Obesity Discussion Forums

[Obesity Discussion]

http://www.panaonline.org/

The Epidemic
61% of Pennsylvania adults are overweight or obese. (CDC BRFSS, 2002)
23% of non-Hispanic white adults, 38% of non-Hispanic black adults, and 24% of Hispanic adults in Pennsylvania are obese. (CDC BRFSS, 2002)
27% of low-income children between two and five years of age in Pennsylvania are overweight or at risk of becoming overweight. (CDC PedNSS, 2002)
The obesity rate among Pennsylvania adults increased by 92% from 1990 to 2002. (CDC BRFSS, 1990, 2002)

Program Priorities
The Pennsylvania Nutrition and Physical Activity Plan to Prevent Obesity and Related Chronic Diseases was developed by a multi-disciplinary group of stakeholders and released by the Department of Health in February 2003. An initial outcome of the planning process was the creation of the Pennsylvania Advocates for Nutrition and Activity (PANA), a statewide, multi-sector coalition that will coordinate the implementation and evaluation of the state plan. The vision of the plan is to promote a Pennsylvania that supports and values healthy lifestyle behaviors.

The seven regional networks of PANA provided a channel for identifying 365 Keystone Healthy Zone Community Champions who play a key facilitative role in promoting Keystone Healthy Zone Campaign.

Five interventions are currently underway:

The Keystone Healthy Zone Campaign’s aim is to recognize schools for their efforts in creating environments that promote physical activity and sound nutrition. Classroom materials and teacher training are provided.
The Color Me Healthy Program is a pilot intervention for preschool children in collaboration with the state Departments of Education (Division of Food and Nutrition, Family Literacy Center) and Public Welfare, the American Cancer Society, Head Start, and the Pennsylvania Nutrition Education Network. The goal of the collaboration is to offer an age-appropriate educational curriculum to childcare centers, Family Literacy sites, and Head Starts throughout Pennsylvania that exposes children, parents, teachers, and caregivers to the importance of healthy eating and physical activity.
The School Growth Screening Program is a tool to see if school-aged children are underweight, at risk of becoming overweight, or overweight using the CDC Growth Chart based on BMI-for-age and gender-specific percentiles using measurements obtained by school nurses.
The Obesity Prevention Project tests nutrition and physical activity strategies to prevent obesity in the rural town of Brockway. This pilot intervention is a school-based initiative with input from a community-driven stakeholder group. The focus is the prevention of childhood obesity, with the specific goals of developing healthy eating patterns and physically active lifestyles in young people using a social marketing approach.
The Southwest Philadelphia Obesity Prevention Pilot Project aims to promote healthy eating and physical activity through activities and social marketing campaigns in an elementary school, a neighboring recreation center, and the surrounding community.
Partners
American Academy of Pediatrics Pennsylvania Chapter
American Heart Association, Pennsylvania Delaware Affiliate
Capitol Blue Cross
Bois Regional Medical Center Regional Health Group
Geisinger Healthcare System
Health Alliance of Pennsylvania
Health Promotion Council of Southeastern Pennsylvania
Highmark Blue Shield
Northeast Region Rails-to-Trails Conservancy
Pennsylvania Advocates for Nutrition and Activity
Pennsylvania Department of Community and Economic Development
Pennsylvania Department of Conservation and Natural Resources
Pennsylvania Department of Education
Pennsylvania Department of Public Welfare
Pennsylvania Environmental Council
Pennsylvania Food Service Association
Pennsylvania Nutrition Education Network
Pennsylvania Planning Association
Pennsylvania Society of Physician Assistants
Pennsylvania State Association for Health, Physical Education, Recreation, and Dance
Pennsylvania State University Cooperative Extension
Pennsylvania State University
Philadelphia Department of Public Health
University of Pennsylvania
University of Pittsburgh

Recent Accomplishments and Products
Three contracts and 15 mini-grants have been awarded for state and local implementation of the state plan.
Information and awareness presentations were made for 19 national, state or local agencies and organizations.
A health, wellness, and quality-of-life objective was added to the Pennsylvania Bike and Pedestrian Plan, Pennsylvania Department of Transportation.
Training was provided for 365 Keystone Health Zone Community Champions.
A Regional Strategy with National Implications (with Highmark Blue Shield) was crafted in partnership with High Mark Blue Shield to provide a Childhood Obesity Forum.
The 2004 Pennsylvania Action For Healthy Kids Summit at Pennsylvania State University was held in Harrisburg.
The 2004 Pennsylvania Action For Healthy Kids Summit at Pennsylvania State University was held in Harrisburg for the Pennsylvania State Association of Township Supervisors (PSATS) training.
Upcoming Events and Products
Training will be offered on the impact of land-use and transportation decisions on public health.
The Growth Screening Program for Pennsylvania's School Age Population will be implemented voluntarily in kindergarten through third grade in 2004-2005; mandatory sc ning will be conducted for children in kindergarten through third grade during the 2005-2006 school year.
Project Period: 2003–2008
Year First Funded: 2001
Funding Stage: Basic Implementation
Contact Person:
Kevin A. Alvarnaz
Chief, Cardiovascular Health Section
Pennsylvania Department of Health
Phone: 717-787-2957
Fax: 717-772-0608
Email: KAlvarnaz@state.pa.us
Web site: www.health.state.pa.us* and www.panaonline.org*


Data Sources
CDC BRFSS — CDC’s Behavioral Risk Factor Surveillance System
CDC PedNSS — CDC’s Pediatric Nutrition Surveillance System
CDC YRBSS — CDC’s Youth Risk Behavior Surveillance System

http://www.cdc.gov/nccdphp/dnpa/obes...nnsylvania.htm

[Obesity Discussion]

Free program helps families fight obesity
Editor, the Record:

This week, parents of students of the East Stroudsburg School District received a letter informing them about their child's Body Mass Index percentile. The Body Mass Index percentile is one tool used by healthcare professionals to help determine underweight, overweight or obesity.

I thought the letter was direct and clearly stated for the parent to turn to their regular healthcare professional if their child was not in the normal range. However, I didn't read what a pediatrician would do to deal with a child's issue. As a parent, I didn't understand what my pediatrician's options were or mine.

I am the program coordinator of the Sustainable Nutrition and Activity Plan program at Marywood University. SNAP! is one program available to assist families. We work with children between the ages of 6-11 and their parents who both have weight management issues. We help people work with the family dynamic that can create generational weight issues and we do it absolutely free. Blue Cross of NEPA awarded us a grant making the program affordable to all members of the community. The third year of SNAP! will begin in a few weeks, but we have some spaces available for families. Our e-mail address is snap.ac@marywood.edu. Parents can learn more about the program at www.marywood.edu/snap. Other programs are available and can be accessed via Steps to a Healthier PA, the Pennsylvania Advocates for Nutrition and Activity panaonline.org, as well as programs which have been done through our local YMCA.

BMIs can be confusing. I encourage parents not only to contact their regular healthcare provider, but to inquire as to whether a nutrition professional, such as a registered dietitian, could give additional support and information to address their specific concerns.

Article

[Obesity Discussion]

Overweight - Pennsylvania Health Leaders Partner On Unique Latino Health Initiative
08 Jun 2006

Congreso, a nationally recognized social service organization in Philadelphia, has joined forces with the Pennsylvania Medical Society to address the negative health impact of excessive body weight. Obesity, a national epidemic, has had a particularly harsh impact among the Latino population nationwide.

HeadsUp on Health(R) - Vanguardia de la Salud is designed to provide sponsoring brands and companies with a unique, multi-media marketing opportunity, while helping address a major health concern in the Latino population. The initiative is planned as a pilot in eastern Pennsylvania beginning in the fall of 2006. Plans also call for a roll out to top Latino markets nationwide beginning in 2007.

The Pennsylvania Medical Society has been a leader in the statewide effort to combat obesity and strongly endorses the program. “Today's obesity epidemic is having a severe impact on Latinos,� explained Mark A. Piasio, MD, President of the Pennsylvania Medical Society. “For example, according to the Centers for Disease Control and Prevention (CDC), 26 percent of U.S. Latina women are obese, compared to 20 percent of white women. Obesity-related diabetes and heart disease are claiming more and more Latino lives.�

The program, which is targeted at mothers and caregivers, aims to gradually introduce healthy, culturally acceptable dietary and lifestyle changes into Latino families.

The three goals of HeadsUp on Health(R) - Vanguardia de la Salud are to 1) raise awareness of the negative health impact of obesity, 2) offer simple advice on diet and exercise, and 3) identify Latinos who are at risk for diabetes and heart disease and direct them to get help.

The components of the pilot are

-- A culturally appropriate, healthy TV cooking show on Telemundo/Comcast, featuring a Latino host chef, guest chefs, medical professionals and dietary and exercise experts.

-- Two informative booklets to be distributed through supermarkets, bodegas, newspapers, physician offices, hospitals and Congreso during November 2006, American Diabetes Month, and February 2007, American Heart Month.

-- Body mass index and blood pressure screenings to be conducted by Congreso and participating clinics. Pending funding, lipid and glucose screenings will be added. At risk people will be directed to obtain medical care.

HeadsUp on Health(R) - Vanguardia de la Salud is planned to take place annually from November through February. The program is based on the national award-winning HeadsUp on Heart Disease(R), which was originated by Melk Communications, a Pennsylvania-based health care communications company.

Congreso and the Pennsylvania Medical Society are currently seeking sponsors and benefactors for this dynamic initiative.

This is an excellent opportunity for sponsoring brands to reach a wide Latino audience, while helping to promote health and wellness,� Nicholas Torres, President of Congreso, said. “With the support of food, pharmaceutical, financial services, health insurance providers and other sponsors, we can impact the well-being of America's fastest growing population,� he added.

Sponsorship packages include full-page ads in nearly 600,000 copies of each of the two booklets, 26-weeks of TV and more. All food sponsors will have their product featured in healthy recipes to appear in the booklets and on the healthy cooking show. The aim is to fund most of the program by July. “We welcome health friendly food and other brands that target Hispanics,� Nicholas Torres stressed. “This program is a win-win because it aims to generate product sales while helping the community.�

Pennsylvania Medical Society
Obesity in Latinos

[Obesity Discussion]

Pennsylvania: A measure under consideration at the Palmyra Area School District would not allow parents who visit their children for lunch to bring them fast food, the AP/Newsday reports. The measure, on which the school board will vote on June 15, is part of an effort to address childhood obesity and promote proper diet and exercise among students, Collene Van Noord, director of curriculum and instruction for the school district, said (AP/Long Island Newsday, 6/9).

[Obesity Discussion]

Schools strive to take a bite out of obesity
By CHRIS SHOLLY
Staff Writer
Lebanon Daily News
Sandy Moritz is passionate about getting children to eat healthier foods and to exercise.
Moritz, a nurse at Cornwall Elementary School, meets her dawn patrol — a group of students who come to school 50 minutes early for some extra exercise, like playing soccer or riding bikes.

Like many districts around the state and nation, Cornwall-Lebanon is looking for ways to help reduce obesity among children, which has become a national concern.

The number of children who are considered overweight in Pennsylvania has risen by 2 percent over the past two years, according to the Pennsylvania Department of Health. Now, one child out of every five is overweight.

“It’s a growing problem,� said Dr. Ronald J. Williams, director of the Penn State Children’s Hospital Pediatric Multidisciplinary Weight Loss Program. “It’s a problem that has not peaked yet. It’s still rising.�

Williams said children who are overweight may develop adult-level illnesses, such as heart disease, high blood


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pressure, sleep apnea and diabetes.
Little research has been done on the long-term effects of obesity in children, he said.

“What we have seen is a significant rise in adult diabetes in teenagers,� he said.

Statistics show that more than half of all childhood cases of diabetes are related to obesity, compared to 20 percent a decade ago, he said. That’s a major concern for the health-care community.

“If you and I get diabetes and hypertension, we have it for 30 to 40 years, we die. That’s life,� he said. “If a teenager has it for 30 to 40 years, they’re still in the prime of their life.�

Physical fitness could help reduce these problems, Williams said.

“Studies show that people who are more active, regardless of their weight, do better than those who are not active,� he said.

Williams said about 30 percent of teens and children he sees have an elevated blood pressure on their first visit, and it takes about three and a half months to get their blood pressure down to normal.

C-L fights obesity

Cornwall-Lebanon is one of three central Pennsylvania school districts — Harrisburg and Lower Dauphin are the other two — participating in a pilot program designed by the Hershey Medical Center to reduce obesity in children. The Derry Township hospital received $135,000 last month from Kohl’s department store for the program.

Moritz said programs like this will help reduce obesity in children.

“It didn’t occur overnight,� she said. “It will take a long time to make it turn around.�

Under the pilot program at Cornwall-Lebanon, elementary students meet with an exercise physiologist from the Hershey Medical Center and a nutritionist, both of whom help them develop better eating and exercise habits.

“We know if students are active between classes: Their brains work better,� said Moritz, who is also Cornwall-Lebanon’s Health Services chairwoman.

At the end of the year, medical-center officials will look at the results of the program to see how much weight students lost and look for other improvements in their health, such as lower blood pressure.

Focusing on wellness

Other school districts are pushing healthier eating habits and exercise, too.

Under a 2004 federal regulation, all schools that participate in the National School Lunch program must give students more healthy food choices and develop wellness policies.

At Cornwall-Lebanon, wellness has been a focus for 17 years. Dr. Joseph V. Kristobak Jr., director of elementary education, said the district began focusing on wellness under former Superintendent Edward Phillips after he suffered a heart attack.

The district’s wellness team includes teachers, administrators and classified employees. The team sponsors free health screenings on campus and some exercise activities for students, such as the annual fun run.

Kristobak said his district developed a new cafeteria menu a year before it was mandated by the new rules.

Palmyra Area School District adopted its wellness program this year. Among other things, the policy limits the number of fatty foods, including cafeteria foods and food sold for fund-raisers or offered at classroom parties.

School districts must meet the federal standards or risk losing money they receive through the federal lunch and other government programs. For Palmyra, that figure could be as high as $400,000, according to business manager Darcy Brenner-Smith.

The district didn’t have to make many changes to its school-lunch menu. She said the menu already met federal requirements of 10 percent or less in saturated fats and 30 percent or less in total fats.

But a la carte items offered were changed this year to meet the new nutrition standards. For example, serving sizes of a la carte snacks and drinks have been reduced.

“Packages of potato chips have been reduced from a 1-ounce serving to a three-quarters-ounce serving,� Brenner-Smith said. “Packages of crackers and Tastykakes that did not meet the nutrition standards were eliminated.�

Rice Krispie Treats have replaced some of the higher-calorie snacks. Fat-free ice cream, yogurt, pudding pops and low-fat ice-cream sandwiches also have been added to the menu.

Palmyra Area High School senior Ryan Snyder said most students have accepted the food changes.

“We’re getting much of the same things; everything is just smaller portions,� the 17-year-old student-body president said. “We also got some stuff that’s really good, such as really good hot popcorn and cinnamon snacks, which everybody really likes. But they did get rid of Pringles. ... Nobody likes that.�

Brenner-Smith said most parents have supported the changes.

“Parents of children with food allergies have been pleased with the policy changes because it reduces the risk of allergic reactions,� she added.

BMI is OK

Pennsylvania also now requires school districts to monitor students’ Body Mass Index, or BMI.

BMI is calculated from a person’s weight and height. Although it does not measure body fat directly, it is an indicator of a person’s body fatness, according to the Centers for Disease Control and Prevention.

Brenner-Smith said the district has received few complaints from parents over the BMI results.

Kristobak said some parents at Cornwall-Lebanon also raised concerns about the BMI numbers, but after it was explained, they understood how it could help them.

“Parents are eager to learn more about (wellness) and helping their kids to do better,� he said. “What is nice is that finally everyone is getting involved, including the food companies.�

Since the district began to monitor students’ BMI last year, Moritz said, rates have declined. She pointed out that 35 percent of students nationally are overweight or at risk of being overweight. At Cornwall Elementary, that figure is 28 percent.

“We’re not seeing a significant drop in our rates, but it’s not increasing as it is nationally,� she said. “We hope we’re having an impact.�

Schools tackle childhood obesity

[Obesity Discussion]

Healthy Weight Awareness Center

Center helps Philadelphia's children combat obesity
Healthy Weight Awareness Center offers medical, surgical treatments and after-school support

In response to the nation's current childhood obesity epidemic, the Healthy Weight Awareness Center at St. Christopher's Hospital for Children offers a comprehensive and multi-disciplinary program for children at risk or already affected by co-morbid conditions associated with being overweight.

According to the Philadelphia Department of Public Health, obesity is increasing among the city's teenage population. In 1999, ten percent of girls and nine percent of boys were overweight. Two years later, those percentages had increased to 12 percent and 19 percent respectively.

The Healthy Weight Awareness Center identifies potential weight problems in children and adolescents and determines medical, and possibly surgical treatments, to suit each patient's needs. "The best treatment for obesity is early recognition and intervention at a younger age," said Dr. Kathy Chen, pediatric gastroenterologist and medical director, Healthy Weight Awareness Center.

The Healthy Weight Awareness Center at St. Christopher's Hospital for Children applies a multi-disciplinary approach to treating pediatric obesity offering:

A medically supervised approach to evaluating and establishing treatment plans for significantly obese patients
A multi-disciplinary team consisting of pediatric gastroenterologists, pediatricians, pediatric surgeons, nutrition specialists, nursing staff and practitioners, social workers and child life specialists
Referrals to sub-specialists for individual medical and surgical complications including endocrinology, pulmonary, surgery, orthopedics, cardiology and physical therapy
Weight management clinics held in conjunction with the hospital's Program for Bariatric Surgery*
The center's after-school programs include:

Way to Go Kids! Directed by a nutritionist, physical therapist and social worker to educate about nutrition and exercise, these eight-week classes are open to referred children and adolescents. Family participation is required.
Melt-Aways: Directed by a social worker and nurse practitioner, this weight management support group is held every third Tuesday evening and is open to adolescents and families.
In April 2004, St. Christopher's Hospital for Children began to perform gastric bypass surgery (bariatric) on children between 16 and 18 years of age.

"Only after traditional dietary measures have failed is a patient considered a candidate for bariatric surgery," said Dr. Christine Finck, pediatric surgeon and surgical director, Healthy Weight Awareness Center. "And even then, patients must meet strict criteria including being twice their ideal body weight, undergoing psychological evaluation, showing inadequate weight loss after six months of treatment and have the presence of co-morbid conditions such as hypertension."

Pediatric surgeons at St. Christopher's Hospital for Children have been speciall trained to perform surgical treatment for obesity in adolescent cases where medical management alone fails. Each patient is treated individually. St. Christopher's Hospital for children is a participating institution in the National Follow Up of Adolescent Bariatric Sugery multi-instutional trail. Adolescents who qualify for surgery receive intensive treatment, both before and after the surgery, including dietary modifications and exercise.

For more information about the Healthy Weight Awareness Center at St. Christopher's Hospital for Children, please call (215) 427-8338.

* To be considered a surgical candidate in the surgical weight management program at St. Christopher's Hospital for Children, the patient must be at least 16 years of age and be considered severely obese, weighing at least two times the ideal body weight. Other criteria must also be met and will be discussed during the surgical consultation. A non-surgical weight management program for pediatric pateints of all ages is available for those not meeting the criteria for surgical weight management .
Kathy D. Chen, M.D.
Medical Director

Christine Finck, M.D.
Surgical Director

Childhood Obesity Hospital

[Obesity Discussion]

Weight Management for Kids and Teens



Just for Kids and Just for Teens are free 12-week programs that offer culturally tailored, comprehensive nutrition and weight management for children and teens in the Philadelphia region . Most meetings are held at MossRehab, 1200 Tabor Road, Philadelphia.


Meetings are located at:
MossRehab - Tabor Road
1200 Tabor Road, Philadelphia

Note: This event requires registration prior to attending. Please call 1-800-EINSTEIN to register, or register online.

Childhood Obesity Program

[Obesity Discussion]

Pennsylvania Receives an ‘A’ in 2006 Univ. of Baltimore Obesity Report Card
HARRISBURG -- Governor Edward G. Rendell said Pennsylvania’s initiatives to curb childhood obesity have scored an “A” in the 2006 University of Baltimore Obesity Report Card, which praised the state for its legislative and public policy work to control childhood obesity.

“Childhood obesity is a health problem that can be prevented and treated,” Governor Rendell said. “Through our work with schools, families and health care providers we are making progress to ensure that every child in Pennsylvania is better able to lead a healthy lifestyle.”

Each year, the University of Baltimore Obesity Initiative grades states on their efforts to pass obesity-reducing legislation. This year, Pennsylvania was one of five states to receive an “A” for its efforts to control childhood obesity.

According to the Centers for Disease Control and Prevention, obesity in the U.S. has steadily increased over the last 20 years, and has doubled in children. It is the second leading cause of death behind tobacco. And, according to the U.S. Department of Health and Human Services, 9 million children, or 16 percent, are overweight. The rate of overweight children in Pennsylvania is 18 percent.

Governor Rendell said Pennsylvania is doing many things to help children not become overweight.

“For example, we are tracking school children’s height and weight through our growth screening program so we can detect unhealthy developments sooner and provide information to help families treat the problem,” the Governor said. “Pennsylvania is also supporting the location of supermarkets and fresh food retailers in our urban and rural communities. And, the commonwealth’s Safe Routes to School and Hometown Streets programs improve the walking routes to and from local schools and offer a built-in physical fitness routine for our kids.”

Below are some of the Pennsylvania initiatives to fight childhood obesity:

· Pennsylvania Nutrition and Physical Activity Plan to Prevent Obesity and Related Chronic Diseases – A state plan designed to systematically target policy and environmental changes in schools, communities, and healthcare to promote a Pennsylvania that supports and values healthy lifestyle behaviors.

· Growth Screening Program – Requires schools to calculate and record students’ body mass index (BMI) and BMI-for-age percentile when the students’ height and weight are measured.

· Keystone Kids Go! – This new initiative in Pennsylvania focuses on improving children’s nutrition and physical activity. Keystone Kids Go! targets early childhood practitioners working in childcare, Head Start, early intervention, family literacy and pre-kindergarten programs.

· Keystone Healthy Zone – This annual program recognizes and rewards schools for making a commitment to improve nutrition and physical activity. Keystone Healthy Zone provides resources, templates, training, technical assistance and mini-grant funding for schools to make healthy changes and meet the federal requirements for school wellness policies.

· Governor’s Fitness Challenge-Keystones to a Healthy PA – The Governor’s Fitness Challenge is a school-based competition for children in grades K-8 to increase physical activity during and/or after school. The top three schools will receive a $5,000 grant to purchase equipment to further promote physical activity or nutrition.

· Balance Media Campaign – The Balance Media Campaign is a social marketing effort designed to complement community-level nutrition and physical activity programming by teaching children aged 6-11 years about the importance of energy balance. The campaign’s slogan, “Energy In. Energy Out.” emphasizes the need to balance the energy we eat with the energy we expend through physical activity.

Last September, Pennsylvania released its first-ever childhood obesity compendium, “PA Healthy Kids: Pennsylvania’s Strategy for Balancing Nutrition and Exercise in Kids.” Produced by Governor Rendell’s Cabinet on Children and Families, the Healthy Kids compendium outlines various programs, services and initiatives offered by the state to increase physical activity and improve the nutritional choices of Pennsylvania’s youth. It also includes success stories highlighting the positive impact of various programs and lists a number of resources that are available to help families, schools, communities, and organizations develop their own programs that promote healthy living.

To view the 2006 University of Baltimore Obesity Report Card, visit http://www.ubalt.edu/experts/obesity/index.html. For more information on obesity prevention, visit www.health.state.pa.us.

Childhood Obesity

[Obesity Discussion]

A touchy subject: obesity testing

By Lini S. Kadaba
The Philadelphia Inquirer
(MCT)
PHILADELPHIA - Down the hall from the cafeteria and away from the gym, schools are deploying one of the latest weapons in the fight against childhood obesity - mandated measurements of body mass index.
On a recent afternoon, seventh graders at Robert K. Shafer Middle School in Bensalem, Pa., waited as school nurse Kathleen McLaughlin recorded their heights and weights, the first step in tabulating BMIs. Each child's score, an indicator of body fat, will be mailed home in letters some have dubbed "obesity report cards."
Concern over childhood corpulence has led at least a half-dozen states to require in-school BMI calculations, intended to alert parents of a present or looming weight problem.
Pennsylvania expanded screenings to grades five through eight this year after launching the program in all elementary schools in the 2005-06 academic year.
Those involved with BMI tests say they step carefully around emotional land mines - and not just with kids.
Adolescents "are more aware of body image," McLaughlin said. "You have to be careful how you're talking to them."
At Shafer, she inquired about activities and snacks, no judgments made. And she pushed fruits, vegetables and calorie-burning extracurriculars.
Wendy Wilkinson dismissed her 6-year-old daughter's BMI report, which placed her in the 99th percentile, indicating overweight. It's "really silly," she said. "She is chubby now, but she goes into growth spurts."
Marcia Shinn also was upset that her 11-year-old girl, who plays football, was found at risk for being overweight. "They just measured based on her weight and height and not physical activity," Shinn said. "It infuriated me."
Some parents and experts are concerned that so much talk of BMI - and students do compare, say nurses - may distort a child's body image, especially among older girls at risk for anorexia and bulimia. In addition, perceptions of heaviness vary by racial and ethnic groups.
"You're going to put another label on a kid," said Wendy Cramer of the Renfrew Center, a Philadelphia treatment facility for eating disorders. "I definitely worry about what's going to happen when this gets to high school." In Pennsylvania, that will be this fall.
Arkansas lawmakers, who passed the nation's first BMI bill in 2003, curtailed the screenings this year because of parent complaints. Testing is now every other year; 11th and 12th graders are exempt, and parents can opt not to have their children participate.
The laws stem from a huge increase nationally in the number of overweight youths - four times more than 40 years ago - and concern for their future health. Groups such as the Robert Wood Johnson Foundation, which this month announced plans to spend $500 million on programs to give children more exercise opportunities and affordable, healthy food, hope to reduce the number of kids whose obesity puts them at risk for adult diseases.
In a 2003 pilot program, BMI screenings at 10 Pennsylvania schools found 38 percent of students were overweight or at risk.
Children in the 95th percentile or higher are considered overweight. (Experts do not use the adult term "obese.") Those between the 85th and 95th percentiles are at risk for being overweight, while those below the fifth percentile are underweight.
Districts consider the BMI letter home an aid to parents, who are encouraged to consult their child's doctor.
The idea is "to detect health issues early," said Allison Topper, head of Pennsylvania Advocates for Nutrition and Activity, which worked with the state on educational materials.
"It is a screening," she emphasized, "not a diagnostic tool."
For grade-schoolers, the yearly evaluations are more fun than anything, said nurse Kim Glielmi of Hillcrest Elementary School in Drexel Hill, Pa., where a BioMeasure machine records weight and height in seconds.
"Kids wouldn't know 99 is bad," she said. Adults, however, "are sensitive." A high score can feel like an indictment of their parenting skills.
"There's such a close relation between nurturing and nourishing," said nutritionist Eileen Ford of Temple University's Center for Obesity Research and Education, who supports the screening program for assessing health risks.
Michelle DeCarlo's 8-year-old daughter, Julianne, a soccer and lacrosse player, had a BMI score at the upper end of the normal range. DeCarlo was reluctant to share it with her.
"With young girls, it's such a sensitive subject," she said. "You don't want to focus on image and what they look like."
Experts caution that BMI numbers aren't foolproof tests. A child's height and weight may change dramatically from year to year, and athletes can score high because of muscle mass.
"It's really intended to be a measure for adults and morbid obesity," said Kim A. Logio, an assistant professor of sociology at St. Joseph's University who studies body image.
Pennsylvania's Lower Merion School District met the new state guidelines with care and caution. Weight is "the big taboo," said Terry Quinlan-Clampffer, coordinator of health services. Even young students talk of diets.
A BMI committee organized parent sessions to stress the importance of focusing on the total picture. Health classes addressed body image, and reports sent home noted the test's limitations. Student privacy was guarded by using no parent volunteers at measurements.
"We've seen little anxiety with the kids," Quinlan-Clampffer said. "I can't think of any complaints from parents at all. That's amazing."
About 21 percent of Lower Merion elementary students scored at risk of becoming overweight or worse this year, she said. For middle schoolers, the number was 26 percent.
Though the figures were lower than average, Quinlan-Clampffer was still surprised. "It shows you get used to seeing overweight," she said.
At Shafer, nurse McLaughlin counseled a self-conscious student that adolescence can be a time of weight gain and encouraged him to join an after-school activity. He passed on swimming and karate, but considered the walking club.
At 13, Dominique Thompson, who is almost 5-foot-1 and 120 pounds, plays field hockey and devours green beans and grapes. She was surprised to find her BMI just over the at-risk line. Most middle school girls, she said, "talk about being on diets." She would like to shed a couple of pounds, but plans to turn to exercise.
That's the goal, said McLaughlin - to focus not on weight, but "on kids making better choices."

Childhood Obesity