Taking the measure of youth obesity
Mass. follows Ark. screening program
LITTLE ROCK, Ark. - April Rodgers knew her two sons were more than a little pudgy. The younger boy could scarcely bend over to slip on his socks and tie his shoes.
Visit after visit, she pleaded with the family pediatrician for help, only to hear the same simple refrain: Eat less, exercise more. The boys kept getting bigger.
Then a letter from her sons' school arrived at the family's home. It assigned a number to what her eyes had long seen. The boys, Trey and Andrew Daniel, ranked nearly off the chart on the body mass index, a measurement used to determine if someone weighs too much or too little.
"When I saw that my sons were considered obese, it was a shock," said Rodgers, who, armed with the weight score sheet, returned to the pediatrician and got a referral to a child weight specialist. Since enrolling at the specialty clinic, the boys have nudged closer to normal weight.
Stories like Rodgers's have inspired Massachusetts to adopt the Arkansas model for combating childhood obesity, a national epidemic that has visited upon children conditions once seen almost exclusively in adults, such as high cholesterol and lifestyle-related diabetes.
Next month, health regulators in Massachusetts are expected to mandate that, just like in Arkansas, every public school student should be weighed and measured so parents can receive a snapshot showing whether their child is headed toward a serious medical problem. Screenings in the first, fourth, seventh, and 10th grades would begin this fall in some schools, and the following year in the remaining schools.
Six years ago, led by an obese governor and a top lawmaker stricken by a heart attack, Arkansas embarked on what was then the most ambitious campaign in the country to address childhood obesity. Since then, persistently rising body mass index readings in the state have leveled off, although the same trend is evident nationwide.
The experience in Arkansas, where a down-home restaurant in the shadow of the state Capitol peddles a burger branded as "the Hubcap," provides lessons both serious and sublime for the architects of the nascent campaign in Massachusetts.
Make sure, doctors and nurses in Arkansas say, that health professionals conduct the screening in a discreet fashion to minimize episodes of teasing. Be sensitive, they said, to the possibility that a child already predisposed to anorexia could be sent into a perilous binge of dieting because of a worrisome weight test.
And beware the prankster: At some schools, students have shown up for their screening wearing concealed ankle weights.
"If you compare a kindergarten class picture from 30 years ago with a kindergarten class picture today, you're struck by the different body profiles," said Dr. Joe Thompson, Arkansas's surgeon general.
One morning last week, fidgeting students clad in crisp polo shirts and khakis queued up at the eStem Elementary Public Charter School. Two by two, they ambled into a room where scales sat on the floor and measuring devices stretched up the wall.
Nurse Marsha Warren gently urged the fourth-graders to remove their shoes, stand ramrod straight, and place their hands at their sides. Her voice assumed that conspiratorial, I'm-on-your-side patois that puts even the most anxious child at ease.
As one boy clambered onto the scale, Warren made sure he stood backward.
"I want you to turn around and face that way because I don't want you to know what the numbers are," Warren told the child. "It's a big secret. If there are kids who are chubby, we don't want them to be embarrassed."
Each child's height and weight were plugged into a formula that yields the body mass index.
Jazmine Jones, possessing a sense of serenity well beyond her 9 years, did not know her score, but she knew this: "It's not about what other people say; it's what you think about yourself. But I think I need to lose weight."
The legislation that created the Arkansas campaign was easily approved by lawmakers and eagerly endorsed by Mike Huckabee, then the governor and a recently converted fitness evangelist. But soon enough, as the public and press became more aware of the initiative, opposition began roiling.
Joy Rockenbach recalled a newspaper cartoon that showed a corpulent child sitting on a curb clutching a report card. There was an "A" for reading, an "A" for math - and an "F" for fat.
"I said to my husband, whoever takes the job of running this program is going to be the most hated person in the state," Rockenbach said.
It turned out she would be that person. And quickly, Rockenbach and other health and education leaders set about dispelling myths and addressing fears that have dogged the program in Arkansas and, already, Massachusetts.
Some parents argued that schools had no right meddling in their youngsters' health.
"I've had some parents tell me, 'I know my child is overweight. I don't need a letter to tell me that,' " said Dr. Karen Young, medical director of the Pediatric Fitness Clinic at Arkansas Children's Hospital.
Responding to this concern, lawmakers amended the law in 2007 to allow parents to exempt their children from testing, but most participate. They also scaled back from annual testing to every other year.
State reviews have found two initial fears were largely unfounded: that overweight children would face bullying as a result of the testing, and that children would engage in dangerous dieting. Indeed, surveys show that the percentage of students who reported enduring teasing about their weight declined from 12 percent in 2004 to 7 percent last year.
A new University of Arkansas study reaches similar conclusions, finding "few adverse effects" related to the campaign.
Dr. Maria Portilla, medical director of the Adolescent Eating Disorder Clinic at Arkansas Children's Hospital, estimated that she had treated five or six children whose latent conditions appeared to have been triggered by the screening. Two teens had to be hospitalized; a third, the doctor said, was suicidal.
"I'm definitely not saying that the BMI letter caused the eating disorder. I'm saying those patients were already at risk for it, they had a lot of things going on, and the BMI letter just kind of pushed them over the edge," Portilla said, adding that all the children survived their illnesses.
The Daniel brothers, 11-year-old Trey and 8-year-old Andrew, began visiting the Arkansas Children's Hospital fitness clinic last April, and they haven't needed jeans with a bigger waist in more than a year. Their body mass scores have declined at almost every visit.
"How can you consciously raise a whole generation of obese children?" said Chris Rodgers, the boys' stepfather. "If the BMI report helps prevent that, then I'm all for it."
Stephen Smith can be reached at firstname.lastname@example.org.