This article by Brett Montgomery, Senior Lecturer in General Practice at The University of Western Australia, Clare Collins, Laureate Professor in Nutrition and Dietetics at the University of Newcastle, Natasha Yates, General Practitioner and PhD Candidate at Bond University, Rachael Jefferson, Lecturer in Human Movement Studies (Health and PE) and Creative Arts at Charles Sturt University and Vivienne Lewis, Assistant Professor Psychology at the University of Canberra originally appeared in The Conversation on 12 September 2024.
One in four Australian children aged two to 17 are classified as above a healthy weight, based on their body mass index (or BMI, which is weight divided by height squared).
The Australian College of Nursing says school nurses can play in curbing childhood obesity and preventing chronic disease by weighing and measuring school-aged children.
Karen Grace, the Australian College of Nursing’s national director of professional practice told the Nine newspapers: "Nurses are perfectly placed to help identify when further help is needed and to refer to a GP or dietitian."
The proposal has sparked anger from health professionals and parents, but the college says its aim is to reduce stigma and judgement, and to support families.
So, should school nurses weigh students? We asked five experts.
Five out of five said no. Here are their detailed responses:
Brett Montgomery
No.
School nurses are capable health professionals, but that doesn’t mean they should routinely weigh kids.
Child obesity is notoriously difficult to prevent, even in ideal research settings. An unsolicited call or letter from an unfamiliar nurse explaining that your child is overweight, and offering referral, seems less than ideal. Some parents find such information useful; others find it belittling. Some students feel stigmatised when weighed at school.
Several studies find such screening to be ineffective in changing weight. So, while well-intentioned, I think the proposed model won’t work. This isn’t surprising, as studies show even significantly more intensive interventions over several years fail to help children’s weight.
We need more research to learn how nurses can best help. Programs incorporating combined dietary education and physical activity in schools, rather than advice and external referral, may be slightly more effective.
We should also act on drivers of obesity outside the health system. Let’s make healthier foods cheaper, and our physical environment more conducive to physical activity.
Clare Collins
This is a definite and emphatic no!
Weighing children at school equates to throwing a bunch of dishcloths to a person whose house is flooding. My plea is to take a step back and look at what’s causing the flood.
Don’t blame and shame people with a genetic predisposition to gaining weight, dropped into today’s environment that promotes energy-dense, nutrient-poor food relentlessly.
A better strategy is to nourish children while they’re at school, especially when the school’s in a socioeconomically disadvantaged area. Provide school breakfast programs that fuel children’s brains so they can concentrate on learning, rather than being distracted by hunger. Offer after-school homework clubs that provide supervision, tutoring and specialised help in subjects children need more support in, plus creative activities and nourishing snacks.
If we really care about children and their families, let’s provide a leg up, not a “fail” on scales.
Natasha Yates
No.
What we measure becomes our target – and our target should be increasing children’s health, not reducing their body size.
Measuring weight and BMI is convenient data to monitor from a public health perspective. But it often means children’s weight becomes the focus of public health programs that use this data.
Research shows focusing on weight increases stigma, and stigma leads to weight gain
Focusing on health, rather than weight, is more effective for weight loss. Professional groups that represent child health experts have adjusted their recommendations around obesity management accordingly.
Weighing children in a semi-public setting such as a school may also contribute to body image issues, embarrassment or bullying. This could worsen mental health in vulnerable children, regardless of their actual weight. Shame around body weight paradoxically increases unhealthy eating behaviours in children.
Funding should instead be directed to evidence-based approaches that are holistic, de-stigmatising, empowering and that support the health of whole families.
Rachael Jefferson
No.
The Australian College of Nursing plan is doomed. Risk factors for overweight and obesity are highly complex, encompassing genetic and environmental factors.
Height-weight measurements are used to calculate body mass index (BMI) – an unreliable evaluation of healthy versus unhealthy weight for adults, let alone children. Critical growth periods during childhood and adolescence can skew these assessments. The effects of puberty can be overlooked, along with ethnicity, fat distribution, and variations in bone density and muscle mass.
The proposal also conflates height and weight, with health and physical activity levels. Weight is a poor predictor of health, and there is no research consensus about how a child’s weight affects their levels of physical activity.
This all feels like a surveillance scheme fuelled by moral panic about childhood obesity. Worryingly, it could lead to body shaming children and young people at a time when they are already extremely vulnerable to mental health conditions.
Vivienne Lewis
No.
Measuring weight is not a helpful marker of physical or mental health and it perpetuates the myth that you can tell a person’s health from their appearance.
Emphasising weight is also likely to add to the shame children and their families may already feel and feed into negative stereotypes of those in larger bodies. Weight comparisons between children can also lead to teasing and body shaming.
Already, almost half of children and young people don’t like their bodies. This is often because of negative perceptions of their weight and the belief something’s wrong with their body. Drawing more negative attention to a child’s weight will only exacerbate this problem and increase their risk of developing eating disorders.
