Should Schools Send BMI Report Cards to Parents? A Review of Literature

body mass index (BMI) report card is a tool to inform parents about their children's risk of obesity, and it aims to encourage parents to help their children, especially if overweight, to become more active and to make wiser food choices. States such as Arkansas, Florida and Pennsylvania have implemented BMI report card programs (Kalich et al., 2008; Kubik, Fulkerson, Story, & Rieland, 2006; Kubik, Story, & Rieland, 2007; Madsen, 2011). Assisted by software such as FITNESSGRAM r, physical education teachers also send home weight classification of students as part of fitness reports (Chomitz, Collins, Kim, Kramer, & McGowan, 2003; Madsen, 2011). Advocates of BMI report cards believe that BMI notifications can help curb childhood obesity rates. In addition to the potential benefits, researchers have previously expressed concerns that BMI report cards could stimulate children and adolescents to focus on their physical appearance instead of their health status (Ikeda, Crawford, & Woodward-Lopez, 2006; Nihiser et al., 2007). More specifically, they have suggested that BMI report cards could lead to unintended consequences such as increased weight-related teasing, higher levels of body dissatisfaction, and adoption of unhealthy weight-loss practices. Weight teasing (Hayden-wade et al., 2005; Storch et al., 2007), body dissatisfaction (Ferreira, Pinto-Gouveia, & Duarte, 2013; Ricciardelli & Mccabe, 2001) and disordered eating (Ikeda et al., 2006; Nihiser et al., 2007) have serious health and psychological consequences for a developing child or adolescent. For these reasons, it is important to determine whether school-led BMI report card programs are safe for students. Uncertainty about the effects of BMI report cards may impede decisions to implement school-based BMI notification programs. Thus, the purpose of this article is to comprehensively review the existing literature to determine the extent to which BMI report cards benefit and/or harm children and adolescents. The following three topics guided the narrative: (1) accuracy of BMI as an indicator of obesity; (2) positive and negative consequences of BMI notification programs; and (3) safety considerations in designing BMI report card programs.