Measuring BM I

StateofAlaska
MeasuringHeight/Weightand
CalculatingBMI
GuidelinesforSchools

2/1/2011
Reprinted3/15/2012

SeanParnell,Governor
StateofAlaska

WilliamJ.Streur,Commissioner
DepartmentofHealth&SocialServices

WardB.Hurlburt,M.D.,MPH
ChiefMedicalOfficer
Director,DivisionofPublicHealth

StephanieBirch,RNC,MPH,FNP,SectionChief
SectionofWomens,Childrens,&FamilyHealth
StateofAlaska
MeasuringHeight/WeightandCalculatingBMI

Acknowledgements:
ThisguidelinedocumentwasdevelopedincollaborationwiththeAlaskaDepartmentofHealthand
SocialServices,DivisionofPublicHealth,SectionofWomens,Childrens,&FamilyHealth,School
Nursing/SchoolHealthProgram,theSchoolHealthNurseAdvisoryCommittee,andtheSectionof
ChronicDiseasePrevention&Control,ObesityPrevention&ControlProgram.
Theguidelineswerepreparedby:
MaryBell,RN,BSN,NCSN MaureenKauleinamoku,MSN,RN

KarolFink,MS,RD ChristyKinter,RN

PatriciaBarker,RN,BSN MartyLanglois,RN

NancyEdtl,MBA,BSN,RN,NCSN MicheleMork,RN

LuannFogels,RN,BSN,NCSN LuannPowers,RN,BSN

KristaGrilliot,RN,BSN,NCSN ChrisVanCleve,RN,NCSN

RebeccaHansen,RN,NCSN NaomiWalsworth,RN,BSN

FaithHundley,BSN,RN,NCSN SuzanneZaw,RN,PHN,MSN
Contactinformation:
MaryBell,RN,BSN,NCSN
SchoolHealthNurseConsultant
DepartmentofHealth&SocialServices,
DivisionofPublicHealth,
SectionofWomens,Childrens,&FamilyHealth
3601CStreet,Suite322,Anchorage,AK99503
9072697368Fax9072693465mary.bell@alaska.gov
StateofAlaska

TableofContents
INTRODUCTIONANDPURPOSE.........................................................................................................1
BurdenofOverweight&Obesity
HowschoolscanhelpwithScreening&Surveillance
BESTPRACTICEDETERMINANTS........................................................................................................3
Bestpracticeconsiderations
Establishingpolicyandprocedures
Safeguardsforsuccessfulimplementation
DEFINITIONS.....................................................................................................................................5
EQUIPMENT......................................................................................................................................5
CriticalComponents
CalibrationofEquipmentandUseofUptoDateScreeningTools
WeightScales
HeightStadiometers
PROTOCOL/PROCEDURE...................................................................................................................7
Whentoscreen
TheProcess
INSTRUCTIONSFORMEASURINGWEIGHT
INSTRUCTIONSFORMEASURINGHEIGHT
CALCULATINGBMI
PLOTTINGBMIVALUESONAPPROPRIATEGROWTHCHARTS
INTERPRETBMIFORAGEPERCENTILESCORE
REPORTRESULTSTOPARENTSORGUARDIANS
ROLEOFTHESCHOOLNURSE..........................................................................................................11
COLLABORATINGWITHTHEDIVISIONOFPUBLICHEALTH...............................................................12
RESOURCES.....................................................................................................................................13
Resourcesforkids
FORMS
Appendices.....................................................................................................................................14
AppendixA:SamplePreScreeningNotificationtoSchoolFacultyandStaff
AppendixB:SamplePreScreeningNoticetoParentsandGuardians
AppendixC:SamplePrescreeningNotificationofLocalPrimaryCareProviders
AppendixD:SampleReferralLettertoParentsandGuardiansforBMIScreeningReferral
AppendixE:SampleScreeningResultsforParentsandGuardians
AppendixF:SamplePhysicianPostScreeningNotificationLetter
AppendixG:BloodPressureValuesRequiringFurtherEvaluation,AccordingtoAgeandGender
REFERENCES....................................................................................................................................21

StateofAlaska

StateofAlaska

INTRODUCTIONANDPURPOSE:
ThepurposeoftheDivisionofPublicHealthsMeasuringHeight/WeightandCalculatingBMIGuidelines
forSchoolsistoprovideschoolstaffwiththenecessaryinformationandtoolstosuccessfullyand
accuratelycollectheightsandweights,calculateBMI,utilizecriteriaforreferral,communicate
effectivelywithparentsandguardians,andprovideaggregatesurveillancedatatotheDivisionofPublic
Healthasdesired.Theseguidelinesareofferedasbestpracticeinformationfromwhichschooldistrict
policyandproceduresmaybebased.Theguidelinesarenotmandatoryandeachschooldistrictmay
adoptthestandardsthatbestmeettheneedsoftheirstudentpopulation.
BurdenofOverweight&Obesity
Childrenwhoarenotofahealthyweightareatriskforavarietyofhealthproblems,makingearly
identificationofweightstatusimportant.Eatingdisorderssuchasanorexia,bulimiaandbingeeating
canresultinbothseriouslongtermhealthproblemsandpoorschoolperformance.1
ObesityhasbecomeamajorhealthproblemforAmericansandAlaskans.Aboutathirdoftheadult
populationisnowobeseandanadditionalonethirdisoverweight.Sincethe1980s,thenational
overweightandobesityrateshavetripledforyouth.Currentlybetween27and40%ofAlaskaschildren
areoverweightandobese.2
ObesechildrenareatincreasedriskofanumberofchronicconditionsincludingType2diabetes,
hypertension,highcholesterol,asthma,certainformsofcancerandnonalcoholicsteatohepatities(fatty
liver).Obeseyouthmayalsoexperiencesocialstigmatizationanddiscrimination,aswellaspsychological
problems.ObesestudentsarelesslikelytoreportearningmostlyAsandBsinhighschoolthannormal
weightstudents.Inaddition,childrenandadolescentswhoareoverweightandobesehaveanincreased
riskofbeingoverweightorobeseasadults.2
HowschoolscanhelpwithScreening&Surveillance
Obtainingheightandweightmeasurementvaluesisthemostpracticalmethodavailableforassessing
childrensgrowth.ThesevaluescanbeplottedonaCDCU.S.2000growthchartforcomparisonwith
otherchildrenofthesameageandsex.ThevaluescanbeutilizedtocalculatetheBodyMassIndex
(BMI)whichistheratioofweight(kg)toheightinmeterssquared.BMIisusedtoassessweightstatus
andtoestimateapersonsriskofweightrelatedhealthproblems.ABMImeasurementisrelativelyeasy
tomeasure,inexpensive,noninvasive,quicktoobtainandcorrelateswithbodyfat.3Inchildrenand
adolescents,BMIchangeswithageandsex.Aschildrenage,BMIincreases.Therefore,forchildrenand
adolescents,BMIvaluesmustthenbeplottedonasexspecificgrowthcurvetodeterminethe
percentileforsexandageinordertoestimatethestudentsriskofweightrelatedhealthproblems.It
shouldbenotedthatBMIshouldnotbeusedalonetodetermineweightstatusofanindividualchild.
Ratheritshouldbeusedtoidentifychildrenandadolescentswhoneedtobeexaminedfurtherbya
healthcareprovidertoobtainaninformeddiagnosis.3,4SchoolbasedBMImeasurementprogramsare
conductedforsurveillanceand/orscreeningpurposes.

StateofAlaska

BMIsurveillanceprogramsassesstheweightstatusoftheschoolpopulationto
identifythepercentageofstudentswhoarepotentiallyatriskforweightrelated
healthproblems.

BMIscreeningprogramsassesstheweightstatusofindividualstudentsto
identifythoseatriskandprovideparentswithinformationtohelpthemtake
appropriateaction.3

BMIscreeninginformationwillenableaschoolhealthprofessionalto:
Identifystudentswhomaybeatnutritionalrisk
Identifystudentswhoareatriskforeatingdisorders
Identifystudentswhoareunderweight,overweight,orobese
Encouragediscussionsbetweenfamiliesandhealthcareprovidersabouttheirchildsgrowth
anddevelopment
Promotehealthyeatingandphysicalactivityintheschoolenvironment1
ThepurposeofBMIsurveillanceisto:
Createawarenessamongschoolandhealthpersonnel,communitymembers,andpolicymakers
oftheextentofweightproblemsinspecificpopulations
Provideanevaluationmeasurefortheeffectivenessofschooldistrictwellnesspolicies,
practices,programsandeffortstoimproveschoolhealth
Strengthenschooldistrictgrantapplicationsbyclearlyidentifyingneed,targetpopulations,and
byprovidinganevaluationmechanism
Providelocalcommunityhealthagenciesinformationformonitoringcommunityhealth,
describingtrendsinweightstatusovertime,identifyingdisparatepopulations,evaluating
communityhealthpromotioneffortsanddeterminingprioritiesfortargetingpreventionefforts
andtreatmentprograms
AssisttheStateofAlaskaDivisionofPublicHealthtoprovidebettertechnicalassistanceto
schooldistrictsandlocalagenciestohelpidentifyhealthrisks,developinterventions,and
determinehowtotargetlimitedfinancialresources2,3
StateofAlaska

BESTPRACTICEDETERMINANTS
Bestpracticeconsiderations
BecauseofthenumerousadvantagesofusingBMIforagetoassessoverweightinchildrenand
adolescents,expertcommitteesandadvisorygroupshaverecommendedBMIforageastheaccepted
measure.In1997,aninternationalconferenceconvenedbytheInternationalObesityTaskForce
concludedthatBMIisareasonablemeasureforassessingoverweightinchildrenandadolescents
worldwide.5AlthoughBMIisusedtoscreenforoverweightandobesityinchildrenandteens,BMIisnot
adiagnostictool.Manyfactorscontributetoyouthheightandweight,andthereareundoubtedly
culturaldifferencesinthedistributionofthosefactors.Nonetheless,becausetherecurrentlyisno
clinicallysignificantdifferenceintherelationshipbetweenBMIandbodycompositionindifferentracial
andethnicgroups,itisrecommendedthatthesameBMIstandardsbeappliedtoallracialandethnic
subpopulations.6,7Thesameholdstrueforathleteswithpotentiallymoreleanmusclemassthanfat
composition.Todeterminewhetherachildorteenhasexcessfat,furtherassessmentwouldbeneeded.
4

TheAmericanPublicHealthAssociation,TheAmericanHeartAssociationandtheInstituteofMedicine
endorsetheuseofBMImeasurementforsurveillancepurposesinclinicalsettingsaswellasschools.
However,viewsonBMIscreeningvary.In2005,theU.S.PreventativeServicesTaskForceconcluded
therewasinsufficientevidencetorecommendfororagainstBMIscreeningprogramsforyouthin
clinicalsettingsasameanstopreventadversehealthoutcomes.TheInstituteofMedicineendorses
annualschoolbasedBMIscreening.BMIscreeningmeetssomeofthecriteriathattheAmerican
AcademyofPediatrics(AAP)developedtoguidedecisionsonwhetherschoolsshouldimplementa
screeningprogram,butnotall.8AAPhasindictedBMIisanacceptablemeasureofweightstatusand
schoolsarethelogicalmeasurementsite.Becauseobesityisprevalentandweightstatusisoften
misperceived,effectivelyadministeredBMIscreeningcouldhelpcorrectmisperceptionswhich
contributetounsafeweightcontrolbehaviors.3TheAmericanMedicalAssociationand12other
organizationsrecommendBMIcalculationannuallybytheprimaryhealthcareprovider.8However,low
ratesofobesityidentificationbyphysiciansmaywarrantalternativeapproachestoobesityscreening
suchasuniversalschoolbasedprograms,especiallyinhighriskcommunities.9
TheStateofArkansassuccessfullyinstitutedstatewideschoolbasedBMIscreeninganddidnotseean
increaseinthefearedharmfulbehaviorssuchasteasing,studentuseofdietpills,orexcessiveconcerns
withweightbystudents.Instead,ArkansasschoolbasedBMIscreeningenhancedawarenessamong
parentsandchildrenaswellasincreasedengagementbyschool,clinical,publichealth,andcommunity
leaderstoaddresstheburdenofobesity.Additionally,ahaltintheprogressionoftheobesityepidemic
wasobservedafterimplementationofcomprehensivestatewideobesitypreventionandcontrol
programthatincludedschoolbasedBMIscreening.10FivestudiesofparentalperceptionsofBMI
screeninginschoolsfoundthatparentssupportandrespondpositivelytoBMIscreeningintheir
childrensschools.Parentssupportprogramsthatprovide:advancenotice,anopportunitytodecline
consent,assurancethatmeasurementsareobtainedinaprivateandrespectfulmannerthatminimizes
weightrelatedteasing,andresultsinaletterthatusesaneutraltoneanddoesnotassignblame.8
StateofAlaska

Establishingpolicyandprocedures
Sincetheneedsofstudentsandfamiliesvary,eachindividualschooldistrictneedstodetermineifaBMI
surveillanceand/orscreeningprogramwouldbebeneficialfortheirstudents,families,andcommunity.
SchoolbasedBMIscreeningprogramsmustestablishproceduresthatdonotstigmatizestudentsthat
mayleadtoharmfulbehaviors.BeforelaunchingaBMImeasurementprogram,schoolsshouldattempt
tominimizepotentialharmandmaximizebenefitsby:
assuringasafeandsupportiveenvironmentforstudentsofallbodysizes(universalbullying
preventionprogramsthataddressweightdiscrimination,curriculafosteringacceptanceof
healthyweight,professionaldevelopmentandresourcesinplaceforstaff)
implementingcomprehensivesetofsciencebasedstrategiestopromotephysicalactivityand
healthyeating
establishingsafeguardsthatensurerespectforstudentprivacyandconfidentiality,protect
studentsfrompotentialharm,andincreasethelikelihoodofapositiveimpact8
Safeguardsforsuccessfulimplementation
Whileitisimportantthatheightandweightmeasurementsbedoneaccurately,itisequallyimportant
thatmeasuringandweighingbedoneinarespectfulandsensitivemanner.Schooldistrictswho
establishheight/weight/BMIscreeningand/orsurveillanceprogramsshouldadheretothefollowing
safeguards:
9 introducetheprogramtoschoolstaffandcommunitymembersandobtainparental
consent
9 trainstaffinadministeringtheprogram(ideally,implementationwillbeledbyahighly
qualifiedstaffmember,suchastheschoolnurse)
9 establishsafeguardstoprotectstudentprivacy
9 obtainanduseaccurateequipment
9 accuratelycalculateandinterpretthedata
9 developefficientdatacollectionprocedures
9 avoidusingBMIresultstoevaluatestudentorteacherperformance
9 regularlyevaluatetheprogramanditsintendedoutcomesandunintended
consequences8
StateofAlaska

DEFINITIONS
BMIorBodyMassIndex: ameasureofbodyfatthatistheratiooftheweightofthebodyin
kilogramstothesquareofitsheightinmeters
Calibration: theuseofstandardtestweightsandmeasuringrodstocheckthe
accuracyofequipment
Height: astandingmeasurementininchesormeters
FrankfortHorizontalPlane: imaginarylinepassingthroughtheexternalearcanalandacrossthetop
ofthelowerboneoftheeyesocket,immediatelyundertheeye(see
Figure2)
MidAxillaryLine: animaginarylinethroughtheaxilla(armpit)paralleltothelongaxisofthe
bodyandmidwaybetweenitsventral(frontoranterior)anddorsal(back
orposterior)surfaces(seeFigure1)
Private: notopenlyorinpublic
Scale: instrumentformeasuringweight
Stadiometer: instrumentformeasuringheight
Weight: ameasurementinpoundsorkilograms
Zeroed: assuringthescalebalancesatzeroor00beforethestudentstepsonthe
platform11
EQUIPMENT
CriticalComponents
Accuracyandreliabilityarethetwomostcriticalcomponentsofheight/weightassessmentandareto
somedegreeafunctionofthequalityoftheequipment.Equipmentmustalsobeproperlyusedand
maintained.Quality,easilycalibratedandwellmaintainedequipmentisagoodinvestmentandwill
provideyearsofaccurateandreliableservice.
Accuracydegreetowhichameasurementofanindividualcorrespondstohis/heractual
weightorstature
Reliabilitydegreetowhichsuccessivemeasurementsofthesamechildagreewithspecified
limits12
CalibrationofEquipmentandUseofUptoDateScreeningTools
WeightScales
Aproperlycalibrated,highqualitybalancebeamorelectronicdigitalscaleshouldbeusedtomeasure
childrenandadolescents.Thescaleshould:
Beusedforthepurposeforwhichitwasdesigned
Beusedinaprivatelocation
Weighin0.1kg(100gm)orlbincrements
Bestableandhavealargeenoughplatformforsupportfortheindividualbeingweighed
Forbalancebeamscales,iscapableofbeinglockedinandisateyelevelofthemeasurer
Canbezeroed
Canbecalibratedthroughprofessionalserviceorbystandardknownweight
Nothavewheelsattached12,13,14,15
StateofAlaska

Scalesshouldbecalibratedregularlytoensureaccuratemeasurements.
o Useknownweights(asetofstandardweightspurchasedfromasportsstore)onthescaleora
professionalservicetocheckaccuracy
o Sendthescaleforprofessionalcalibrationifthestandardweightandthescaleweightareoffby
poundormore.Foradigitalscale,changethebatteriesandifitisstilloffaftercheckingagain
withthestandardweights,sendscalesforprofessionalcalibrationand/orchecktheowner
manualforscaleinstructions
o Recalibrateifthescalehasbeenmovedtoadifferentsurface
o Portabledigitalscales,frequentlymoved,shouldbecalibratedmonthly
o Forscalesthatarenotmovedorusedexcessively,calibrateatleastannually1,14,15

HeightStadiometers
Aportableorwallmountedstadiometershouldbeused.Thetoolshould:
Beusedforthepurposeforwhichitwasdesigned
Notincludetapes,yardsticksorgraphicsattachedtothewall
Measurein0.1cmor1/8inchincrements
Haveaneasilymoveablehorizontalheadboardatleast3incheswidethatcanbebroughtinto
contactwiththemostsuperiorpartofthehead
Shouldhaveawideandstableplatformorfirmuncarpetedfloorasthebase
Notusemetalheightattachmentattachedtoascale1,12,13,15

Checkthestadiometerregularlytobesurethebaseisstableandmeasuresareaccurate.
o Lengthrods,astandardmeasuringtestrod,shouldbeusedtoverifyaccuracyatleastannually
o Portablestadiometersshouldbecheckedmorefrequently
o Ifadiscrepancyisfoundinaccuracy,contactthemanufacturerforadvice12,14
StateofAlaska

PROTOCOL/PROCEDURE
Whentoscreen
Ideally,growthscreeningshouldtakeplaceeachyearinaschoolchildslife.Aseriesofmeasuresover
timearevaluableindeterminingastudentsgrowthpattern.Deviationsfromthestudentsnormal
growthpatternmayindicatesomeintrinsicillness/diseaseprocessorenvironmentalconcerns.These
deviationswarrantacomprehensiveevaluationbyahealthcareprovider.13
Ifschooldistrictcapacitycannotsupportannualheight,weightandBMImeasurements,policiesfor
schoolscreeningshouldreflectthefollowingcriticaltimes:
Kindergarten
Latencyperiod910yearold/5thgradeformoststudents
Earlyadolescence9thgrade13
TheProcess
Accuracyisimportantinobtainingheightandweightmeasurementsbecausethesemeasurementswill
beusedtocalculatetheBMIwhich,inturn,isutilizedtoassesshealthyweightstatusand/orprovidefor
surveillancedata.Accurateweighingandmeasuringhavethreecriticalcomponents:
Techniquestandardizedandappropriatetechniqueforeachmeasuremustbeutilized
Equipmentmustbecalibratedandaccurate
Trainedmeasurersmeasuresshouldbeperformedbyatrainedmeasurer12

Theprocesssteps,dependingontheschooldistrictBMIprogram,areasfollows:
1. Measureweightandheight(surveillanceandscreening)
2. CalculateBMI(surveillanceandscreening)
3. PlotBMIvalueonanappropriategrowthchart(screening)
4. InterprettheBMIforAgePercentileScore(screening)
5. Reportresultstoparents(screening)
6. CollaboratewiththeDivisionofPublicHealth(optional,surveillance)

INSTRUCTIONSFORMEASURINGWEIGHT
o Setthescaleatzeroreading
o Havethestudentremoveshoes,heavyouterclothing(jacket,vest,sweater,hat),andempty
pockets(cellphones,iPods)toextentpossible
o Havethestudentsteponthescaleplatform,facingawayfromthescalereadout,withbothfeet
ontheplatform,andremainstillwitharmshangingnaturallyatsideandlookingforward
o Readtheweightvaluetothenearestpoundor0.1(1/10)kilogram
o Havethestudentstepoffthescaleandtakeasecondmeasurement,repeatingthestepsabove
(measurementsshouldagreewithin0.1kilogramorpound;ifnot,remeasureuntilthis
standardismet)
o Forconfidentialityandtoavoidstigmaorharassment,donotcalloutweightvalue
o Recordtheweightvalueimmediatelyonthestudenthealthrecordordatalog
o Ifusingabalancebeamscale,returntheweightstozeroposition
StateofAlaska

INSTRUCTIONSFORMEASURINGHEIGHT
o Havethestudentremoveshoes,hat,andhairornaments/buns,/braidstoextentpossible
o Havethestudentstandonthefootplateoruncarpetedfloorwithbackagainststadiometerrule
o Havethestudentbringlegstogether(incontactatsomepoint,whatevertouchesfirst)
o Assurestudentslegsarestraight,armsareatsides,andshouldersarerelaxed
o Assurethebackofthestudentsbodytouches/hascontactwiththestadiometeratsomepoint,
preferablywithheels,buttocks,upperbackandheadtouchingthemeasuringsurface
o Assurethatthestudentsbodyisinastraightline(midaxillarylineparalleltothestadiometer),
seeFigure#1

Figure#1MidaxillaryLine Figure#2FrankfortHorizontalPlane

o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o Assuretheheadisintheappropriateposition(Frankfortplane)seeFigure#2
o Askthestudenttobreatheinandholdhis/herbreathwhilebeingmeasured
StateofAlaska

>Lowertheheadpieceuntilitistouchesthecrownofthe
headfirmly,compressingthehair
>Positionyourselfsothatyoureyesareparallelwiththe
headpieceandreadthemeasurementtothenearest0.1
cmor1/8inch,makenoteofthefirstmeasurement
>Movetheheadboardaway,checktheposture,andre
measurethestudent
>Measurementsshouldagreewithin1cmorinch,re
measureandselecttheaverageofthetwomeasuresthat
agreethemost
>Immediatelyrecordtheresultsinthestudenthealthrecord
ordatalog12,13,14,15

CALCULATINGBMI
Aftercollectingthestudentsheightandweight,theBMIcanbecalculated.Thereareseveralmethods
todetermineBMI:
BMIWheel
BMIcalculationcomputersoftware
BMITable,foundonlineattheCDCwebsite
http://cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/00binaries/bmitables.pdf
TheChildren'sBMIToolforSchools:
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/tool_for_schools.html
o ThisExcelspreadsheetcanbeusedbyschool,childcare,andotherprofessionalswho
wanttocomputeBodyMassIndex(BMI)forageforagroupofupto2000children,
suchasforaschoolclassroomorgrade.
Ifusingelectronichealthrecords,theprogrammaycalculateandplotBMIonthegrowthchart
BMIPercentileCalculatorforChildandTeenhttp://apps.nccd.cdc.gov/dnpabmi/
BMIcalculationbymathematicalequation4

(weightinpounds)

dividedby
BMI= X703
(heightininchesXheightininches)

OR

(weightinkilograms)
BMI= dividedby
(heightinmetersXheightinmeters)

StateofAlaska

PLOTTINGBMIVALUESONAPPROPRIATEGROWTHCHARTS
OnceBMIisdetermined,thestudentsageandgenderareusedtoselecttheappropriategrowthchart.
ThesegrowthchartscanbefoundontheCDCwebsite:
http://www.cdc.gov/growthcharts/clinical_charts.htm
UsingthegendercorrectgrowthcharttitledBMIforage,findthestudentsage(tothenearestyear)
onthehorizontalaxisandtheBMIontheverticalaxis.ThepointofintersectionisthestudentsBMIfor
agepercentile.Aftergraphingasetofmeasurements,checktoseeiftheyareconsistentwiththose
frompreviousmeasurements,ifpossible.Asignificantpercentilechangeshouldberecheckedforerrors
inmeasuring,recording,orgraphing.13,16,17
INTERPRETBMIFORAGEPERCENTILESCORE
UtilizethefollowingtabletoclassifythestudentsBMIpercentilescoreforinterpretation.2,16
BMIClassificationforChildren220YearsOld
BMIforAgePercentiles WeightClassification
th
<5 Underweight
5thto<85th HealthyWeight
85thto<95th Overweight
95th Obese
REPORTRESULTSTOPARENTSORGUARDIANS
IfyourschooldistricthasintroducedandutilizesaBMIscreeningprogram,communicatingtheresultsof
theheight/weight/BMIscreeningwithparentsandguardiansisanimportantcomponentofthe
program.Ensuringthatallparentsreceiveaclearandrespectfulexplanationoftheresultsand
appropriatefollowupactionsisimperativetothesuccessofaBMIscreeningprogram.3Thescreening
resultsalongwithinformationaboutresourcesavailablewillgivethemtheknowledgetheyneedto
beginaconversationwiththeirhealthcareproviderabouttheirchildsweightstatus,eatinghabits,and
physicalactivitybehaviors.Forsampleletterstoparents,staff,andhealthcareprovidersseeAppendix
AF.NOTE:itisrecommendedtoconsultyourschooldistrictpoliciesandproceduresbeforeutilizing
anysampleletters.
Referstudentsforfurtherevaluationbyahealthcareproviderwho:
HaveaBMI>95th
HaveaBMI85thto94th,especiallyiftheyhave:
o afamilyhistoryofdiabetes
o elevatedbloodpressure(seeAppendixGforbloodpressurevaluesrequiringfurther
evaluation)
o alargechangeinBMIpercentile(morethan2BMIpoints)withinthepastyear
o areconcernedabouttheirweight
HaveaBMI<5thwitharecentdecreaseinBMI
Anystudentwithnogrowthprogressoralargeshiftinpercentiles13,15,18
StateofAlaska

ROLEOFTHESCHOOLNURSE
Schoolnursescanprovideessentialleadershipinhelpingstudentsmaintainahealthyweightand
identifyingthosechildrenwhomayneedinterventionfortheirweightstatus.AccordingtotheNational
AssociationofSchoolNurses,schoolnursesareknowledgeableexpertsintheareasofnutrition,weight
maintenance,andexercise.Theschoolnursecanutilizehis/herknowledgeinpreventionprogramsand
interventionsforstudentswhoareofunhealthyweight.17
TheroleoftheschoolnurseintheBMImeasurementprocessisto:
Notifyparentsandguardians,students,schooladministratorsandstaffaboutthepurposeand
processoftheschoolsBMIscreeninginitiativepriortocollectingtheheight/weight/BMI
measurements.Parent,student,andschoolstaffsupportisanessentialcomponentoftheprogram
success.Notificationcanbeprovidedinnewsletters,schooldistrictwebsites,registration
information,orspecificletters(seeAppendixA,B).Considerincludingcommunityhealthcare
providersinyoureffortstoenlistsupport(seeAppendixC).

ProvideparentsandguardianswiththeopportunitytooptoutoftheBMIscreening.
Checkscalesandstadiometersforaccuracy(calibrate)withstandardweightsatleastannually.
Establishandfollowstandardsandappropriateproceduresforobtainingheightandweightvaluesto
assureaccurateassessments.
Providetraining,monitoringandfollowupofallscreeningactivities.
Trainstaffinvolvedinthescreeningprocess.Toimproveaccuracy,especiallyifmassscreeningof
students,itisrecommendedthatatleasttwostaffconducttheBMIscreening:onetomeasurethe
childandonetorecordthedata.Trainingshouldinvolve:

1. Properuseofequipmentforaccurateandprecisemeasurement
2. Reviewofformsfortherecordingofinformation
3. Emphasisontheimportanceofprivacyandconfidentialityforthestudents
4. Appropriateandsensitivecommunicationwithstudentsregardingheightandweight
measurement(e.g.,sayingLetscheckyourweightinsteadofLetsseehowbigyouare;
reassuringstudentsthatkidsbodiescomeindifferentsizesandshapes;avoidinglabelssuchas
obese,overweight,toothin,ortooshort;andrespondingtoteasingbymodelingwe
respectthebodiesofotherseventhoughtheyaredifferentfromourown).IfachildasksamI
toofat?Ortooskinny?saythatyoudontknowtheanswerandsuggestthechildaskhis/her
doctorthisquestion.
Studentsmustbeweighedandmeasuredinasettingthatprovidesforprivacyandconfidentiality.
Nootherstudentsshouldbepresentorwithinsightorhearingofthestudentbeingscreened.
Studentsheight/weight/BMIscreeningresultsshouldberecordedinthestudenthealthrecord,are
strictlyconfidentialandshouldnotbediscussedwithanyoneotherthanthestudentandhis/her
parentorguardian.
StateofAlaska

Whenreportingresultstothefamily,utilizeameaningfulformat.Avoidcomplicatedgraphswithout
clearexplanation.Ensureprivacyofinformationwhenselectingamethodtosendhomeresults.
Workingwiththeprincipaltodevelopamechanismtosharethisinformationwithparentsis
stronglyrecommended.
Studentswhoaretakingmedicationswhichcanaffecttheirheightorweightaswellasstudentsina
weightclassificationotherthannormalshouldbescreenedmoreroutinely.
Forstudentswithspecialhealthcareneeds,alternativemethodsofmeasurementand/or
interpretationofresultsmaybenecessary.Childrenwithscoliosis,trisomy21,cerebralpalsy,Pradi
Willi,TurnerSyndrome,andthosewithcontracturesorwhoarewheelchairbound,tonameafew,
haveconsiderationsthatmayaltertheprotocolfordetermininghealthyweightforthat
individual.1,3,11,12,13,17,20TolearnmoreregardingCDCgrowthchartsforspecialhealthcareneedsgo
to:http://depts.washington.edu/growth/cshcn/text/page1a.htm
COLLABORATINGWITHTHEDIVISIONOFPUBLICHEALTH
IfyourschooldistrictisinterestedinutilizingBMIdataforsurveillancepurposesandwishingto
collaboratewiththeDivisionofPublicHealthpleasecontacttheStateofAlaskaObesityPreventionand
Controlprogramtodeterminethedatacollectionprotocol.
Email:Obesity@alaska.gov
Phone:907.269.3457or907.269.2020
Web:http://www.hss.state.ak.us/dph/chronic/obesity/
StateofAlaska

RESOURCES
AmericanAcademyofPediatricswww.aap.org
BMIPercentileCalculatorforChildandTeenhttp://apps.nccd.cdc.gov/dnpabmi/
CDCHealthyYouthwebsitewithkeystrategiestopreventobesity:
www.cdc.gov/HealthyYouth/KeyStrategies
CDCGrowthInformationforChildrenwithSpecialHealthCareNeeds
http://depts.washington.edu/growth/cshcn/text/moduleprint.doc
HealthierUSbroadpresidentialagendadesignedtohelpAmericans,especiallychildren,live
longerandhealthierliveswww.healthierus.gov
HumanResourcesandServicesAdministration(HRSA),MaternalChildHealthBureau,GrowthCharts
TrainingModuleshttp://depts.washington.edu/growth/index.htm
LetsMovenationalinitiativeforimprovinghealth,nutrition,physicalactivityfor
http://www.letsmove.gov/
NationalAssociationofAnorexiaNervosaandAssociatedDisorderswww.anad.org
PresidentsCouncilonPhysicalFitnessandSportswww.fitness.gov
RobertWoodJohnsonFoundationnotforprofitorganizationforobesityprevention
http://www.rwjf.org/childhoodobesity/
TeamNutritioninitiativeoftheUSDAFoodandNutritionServicewww.fns.usda.gov/tn
SchoolHealthIndexassessmentandplanningguideforimprovementofprograms,physicalactivity,
healthyeating,tobaccouseandsafetypolicies
http://www.cdc.gov/HealthyYouth/SHI/use.htm
StateofAlaskaObesityPreventionandControlhttp://www.hss.state.ak.us/dph/chronic/obesity/
WeCan!WaystoEnhanceChildrensActivity&Nutritionnationalprogramforfamiliesand
communitiestohelpchildrenmaintainahealthyweight
http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/index.htm
Resourcesforkids:
BAM!BodyandMindinteractivewebsitedevelopedbytheCDCthatgiveskidsaged913
healthylifestyleinformationhttp://www.bam.gov/
EmpowerMEwebsitedevelopedbytheAllianceforHealthierGenerationdesignedtoinspire
kidstoeathealthierandmovemorewww.empowerme2b.org
KidsHealthhttp://kidshealth.org/kid/stay_healthy/fit/overweight.html
SmartMouthinteractivewebsitedevelopedbytheCenterforScienceinthePublicInterestthat
givesinformationonhowthefoodindustrysdriveforprofitaffectswhatkidseat
http://www.smartmouth.org
YourSELFpublicationbyUSDATeamNutritiondevelopedespeciallyformiddleschoolstudents
www.fns.usda.gov/tn/tnrockyrun
FORMS:
CDC website to obtain clinical growth charts:
http://www.cdc.gov/growthcharts/
StateofAlaska

AppendixA
SamplePreScreeningNotificationtoSchoolFacultyandStaff
[SchoolLetterhead]
[Date]
DearFacultyandStaff:
IamwritingtoinformyouaboutourBodyMassIndex(BMI)screeningprogramsothatyou,alongwithstudents,
parents,guardians,andthecommunity,canhelpmakethisyearsprogramasuccess.
AlthoughassessmentofheightandweightarenotspecificallyrequiredbyAlaskaStatute,assessmentofheight
andweightusingBMIisanimportantclinicaltoolinassessingthehealthandgrowthofachild.Ourschool/district
hasbeenassessingheightsandweightsofstudentseachyearsincethe[year].
TheresultsoftheBMIscreeningwillbekeptconfidentialineachstudentsschoolhealthrecordandwillbemailed
ordirectlycommunicatedinwritingtotheparentsorguardians;notsenthomewiththestudent.Theparentor
guardianletterwillincludeadescriptionofthescreeningprogramandinterpretationoftheresultsaswellas
recommendationstosharetheresultswiththeirchildsprimaryhealthcareprovider.
BecausestudentsmayreactinavarietyofwaystotheBMIscreeninginschool,itisimportantthatyouareaware
thatthisscreeningistakingplacesothatyoucanrespondappropriately.Forexample,ifachildmakesanegative
commentabouthis/herbody,asensitiveresponsemightbe,Kidscomeindifferentsizesandshapes.Youcan
helpbybeingobjectiveandopenaboutyourstudentsconcernsabouttheirweightinyourresponses.
Thescreeningswillbeconductedon[Insertdates]in[Insertlocations].Letterswithresultsofthescreeningfor
parentsorguardianswillbesenton[Insertdate].
Thisisanopportunityforourschooltocoordinateeffortstocommunicatewithstudents,parentsorguardians,
andthecommunityaboutthepositivestepsourschoolistakingtosupporthealthyeatingandphysicalactivity.At
thepresenttime,weprovide[Insertprogramsthatarecoordinatedwithinthedistrictand/orschooltoencourage
healthyeatingandactivelivingforbothstudentsandstaff],andareplanning[Insertinformationaboutthe
positivethingsyouwouldliketostartatyourschool(e.g.,schoolhealthcouncil,parentpresentation,physical
educationprogramsorhealtheducationclasses)]
ParentsaregiventheopportunitytooptoutoftheBMIscreeningandwillbeaskedtonotifymeby[date]ifthey
arenotinterestedinhavingtheirchildparticipateinthisscreening.
Pleasetakeamomenttostopbymyoffice,oremailmetoletmeknowifyouhaveanyquestionsaboutthis
screeningprogramorifyoudliketobeapartofourschoolseffortstocreateahealthierenvironment.Together
wecanmakearealdifferenceinthehealthandwellnessofourstudents!
Thankyouforyourtimeandconsideration.
Sincerely,
SchoolNurse[youmayalsoconsiderhavingtheprincipalcosigntheletter]
LetteradaptedfromMassachusettsDepartmentofPublicHealth,ComprehensiveSchoolHealthManual
StateofAlaska

AppendixB
SamplePreScreeningNoticetoParentsandGuardians
[SchoolLetterhead]
[Date]
DearParentorGuardian:
ThisletteristoletyouknowabouttheBodyMassIndex(BMI)ScreeningProgramthatwillbehappeningsoonat
yourchildsschool.
ABodyMassIndex,orBMI,isameasurethatisusedtoshowapersonsweightforheightforage.Itiscalculated
usinganindividualsheightandweight.Justlikeabloodpressurereadingoraneyescreeningtest,aBMIcanbea
usefultoolinidentifyingpossiblehealthrisks.
ThepurposeoftheBMIScreeningProgramistogiveyouinformationaboutyourchildsweightstatusandideas
forlivingahealthylife.In[nameofschoolordistrict],weaddressourchildrenshealthandwellnesswitha
comprehensiveapproachthatincludeshealthscreeningsand[Insertlistofinitiatives].
EachchildsheightandweightwillthenbeusedtocalculatetheirBMI.Theresultswillbemailedhomeordirectly
communicatedinwritingtoyou.
Theschoolnursewillsuperviseyourchildsscreeningandwillmakesureyourchildsprivacyisrespectedatall
times.Theresultsofyourchildsheight,weight,andBMImeasurementsarestrictlyconfidentialtheresultswill
bekeptinyourchildsschoolhealthrecordandgiventoyoudirectlyby[statewhatformofdirectcommunication
willbeused].
ABMIdoesnottellthewholestoryaboutyourchildshealthstatus.BMIdoesnotdistinguishbetweenfatand
muscle.Forexample,ifachildisveryathleticandhasalotofmuscle,hisorherBMImaybehigheventhoughhe
orsheisnotoverweight.Thatiswhyweencourageyoutosharetheresultswithyourchildshealthcareprovider.
Yourchildsdoctorornurseisinthebestpositiontoevaluatehisorheroverallhealthandcanexplaintheresults
ofhisorherBMIscreening.Theycanalsotalkwithyouaboutwhethertherearestepsyoucantaketoencourage
healthyeatingandphysicalactivity.

Weareveryinterestedinmakingsurethatallourstudentsarehealthy.Thisyear,theBMIscreeningwilltake
placein[insertmonthofscreening].Allchildreningrades[listgrades]willhavetheirheightandweightmeasured
andwillhavetheirBodyMassIndex(BMI)calculated.Ifyouarenotinterestedinhavingyourchildparticipatein
thisimportanthealthscreening,pleaseletmeknowby[date]

Pleasefeelfreetocallmeat[insertphonenumber]withanyquestionsyoumayhaveabouttheBMIscreening.
Additionalinformationaboutchildrenswellnessandfitnessisavailableuponrequestoryoumayaccessthe
CentersforDiseaseControlandPreventionresourcesat
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.
Sincerely,
StateofAlaska

AppendixC
SamplePrescreeningNotificationofLocalPrimaryCareProviders
[SchoolLetterhead]
DearPrimaryCareProvider:
Thehealthandwellnessofourchildrenisanationalpriority.However,thelatestfederaldatacontinuetoshow
increasesinratesofchildhoodobesityandincidenceofeatingdisorders.TheUnitedStatesDepartmentofHealth
andHumanServicesestimatesthatby2010,20%ofchildrenandyouthintheUnitedStateswillbeconsidered
obese.Researchershavefoundthatchildhoodobesityisassociatedwithanumberofdisordersincluding

hypertension,insulinresistance,sleepapnea,menstrualabnormalities,andorthopedicproblems(GAO,2006)
Parentsandguardianswillbenotifiedoftheresultsofthisscreeningforeachoftheirschoolagechildren.
[Statewhatformofdirectcommunicationwillbeused]BMIresultswillbemailedordirectlycommunicatedto
parentsandguardiansofeachstudentscreened.Arecommendationtodiscusstheresultswiththechildsprimary
careproviderwillbemadeforthosechildrenwhoseBMIforagescreeningplacethemunderweight(<=5th
percentile)oroverweight/obese(>=85thpercentile)categories.
Asyouknow,theAmericanAcademyofPediatricsrecommendsscreeningallchildrenannuallyaftertheageof2.
Oftenchildrenarenotseenonayearlybasisintheprimarycaresettingandschoolscanplayanimportantrolein
obtainingBMIscreeningintheefforttopromotehealthyweightinchildren.
Pleasebeawarethatthe[insertschoolname]and/orthetownof[inserttownname]haveseveralresources
availabletohelpcombatobesityinouryouth.[Insertlistofresources].Otherresourcesthatyoumayfinduseful
include:
AssessmentofChildandAdolescentOverweightandObesity:ASupplementtoPediatrics
http://pediatrics.aappublications.org/content/vol120/Supplement_4/index.dtl
TheHealthyCareforHealthyKidsToolkitManagementandTreatmentOfficeToolsdevelopedby
NICHQandBlueCrossBlueShieldofMAareavailableat
http://www.nichq.org/childhood_obesity/toolkit_prevention_office.html
IfyouhaveanyquestionsconcerningtheBMIScreeningProgrambeingimplementedatthe[insertschoolname]
School,pleasecontacteither[insertprincipalname],theschoolprincipalat[insertprincipalsphone]or[insert
schoolnursename],theschoolnurseat[insertphonenumber].
ThankyouforyoureffortstomaintainthehealthofAlaskaschildren.
Sincerely,

StateofAlaska

AppendixD
SampleReferralLettertoParentsandGuardiansforBMIScreeningReferral
[SchoolLetterhead]
[Date]
_____________________wasrecentlyweighedandmeasuredinourschoolas
(Studentname)
partoftheschoolsgrowthscreeningprogram.Yourchildsmeasurementswere:
Weight__________________Height_________________

ThisinformationisusedtocalculateaBodyMassIndex(BMI)thatisadjustedforageandsextodetermine
appropriategrowthandweightbyhealthprofessionals.
YourchildsBMIforageandsexpercentileis_____%.ThisBMIisconsidered:
underweight____healthyweight____overweight____obese____
Childrenwhoarenotinthenormalweightrangeareatriskforcertainhealthproblems.Werecommendthatyou
talkwithyourchildshealthcareprovidertoidentifywaystoensureyourchildsoptimalhealth.Thebestperson
toevaluateyourchildsweightstatusisyourchildsregulardoctororhealthcareprovider.
Askyourdoctorforadviceaboutgoodnutritionandphysicalactivity.Healthcareprovidersrecommendthe
followingforallchildren:
5Fiveservingsoffruitsandvegetablesperday
2Lessthan2hoursscreentimeperday
1Onehourofphysicalactivityperday
0Zerosodaorsugaredsweetenedbeveragesperday.

Ifyoudonothavehealthinsuranceoraccesstohealthcare,pleasecontactmeforinformationaboutpossible
medicalservices.
Ifyouhaveanyquestions,pleasecall_______________________,SchoolNurseat
(Schoolnursename)
_________________.Email___________________
(Phone#)
Letteradaptedfrom MaineDepartmentofEducationSchoolHealthManual,MeasuringChildrensHeightandWeight
StateofAlaska

AppendixE
SampleScreeningResultsforParentsandGuardians
[SchoolLetterhead]
[Date]
Yourchild,[insertnameofstudent],wasweighedandmeasuredaspartofourschoolsBMIScreeningProgram.A
BodyMassIndex(BMI)forAgepercentilewasalsocalculated.
ThepurposeoftheBMIScreeningProgramistoinformyouaboutyourchildsweightstatusandletyouknowif
yourchildisinahealthyweightrange,overweight,obese,orunderweight.TheresultofyourchildsBMI
screeningisstrictlyconfidential,andwillnotbediscussedwithanyoneotherthanyou.
Yourchildsmeasurementswere:Height:________Weight:________ BMIPercentile:_____

th
underweight,lessthanthe5 percentile
healthyweight,5thpercentiletolessthanthe85thpercentile
overweight,85thtolessthanthe95thpercentile
obese,95thpercentileorgreater
IfyourchildsBMIisbelowthe5thpercentilehe/shemaybeunderweight.IfyourchildsBMIisabovethe85th
percentile,he/shemaybeoverweightorobese.Youshouldsharetheseresultswithyourchildshealthcare
provider.Ifyourchilddoesnothavearegularhealthcareprovideroryoudonthavehealthinsurancefor
him/her,pleasecontactusforinformationaboutobtaininghealthinsurancecoverageorfindingaprovider.
BMIdoesnottellthewholestoryaboutyourchildsweightstatus.Manyfactorsotherthanheightandweightcan
influenceyourchildsweightsuchasfamilyhistory.Also,BMIdoesnotdistinguishbetweenmuscleandfat.For
example,ifachildisveryathleticandhasalotofmuscle,hisorherBMImaybehigheventhoughheorsheisnot
overweight.Pleaseseetheinformationthathasbeenincludedwiththislettertohelpyouunderstandwhatyour
childsBMImeansandwhatyoucandotohelpkeepyourchildhealthyandphysicallyactive.Moreinformationis
availableattheCentersforDiseaseControlandPreventionwebsite:
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.
Ifyouhaveanyquestions,pleasecallmeat[insertphonenumber].
Sincerely,
SchoolNurse
StateofAlaska

AppendixF
SamplePhysicianPostScreeningNotificationLetter
SampleLetter:Physiciannotificationpostclient/patientscreeningtobeincludedinthemailingtoparentsor
guardiansofchildrenwithBMIsbelowthe5thorabovethe85thpercentile
[SchoolLetterhead]
[Date]
DearHealthCareProvider[orPhysicianornameofphysician]:
Thisletteristonotifyyouthatyourpatient,[insertstudentname],wasmeasuredforheightandweightduringthe
[insertschoolname]SchoolsBodyMassIndex(BMI)ScreeningProgram,aspartofourdistrictroutinehealth
screening.ThefollowingisthechildsBMIresults:Ht____Wt_____BMIPercentile____
Toassistinidentifyingcommunityresourcestopromotehealthyeatingandphysicalactivity,weareincludinga
resourcelist[listresources].AdditionalresourcethatyoumightfindusefularetheHealthyCareforHealthyKids
ToolkitManagementandTreatmentOfficeToolsavailableat
http://www.nichq.org/childhood_obesity/toolkit_prevention_office.htmlandAssessmentofChildandAdolescent
OverweightandObesity:ASupplementtoPediatrics
http://pediatrics.aappublications.org/content/vol120/Supplement_4/index.dtl
Wewelcomeyourfeedbackandanyrecommendationsyoumayhavethatwillhelpinplanningforthischilds
schoolprogram.IfyouhaveanyquestionsconcerningtheBMIScreeningProgrambeingdoneatthe[insertschool
name]School,pleasecontacteither[insertprincipalname],theschoolprincipalat[insertprincipalsphone]or
[insertschoolnursename],theschoolnurseat[insertnursesphone].
Thankyouforyoureffortstokeepyourpatientsandourstudentshealthy.
Sincerely,
SchoolNurse

HEALTHCAREPROVIDER:Pleasecompleteandreturnto[insertSchoolNurse,School&Address]
Ihavechecked(childsname)_____________________________________on(date)_______________
withthefollowingfindings:
BMI:________ Percentile:________
Recommendations:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Signature/Title:__________________________________________Date:__________________
LetteradaptedfromMassachusettsDepartmentofPublicHealth
StateofAlaska

AppendixG

References:
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis,
evaluation,andtreatmentofhighbloodpressureinchildrenandadolescents.Pediatrics.2004;114(2suppl4threport):555576

ChobanianAV,BakrisGL,BlackHR,etal.TheseventhreportoftheJointNationalCommitteeonPrevention,Detection,Evaluation,andTreatmentofHighBlood
Pressure:theJNC7report.JAMA.2003;289(19):25602572
Kaelber, D.C. & Pickett, F. (2009). Simple table to identify children and adolescents needing further evaluation of blood pressure. Pediatrics. 123, e972e974.
http://www.pediatrics.org/cgi/content/full/123/6/e972
StateofAlaska

REFERENCES
1. MassachusettsDepartmentofPublicHealth.BMIScreeningGuidelinesforSchools.
http://www.mass.gov/Eeohhs2/docs/dph/mass_in_motion/community_school_screening.pdf.
Updated2009.AccessedNovember2010.

2. AlaskaDepartmentofHealthandSocialServices,DivisionofPublicHealth,SectionofChronic
DiseasePreventionandHealthPromotion.PrevalenceofOverweightandObesityamong
AnchorageSchoolDistrictStudents,19982008.Chronicles.Volume2.Issue1.February2009.
Availableat:www.hss.state.ak.us/dph/chronic/

3. NihiserAJ,LeeSM,WechslerH,McKennaM,OdomE,ReinoldC,ThompsonD,GrummerStrawn
L.Bodymassindexmeasurementinschools.JSchHealth.2007;77:651671.

4. CentersforDiseaseControlandPrevention(CDC).AboutBMIforchildrenandteens.Available
at:http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.
UpdatedJanuary272009.AccessedNovember,2010.

5. Dietz,WHandBellizzi,MC.Introduction:theuseofBMItoassessobesityinchildren.American
JournalofClinicalNutrition.1999;70(suppl):123s5s.

6. HedleyAA,OgdenCL,JohnsonCL,CarrollMD,etal.Prevalenceofoverweightandobesity
amongU.S.children,adolescents,andadults.JAMA.2004;291(23):28472850.

7. TyrellVJ,RichardsGE,HofmanP,GilliesGF,RobinsonE,CutfieldWS.ObesityinAuklandschool
children:acomparisonofbodymassindexandpercentageofbodyfatasdiagnosticcriterion.
InternationalJournalofObesity.2001;25:164169.

8. NihiserAJ,LeeSM,WechslerH,MckennaM,OdomE,ReinoldC,ThompsonD,GrummerStrawn
L.BMIMeasurementinSchools.Pediatrics.2009;124:S89S97.

9. DemerethE,MuratovaV,SpanglerE,LiJ,MinorVE,NealWA.SchoolbasedObesityScreeningin
RuralAppalachia.PreventiveMedicine.2003;37(6):553560.

10. ThompsonJ,CardHigginsonP.ArkansasExperience:StatewideSurveillanceandParental
InformationontheChildObesityEpidemic.Pediatrics.2009;124:S73S82.

11. ArkansasCenterforHealthImprovement.ATrainingManualforHeightandWeightAssessment.
Availableat:
http://www.achi.net/ChildObDocs/Height%20and%20Weight%20Measurement%20Training%20
Manual.pdf.AccessedNovember2010.

12. HumanResourcesandServicesAdministration(HRSA).MaternalChildHealthBureauandthe
CentersforDiseaseControlandPrevention.GrowthChartsTrainingModules.Availableat:
http://depts.washington.edu/growth/index.htm.AccessedNovember2010.

StateofAlaska

13. SelekmanJ.HealthPromotion.SchoolNursing:AComprehensiveText.Philadelphia,Pa:F.A.
DavisCompany;2006:439442,833864.

14. AlaskaDepartmentofHealth&SocialServices,DivisionofPublicHealth,SectionofPublicHealth
Nursing,InternalPolicy.PublicHealthNursingPracticeGuidelines.CalibrationandAccuracyof
Equipment.July2010.

15. SchoolNurseRoleBMI,ScreeningsandReferrals.In:NationalAssociationofSchoolNurses,
S.C.O.P.E.(SchoolNurseChildhoodObesityPreventionEducation)Manual.SilverSpring,MD.
March2008.

16. CentersforDiseaseControlandPrevention.UseandInterpretationoftheCDCGrowthCharts.
Availableathttp://www.cdc.gov/nccdphp/dnpa/growthcharts/resources/growthchart.pdf.
AccessedNovember2010.

17. CentersforDiseaseControlandPrevention.Nutrition&PhysicalActivity.CDCGrowthChart
Training,OverweightChildrenandAdolescents:Screen,Assess,andManageModule.Available
at:http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module1/text/mainmod
ules.htm.AccessedNovember2010.

18. HaganJF,ShawJS,DuncanPM,eds.2008.BrightFutures:GuidelinesforHealthSupervisionof
Infants,Children,andAdolescents,ThirdEdition.ElkGroveVillage,IL:AmericanAcademyof
Pediatrics.

19. NationalAssociationofSchoolNurses.PositionStatement:OverweightChildrenand
Adolescents.Availableat:http://www.nasn.org/Default.aspx?tabid=236.AccessedNovember
2010.
20. IkedaJ,CrawfordP.GuidelinesforCollectingHeightsandWeightsonChildrenandAdolescents
inSchoolSettings.CenterforWeightandHealth.Availableat:
http://cwh.berkeley.edu/resource/guidelinescollectingheightsandweightschildrenand
adolescentsschoolsettings.UniversityofCalifornia,Berkeley,Sept2000.AccessedNovember
2010

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