Parents' Perceptions of and Responses to School‐Based Body Mass Index Screening Programs—A Systematic Review

Abstract

BACKGROUND Evidence for the effectiveness of state‐mandated body mass index (BMI) screening programs in the United States has been inconclusive, and potential unintended consequences of the programs have been debated. The present review aims to understand parents' perceptions of and responses to school‐based BMI screening, and to highlight racial/ethnic differences. METHODS We systematically identified studies published January 2003‐May 2019 examining parent and/or youth perceptions of and/or responses to US school‐based BMI screening. RESULTS A total of 16 studies were included in the review. Studies suggested that while parents largely found BMI screening helpful, they held concerns regarding stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school‐based screening. Furthermore, parents did not frequently follow‐up with health care providers, although they reported some healthy behavior changes. CONCLUSIONS Our review highlights existing parent perceptions of school‐based BMI screening including the potential for healthy behavior change and important concerns regarding weight‐stigma and disturbed eating attitudes/behaviors. Additionally, racial/ethnic differences in screening preferences and experiences were found. Limitations of existing literature included a need to understand youths' experiences and a lack of standardized, reliable outcomes research. Implications for future research and the role of parents, schools, and providers are discussed.

What Are the Challenges of School Nurses in South Korea in Managing Obese Children From Low-Income Households?

“…Conversely, parents were concerned about potential negative impacts, including decreased self-esteem and increased weight-related teasing (Moyers et al, 2005). Tatum et al (2021) reported that while parents largely found obesity prevention programs helpful, they were concerned about stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school-based screening. The Commission on Ending Childhood Obesity (WHO, 2016) emphasized the critical role of parents and caregivers in encouraging children to engage in healthy behaviors; thus, it is necessary to continue to educate parents to expand the role of parents in preventing childhood obesity and educate the nurses on the best way to engage with the parents to enlist their participation.…”

Weight-Based Disparities in Youth Mental Health: Scope, Social Underpinnings, and Policy Implications

“…Advocacy from policymakers against such weight surveillance campaigns is critical to avoid sending messages to youth that reinforce beliefs about the social (un)acceptability of high weight and exacerbate internalized weight stigma (Pearl, 2018). Indeed, findings from a recent systematic review highlighted weight stigma as a common concern of parents related to BMI reporting (Tatum et al, 2021), and few educators support in-school weight assessments or reporting students' weight status to their families (Puhl, Neumark-Sztainer, et al, 2016).…”

A scoping review of school‐based anthropometric measurement

“…Some parents and guardians in the US have reported favorable perceptions of BMI measures, school screening programs, and BMI report cards 32 . However, parents in the US have also expressed concerns about the maintenance of privacy and respect during measurement, the risk of weight stigma and unhealthy behaviors and attitudes, as well as the communication of BMI results in a non‐stigmatizing manner 35,38 . Along similar lines, Australian parents did not view schools as a setting where AM should take place because of concerns about bullying and its effects on self‐esteem, 39 and evidence suggests that these concerns are not unfounded 23,40 …”

“…33 Beyond the risks of measurement, measurement itself does not mean that a child's health status has been accurately described or that health promotion efforts will be realized. Information provided to parents is not always useful, interpretable, or actionable, 34 and neither parental follow-up with health care providers 35 nor improvements to the child's health are common. 36,37 Some parents and guardians in the US have reported favorable perceptions of BMI measures, school screening programs, and BMI report cards.…”

“…32 However, parents in the US have also expressed concerns about the maintenance of privacy and respect during measurement, the risk of weight stigma and unhealthy behaviors and attitudes, as well as the communication of BMI results in a nonstigmatizing manner. 35,38 Along similar lines, Australian parents did not view schools as a setting where AM should take place because of concerns about bullying and its effects on self-esteem, 39 and evidence suggests that these concerns are not unfounded. 23,40 Understanding the quality, processes, and procedures of AM and critically examining its utility in school settings is crucial considering the risks of AM among children and how common AM is in some countries.…”