A. Positive eating environments. To promote positive attitudes toward a variety of foods and the consumption of healthy food choices, school policies will assure every child access to a nutrient-dense lunch (as well as breakfast and snacks in some schools), provide a pleasant, positive eating environment, and allow enough time to eat — at least 15-20 minutes of actual eating time after being served.17 We recommend limiting competition from sources of less nutritious foods, and avoiding sales of soft drinks and candy during school hours and for at least 30 minutes before and after school.
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B. Physical activity opportunities for all children. Physical education classes or recess on a daily basis as appropriate can greatly contribute to a child’s access to physical activity. These experiences should provide a variety of activities so that every child has the opportunity to discover activities that he or she can succeed in and will enjoy.
C. Promotion of size and weight acceptance. Acceptance and respect for oneself and others can be effectively addressed as part of the overall school policy on acceptance of diversity and refusal to tolerate teasing or harassing of students or staff. Obesity prevention programs need t be periodically assessed by appropriate professionals to ensure that they do not create unintentional stigmatization or promote dangerous eating and exercise behaviors.18
D. Sensitive practices related to assessment, referral, and re-entry. Weighing and measuring students in a school setting can potentially have lasting stigmatizing effects (especially for larger students, shorter boys, and taller girls). Safeguards include continuous attention to issues of privacy, respect, social environment, education on growth patterns and realistic body image, follow-up with parents, and referral for diagnosis (see Guidelines for Collecting Heights and Weights, below). Our recommendation is that screening for weight, height, and body fat in schools be limited to situations of identified need and purpose, such as initial assessment and program outcome evaluations.
Height/weight measurements and BMIs need to be considered as part of an overall assessment and not as the single measurement for determining health status. Use of BMIs alone has resulted in inaccurately labeling of children.19 Tables for interpreting weight for height or BMI are based on assumptions that higher weight means higher body fat. However, some children with higher body weights will not be over fat, depending on physical activity, age, stage of puberty, gender, and ethnicity. For example, a recent US Department of Agriculture study shows that one in four children categorized as “at risk” (BMI of 85th to 95th percentile) have normal body fat, and one in six in the normal weight range have high body fat.1 behaviors, weight loss practices, and body image attitudes. Interpretation of data may be 9 Children grow and mature in different ways, and a child’s weight for height or BMI can best be evaluated in relation to his or her own growth history.19, 20 Also, growth spurts may be preceded by an increase in body fat. 21 When weights are measured in schools, we recommend measuring and tracking related factors as well, including fitness levels, eating and activity completed by qualified school personnel or consultants as needed.
It is also desirable for schools to develop a process for dealing with eating problems. This process starts with early detection of eating disorder warning signs, and includes parental involvement and appropriate referrals.
When a problem is diagnosed, the school can be helpful in supporting treatment plans. This is especially critical in the case of students re-entering school after inpatient treatment. Providing training and consultation for school personnel is helpful in dealing with these situations.
