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
Obese
BMI at or above the 95th percentile
Overweight
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
Underweight
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.

raising the curtain

Aurora high school students started rehearsing a musical about an earlier time — and discovered ‘harsh truths’ about today

Ebony Nash, left, sings during a rehearsal of Ragtime at Hinkley High School. (Photo by Yesenia Robles, Chalkbeat)

Nine weeks ago, more than 50 theater and choir students at Aurora’s Hinkley High School came together to begin work on a musical set in turn-of-the-20th-century New York.

At first, the kids did what high school students often do — cluster into familiar cliques, or self-segregate by race. Then the students started immersing themselves in the material.

The musical, “Ragtime,” intertwines the stories of a white family, a Jewish immigrant family and an African-American couple to spotlight differences and commonalities in the American experience.

At the urging of their teachers and directors, the Hinkley students began to use the plot and characters to examine their own actions, prejudice and biases. About 92 percent of Hinkley’s more than 2,100 students are students of color, the vast majority of them Latino.

The cliques and segregation slipped away. The production began taking shape.

“Ragtime” gets its Hinkley High School debut on Thursday and will be performed again on Friday and Saturday.

Chalkbeat sat down with a group of students involved in the production as they were in final preparations to learn about what their experience had taught them. The following is a portion of that conversation, slightly condensed and rearranged for clarity:

Janelle Douglas, a 17-year-old senior who portrays a friend of one of the story’s main characters, said the first time she saw and read through Ragtime, “it was intense.” She often cries as she rehearses her solo, sung during a funeral.

DOUGLAS: “I thought, this is powerful. This is overwhelming. This is amazing.”

Pamela Arzate, 17, plays the role of Evelyn Nesbit, a real model and actress who is incorporated into the fictional story and accused of being shallow.

ARZATE: “It’s very eye-opening because you look at it and it’s just a simple musical, but if you take a step back and go to the real world, it’s the exact same thing that’s going on today.”

Hodaly Sotelo, 17, plays the role of Mother, a woman whose attitudes toward her identity as a wife and woman evolve throughout the story.

SOTELO: “It reminds me of when I was younger and I was like, ‘Oh yeah, we’re over all that racism.’ But now, I look back and I think, what the heck? This stuff is still going on and we thought it was way over.”

Brianna Mauricio-Perez, 17, is one of two student directors.

MAURICIO-PEREZ: “It talks about all of the harsh truths that no one wants to talk about.”

DOUGLAS: “I think it’s safe to say it shows the true colors of our history.”

MAURICIO-PEREZ: “Even within our cast we did have to have a talk about how we were so separated because we were at the very beginning. Everyone was in their little groups and with their friends. You just want to keep to yourself.”

DOUGLAS: “It was literally ‘Ragtime.’”

MAURICIO-PEREZ: “We had a big talk with everybody. Things have gotten so much better. By the end of Act Two, we were all mixed up.”

Brenda Castellanos, 17, plays the role of Emma Goldman, drawn from a real-life political activist and anarchist.

CASTELLANOS: “Now that we’re closer, now that we’re all comfortable, we put in more effort.”

After nearly every rehearsal, teachers and directors give students a talk, urging them to immerse themselves in the feelings of their characters, relating to them if necessary through their parents, grandparents or ancestors who were immigrants, or through current events.

“What if you saw someone beaten, and bloodied and killed in front of you?” one director asked.

They also remind students of why the play should be impactful. “You have to figure out how for two-and-a-half hours you can give hope to that audience,” Marie Hayden, Hinkley’s choir director told students last week.

CASTELLANOS: “I think it it helps us. Every day, we get more into it and more into it until we actually believe it. You actually feel it — like how Janelle feels when she’s singing and she starts crying and makes everybody cry. We all feel connected.”

Students say they have different scenes that impact them the most, but they don’t hesitate to find how the scenes relate to their life despite the story being set in the first decade of the 1900s. Hayden’s class and the practice for the musical are safe places where they can discuss those parallels, they said.

Shavaun Mar, 16, is a junior who plays the main character of Coalhouse Walker Jr., a ragtime piano player who is the target of racial attacks and struggles with revenge and forgiveness.

MAR: “I feel like that is crucial that we give people those opportunities to talk because a lot of people have very valid things to say but they just don’t have a way to get it out.”

CASTELLANOS: “The shootings.”

ARZATE: “The racism. They help us discuss it because there’s so many things that are going on. Pretty much everyday there’s a tragedy going on. And so, in a way, we can use that sentiment, that emotion that we feel with the real world and convey it when we’re doing this show. We use those feelings and we try to think about it in that way. To display that emotion. To display it to everyone else. And not directly represent what’s going on today but just to give them that ‘aha’ moment, like ‘wow.’”

Ebony Nash, 17, plays the character of Sarah, an innocent girl who wants to help her boyfriend settle his problems.

NASH: “It just makes us want justice in real life because these things are still going on even though it’s not out there. It just makes us want justice for our community. This musical showed me that I need to become better within myself because I’m not perfect.”

SOTELO: “It opened my eyes a lot more for sure. This kind of just makes me realize the problems I have. It makes me realize yea, I’m having immigration issues with my father right now, but that also my friends, you know, they’re going through the same thing too. This DACA stuff or this coming out stuff. I became more accepting of what other people might be going through and how I can help.”

MAR: “The past few years, I have been in a bit of a shell. So putting myself in this situation and pushing myself to be this other person has really shown me what I’m capable of and it’s helping me break out of that shell and realize who I am as a person.”

NASH: “Basically, this is our getaway from real life because we get to come on stage and be somebody else. It also makes us want to put the story out right so people can understand. So people can feel what we want them to feel.”

CASTELLANOS: “That there’s hope after all this corruption that’s going on.”

DOUGLAS: “That even in your bad times you can still laugh, cry, dance.”

NASH: “What I want people to get from this is change. To learn how to change and learn how to forgive and learn how to come together as a community and just, like their worth.”

SOTELO: “And to be strong. To stand up for what’s right.”

ARZATE: “And it might sound weird, but I feel like they should feel a certain level of uncomfort because that means that they’re going to look at themselves while seeing the musical. Maybe they’ll go ‘I’m uncomfortable because I do that’ or ‘I have that prejudice’ or ‘I feel that certain way,’ so if they come out and they feel uncomfortable and then at the end they’re like, ‘Wow. There’s that hope for change.’ Hopefully that like…”

DOUGLAS: “… It inspires them to do better.”

ARZATE: “Like, you can do it.”

SOTELO: “It’s kind of like a water droplet. One small move can domino-effect to something bigger.”

 



Taking attendance

Want to make middle school admissions more fair? Stop looking at this measure, parents say

PHOTO: Monica Disare
Middle school students write their names down at a high school fair in Brooklyn.

Parents across New York City have pushed for changes in the way selective middle schools pick their students, saying the process is unfair.

Now, a group of Manhattan parents has come up with a novel solution: Stop looking at students’ attendance records.

The parent council in District 2 — where about 70 percent of middle schools admit students based on their academic records — points to research showing that students from low-income families are far more likely to miss school. Those children are at a distinct disadvantage in the competition for the district’s top middle school seats, the council argues, even though factors beyond the control of any fourth-grader — especially family homelessness — often account for poor attendance and tardiness.

“This outsized focus on attendance disproportionately impacts students who don’t have secure housing and may not have secure healthcare, and that is troubling to me,” said Eric Goldberg, a member of the community education council in District 2, which includes stretches of Lower Manhattan and the Upper East Side. “There are many factors that should not impact a student’s educational opportunities — and the way the system is set up, it does.”

Eighteen of the district’s 24 middle schools are “screened,” meaning they rank applicants based on factors including test scores, grades, and interviews. Of those, all but one school also considers how often students were late or absent in fourth grade, according to the parent council.

Most of the schools assign points to each factor they consider. Some give absences 10 times more weight than science or social studies grades, the council found, while others penalize students for even a single absence or instance of tardiness.

Disadvantaged students are especially likely to miss school.

A recent report by the city’s Independent Budget Office found that homeless students are more likely than other students to be chronically absent — typically defined as missing about 10 percent of the school year.

Schools with the highest chronic absenteeism are in communities in “deep poverty,” which have the highest rates of unemployment and family involvement with the child-welfare system, according to a 2014 report by the New School at the Center for New York City Affairs.

“We can use chronic absenteeism as a good guess of all the other things kids are dealing with,” said Nicole Mader, a senior research fellow at the New School and a co-author of the report. “If these middle schools are using absenteeism to weed kids out, that means they’re going to automatically weed out those kids who have the most barriers to academic success already.”

The attendance requirement can put pressure on any family, regardless of their financial status or housing situation.

Banghee Chi, a parent of two children in District 2, said she sometimes sent her younger daughter to school with a fever when she was in fourth grade rather than have her marked absent.

Her daughter would show up to class only to be sent to the school’s health clinic — which would call Chi to pick her up. Chi was thinking ahead to middle school, when a missed day of class could hurt her chances of getting into the most sought-after schools.

“It was something I was really conscious and aware of during my child’s fourth-grade year,” she said. “I think it’s unfair.”

The education council’s resolution, which will be put to vote in December, is nonbinding because middle schools set their own admissions criteria. But a show of support from parents could lead to action from the education department, which has been prodded by integration advocates to make other changes in high school and middle school admissions.

This summer, the department announced it would end the practice of “revealed rankings,” which allowed middle schools to select only those students who listed them first or second on their applications. The city is also appointing a committee of parents, educators, and community leaders in Brooklyn’s District 15 to come up with a proposal for making that district’s middle school applications process more fair.

“We’re collaborating with communities across the city to make school admissions more equitable and inclusive, including in District 2,” said department spokesman Will Mantell in an email. The department looks forward “to further conversations about this resolution and other efforts to improve middle school admissions in District 2.”