Provide constructive feedback on some or all of the guidelines for the problem statement (i.e. is the policy problem clearly and concisely articulated? Is the problem as framed one that can be addressed by public intervention [vs private]? Is the policy problem specific Do two separate responses to the following two posts COLLAPSE Lack of BMI screening and involvement of parents/guardians in schools is a missed health education opportunity. In 1998 the US government declared an epidemic of childhood obesity which led to the Surgeon General’s call to action to prevent and decrease overall obesity.1 Since this call to action, 25 states have implemented policies to monitor BMI as an indicator of the youth’s current and predicted state of health. Although not the only predictor of potential future health problems, BMI screening can be performed quickly and allow for an assessment of a community’s need for education or access to resources to reduce the adverse effects associated with a high BMI. In a study conducted by Jones, Huffer et al,2 they found that parents perceived the screening helpful and understood the potential risks associated with a high BMI, however, didn’t feel that it accurately reflected their child’s health status. This is where having qualified health professions available to have conversations that are culturally appropriate, could be helpful to determine what actions the community believes would be beneficial to improving their overall health. Conversely in a study by Madsen and Linchey,3 about the effectiveness of BMI screening in schools in California, found that although screening is becoming more widespread across the state, notification and education to the families was inconsistent, thus not reducing the rates of childhood obesity as hoped. A proposed solution to increasing the awareness of screening in schools and the outcomes of screening could be to implement a uniform process for all schools wishing to conduct screenings with a set of procedures in place that mandate timely notification to the parent/ guardian, tailored messages with actionable ways to change the results of the BMI screening, and a process of steps for referrals to necessary community resources for further intervention if the adolescent in question falls within the overweight or obese categories. Even if a child doesn’t fall into the overweight or obese category, an open conversation with a qualified professional could be an effective way to discuss the potential mental health complications of weight stigmatization, disordered eating, and body satisfaction. REFERENCES: 1. Ikeda Joanne, Crawford Patricia, Woodward-Lopez Gail. BMI screening in schools: Helpful or harmful. Health Educ Res. 2006;21(6):761-769. doi: 10.1093/her/cyl144. 2. Jones M, Huffer C, Adams T, Jones L, Church B. BMI health report cards: Parents’ perceptions and reactions. Sage Journal; Health Promotion Practice. 2018;19(6):896-904. doi: 10.1177/1524839917749489. 3. Madsen K, Linchey J. School‐Based BMI and body composition screening and parent notification in california: Methods and messages. Journal of School Health. 2012;82(6):294-300. doi: 10.1111/j.1746-1561.2012.00700.x. Post 2 One of the most pressing public health issues facing the United States as a whole is obesity, and specifically the issue of obesity that is identified in childhood. Ongoing obesity beginning in childhood can have a host of long ranging physical and psychological ramifications. However, when making attempts to find solutions, officials must be careful not to create larger problems. While I applaud Representative Jones’ involvement of the school system in measuring and monitoring our school children’s BMI, this creates some potential concerns which must be addressed prior to implementation. The first consideration is one of equity: this state’s population is not homogeneous. It consists of rural, urban, and suburban populations, each with their own needs and challenges in adopting this policy. Nicosia and Datar¹ found that, when reviewing similar policies, found that children in rural environments were more likely to benefit, as opposed to children in urban environments. Potential explanations for these differences include access to means of exercise and healthy food, as well as level of parental involvement. Differences also exist in resources – while a referral to a dietitian may be a novel intervention to assist in developing healthy eating patterns, it is also not a resource that is available to all families depending on insurance status and income level. Rural families are less likely to have the private insurance needed to access these services², meaning that even if the need is identified, they may not be able to access the necessary medical care. A further consideration is the psychological impact of broadcasting BMI scores to families and children. A higher BMI has been associated with increased peer victimization and bullying in schools³. Raising awareness of BMI scores for youth and adolescents may not have the intended impact of assisting children and their families in managing weight, but may instead increase victimization and impact self image at the critical stages of development in childhood and early adolescence. While increased awareness of the importance of maintaining a healthy body is important, it is possible that increasing awareness of BMI may not be the most advantageous way to do so. Perhaps instead of focus on body weight alone, policy change should focus on education for families on healthy diets and exercise, as well as increasing the amount of healthy foods available for school lunches. Sometimes, the main barrier in healthy children is lack of knowledge and resources for the parents, and therefore by targeting the community as a whole, instead of public school children, we may increase our ability to effectively manage community health. However, the plan proposed by Representative Smith needs further consideration prior to implementation. References Nicosia N, Datar A. The impact of state policies for school-based BMI/fitness assessments on children’s BMI outcomes in rural versus urban schools: Evidence from a natural experiment. Preventive medicine. 2020;141:106257-106257. Allen H, Wright B, Broffman L. The Impacts of Medicaid Expansion on Rural Low-Income Adults: Lessons From the Oregon Health Insurance Experiment. Medical care research and review. 2018;75:354-383. Bacchini D, Licenziati MR, Affuso G, et al. The interplay among BMI z-score, peer victmization, and self-concept in outpatient children and adolescents with overweight or obesity. Childhood Obesity. 2017;13(3):242-249.
