Skip to main content

African-American Parents' Knowledge and Perceptions About BMI Measurements, School-Based BMI Screening Programs, and BMI Report Cards: Results from a Qualitative Investigation and Implications for School-to-Parent Communication

Abstract

School-based body mass index (BMI) screenings can help parents make informed decisions about their child’s health, but schools have questioned parents’ understanding and attitudes about BMI measures and report cards. Although researchers have investigated minority parents' perceptions of their child's weight, no research has explored minority parents' knowledge and perceptions related to BMI measurements, school-based BMI screening programs, and BMI report cards. To address this gap, focus groups were conducted (n = 20) with female Black or African-American parents/guardians from a large urban school district. Participants were asked to share their perceptions before and after receiving education about BMI measurements and screening programs. Pre-education: Many participants had heard of BMI, thought it was similar to body fat, believed screenings were intended to track students’ weights and monitor eating habits, and were concerned that screenings could cause their child embarrassment. Post-education: Most participants did not object to screenings, but said they would have without education about why and how BMI measurements are taken. They also voiced concerns about lack of prior notice, confidentiality, and the need for schools to serve healthier food. Some of these findings support those of other qualitative studies of parents' concerns about BMI screenings, but no previous studies have compared parents' perceptions of screening programs pre-/post-education. The results reinforce that schools' efforts to explain what BMI measurements are as well as why and how they are taken can increase parents' confidence in the schools and level of comfort with BMI screening programs and report cards.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. US Department of Health and Human Services, Centers for Disease Control and Prevention. Youth risk behavior surveillance—United States 2011. Morbidity and Mortality Weekly Report. 2012;61(4):1–162.

    Google Scholar 

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Ruggieri DG, Bass SB. A comprehensive review of school-based BMI screening programs and their implications for school health: do the controversies accurately reflect the research? Journal of School Health. 2015;85(1):61–72.

    Article  PubMed  Google Scholar 

  4. Institute of Medicine of the National Academies. Preventing childhood obesity: health in the balance. 2005. http://www.nap.edu/catalog/11015.html#toc. Accessed June 24, 2015.

  5. Pagnini DL, Wilkenfeld RL, King LA, Booth ML, Booth SL. Mothers of pre-school children talk about childhood overweight and obesity: the Weight of Opinion study. Journal of Paediatrics & Child Health. 2007;43(12):806–10.

    Article  Google Scholar 

  6. Small L, Melnyk BM, Anderson-Gifford D, Hampl JS. Exploring the meaning of excess child weight and health: shared viewpoints of Mexican parents of preschool children. Pediatric Nursing. 2009;35(6):357–66.

    PubMed  Google Scholar 

  7. West DS, Raczynski JM, Phillips MM, Bursac Z, Heath Gauss C, Montgomery BEE. Parental recognition of overweight in school-age children. Obesity. 2008;16(3):630–6.

    Article  PubMed  Google Scholar 

  8. Reifsnider E, Flores-Vela AR, Beckman-Mendez D, Nguyen H, Keller C, Dowdall-Smith S. Perceptions of children's body sizes among mothers living on the Texas-Mexico Border (La Frontera). Public Health Nursing. 2006;23(6):488–95.

    Article  PubMed  Google Scholar 

  9. Myers S, Vargas Z. Parental perceptions of the preschool obese child. Pediatric Nursing. 2000;26(1):23–30.

    CAS  PubMed  Google Scholar 

  10. Young-Hyman D, Herman LJ, Scott DL, Schlundt DG. Care giver perception of children’s obesity-related health risk: a study of African American families. Obesity Research. 2000;8:241–8.

    CAS  Article  PubMed  Google Scholar 

  11. Adams AK, Quinn RA, Prince RJ. Low recognition of childhood overweight and disease risk among Native-American caregivers. Obesity Research. 2005;13(1):146–52.

    Article  PubMed  Google Scholar 

  12. Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C, et al. BMI measurement in schools. Pediatrics. 2009;124 Suppl 1:S89–97.

    Article  PubMed  Google Scholar 

  13. Baughcum A, Chamberlin L, Deeks C, Powers S, Whitaker R. (6), 1380. Maternal Perceptions of Overweight Preschool Children. Pediatrics. 2000;106(6):1380–6.

    CAS  Article  PubMed  Google Scholar 

  14. Chaparro MP, Langellier BA, Kim LP, Whaley SE. Predictors of accurate maternal perception of their preschool child's weight status among Hispanic WIC participants. Obesity. 2011;19(10):2026–30.

    Article  PubMed  Google Scholar 

  15. Chomitz VR, Collins J, Kim J, Kramer E, McGowan R. Promoting healthy weight among elementary school children via a health report card approach. Archives of Pediatrics and Adolescent Medicine. 2003;157:765–72.

    Article  PubMed  Google Scholar 

  16. Hearst MO, Sherwood NE, Klein EG, Pasch KE, Lytle LA. Parental perceptions of their adolescent's weight status: the ECHO Study. American Journal of Health Behavior. 2011;35(2):248–55.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rivera-Soto WT, Rodriguez-Figueroa L. Childhood obesity among Puerto Rican children: discrepancies between child and parent's perceptions of weight status. Int J Environ Res Public Health. 2012;9(4):1427–37. doi:10.3390/ijerph9041427.

    Article  PubMed  PubMed Central  Google Scholar 

  18. . University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health. Year Six Evaluation: Arkansas Act 1220 of 2003 to combat childhood obesity. University of Arkansas for Medical Sciences, Little Rock. 2009. http://publichealth.uams.edu/files/2012/06/COPH-Obesity-Evaluation-Report-6.pdf. Accessed December 20, 2010

  19. Vanhala M, Keinanen-Kiukaanniemi S, Kaikkonen K, Laitinen J, Korpelainen R. Factors associated with parental recognition of a child's overweight status—a cross sectional study. BMC Public Health. 2011;11(1):665–71.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wald ER, Ewing LJ, Cluss P, Goldstrohm S, Cipriani L, Colborn DK, et al. Parental perception of children’s weight in a paediatric primary care setting. Child: Care, Health and Development. 2007;33(6):738–43.

    CAS  Google Scholar 

  21. Eckstein KC, Mikhail LM, Ariza AJ, Thomson JS, Millard SC, Binns HJ. Parents' perceptions of their child’s weight and health. Pediatrics. 2006;117:681–90.

    Article  PubMed  Google Scholar 

  22. Kersey M, Lipton R, Quinn MT, Lantos JD. Overweight in Latino preschoolers: do parental health beliefs matter. American Journal of Health Behavior. 2010;34(3):340–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Boutelle K, Fulkerson JA, Neumark-Sztainer D, Story M. Mother’s perceptions of their adolescents’ weight status: are they accurate? Obesity Research. 2004;11:1754–7.

    Article  Google Scholar 

  24. Campbell M, Williams J, Hampton A, Wake M. Maternal concern and perceptions of overweight in Australian preschool-aged children. Medical Journal of Australia. 2006;184(6):274–7.

    PubMed  Google Scholar 

  25. Moore L, Harris C, Bradlyn A. Exploring the relationship between parental concern and the management of childhood obesity. Maternal & Child Health Journal. 2012;16(4):902–8.

    Article  Google Scholar 

  26. Jeffery AN, Voss LD, Metcalf BS, Alba S, Wilkin TJ. Parents’ awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21). British Medical Journal. 2005;330(7481):23–4.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Maynard LM, Galuska DA, Blanck HM, Serdula MK. Maternal perceptions of weight status of children. Pediatrics. 2003;111(5 Pt 2):1226–31.

    PubMed  Google Scholar 

  28. Booth ML, King LA, Pagnini DL, Wilkenfeld RL, Booth SL. Parents of school students on childhood overweight: the Weight of Opinion Study. Journal of Paediatrics and Child Health. 2009;45:194–8.

    Article  PubMed  Google Scholar 

  29. Harris CV, Neal WA. Assessing BMI in West Virginia schools: parent perspectives and the influence of context. Pediatrics. 2009;124:S63–72.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Krukowski RA, West DS. Response to the article, "The risks of a quick fix: a case against mandatory body mass index reporting laws". Eating Disorders: The Journal of Treatment & Prevention. 2009;17(2):103–6.

    Article  Google Scholar 

  31. Lampard AM, Byrne SM, Zubrick SR, Davis EA. Parents' concern about their children's weight. International Journal of Pediatric Obesity. 2008;3(2):84–92.

    Article  PubMed  Google Scholar 

  32. Denehy J. Health report cards: an idea whose time has come? Journal of School Nursing. 2004;20(3):125–6.

    Article  PubMed  Google Scholar 

  33. Evans EW, Sonneville KR. BMI report cards: will they pass or fail in the fight against pediatric obesity? Current Opinion In Pediatrics. 2009;21(4):431–6.

    Article  PubMed  Google Scholar 

  34. U.S. Census Bureau. Census Interactive Population Map, 2010. 2010. www.census.gov/main/www/access.html. Accessed March 15 2014.

  35. Institute of Education Sciences National Center for Education Statistics, U.S. Department of Education. Common Core of Data for the Philadelphia City School District: 2011–2012 school year. 2014. http://nces.ed.gov/ccd/districtsearch/district_detail.asp?Search=1&City=philadelphia&State=42&DistrictType=1&DistrictType=2&DistrictType=3&DistrictType=4&DistrictType=5&DistrictType=6&DistrictType=7&NumOfStudentsRange=more&NumOfSchoolsRange=more&DistrictPageNum=4&ID2=4218990&details=5. Accessed March 15, 2014

  36. Centers for Disease Control and Prevention. Youth Online: High School YRBS - Philadelphia, PA 2011 and United States, 2011 Results. 2014. http://apps.nccd.cdc.gov/youthonline/App/Results.aspx?TT=G&OUT=0&SID=HS&QID=QQ&LID=PH&YID=2011&LID2=XX&YID2=2011&COL=&ROW1=&ROW2=&HT=5&LCT=&FS=1&FR=1&FG=1&FSL=&FRL=&FGL=&PV=&TST=False&C1=&C2=&QP=G&DP=1&VA=CI&CS=Y&SYID=&EYID=&SC=DEFAULT&SO=ASC. Accessed March 15, 2014

  37. Krueger RA, Casey MA, Focus Groups. A practical guide for applied research. 2000. SAGE Publications.

    Google Scholar 

  38. Rabiee F. Focus-group interview and data analysis. Proc Nutr Soc. 2004;63(4):655–60.

    Article  PubMed  Google Scholar 

  39. Doolen J, Alpert PT, Miller SK. Parental disconnect between perceived and actual weight status of children: a metasynthesis of the current research. Journal of the American Academy of Nurse Practitioners. 2009;21(3):160–6.

    Article  PubMed  Google Scholar 

  40. Carnell S, Edwards C, Croker H, Boniface D, Wardle J. Parental perceptions of overweight in 3–5 year olds. International Journal of Obesity and Related Metabolic Disorders. 2005;29:353–5.

    CAS  Article  Google Scholar 

  41. Genovesi S, Giussani M, Faini A, Vigorita F, Peiruzzi F, Strepparava MG, et al. Maternal perception of excess weight in children: a survey conducted by pediatricians in the province of Milan. Acta Paediatrica. 2005;94:747–52.

    Article  PubMed  Google Scholar 

  42. Hudson E, McGloin A, McConnon A. Parental weight (mis)perceptions: factors influencing parents' ability to correctly categorise their child's weight status. Maternal and Child Health Journal. 2012;16(9):1801–9.

    Article  PubMed  Google Scholar 

  43. Rhee KE, Lago CWD, Arscott-Mills T, Mehta SD, Davis RK. Factors associated with parental readiness to make changes for overweight children. Pediatrics. 2005;116:e94–e101.

    Article  PubMed  Google Scholar 

  44. Goodman E, Hinden BR, Khandelwai S. Accuracy of teen and parental reports of obesity and body mass index. Pediatrics. 2000;106:52–8.

    CAS  Article  PubMed  Google Scholar 

  45. Murphy M, Polivka B. Parental perceptions of the schools' role in addressing childhood obesity. Journal of School Nursing. 2007;23(1):40–6. doi:10.1177/10598405070230010701.

    Article  PubMed  Google Scholar 

  46. Johnson A, Ziolkowski GA. School-based body mass index screening program. Nutrition Today. 2006;41(6):274–9.

    Article  Google Scholar 

  47. Di Benedetto GB. Body Mass Index (BMI) report cards: should schools be responsible for screening? [Editorial - Con Position]. American Journal of Maternal Child Nursing. 2009;34(4):209.

    Article  Google Scholar 

  48. Tuttle M. Did you call my kid fat? In: Philly Moms Blog. 2009. http://www.phillymomsblog.com/2009/02/body-image-and-children.html. Accessed December 20, 2010.

  49. Stalter AM, Chaudry RV, Polivka BJ. Regional differences as barriers to body mass index screening described by Ohio School Nurses. Journal of School Health. 2011;81(8):437–48.

    Article  PubMed  Google Scholar 

  50. University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health. Year Seven Evaluation: Arkansas Act 1220 of 2003 to combat childhood obesity. University of Arkansas for Medical Sciences, Little Rock. 2011. http://publichealth.uams.edu/files/2012/06/COPH-Year-7-Report-Sept-2011.pdf. Accessed July 30 2013

  51. Adams JB, Adams JB. Practical applications and limitations of tracking body mass index in schools. Journal of Physical Education, Recreation & Dance (JOPERD). 2009;80(4):14–7.

    Article  Google Scholar 

  52. Gordon R. Children's weight data 'inaccurate', say school nurses. Nursing Standard. 2007;22(8):8–11.

    Google Scholar 

  53. Dietz WH, Story MT, Leviton LC. Issues and implications of screening, surveillance, and reporting of children's BMI. Pediatrics. 2009;124 Suppl 1:S98–S101.

    Article  PubMed  Google Scholar 

  54. Stoddard SA, Kubik MY, Skay C. Is school-based height and weight screening of elementary students private and reliable? Journal of School Nursing. 2008;24(1):43–8.

    Article  PubMed  Google Scholar 

  55. Stalter AM, Chaudry RV, Polivka BJ. Facilitating factors and barriers to BMI screening in schools. Journal of School Nursing. 2010;26(4):320–30. doi:10.1177/1059840510368524.

    Article  PubMed  Google Scholar 

  56. Kaczmarski JM, DeBate RD, Marhefka SL, Daley EM. State-mandated school-based BMI screening and parent notification: a descriptive case study. Health Promotion Practice. 2011;12(6):797–801. doi:10.1177/1524839911419289.

    Article  PubMed  Google Scholar 

  57. Kaczmarski JM. Exploring the effects of BMI health report card letters among 6th grade students and parents: An application of the social cognitive theory [Masters Thesis]. Tampa, FL. 2009.

  58. Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C, et al. Body mass index measurement in schools. Journal of School Health. 2007;77(10):651–71.

    Article  PubMed  Google Scholar 

  59. Ruggieri DG. An investigation of parents’ perceptions of BMI and BMI-for-age, school-based BMI screening programs and BMI report cards: using framing theory and perceptual mapping methods to develop a tailored BMI report card for the school district of Philadelphia [Dissertation]. Philadelphia: Temple University; 2011.

  60. University of Arkansas for Medical Sciences College of Public Health. Establishing a Baseline to Evaluate Arkansas Act 1220 of 2003: An Act of General Assembly to Combat Childhood Obesity. University of Arkansas for Medical Sciences, Little Rock. 2005. http://publichealth.uams.edu/files/2012/06/2004Act12202003Y1Eval.pdf. Accessed December 20, 2010

  61. University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health. Year Three Evaluation: Arkansas Act 1220 of 2003 to combat childhood obesity. University of Arkansas for Medical Sciences, Little Rock. 2007. http://publichealth.uams.edu/files/2012/06/2006Act1220_Year3.pdf. Accessed December 20, 2010

  62. University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health. Year Four Evaluation: Arkansas Act 1220 of 2003 to combat childhood obesity. University of Arkansas for Medical Sciences, Little Rock. 2008. http://publichealth.uams.edu/files/2012/06/COPH-Obesity-Evaluation-Report-4.pdf. Accessed December 20, 2010

  63. University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health. Year Five Evaluation: Arkansas Act 1220 of 2003 to combat childhood obesity. University of Arkansas for Medical Sciences, Little Rock. 2008. http://publichealth.uams.edu/files/2012/06/COPH-Obesity-Evaluation-Report-5.pdf. Accessed December 20, 2010

  64. Nauta C, Byrne C, Wesley Y. School nurses and childhood obesity: an investigation of knowledge and practice among school nurses as they relate to childhood obesity. Issues Comprehensive Pediatric Nursing. 2009;32(1):16–30.

    Article  PubMed  Google Scholar 

  65. Hendershot C, Telljohann SK, Price JH, Dake JA, Mosca NW. Elementary school nurses' perceptions and practices regarding body mass index measurement in school children. Journal of School Nursing. 2008;24(5):298–309.

    Article  PubMed  Google Scholar 

  66. Dodd AC. Act 1220 reviewed: an examination of the effect of parent attitude toward the Child Health Report [Dissertation]. Conway: University of Central Arkansas; 2013.

    Google Scholar 

Download references

Conflict of Interest

D. G. Ruggieri and S.B. Bass declare that they have no conflict of interest.

Ethics and Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants for being included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dominique G. Ruggieri.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ruggieri, D.G., Bass, S.B. African-American Parents' Knowledge and Perceptions About BMI Measurements, School-Based BMI Screening Programs, and BMI Report Cards: Results from a Qualitative Investigation and Implications for School-to-Parent Communication. J. Racial and Ethnic Health Disparities 3, 320–330 (2016). https://doi.org/10.1007/s40615-015-0149-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-015-0149-0

Keywords

  • Body mass index (BMI)
  • Screening programs
  • School health
  • BMI report cards
  • Focus groups
  • Black or African-American parents