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Randomized Controlled Trial
. 2021 Mar 1;175(3):251-259.
doi: 10.1001/jamapediatrics.2020.4768.

Effect of School-Based Body Mass Index Reporting in California Public Schools: A Randomized Clinical Trial

Kristine A Madsen  1 , Hannah R Thompson  2 , Jennifer Linchey  2 , Lorrene D Ritchie  3 , Shalika Gupta  2 , Dianne Neumark-Sztainer  4 , Patricia B Crawford  3 , Charles E McCulloch  5 , Ana Ibarra-Castro  2
Affiliations
Randomized Controlled Trial

Effect of School-Based Body Mass Index Reporting in California Public Schools: A Randomized Clinical Trial

Kristine A Madsen et al. JAMA Pediatr. .

Abstract

Importance: Annually, US schools screen millions of students' body mass index (BMI) and report the results to parents, with little experimental evidence on potential benefits and harms.

Objective: To determine the impact of school-based BMI reporting on weight status and adverse outcomes (weight stigmatization and weight-related perceptions and behaviors) among a diverse student population.

Design, setting, and participants: Cluster randomized clinical trial. The Fit Study (2014-2017) randomized 79 California schools to BMI screening and reporting (group 1), BMI screening only (group 2), or control (no BMI screening or reporting [group 3]) in grades 3 to 8. The setting was California elementary and middle schools. Students in grades 3 to 7 at baseline participated for up to 3 years. A modified intent-to-treat protocol was used. Data analysis was conducted from April 13, 2017, to March 26, 2020.

Interventions: School staff assessed BMI each spring among students in groups 1 and 2. Parents of students in group 1 were sent a BMI report each fall for up to 2 years.

Main outcomes and measures: Changes in BMI z score and in adverse outcomes (based on surveys conducted each fall among students in grades 4 to 8) from baseline to 1 and 2 years of follow-up.

Results: A total of 28 641 students (14 645 [51.1%] male) in grades 3 to 7 at baseline participated in the study for up to 3 years. Among 6534 of 16 622 students with a baseline BMI in the 85th percentile or higher (39.3%), BMI reporting had no effect on BMI z score change (-0.003; 95% CI, -0.02 to 0.01 at 1 year and 0.01; 95% CI, -0.02 to 0.03 at 2 years). Weight dissatisfaction increased more among students having BMI screened at school (8694 students in groups 1 and 2) than among control participants (5674 students in group 3). Results of the effect of BMI reporting on other adverse outcomes were mixed: compared with the control (group 3), among students weighed at school (groups 1 and 2), weight satisfaction declined more after 2 years (-0.11; 95% CI, -0.18 to -0.05), and peer weight talk increased more after 1 year (0.05; 95% CI, 0.01-0.09); however, concerning weight control behaviors declined more after 1 year (-0.06; 95% CI, -0.10 to -0.02).

Conclusions and relevance: Body mass index reports alone do not improve children's weight status and may decrease weight satisfaction. To improve student health, schools should consider investing resources in evidence-based interventions.

Trial registration: ClinicalTrials.gov Identifier: NCT02088086.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Ritchie and McCulloch reported receiving grants from the National Institutes of Health (NIH). No other disclosures were reported.

Figures

Figure.
Figure.. The Fit Study: CONSORT Flow Diagram
See this image and copyright information in PMC

Comment in

References

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