‘Body’ Report Cards Aren’t Influencing Arkansas Teenagers

The article below comes from the New York Times.

It is evidence of what most of us already know.  The intrusive nanny state do-gooders are spending a lot of time and taxpayer money for nothing.

As both a physician and patient, I have learned from first hand experience that nagging people to change maladaptive behaviors is ineffective at best, and counter-productive at worst.  Harping on someone to make a lifestyle change that they are not ready to do often spurs them to double down on that behavior to demonstrate their own autonomy.  In effect, they are saying, “You’re not the boss of me!”

As the article points out, people know if they are overweight.  Pointing out the obvious and shaming them does not help.  How often to you hear of a parent, teacher, doctor, or coach walking up to a teenager and say, “You are fat and need to lose weight,” and have the teen respond, “Thank you for pointing this out.  I never realized this.  Because of your brilliant insight, I will endeavor to change my life.”?  Answer: NEVER!

People do not change bad habits until they are ready to do it, for themselves, not because of outside pressures.  The best thing we can do is be supportive.  A conversation about the subject should be honest, and often blunt, but also non-judgemental.  Express your concern for the person, and provide facts if necessary.  Also offer support and understanding.  If nothing else, you are planting a seed.  It may take a long time for it to bloom, but know that it may not. If the person feels that they are being judged and attacked, you will be shut out from that time forward.

Once, a woman walked up to a man and said, “You are fat.”  He replied, “That may be true, but even if I lose weight, you will still be a jerk.”

Michael A. Ciampi, M.D.


 

‘Body’ Report Cards Aren’t Influencing Arkansas Teenagers

It is one of the boldest and most controversial tactics in the battle against childhood obesity: A growing number of schools are monitoring their students’ weight and sending updates home, much like report cards.

Nine states require schools to send such notifications, sometimes called “B.M.I. letters,” or less charitably “fat letters.” But a new study of the first state to adopt the practice shows that the letters have had almost no effect, at least on older teenagers.

The disappointing results not only raise questions about the efficacy of the letters but highlight the challenges schools face more generally in addressing adolescent obesity.

Kevin A. Gee, the author of the study, which looked at high school juniors and seniors in Arkansas and appears in The Journal of Adolescent Health, said that while the letters attempted to embed in a school setting the public-health goal of slowing obesity, the reality of adolescence could confound the best intentions.

“The typical 16-year-old’s reaction to getting a letter at home and having your parents tell you to eat right and exercise, would be, ‘Don’t nag me,’ ” said Dr. Gee, an assistant professor of education policy at the University of California, Davis.

In 2003, Arkansas, with one of the country’s highest child obesity rates, became the first state to initiate a comprehensive, school-based program that included annual weigh-ins and letters home, informing families whether a child’s B.M.I., or body mass index, a calculation using height and weight, fell in the underweight, healthy, overweight or obese range. The act was signed by Gov. Mike Huckabee, an anti-obesity advocate who lost more than 100 pounds himself while in office.

Today, 25 states, including the 10 where parents are notified, weigh public school students to monitor population data on obesity rates.

The letters have received sharply mixed reviews. Some nutritionists and parent groups say that labeling the weight range of a child, especially a teenager, may contribute to eating disorders and poor body image. Some educators feel that although schools also measure vision and hearing, tracking a student’s weight and height is best left to health care providers.

“There is so much stigma with being overweight, and children in adolescence are particularly sensitive to that,” said Mary T. Story, an expert on adolescent obesity at Duke University. “In some schools, there is no privacy screen when they’re being weighed, and the process is embarrassing for them.”

But Dominique G. Ruggieri, a faculty fellow at the University of Pennsylvania’s Center for Public Health Initiatives, who has studied the B.M.I. letters, said in an interview that the letters could be “an important resource for parents who don’t get the message.”

A Sample Letter

A parent in California received this letter about her daughter from the Los Angeles Unified School District.

And some districts that cannot afford to mail the letters, she added, hand them to students. That may likely guarantee delivery will be rerouted: Either the letter descends to the bottom of that archaeological dig known as the backpack, or the student tosses it away.

Allyson Gevertz recently asked her daughter, a high school sophomore in DeKalb County, Ga., about last year’s letter, which Ms. Gevertz did not remember seeing. Her daughter protested that she had brought it home after the letters had been distributed in her physical education class. Ms. Gevertz said her daughter told her: “Everyone started talking about their B.M.I.s and comparing them. And all it did was make everyone feel self-conscious.”

In 2007, Arkansas adjusted its policy, bowing to complaints about the intrusiveness of the letters into a family’s private life, as well as to economic and pragmatic burdens placed on individual districts. Rather than having the letters sent annually, legislators decided that students should be monitored every other year and that high school juniors and seniors should not receive the letters at all.

(Dr. Joseph W. Thompson, a former state surgeon general who oversees the Arkansas Center for Health Improvement, a health policy center that analyzes the school data, said the decision to stop sending letters to juniors and seniors was also prompted by teenage pranks that undermined the annual weigh-ins. At one school, he recalled, teenagers wore ankle weights under their jeans to skew the numbers.)

The Arkansas study by Dr. Gee looked at the B.M.I. results of juniors and seniors who had been evaluated and, after the 2007 legislative changes, those who had not. It found that students whose families had received the letters showed no appreciable improvement in B.M.I. scores after two years, compared with those who had not been screened. Another peer-reviewed study of such letters, a 2011 examination of younger students in California, had similar findings.

Dr. Gee did not have access to the state’s records, but used secondary data that Arkansas reported to the Centers for Disease Control and Prevention for its Youth Risk Behavior Survey. But as experts have observed, self-reporters on surveys tend to minimize their weight and exaggerate their height. The direct data itself might have been even more disappointing than Dr. Gee’s results.

Martha M. Phillips, an associate professor of epidemiology at the University of Arkansas for Medical Sciences who evaluated the annual Arkansas data for a decade, said the letters alone were never expected to change behavior.

Arkansas schools, she said, reinforced the message with many efforts. Some school districts banned vending machines or regulated student access to them, and limited the snacks’ calorie count. Others restricted the number of parties a classroom could hold in a year, to cut off seemingly endless supplies of cupcakes and brownies. Others beefed up staff for physical education classes.

The result? Obesity rates among Arkansas schoolchildren have remained roughly the same since the initiative began.

This, some experts say, constitutes good news.

“It didn’t get worse,” Dr. Phillips said, who noted that obesity rates had been rising steadily for some three decades before the new program took effect.

Yet Arkansas teenagers have a heavier profile than the overall average of the state’s schoolchildren. Dr. Thompson, a pediatrician, said that although he believes schools have a critical role in obesity prevention, by the time students reach older adolescence, “it’s more of a clinical treatment issue as opposed to a prevention strategy.”

The study questioned whether a school’s scarce resources were best spent on sending B.M.I. reports home to teenagers.

”A letter home in high school doesn’t make a lot of sense,” said Dr. Story of Duke, who conducted research in Minnesota on obesity prevention programs for adolescents. “Most teenagers already know when they’re overweight.”

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