BMI Measurement in Schools

BMI's in schools.  Huge issue.  Here are my thoughts.

I see both sides of the coin.  I have a unique stance due to my positions at one point in time being on both sides.

As a 22 year old dietetic intern at Vanderbilt, we have a very extensive final community nutrition project that needs to be executed before graduation.  My project was titled, "Address your Health. A Sample Systems Guide to Implementing Health Report Cards in your State."  Seriously, here is proof.

Back then, I was working in Tennessee, a state at the time that ranked 47th in childhood health.  I was in and out of the schools doing various nutrition presentations.  You can't help but physically see the obesity issue.  My project conclusion was a guide to help schools implement "Health Report Cards" that included height, weight, BMI, blood pressure, body fat percentage and waist circumference with suggestion of adding 24 hour diet recall.  It also included sending a letter out to parents in advance allowing them to opt their child out of the Address Your Health screening.  See below.

After I graduated from Vanderbilt, passed my RD Exam and jumped into the world of medical nutrition therapy, guess what my first job was?  Lead Registered Dietitian at a private intensive outpatient treatment center for eating disorders.  My world changed drastically and became a revolving door of anorexia, bulimia, binge eating and addiction.  Patients of all ages cried in my office every single day over how much they hated their bodies, how evil food was, and how they struggled to have a positive personal relationship with themselves.  My view of calories and numbers on a scale swung to the other extreme.  Maybe we should just get rid of all nutrition labels and all scales?

Currently, I treat various different people. I specialize in eating disorders but I also see kids, adults, issues of weight loss, chronic disease management, etc.  I have been in both camps and have felt both sides of the argument.  The bottom line is that health is a major problem with our youth.  The question is, what do we do about it, and who is primarily responsible to do something about it?

Here is my current stance.  It is the parent or guardian's responsibility to ensure that their children are as healthy as possible - in physical health and emotional health.  There are some great parents out there, there are some not-so-great parents out there.  There are also some great parents who struggle with certain aspects of life themselves; for example parents with their own eating issues.  The primary responsibility lies with the parents.

However, educators, administrators, health care providers, coaches and other adults also have a responsibility to demonstrate what a healthy life looks like.  I think it is absolutely ridiculous and hypocritical to be measuring children at school for health data and then offering soda and fried chicken nuggets to them for a meal at lunchtime.  French fries and ketchup are not vegetables.  Schools should be embarrassed if that is the case.  That sends a very confusing message to the child and the parents.

So here is my solution.  If you, your school, your district, your community, truly care and want to get involved in the youth health crisis on a personal or a school level, here is what you need to do.

• As a school, send a letter to the parents.  State the the concern regarding the current youth health crisis and encourage them to visit their doctor or a dietitian to learn their child's trending height, weight, BMI as related to age, and waist circumference.  Let them know in the letter that your school nurse and school psychologist are available for any advice or questions.  And lastly, find a local registered dietitian nutritionist in your area and ask if they wouldn't mind being a resource for your students and parents.  And get the junk food out of your school, period.

• As a school employee, lead by example.  Do not reward children in class with candy or any food.  Do not eat the unhealthy options in the lunch line.  Do not use the soda vending machines.  Let your students see you being healthy and making positive changes.

• As a parent, lead by example.  Stock healthy foods at home.  Do not reward or punish with food.  Do not eat and drink junk food at home.  If you have your own issues with food, let your children see you work towards getting help and changing things for the better.  Do not talk about your body in a negative way.  Do not talk about their bodies in a negative way.  Be open to questions from your kids about anything.  

• As a health care provider, ask the child what they eat in a typical day - yes, ask about nutrition always.  Monitor health data, but never react to it or comment about it in front of the child.  It is typically a comment from a health care provider, said hastily and without support, that will give children the idea that they are overweight, obese, unhealthy, or not good enough.  Please watch your words.

As a registered dietitian nutritionist I would be happy to talk about this topic anytime.  I'll even let you read my "Address Your Health" proposal from grad school.  I will connect you with a registered dietitian nutritionist in your area for a reference.  The road to cleaning up this mess is not easy, but we have to start by taking individual responsibility first, and then we can help others.  The old airplane oxygen mask rule right?

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Mindful Eating

Most of the patients that we see as dietitians struggle with mindless eating on some level. Whether its a severe case of checking out and eating a whole bag of chips, or minor, like coming home from work and going directly to the fridge or pantry. Crave Health intern Alyssa Rieser is going to help you understand the why behind mindless eating.

-Ashley

Have you ever had the experience of eating while under stress - after an argument or rushing to work in the car - and afterwards noticed some digestive upset? Maybe you had a bellyache, felt like your food was “stuck”, or experienced acid reflux. Or maybe you felt completely unsatisfied and were compelled to continue eating past fullness. We’ve all been there before, mindlessly wolfing down our food or eating when in a negative frame of mind. It’s usually followed by poor digestion and discomfort. We know that stress has an impact on health, but too often underestimate the extent of its impact on the digestive system specifically.

Let’s examine what happens on a biochemical level when we eat during a stressful state.

The sympathetic nervous system tells the body to shut down digestion and redirect its energy to other parts of the body for “fight or flight”. The body undergoes many changes occur at this point, including:

• Decreased nutrient absorption increased nutrient excretion

• Increased levels of serum LDL cholesterol (the "bad" cholesterol) and triglycerides

• Decreased gut flora populations (healthy gut bacteria)

• Delayed or increased gastric emptying time

• Increased oxidative stress and inflammation

• Decreased muscle mass

As if that weren’t bad enough, chronic low-level stress is associated with increases in cortisol and insulin, hormones in the body that decrease calorie-burning, increase weight gain, and prematurely age the body.

Yikes! I know this is bad news, but don’t let it stress you out too much yet. By altering your approach to mealtimes you can immediately reap the benefits of better nutrient assimilation, smoother digestion, and a faster metabolism.

Termed eating mindfully, it involves slowing down at mealtimes and cuing in to how you feel on an emotional and physical level. Some of the other benefits of mindful eating include reducing overeating, being satisfied with less, and developing a more joyful relationship with food. A registered dietitian can work with you to not only improve what you’re eating, but how you’re eating. Here are some tips to get you started:

• Make your eating environment peaceful and beautiful - light candles, sit beside a window or outside, place a bouquet of flowers on the dinner table.

• Avoid distractions - put away work, turn off the television, and eat away from the computer. This is not the time to multitask.

• Take 3 slow, deep breaths before beginning a meal to set a slow, relaxed pace. Pay attention to your breathing throughout the meal, reminding yourself that oxygenation helps fuel digestion.

• Practice gratitude. Begin your meal by saying grace or having a moment of silence to acknowledge the nourishment you are about to receive.

• Place your fork or spoon down between bites and chew each bite thoroughly.

• Savor each morsel of food, paying attention to texture, flavor, and any sensations that arise.

• Share your mealtimes with others. Make this a time to enjoy the company of your loved ones. Studies show that families that eat together are closer and experience a greater sense of well-being.

• Choose quality over quantity. Prepare meals with the freshest, highest quality ingredients you can afford.

• Get in the kitchen. Cooking is a powerful way to develop a more positive relationship with food. When we nourish ourselves and others, we derive more satisfaction from eating.

If you’re interested in learning more about eating mindfully, the following books are a great place to start: The Slow Down Diet by Marc David, Intuitive Eating by Evelyn Tribole, and Eating Mindfully by Susan Albers, Psy.D.

by: Alyssa Rieser

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UW Eating Disorder Event

National Eating Disorder Awareness Week is February 20-26th 2011 and is put on by NEDA (www.nationaleatingdisorders.org) around the nation.

Dr. Mehri D. Moore, M.D. is the program founder and medical director for The Moore Center for Eating Disorders here in Washington State.

In celebration of National Eating Disorder Awareness Week, Dr. Moore will be speaking on an expert panel at the University of Washington on eating disorders and body image on Monday, February 28 from 5-6 pm at the Parrington Hall Forum on the UW campus.

Dr. Moore will be joined on the panel by Dr. Emily Cooper, Lisa Geraud, LMFT, RD and Julie Church, RD, CD.

The event is sponsored by the Student Health Consortium at UW and is open to students, professionals and the public. Anyone interested in learning more or joining the discussion please RSVP to Liz at edill@moorecenterclinc.com or 425-451-1134, ext. 102.

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Unbearable Lightness

Portia di Rossi aka Portia deGeneres has written an autobiography titled "Unbearable Lightness" which touches on her struggle with anorexia and bulimia as well as her sexuality. The book was released to the public on November 1st 2010, and I bought and finished it that week.

The book is an open and honest account of her daily struggles with shame, drive and the insanity that comes with obsessing about body weight and living for other people.

As an eating disorder specialist it is interesting to hear different accounts of how people cope with the illness of anorexia, bulimia or body dysmorphic disorder. Reading this book was like hearing the account of any number of patients in my office - the stories are all so similar, but from the inside, each person feels as if he or she is the only one that feels this way or thinks this way or acts this way. Some are ashamed of those thoughts and behaviors and some are proud of them. That's the bizarre world of an eating disorder.

She does reveal numbers, which some in recovery choose not to do, since those who are active in their disorders tend to use those numbers as a goal or a new record to beat. She reveals things like her highest and lowest weight, number of calories consumed in a typical restrictive day and number of times she binges, purges and hours spent at the gym. Obviously if you see these numbers as a personal challenge...you my friend, belong in my office.

Its a must read for anyone who struggles with body image, anyone who has a child and anyone who is active in their own disorder.

A+ Rating from this ED dietitian!

Pick it up from itunes or ibooks or from Amazon:

http://www.amazon.com/Unbearable-Lightness-Story-Loss-Gain/dp/1439177783/ref=pd_nr_b_16?ie=UTF8&s=books

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Influence of the Media

I cannot tell you how often young men and women sit in my office and tell me how hard it is to accept the goals and direction that I am giving them towards health, when they have to see and hear completely opposite information on TV, in magazines, on the radio, everywhere.

The influence that the media has over our minds is incredible, and lately very dangerous. The average American watches about 4 hours of TV per day (about 28 hours per week or a nonstop 2 months per year) compared to the average 3.5 minutes parents spend in meaningful conversation with their child. Wait, what?! Let me repeat that:

The average time an American watches TV per DAY: 4 HOURS

The average time an American parent spends in
meaningful conversation with their child per WEEK: 3.5 MINUTES.

Wow. We have some work to do.

We are subjected to a lot of media including television, magazines, internet and radio. There are shows about people who are too skinny, too fat, addicted, wanna-be models, wanna-be body builders, etc. And when those shows cut to commercial we see ads for diet pills (you know how I feel about those), diet food, makeup, clothes, hair, exercise equipment, and on and on and on…

The funny thing is, that no matter how smart you think you are, how confident, how “above others influences”, there are things in the media that will actually make you think twice about something you already know. The way information is presented, with tiny bits of science blown so out of proportion it’s insane, can actually get your brain thinking it’s true. How many people have heard of “The Blood Type Diet” or “The Lemonade Cleanse” or “Acai Berry” juice, pills, etc. I have been asked about all of these and many more by people who are in the health and fitness field and by those who aren’t. My point is that its very hard to sift through all this information when we don’t know who or what is actually credible. More on that topic in another post.

What concerns me is the youth, whose minds are still very impressionable and quick to jump to conclusions about themselves and their own bodies, which in turn severely impacts self-esteem and confidence. Let me show you what I mean:

The Dove Campaign is absolutely fantastic and I applaud Dove for stepping up and taking on the responsibility of showing young girls positive role models. The statistics of dieting and eating disorders among young girls is horrific and it gives me goosebumps just thinking about how staggering the numbers are. As adults, we all have a responsibility to set an example for our children, friends, peers, acquaintances and yes, even strangers. Accepting and loving yourself just the way you are can sometimes seem hard to do, but think about why its hard. Is it because you don’t look like the lingerie model on the billboard? Well if you watched that video you should know that model doesn’t look like that either.

God created each and every one of us the way we are for a specific reason. We are all not meant to look the same! Now, if you’ve not treated your body well, and it has morphed into something you don’t recognize, then you can work to get back the body God intended for you (my friend Paula calls it her “inheritance weight”). Being happy and healthy is what matters, not your pant size or a number on the scale.

Take today to walk with your head held high, and a smile on your face. The way you carry yourself on a daily basis has more influence over someone’s impression of you than the way you look. No matter what you might think. Do this in your own life and it may rub off on a child or a teenager you didn’t know was watching.

Blessings,

Ashley

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