You may have seen my name in this article originally posted in the Chicago Tribune, discussing our school district's use of Fitnessgram, "a fitness assessment and reporting program for youth." This program requires that students have their BMI calculated in school, and each student is privately shown the result; a report is also sent home to parents. There has been significant community discussion on the subject, largely centered around concern for students' health and concern for students' privacy and self-esteem.
One medical expert in obesity, speaking in favor of the measure at a recent school board meeting, horrified me by saying that he became an anti-obesity activist when one of his young patients wanted to lose weight because "she wanted A friend." While the doctor relayed this story with real compassion, his example illustrates my concerns exactly: the problem he describes is not with the child's weight, but with weight discrimination.
Weight loss (while it may be indicated medically) is not an acceptable solution for discrimination. This young woman’s experience is not uncommon: a recent study in the UK showed that children as young as four rejected a heavy character in a story, and that the harshness of their rejection increases with age. The majority of children in the study thought the "fat" character was "less likely to win a race, do good school work, be happy with the way he looks, get invited to parties, and more likely to be naughty at school."
I want to bring weight bias to the forefront of this discussion. Numerous studies have shown that children and adults whose bodies do not meet our exacting cultural standards face discrimination in the workplace, at school, and even in the doctor's office. The Yale Rudd Center has a research division dedicated to studying weight bias and stigma and the serious negative effects it has on the lives of children and adults. Confusing weight bias with pro-health policies is a common problem in the field of public health which can be seen in advertising in Georgia, more subtly in New York City, and which has been the subject of diet books for children. (You heard me - diet books for children.)
An excellent example of weight bias was created by art professor Haley Morris-Cafiero in her photography project Wait Watchers. She elaborates on her experiences with weight discrimination in Pictures of People Who Mock Me. I also encourage readers to listen to the video panel discussion, Fat Stigma Starts Young, which discusses cases where school programs intended to improve student’s health fostered an environment of discrimination instead.
What does weight bias have to do with measuring BMI in a school setting? Instead of focusing on offering all children the tools they need to take care of themselves, BMI is contextualized as a "healthy zone" which students use to "set goals." In other words, it shifts the focus from appropriate self-care to body shape, thus supporting the beliefs that drive weight bias. In a vacuum, BMI is "just a number," or "just information," but unfortunately middle schools do not operate in a vacuum - they are a pressure-cooker for societal attitudes. Schools need to be mindful of the risk involved in providing fuel for weight bias, via an easily-shared, easily-compared number.
It's difficult to really understand the effect of weight bias unless you have a personal connection to it. I've written before about the blog Dog-lbs.com. While much of Lori's writing journals her personal success in improving her health, she also documents the times when total strangers publicly taunt her, or review the health of the food in her shopping cart or discuss her exercise habits. I talked to her about what I was writing today, and I've asked her to add her own experience to this post, which I have included below. One important theme of her blog "...success is measured in more than a number on the scale."
All children need to learn to take care of themselves—that is the point of our educational system. We need to ensure that school policies, especially health policies, are carefully crafted to minimize potential risks and support the well-being of every child.
From my friend Lori Hiltenbeitel, of Dog-lbs.com:
Perhaps the most powerful thing when you unlock your past is the very small hope that you can make it better for someone else in the future.
I do not remember a time in my life I was not chunky, big boned, hefty, plus sized, fat, overweight, obese, super obese or morbidly obese. I weighed over 300lbs entering 6th grade and graduated from high school well over 500lbs then reaching my heaviest at 600+ pounds shortly after graduating from college. I don't know which I learned first shame or the harsh reality of labels that were attached to me because of my size. I would sit in desks that were too small for my girth, a middle school English teacher refused to let me sit in a freestanding chair looking at me with such disgust I knew that she hated me for being so fat. I still have a 3 inch scar on the right side of my waist from the metal digging into my flesh day after day. My mom would ask why there was blood on my shirt and I would tell her I picked a mosquito bite or got scratched with a stick or the cat got me with his claws, I learned to be an imaginative liar from being so fat.
Metal chairs collapsed under my weight, I wore jeans that had dark denim patches sown on the thigh area where my fat legs would rub together wearing the light blue material until their became giant hole that required mending as it was very hard to find clothes to fit, let alone anything stylish or popular. Speaking of clothes, I did not fit into the cool looking gym outfits with our Greendevil mascot printed on the bottom left of the shorts, no t-shirts from concerts or events. I would take my Dad's yardstick and wash a shirt and try to stretch it out so it would fit over my stomach, there was never enough fabric. My junior year, I was no longer permitted to eat the school lunch offerings that were served, I could only eat from the salad bar or bring my lunch. I would be called so many names I can hardly remember them all but I will never forget being told by a group of teenage boys that I was so gross, so fat that I wasn't even worth raping.
I could go on and on with sad descriptions of events and situations that would drive home the fact that being a fat kid, teen, and adult is hard, hard is an understatement, it is hell. What is most important, what I want to scream at the top of my lungs standing on a lunch table to all the kids in any school everywhere is this... DO NOT BECOME A PRODUCT OF THE LABELS THEY SLAP ON YOU! For years I became and stayed obese because that is what was expected of me, that was my trademark branded on me by every teacher, counselor, nurse and doctor who threatened me, belittled me and thought they were helping me by creating a giant sea of shame for me to spend years stagnantly searching for a way out. You will have kids that will be so deeply hurt by the arsenal of shame attached to the BMI ratings and you will never know the pain, anger and self-loathing you created by that number. The ones that will be hurt most will be the ones who lament, and obsess over it, the ones who take to heart all the cruel and heartless words that will wash over them defining them for a lifetime.
The difference in successful weight loss programs in schools will come at the hands of complete honesty that goes hand in hand with kindness, acceptance and compassion. Acknowledging the issues and the severity of living an unhealthy lifestyle while working together with parents, teachers and kids to create a platform of support which encourages healthy choices where kids are given the tools to succeed as healthy adults, not skinny adults.
Filed under: Food News