Guiding Principles for BMI Reporting in Children & Adolescents When Performed in a School Setting  Important lessons were learned during the first four years of conducting body mass index (BMI) assessments in Arkansas public schools.  The guiding principles presented here were imperative to successful use of BMI as a health screening tool in Arkansas's fight against childhood and adolescent obesity.  Review by those involved in, or considering, implementation of such a program is strongly encouraged.   Click here to review

Child Health Advisory Committee

The Child Health Advisory Committee (CHAC), established by Act 1220, includes an ACHI representative. ACHI’s Health Policy Board endorsed CHAC recommendations to the Arkansas Board of Education for nutrition and physical activity in public schools. The Rules Governing Nutrition and Physical Activity in Arkansas Public Schools, adopted by the Board of Education in 2005, limited access to unhealthy foods and mandated at least 150 minutes of physical activity each week for students.  Legislation was enacted in 2007 to increase academic instruction time and limit physical education requirements for public school students.  Children's Health Advisory Committee Recommendations

Public School BMI Assessment Program

Following recommendation by the American Academy of Pediatrics, the Institute of Medicine and the American Medical Society, one facet of Act 1220's multiple intervention approach was the annual assessment and confidential reporting to parents of each public school student’s BMI, a screening tool for obesity. At the request of the Arkansas Departments of Education and Health, in the 2003-2004 school year, ACHI created and implemented the BMI screening process for all public school children in the state.  In 2007, during the 86th Arkansas General Assembly, legislation was passed to strengthen the protocol followed by school and nursing staff in performing the assessment, require parents to advise schools in writing if they do not wish to have their child's BMI assessed, and change the periodicity of assessments to even grades - kindergarten through grade 10.

 Sample Child Health Report to Parents

It is important to note that the BMI assessment's primary purpose is to alert parents to the problems of obesity by giving them a health marker.  BMI is one of the few tools available to screen children and adolescents for overweight.  Secondarily, this information was collected and used as a surveillance tool regarding the spread of the obesity epidemic and as a method to monitor weight trends among children throughout the state.

Web-based Data Entry System

ACHI developed and distributed a system for gathering BMI assessments and delivery of individualized, confidential Child Health Reports to parents of children in public schools.  The first year data collection was a paper-based system that was expensive in terms of labor and materials.  By year 2, ACHI had developed a web-based data entry system for schools to use.  Within a year, ACHI had taken the electronic entry of data and automated generation of Child Health Reports statewide, thus eliminating dependence on paper exchange of information and reducing costs and potential error rates.

Longitudinal Analysis

ACHI's enactment of the BMI Initiative amassed the largest database on childhood obesity in the nation.  One of the long-term values of the data is the ability to capture longitudinal data covering four years of BMI assessments on nearly half-a-million children.

In July 2006, ACHI submitted a 3-year proposal that was funded by the Robert Wood Johnson Foundation to use ACHI's BMI database to define and classify diseases and risks linked to childhood obesity.  Through this project, ACHI will take the next step in defeating the epidemic by informing and supporting development of a clinical risk classification system that will guide future targeted interventions for childhood obesity.

Other ongoing work to understand the childhood obesity epidemic includes detailed analyses of socio-demographic variables linked to obesity.

Maximizing Parental and Clinician Involvement

In October 2006, ACHI was awarded a non-competitive grant from the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, to identify the most effective means of relaying child BMI assessment information to parents and clinicians.  Information gained through this work will be used to maximize the Child Health Report's value as a public health tool to effect positive behavior change among families. Consideration is currently being given to consolidating all school health screenings, including hearing, vision, scoliosis and BMI, into one comprehensive child health report.

Contacts for the Arkansas BMI Assessment Project are:

Michelle Justus, Program Manager

Arkansas Center for Health Improvement
501-526-2258
JustusMichelleB@uams.edu

Joy Rockenbach, Act 1220 Coordinator (Arkansas Dept. of Education)

Arkansas Departments of Education and Health
501-371-8039
Joy.Rockenbach@arkansas.gov

Peer-Reviewed Articles

Ryan K, Card-Higginson P, Shaw JL, Ganahl SA, Thompson JW, Public Health "Malpractice" and the Obesity Epidemic, Public Health Reports 2007; 122:414-416.

Ryan K, Card-Higginson P, McCarthy S, Justus M, Thompson J, Arkansas Fights Fat: Translating Research into Policy to Combat Childhood and Adolescent Obesity.  Health Affairs July/August 2006; 25(4): 992-1004.

Thompson J, Shaw J, Card-Higginson P, Kahn R.  Overweight among Students in Grades K-12 - Arkansas, 2003-04 and 2004-05 School Years.  Morbidity and Mortality Weekly Reports January 2006;55(1):5-8.