While eating too much and exercising too little clearly put children's health in jeopardy, so might the methods used to change their behavior. As with any losing war, this one lacks a battle plan that everyone agrees upon. Robert Jeffery, director of the Obesity Prevention Center at the University of Minnesota School of Public Health, is one of many who believe that the solution lies in focusing more attention on body weight by screening kids at school and educating them about the dangers of obesity. One Minnesota high school last year showed the documentary Super Size Me, for example, to illustrate the ill effects that greasy burgers and fries have on the body. And proactive states like Florida and Pennsylvania mandate that schools weigh students yearly and send letters home warning parents if their child's body mass index, a number that relates weight to height, is too high. Down the hall and around the corner from Jeffery, meanwhile, Minnesota's Dianne Neumark-Sztainer, who studies adolescent eating behaviors, argues that such "overzealous efforts" may push teens to seek a quick and unhealthful weight-loss remedy. "Overweight teens are far more likely to turn to these risky behaviors instead of incorporating exercise or a more nutritious diet," she says.
Jillian Croll, a nutritionist who treats eating disorders at the Anna Westin House, a private facility in Chaska, Minn., has seen the evidence. "We find ourselves unteaching" girls raised to believe that their self-worth is measured by how much they weigh, she says. On a June afternoon tour of the suburban house filled with handmade quilts and stuffed teddy bears, the mood is tense as the eight residents sit down to sloppy Joes and buttered broccoli.
No joke. The path to an eating disorder is often paved with the good intentions of parents and educators who presume that warning and cajoling or joking will motivate children to lose weight. Neumark-Sztainer's findings suggest just the opposite in a study of 130 previously overweight teens. About 65 percent of the teens reported being teased about their body weight, and they were more likely to engage in binge eating, which leads to weight gain over time. And when parents harp on children's body weight, kids are also likely to become preoccupied with achieving thinness, says Neumark-Sztainer. Her research found that approaches that may be effective weight-loss strategies in adults, like daily weigh-ins and attempting a restricted diet, may trigger diet-pill use and purging in teens.
Shaming kids is prevalent in schools as well, and it's just as counterproductive there. A review paper published in the July issue of the journal Psychological Bulletin found that teachers perceive obese people to be sloppy and less likely to succeed than thinner people. Gym teachers usually have higher expectations for normal-weight kids, which means they might let heavier kids languish on the sidelines. "When kids are made to feel ashamed of themselves for being fat, they will cope by finding ways to make themselves feel better, often turning to food," says Schwartz. Studies have shown they're more likely to be depressed and dissatisfied with their bodies and develop other health problems like high blood pressure and eating disorders. "Yet I still hear educators and health professionals at conferences saying that weight bias serves a purpose."
School weight screenings, now performed in 16 states, have yielded mixed reviews. Though the report cards sent home with kids who have high body mass indexes work to inform parents about the problem, they don't provide effective solutions. "Many parents assume they should put their child on a diet," says Berkeley's Ikeda.
What's worse, the reports may be inaccurate. A government analysis found that 17 percent of kids who have a BMI that nudges them into the overweight category actually have a normal percentage of body fat but are large boned or have a greater muscle mass. Nine-year-old Ben Baturka, an avid swimmer who does up to 2 miles of laps while training for his swim meets, was put in the BMI "at risk" zone last year by Hillcrest Elementary School in Drexel Hill, Pa. "He's always been a big boy, but he's a healthy eater and as fit as he can be, so I'm going to ignore the school letter," says Ben's mother, Angie. The American Medical Association recently recommended that doctors perform BMI screenings during annual physicals, looking for weight-related health risks like hypertension or high cholesterol, too.
Clarified on 9/19/07: This story states that 17 percent of kids are now obese, which means they're at or above the 95th percentile for weight in relation to height. The reason that a greater percentage of kids now fall into the "top 5 percent" category is that the standard measurement charts that define obesity were created using data from the 1960s and '70s when kids weighed less than they do now.