‘Please stop permitting the use of stigmatic and categorical labels such as obese and overweight’

Recently I received my child’s ESU4 health screening results in the mail. After reviewing the results and literature as it pertains to children as young as three years old, I have a number of concerns and seek to ensure they are formally noted. Firstly, the proven ineffectiveness and dangers of utilizing the BMI scale; secondly, potential and current harmful impacts this ‘tool’ has on students; and lastly, the vast detrimental life-long implications of ignoring these factors. All things considered, I am overwhelmingly grateful for the care my child receives at Falls City Public Schools (FCPS) and couldn’t say more complimentary things about her educational experience. I do, however, have immense and growing concerns about the ESU4 screening instrument and its potential for negative impact on my daughter and hundreds of other students served at FCPS.

I work as a mental health professional, providing psychotherapy services to individuals, groups, and families of all ages. Throughout my education and career, I have worked with a myriad of presenting issues ranging from grief and loss, self-esteem, family disruptions and separations, anxiety, depression, self-harm, and eating disorders. I have firsthand experience with the tremendous psychological harm caused by labels such as “obese” on supposedly helpful screening instruments such as those used by ESU4.

My daughter, much like many other students served by ESU4, is a healthy, vibrant, and intelligent four-year-old. She is curious young person, learning, and growing each and every day. As she develops, I seek to instill a sense of the vital importance of overall wellness and health so that she may have a long and fulfilling life, psychologically, emotionally, and physically. She, like many others, returned an erroneous result of “overweight” on the ESU4 orchestrated BMI screening. I use the term “erroneous” since evidence suggests the screening tools used to assess her physical health- specifically her size- are dangerous and pose a serious risk to her long-term physical and mental wellbeing.

ESU4 utilizes the Body Mass Index scale to assess health of size and weight. Within the scientific community, Body Mass Index (BMI) has been profoundly rejected as a helpful tool to measure wellness. It’s considered insufficient as BMI does not account for muscle mass, waist size, frame size (bone is denser than muscle and double the density of fat), and it lumps all people into distinct categories: underweight, ideal, overweight, and obese. This tool fails to consider individuality and other vital health factors such as a child’s level of physical activity, sleep, and emotional wellbeing.

Research finds that weight-category labels assigned to children as young as three years old have been proven to have little to no positive effect. To the contrary in fact, these instruments are found to increase risk to psychological and physical health in the developing mind. Statistics illustrate that roughly 50% of girls from age six to eight report body dissatisfaction and a desire to diet, lose weight, and be thinner; concurrently, one third of boys the same age hold these beliefs. These so-called obesity prevention interventions have proven to increase disordered eating, decrease self-esteem, and increase isolative tendencies within peer groups and parent-child dyads.

I am grateful that at this point my child is only four years old and largely unaffected by this piece of paper and the combination of words and numbers typed upon it. However, it will not be long before she understands these labels and their societal implications. Weight bias is extremely detrimental to the developing individual sense of self and personhood.

While I present evidence proving the inadequacy of the BMI tool, my concerns are not only theoretical. I have witnessed the dramatic impact of said screening results on children enrolled in ESU4 schools. An FCPS student received her results in her third grade physical education class and was distraught as she, like my four year-old daughter, was erroneously placed in the overweight BMI category. The aforementioned student is active in gymnastics, taking classes four nights or more per week. She’s an objectively good student, receiving straight A’s, excelling socially, and performing at the top of her physical education class on fitness measures when evaluated on flexibility, speed, strength and endurance. All of these positive qualities were overshadowed when she reviewed her ESU4 screening. Left unchecked in delivery by discussion about BMI, the inherent flaws of the tool, or scientific criticisms of the measure, these results quickly shifted the entire paradigm of her self-perception to include a socially unacceptable label of overweight.

When I myself was a fourth grader at Falls City South School, I was also affected by the ESU4 screening instrument. Similar to the student noted above, prior to receiving these results I was leading an objectively well-rounded and healthy life, receiving straight A’s, excelling in multiple extra-curricular activities and sports, and having healthy social interactions. I will forever remember the devastating experience of my parents bringing the documented ‘spike’ in my weight to my attention. Immediately, every positive defining quality previously seeming to make me feel like “me” fell by the wayside. From that point into my early adulthood, my identity was fused to a number. Life revolved around weighing myself daily, limiting food intake, and most insidious of all- a sense of self-hatred. Overnight, I transitioned from an objectively healthy child into a child whose sole focus was to fit into categorical acceptableness on a BMI screening tool.

The dysfunctional label of being overweight led me down a frightening path. By high school graduation I had already been treated at a variety of outpatient eating disorder treatment centers. Immediately following graduation, I was admitted to Children’s Hospital in Omaha for over two months of inpatient treatment due to my life-threatening eating disorder. My entire early adulthood was fraught with hospital admissions, treatment facilities, dietitian appointments, and ongoing therapy. Fortunately, after thousands of hours and hundreds of thousands of dollars in treatment costs, I am able to consider myself one of the lucky individuals able to find a renewed sense of overall wellbeing on the other side of dangerous diagnoses of anorexia and bulimia.

These facts and anecdotes are shared to implore ESU4 and FCPS to immediately stop the use of such flawed screening instruments and their delivery to children and their parents. We must heed tremendous caution in our responsibility to care for developing children, as they are so incredibly impressionable at school age. The impact of utilizing insufficient screening tools which render erroneous screening results with societally charged labels has incredible risk associated with altering the course of their lives permanently.

ESU4 and FCPS educators exude love and value in caring for developing minds. I, along with many others, am incredibly grateful to have firsthand experience of their passion. I also know when we know better, we do better. It’s time that ESU4 and FCPS improve their screening tools. In doing so, our processes will begin to reflect the care that educators strive to show students daily. I ask that we cease to blindly perpetuate the use of a tool that is falsely understood to have an interventional impact on obesity. Please stop utilizing BMI to measure physical health in schools. Please stop permitting the use of stigmatic and categorical labels such as obese and overweight on the base of inaccurate measurements. Please regard this letter as a call to action in familiarizing ESU4 educators and administrators with the exceedingly negative impacts researchers and mental health professionals like myself have found to result from supposed obesity prevention measures. Please know better. Most of all, please, I implore you, do better.

Thank you, Laura Bartek