My initial reaction to last week's announcement of a new Michigan policy to track kids' weight was emotional and negative. Indeed, so many recently publicized policies and prescriptions regarding weight seem to be uninformed and often stigmatizing toward people who have obesity. For example, there have been calls for taxes levied against people with obesity and proposed laws against serving food to people with obesity, not to mention doctors who systematically refuse to treat patients who are heavy.
So when I heard that Gov. Rick Snyder would mandate doctors to report their patients body mass index (BMI), I jumped to the conclusion that this was yet another example of punishing people for their weight in a society that strongly pushes overeating and weight gain.
But let me explain why this is a good public health measure: It's a core, essential step in our approach to the childhood obesity epidemic. That is, as long as it's done right.
Some argue that this is a case of the government legislating what we eat. Not true. This policy simply asks pediatricians to measure and report kids' height and weight to the Michigan public health system, just as they routinely do for other health measures, such as immunizations, certain infections and other health measures.
This is called public health surveillance. It is the first step in the systematic process of understanding public health problems and implementing solutions. Surveillance is information gathering: collecting, analyzing and interpreting data. Without understanding the scope, magnitude, distribution and other facets of the problem, finding appropriate solutions would essentially be just "shooting in the dark."
Some argue it's a bad idea because BMI is an inaccurate measure of body fat. True, BMI doesn't distinguish between fat and muscle, so some muscular people are inappropriately labeled as overweight (and even more thin-appearing people actually have body fat percentages that put them in the overweight range). For many reasons, I don't depend on BMI in my clinical obesity practice.
But in this case, it isn't being used for individual purposes. All the BMI measurements will be tallied and averaged to understand the distributions of weight and height in the population as a whole. For population assessments, BMI is well studied, effective and affordable.
Others believe the policy will stigmatize overweight kids. That's an important consideration, especially given the stigma we have toward obesity in general. But in this case the policy is right on. The BMI data is collected by pediatricians during annual check-ups and reported anonymously to a public health database. This is no different from how we report immunizations or other health measures. It's "public health 101."
In contrast, imagine how this policy could have gone wrong. What if the policy required measurements to be done at schools -- i.e., kids line up in gym class, shirts off, to be weighed. Few things could be more shaming than this. Some policymakers actually think that a nice ancillary benefit would be the inevitable mockery of the fat kids, which might encourage them to lose weight. It wouldn't. I believe it's a fallacy and a tragedy to think that shaming people will motivate them. As is, kids with obesity experience worse emotional quality of life than kids with cancer.
Sure, this won't solve the obesity problem -- it's not supposed to. But it's an initial step in a tried-and-true public health process that will ultimately help us address this health problem over time.
I hope that it leads to other well-meaning and appropriate interventions. While this policy prompts physicians to measure BMIs, it doesn't give them the knowledge and training to productively and empathically partner with patients to manage their weight. I hope that educating physicians about clinical strategies for weight management and health behavior change will soon be a policy priority.
Right now, medical students and residents are taught almost nothing about obesity, nutrition or behavior change counseling. It shows, as doctors are often disrespectful toward patients with obesity, and they admit to having little knowledge to help their patients. I recently created the first-ever course on obesity at the George Washington University School of Medicine. It was very well received by students and the administration, but it should have been a core part of the curriculum years, if not decades, ago. Indeed, it's one of exceedingly few such courses in the country.
For now, this policy is a fine start to help Michigan understand their childhood obesity epidemic and monitor the effect of future obesity measures. If properly implemented, it should be copied by other states. It's just plain good public health practice.