Mike Kilen

The Des Moines Register

DES MOINES, Iowa — The teacher called her to the front of the physical education class to be weighed.

She is 13. She does not like to weigh herself. She especially does not like to be weighed in front of her class. So Ireland Hobert Hoch said no. The teacher said yes. Others in the class told her to just go up and get it over with.

Ireland continued to refuse. She wouldn't be weighed. She was sent to the principal's office.

"I really wasn't comfortable with anybody but my mom and doctor knowing my weight," Ireland said. "For another person to know — that's not important to them."

Ireland's refusal and her mother's complaints to the school board last week sparked the school district to suspend weighing students as part of a measure to determine their body mass index, or BMI, a common health assessment tool in schools across the country.

It also brought up a tender subject. In an era when the country's weight problem is a leading public health concern, school and health officials say it's a vital measure, however imperfect.

About 40 percent of the nation's schools use the measure, and about 20 states require it.

"If it's a math test, is a teacher not going to include something that is vital for a student's math skills?" asked Jennifer Peterson, president of the Iowa Association of Health, Physical Education, Recreation and Dance.

But experts remain divided about its use. The federal Centers for Disease Control and Prevention supports using the measure, but the Eating Disorders Coalition questions whether its focus on weight can cause harm.

Ireland, who is tall (5-foot-7) and lean, surprised her mom by being so outspoken.

Last year, the Pleasant Hill girl quietly took her BMI results — a measure of weight divided by height squared — and crumpled up the paper without looking at them. Her mom didn't even see them.

"If it's so important, why are parents not told? So what is the purpose?" Heather Hobert-Hoch asked.

She has known her daughter is sensitive to her weight and hasn't known the number for more than five years because it bothered her daughter, and she constantly talked about it.

"I wanted to get rid of it as an issue. I didn't want it to affect her eating," Hobert-Hoch said. "I just don't want her to become so worried about weight that it defines who she is."

She thinks a physician's office is the appropriate location for such measures. She was also troubled that her daughter was sent to the office, and she called the school when she found out.

"When I voiced my concerns they said, 'We've done this for years, and you are the only one complaining,' " she said.

Southeast Polk Junior High Principal Mike Dailey said he has received no other complaints about the BMI test.

He said the weight information is private, and other students couldn't see it because they were 5 to 10 feet away. The figures are viewed only by a physical education teacher to assess the child's health, along with measures of strength, cardiovascular condition and flexibility.

The district also uses the data to assess its physical education programs to make sure they are helping students, said Jo Ellen Latham, Southeast Polk's curriculum director.

Ireland isn't backing down, however. She said the documents with weight figures sometimes end up in other students' hands.

"I think there are some body image issues with this girl," Latham said. "The more attention to it, the more it challenges her."

EXPERTS: BMI HELPS FIGHT OBESITY

The fitness assessment program that many students grew up with was from the President's Council on Fitness, Sports and Nutrition. After doing several tests, a student was awarded a badge for making the grade.

But another program, FitnessGram, is now widely used across the country and in Iowa, including Southeast Polk, and measures BMI. An Iowan is its scientific director.

"The use of BMI is widely recommended by the Institute of Medicine, by the Centers for Disease Control and almost every other agency because of the obesity epidemic," said Gregory Welk, professor of kinesiology at Iowa State University and scientific director for the Cooper Institute's FitnessGram.

Helping children learn about their body composition will help them reduce future health risks, he said.

"All measurements should be done in a private way," he said. "But I think it's important they not let one case" prevent other children from getting this information.

BMI has been debated because some results can be skewed, especially if the subject is a thickly muscled athlete. They may score above the normal range, yet be in fine physical condition.

But the federal CDC still recommends its use as one of the least invasive ways of assessment, versus using skin pinch tests or underwater body fat tests that may be more accurate. The agency also acknowledges that little is known about the outcomes of BMI-measurement programs and their utility for young people.

FOCUS ON WEIGHT QUESTIONED

The Eating Disorders Coalition, a national advocacy organization, said there is no evidence that BMI testing has a positive impact on reducing obesity and contends it can do harm.

Studies have shown a higher prevalence of eating disorders among children in activities where weight is emphasized, such as youth recreational wrestling, gymnastics and ballet. Focus on weight also can subject students to bullying and teasing.

A school counselor from Sioux City said such tests should be done with caution.

"I remember wanting to stay home from school the day we were weighed," said Amy DeGroot-Hammer, president of the Iowa School Counselors Association. "We had another student recording the weight and another student writing it down, sometimes yelling out the numbers with all the other students standing around.

"We don't want to ignore health issues, but sometimes you end up with eating disorders," DeGroot-Hammer said. "They end up eating different because of it. The intent might be good, but it is the process. It should maintain a sense of dignity."

There need to be more messages that "you are OK with who you are," she said.

And that's the point Ireland hopes her actions get across to her fellow students.

She said already other girls have whispered to her that they didn't want to be weighed, either.

"I don't want them to feel uncomfortable when they get weighed. I just feel really strongly about it," she said. "Now I feel like it will make a difference."