NOV. 23, 2004 | Arkansas’ landmark battle against childhood obesity is entering its second year for taking body mass index (BMI) measurements of public school students and now that the health issue has been identified, the continued measurements can chart trends and be used to develop solutions. 

BMI-for-age is a screening tool for assessing risk of overweight and overweight in children and adolescents. The formula was developed by the Centers for Disease Control and Prevention and is supported by the American Academy of Pediatrics and the Institute of Medicine as well as many other health-related organizations and health care professionals. 

The Arkansas Center for Health Improvement (ACHI), a collaboration of the University of Arkansas for Medical Sciences (UAMS), the Arkansas Department of Health and Arkansas Blue Cross Blue Shield,  which oversaw the BMI Project last year, distributed measurement forms to Arkansas school districts in October and is now preparing to analyze the data from year two of the project.

In the 2003-2004 academic year, the first-ever legislatively mandated BMI measurements showed nearly 40 percent of Arkansas’ public school students as either overweight or at risk for being overweight.

“As we continue to collect data, we will be able to identify trends and also chart what policy changes and programs are having a positive impact on addressing the epidemic of childhood obesity,” said Joe Thompson, M.D., M.P.H., ACHI director. “One thing we have already accomplished is a dialogue among families, schools, physicians and policy makers to focus on how all of us can fight obesity.”

Changes made

ACHI points to feedback from school officials across the state showing that the dialogue has been successful at prompting districts to make more health-conscious decisions. The incentives offered to students in some areas have changed from pizza parties or ice cream to yogurt parties or other more healthy food choices.

Some schools have begun walking programs for students. Others have replaced high-sugar, high-calorie sodas in drink machines with juices and water or even removed the machines altogether.

“I think the numbers quantified something that many school officials and parents already knew – that childhood obesity, which increases the risk of developing a range of health problems – was at epidemic levels in Arkansas,” Thompson said. “We are seeing obesity-related diseases starting in earlier and earlier in life that were once unheard of before middle age. These illnesses, such as heart disease and arthritis, are beginning in adolescence and may continue throughout adulthood.

More than 345,000 Arkansas students in grades K-12 were measured during the first year of the BMI mandate. ACHI used the Centers for Disease Control and Prevention’s BMI-for-age charts, which are both age- and gender-specific, to determine whether a child was underweight, normal weight, at risk for being overweight or overweight.

Overall, 38 percent of Arkansas’ public school students were identified as being either overweight or at risk for being overweight in reports that were sent home to parents. Approximately one-third of the state’s children – 32 percent – entered kindergarten in 2003 either overweight or at risk for being overweight. The obesity epidemic steadily increased, according to the ACHI data, until it peaked in the middle school years, with 42 percent of sixth-grade children in one of the two high-risk categories.

The information, broken down by race, gender and other categories, showed that children at any age, economic status or ethnic group were vulnerable. When ACHI reported the results of the first measurements in September, it came in conjunction with an announcement by Gov. Mike Huckabee of plans to increase the number of community health specialists to assist advisory committees being formed to develop local solutions to the obesity problem.

Year Two

Moving into the second year of the process, ACHI will continue to maintain and analyze the BMI data and work for health solutions as set forth by the 2003 law. The state Health Department is becoming more involved in working with schools for data collection.  Next academic year, the Health Department will take over management of the BMI screening process, though ACHI will continue to calculate BMI, generate health reports and track obesity trends. The Health Department has hired a community health nurse to work with ACHI in learning first-hand the details involved in successfully implementing this massive endeavor. 

ACHI officials have looked to schools and families for feedback on how to improve the measurement process and refine information given to parents. Act 1220, passed by the Arkansas General Assembly in 2003, offers a multi-faceted approach to reducing childhood obesity in Arkansas that involves the state, the school and families.

One component called for the formation of a School Nutrition and Physical Activity Advisory Committee in each school district to develop and implement local policies that encourage health programs and activities. The panels are made up of members from school district governing boards, school administrators, food service personnel, teacher organizations, parents, students and professional groups, such as nurses and local businesses.

The law mandated the BMI measurements of every public school student to alert parents to possible health problems and to assess the prevalence of childhood obesity. A state Child Health Advisory Committee was created and meets monthly to coordinate statewide health efforts to combat childhood obesity.

The agency has addressed concerns about using the BMI as the screening tool to assess obesity in children and adolescents. ACHI and other health officials acknowledge that an elevated BMI does not necessarily label a child as obese; for example, a stocky, muscular child can have a deceptively high BMI. In addition, a child’s BMI is not calculated in the same manner as an adult’s. Children’s body fatness changes as they grow, and girls differ from boys as they mature.

“We urge parents with concerns to visit with their child’s health care provider, who can assist with reading the BMI report and what it means on an individual basis,” Thompson said.

Thompson said he is pleased with response from the schools in completing the BMI measurements. In the first year of the BMI initiative, 93 percent of the state’s 1,135 schools reported results with individual data forms submitted for almost 95 percent of the state’s 449,485 public school students. A 100 percent completion rate is a goal of the second year of measurements.

“We hope that schools embrace this and not treat it as just one more thing they have to do. Scoliosis screening is mandated in Arkansas’ public schools and most schools perform vision and hearing tests. Measuring height and weight for BMI takes very little time and it is one of the ways we are going to make a difference in this battle against obesity,” Thompson said.  “We need schools, parents and communities across the state to get onboard and become active in this effort that will make a profound difference in our childrens’ lives.”

Links on This Page
Arkansas Center for Health Improvement: http://www.achi.net/

Arkansas Department of Health: http://www.healthyarkansas.com/

Arkansas Blue Cross Blue Shield: http://www.arkbluecross.com/

Institute for Medicine

American Academy of Pediatrics

Centers for Disease Control and Prevention BMI-for-age: http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm

University of Arkansas for Medical Sciences: http://www.uams.edu/


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