In reviewing current research and research-based recommendation regarding body mass index
(BMI) screenings for children in the school setting, the West Virginia Council of School Nurses feels this is a clinical screening which should be performed by the student’s medical home. The student’s medical home is able to provide the student and parent with individualized medical advice, continued follow-up, community resources including behavioral interventions, education and/or prescribed physical activity and nutritional plans. While the school is able to provide screening with medical home referrals and some education, the ability to follow-up, provide comprehensive science-based prescribed strategies around physical activity, nutrition and behavioral interventions for individual students does not exist. Schools provide evidence-based health strategies and programming for all students, not prescribed medical strategies for individual students. Public schools are educational models with a health component to provide for individualized special health care needs based on the prescribed order of a medical provider during the school day.
The HealthCheck medical provider manual requires the measurement of height and weight for ages 0-20 years with the option to plot measurements on a standard growth chart or use BMI calculations. The 2010 revisions of the HealthCheck documentation form does incorporate the
BMI. The United States Prevention Services Task Force (USPSTF) recently recommended clinicians screen children aged 6 to 18 years for obesity and offer or refer them to comprehensive weight management programs. Comprehensive weight management programs incorporate counseling and other interventions targeting diet and physical activity along with intensive behavioral interventions to promote improvement in weight status (USPSTF, 2010).
Interventions that focused on younger children incorporated a parental involvement component in the program.
Over the past several years, research into weight management in obese children and adolescents has improved in quality and quantity. Despite important gaps, available research supports at least
Devised: November 1, 2010

short-term benefits of comprehensive medium- to high-intensity behavioral interventions in obese children and adolescents ( Whitlock, 2010 ).
As public school systems continue to work with the student’s medical home, the medical provider must be made aware of the importance of documenting the student’s height and weight along with BMI calculation on the HealthCheck/comprehensive screening form. If the height, weight and/or BMI are not documented on the HealthCheck or comprehensive screening form please request the parent complete a school HIPAA/FERPA consent to allow school health/entry personnel to speak directly to the medical provider’s office or have the parent request the proper documentation from the medical provider. The West Virginia Department of Health and Human
Resources (WVDHHR)-HealthCheck Program has incorporated the BMI into the 2010
Periodicity Schedule and the HealthCheck documentation form (WVDHHR, 2010)
The Centers for Disease Control and Prevention (CDC) recommends BMI surveillance, as seen with the WVU-Coronary Artery Risk Detection In Appalachian Communities (CARDIAC)
Project, instead of census screening completed by schools (CDC, 2007). A representative sample through surveillance data allows the data to be generalized to the entire population with a minimal confidence interval for accuracies. We must work to maintain the measurement of height and weight along with the calculation of BMI within the student’s medical home to ensure a comprehensive medical record with proper interventions and resources as applicable.
Note:
The U.S. Preventive Services Task Force (USPSTF), first convened by the U.S. Public Health
Service in 1984, and since 1998 sponsored by the United States Department of Health and
Human Services (USDHHS)-Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The
USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services.
Public Law Section 915 mandates that USDHHS-AHRQ convene the USPSTF to conduct scientific evidence reviews of a broad array of clinical preventive services, develop recommendations for the health care community, and provide ongoing administrative, research, technical, and dissemination support.
The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care. For more information, please go to http://www.ahrq.gov/clinic/uspstfab.htm
.
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References
Centers for Disease Control and Prevention. (2007). Body Mass Measurement in Schools
Executive Summary . CDC Retrieved on November 1, 2010 form http://www.cdc.gov/HealthyYouth/obesity/BMI/pdf/BMI_execsumm.pdf
.
Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C,Thompson D, Grummer-
Strawn L. (December, 2007). Body Mass Index Measurement in Schools.
Journal of
School Health. 2007;77:651-671. Retrieved on November 1, 2010 form http://www.ashaweb.org/files/public/JOSH_1207/josh_Final_249_07Nov27.pdf
.
U.S. Preventive Services Task Force. (January 2010). Screening for Obesity in Children and
Adolescents . Agency for Healthcare Research and Quality, Rockville, MD. Retrieved on October 13, 2010 from http://www.ahrq.gov/clinic/uspstf/uspschobes.htm
.
West Virginia Department of Health and Human Resources. (2010). Periodicity Schedule .
Office of Maternal Child and Family Health, HealthCheck Program, Charleston, W.V.
Retrieved on November 1, 2010 from http://www.wvdhhr.org/healthcheck/manual/Appendix_G.pdf
.
Whitlock, Evelyn. (January 2010). Effectiveness of Weight Management Interventions in
Children: A Targeted Systematic Review for the USPSTF. e418. Retrieved on February 10, 2010 from http://www.ahrq.gov/clinic/uspstf10/childobes/chobesart.htm
Pediatrics
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2010;125:e396-
DISCLAIMER :
The “Recommendation” of the West Virginia Council of School Nurses (WVCOSN) is not representative of West Virginia
State Code or West Virginia State Board of Education recommendation or policy. This is a recommendation based on consensus, evidence-based practice reviews and current research from the WVCOSN. The WVCOSN is set forth by W.Va.
Code §18-5-22.
The certified school nurse is responsible for utilizing nursing judgment and skill to determine the safest delivery of health care on an individual case-by-case situation in the West Virginia public school setting while protecting the welfare and health of the student. Every situation is unique and requires a collaborative team approach lead by the certified school nurse, which includes, but not limited to, the student, parents/guardians, school administrator, experts in the field and the student’s primary health care provider, at the local level.
Devised: November 1, 2010