by people my age. I have never seen people this young doing stuff like this. It was inspiring. There’s this perception in society that there’s a gun problem in America and that’s how the world will always be. But here, I’m seeing young people, who are the future of America, changing the world, and I wanted to be a part of that.

What message do you hope to send?

I hope people hear that even though we’re young, we’re not kidding about this, and we won’t back down. I want people in Shelby County to care more about this issue and listen to us. I hope people recognize that even if they have a right to protection, no one should have to fear for their life while receiving a public education. This is a serious issue. If we don’t do something, it only gets worse from here.

But I also hope we can broaden the conversation beyond school shootings. We have one of the highest gun homicide rates in the world, one of the highest suicide-by-gun rates in the world. We’re talking about people killing themselves, not just people killing people. Suicide and homicide aren’t often brought into this conversation. I hope that changes in Memphis.

I also want the march to remind us that we can’t become desensitized to gun violence. Whenever we read that someone was shot, we don’t always think how somebody just lost one of their own. That person will have to go home to empty bedrooms.

What specifically would you like to see happen in Tennessee?

I’m personally not one to advocate for the total removal of guns. I think that’s sometimes an assumption of people who are against protests like March for Our Lives. They assume we want to take all guns away. That’s not necessarily true. But I want a written exam to purchase a gun, like in Japan. I also want a longer wait time when you purchase a gun. I don’t think you should be able to walk into a gun shop and walk out the same day with a weapon. School shootings, or gun violence in general, can often be a spur-of-the-moment decision. What if the person had to wait a few days, weeks or months before they actually got that gun? Would they still feel the same way they did when they first went to buy the gun?

Have you or your family or your friends ever been personally touched by gun violence?

My family has never been a gun family. My parents are immigrants from India, and it’s just never been a thing for us. Going to school where I do, there’s a lot of political viewpoints. Some people are really pro owning guns, some are really against. And it’s an interesting place to talk about this. But also, I’ve gotten to know people from different backgrounds. I know people in Memphis and areas surrounding it who have lost someone to guns. I’ve known people who have lost loved ones to guns in homicides or gang violence.

Starting young

These 11-year-old Brooklyn students are asking New York City to do something about segregated schools

PHOTO: Christina Veiga
Matilda and Eliza Seki, left, and their friends Noa and Benji Weiss, right, collected signatures at a district 15 meeting to discuss middle school integration efforts.

While they learned about the history of segregation, a group of Brooklyn 11-year-olds took a good look around their classrooms and realized their schools weren’t so different from the photos in their textbooks.

So Matilda and Eliza Seki paired up with their friends Noa and Benji Weiss — two sets of twins — and decided to do something about it. They launched a petition on calling on the city to integrate its schools.

“We learned about separate and equal in the civil rights movement, and that it was not equal,” Eliza said, referring to the “separate but equal” legal doctrine once used to justify segregation. “And since there are schools with people of only one race, and it’s all separated, it cannot be equal.”

Matilda and Eliza are in the sixth grade at M.S. 839, and Noa and Benji are fifth-graders at P.S. 10. They already have a bit of experience in activism, having joined the Women’s March in D.C., and helping to lead environmental clubs at their school. They hold sophisticated views for kids their age, and are aware of the hurdles ingrained in addressing school segregation.

Describing how housing patterns can tie into school quality, Benji began his thoughts by saying: “Let’s say you’re from a different culture or race and you don’t have as much money as other people do — because we still live in a racist country — and you’re in an area where the housing is cheaper but you don’t have as good schools.”

Across New York City, adults have debated how to spur integration in the country’s largest school system — and one of the most segregated. According to one recent analysis, the city’s most selective high schools enroll 84 percent white and Asian students, even though those groups make up only 30 percent of the city’s student enrollment.

But student-organized groups have also been at the forefront of a grassroots movement for more diverse schools. The work of budding advocates Matilda, Eliza, Noa and Benji caught the attention of some those groups, and they’ve now joined the ranks of Teens Take Charge and IntegrateNYC as some of the youngest members. The changes they’d like to see go beyond admissions policies, but also include a push for additional resources for underserved schools, hiring more teachers of color and curricula that reflects all students and cultures.

“We decided it was an important issue and we wanted to help fix it,” Noa said.

Matilda added: “Our schools should look like our city.”

Their schools are in District 15, where 81 percent of white students are concentrated in just three of the district’s most selective middle schools, according to an analysis by parents. The city has launched a series of public workshops to craft a new admissions model to integrate middle schools there, but these kids already have their own ideas for how to do that.

Benji, who is heading to middle school next year, said it would be “pretty good” if schools stopped picking students based on criteria such as class grades and attendance. Such “screening” contributes to segregation because of a number of factors — from which elementary schools students attend, to their parents’ ability to navigate the complicated admissions process.  

“It’s… important to learn about different peoples’ backgrounds, and religions, and cultures,” he said. “And also to make sure that all kids, no matter their race, religion or where they live can get the same, good education.”