COMMENTARY

Weighing Children in School: No Good Can Come of It

Yoni Freedhoff, MD

Disclosures

August 21, 2020

The United Kingdom's National Obesity Forum has apparently decided that returning to school this fall in the middle of a pandemic isn't stressful enough for kids, and is recommending that its National Child Measurement Programme be expanded to have 4- to 5-year-old and 10- to 11-year-old children weighed when they return to the classroom — and then weighed again in the spring — in a bid to tackle COVID-related gains.

It's difficult to conceive a single plausible mechanism by which this recommendation could be helpful. Given that weight is, by a substantial margin, the number-one reported cause of schoolyard bullying, it's certainly unlikely that children with obesity don't already know that they have it. It's also unlikely that they don't know that obesity confers risks to health, given the near constant drumbeats of concern percussed by the media and public health authorities, and the fact that watching people with obesity be blamed, shamed, and berated for their condition has in the past two decades become a regularly repeated primetime reality show spectacle.

It's also unlikely, especially in younger grades, to be something within a child's direct control.

What about the parents? Well, given that they dress their children and that changes in weight affect clothing sizes and fit, they're already aware if their kids are gaining weight. And like their children, they have been exposed to constant public health alarms around obesity.

Many parents will have seen their time and resources, both real and mental, become significantly impaired during the time of COVID-19, which in turn understandably challenges change. Simply put, permanent intentional behavior change in the name of health requires tremendous privilege and is elusive for many people even during easier times. For non–evidence-based proof of this assertion, simply reflect on all of your own best-laid intentions and plans that might have been good for your health (fitness, relationships, CME, etc) that you let slide despite probably having far more privilege than the average person.

Then, of course, there is the hugely inconvenient truth that we have yet to see the development of a parent- or child-based educational intervention or directive for weight gain that has shown itself to be beneficial on a population level.

Can Something Else Be Done Instead?

At this point, we can only speculate about the potential risks associated with school room weigh-ins because randomized controlled trials have thankfully not been conducted to explore this area. But I can certainly tell you that I have met many adult patients in my office who traced their lifetime of yo-yo dieting — along with a history of teenage eating disorders, at times — to their well-intentioned physician, school nurse, gym teacher, or parent using a scale to measure their weights. And in doing so, they were teaching that scales measure health, happiness, success, self-worth, and effort.

If governments are concerned about weight gain in children, they need to look to initiatives that will help all children and parents. Weighing them will not somehow inspire parents or kids to discover an as yet unknown effective childhood obesity treatment. Changes that would be helpful may include:

  • Banning food advertisements to children

  • Reforming school cafeteria meals and then ensuring that school meals are made available to children during COVID-related school shutdowns

  • Bringing back home economics classes to teach children how to cook (and perhaps doing the same for parents during school off-hours or in community centers)

  • Enacting sugar-sweetened beverage taxes and using revenues to fund aforementioned reforms and programs, along with others, which might include the subsidization of fresh produce

  • Reforming front-of-package health claim for foods with questionable nutritional quality

Given that there is literally no age category in any country on the planet that hasn't seen rising weights, this is clearly not a disease reflecting a pandemic loss of willpower. Rather, this is a disease of the world's changing food environments and culture, and until we address both through systemic changes, schemes such as the one being proposed by the UK National Obesity Forum are far more likely to do harm than good.

Yoni Freedhoff is an associate professor of family medicine at the University of Ottawa and medical director of the Bariatric Medical Institute, a nonsurgical weight management center. He is one of Canada's most outspoken obesity experts and the author of The Diet Fix: Why Diets Fail and How to Make Yours Work.

Follow Yoni Freedhoff on Twitter: @YoniFreedhoff

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