By Dr. Danielle Keenan-Miller
If you haven’t seen it yet, it’s time to gather the kids or teens in your life and watch The Student Body. It’s an inspiring documentary about the negative consequences of an Ohio state law that mandated weighing in schools and so-called “fat letters” being sent home to students. Bailey Webber, a high school student, learns of a fellow student who received a letter from the school nurse telling her that her Body Mass Index (BMI) was outside of the “acceptable” range. Unsurprisingly, the letter resulted in shame, feeling out of place at school, and significant frustration for the otherwise healthy young woman who is active and eats well but who suffers from a disorder related to growth hormone. As the documentary unfolds, Bailey meets with a wide range of students and parents negatively impacted by this school weighing program. One particularly poignant moment is her interaction with a group of energetic and seemingly healthy kindergarten and elementary school children who report that the letters caused them to start wondering which parts of their bodies were “too fat”. Many of the adults who advocate for the law, telling Bailey that it’s important that “everyone knows where they fall on this scale”, are themselves unwilling to step on the scale that she offers at the end of the interview.
Although the documentary is focused mostly on the lived experience of the children and teenagers impacted by these forced public weigh-ins, many of the points that Ms. Webber makes are well supported by science. First, BMI is a poor indicator of health. Recent research led by Janet Tomiyama of UCLA¹ has demonstrated that nearly half of individuals characterized as overweight by their BMI and nearly one-third of people characterized as obese were, in fact, healthy by more precise measures of metabolic health (such as blood pressure, cholesterol, insulin resistance, and others). In addition, nearly one-third of individuals with a BMI in the “healthy” range showed signs of poor cardiometabolic health. This lack of clear association between BMI and other indicators of health should not be surprising given that it is not an accurate measure of body composition, does not take into account the amount of muscle an individual has and does not necessarily reflect an individual’s health behaviors.² A large body of research has shown that the improvements in cardiovascular health that accompany exercise may not be accompanied by changes in BMI, making BMI a particularly poor metric to focus on when aiming to encourage people to engage in healthier lifestyle behaviors.³ Health, and lack thereof can occur across the full spectrum of weight.
Even if BMI were a more precise indicator of health, fat shaming is not likely to lead to healthy behavior change. In fact, facing weight discrimination and stigma has been linked to increased caloric intake among higher weight individuals⁴ and to greater weight gain over time.⁵ The psychological effects of fat shaming are even worse. Kids who are teased or bullied because of their weight are more likely to engage in disordered eating behaviors, like binge eating or unhealthy methods of weight control.⁶’⁷ Weight-based stigma, regardless of actual weight, is also associated with depression, anxiety, and substance abuse.⁸
I am heartened to see the willingness of Bailey Webber (as well as many others who stood up to this Ohio law) to question the basis for the law and to advocate on behalf of students who felt targeted by it. Hopefully, the next generation will be more enlightened about the impact that misguided public health campaigns can have for stigma and advocate for programs that truly promote health.
 Tomiyama, Hunger, Nguyen-Cuu, & Wells (2016).
 Ahima & Lazar (2013)
 Ross & Janiszewski (2008)
 Schvey, Puhl, & Brownell (2011)
 Sutin & Terracciano (2013)
 Neumark-Sztainer et al. (2002)
 Haines et al. (2006)
 Hatzenbuehler, Keyes, & Hasin (2009)