\u27No Body Left Behind\u27: Re-Orienting School-Based Childhood Obesity Interventions

Although there are now laws on the books in virtually every jurisdiction aimed at addressing childhood obesity in K-12 schools, these efforts are inadequate and may even be misguided in important ways. Efforts aimed at health promotion - through healthier eating and increased physical activity - remain woefully underfunded even as they proliferate at every level of government. It is one thing to enact a requirement that all schools offer a minimum number of minutes of physical education each week or that school lunches include more fruits and vegetables. But it is quite another to make the budgetary commitment to ensure that physical education classes are accessible, stimulating, and enjoyable for children of all sizes and ability levels or that school meals are both healthy and appealing. Moreover, the problem with current approaches to school-based anti-obesity interventions goes deeper than a lack of funding. Interventions aimed at reducing obesity - as opposed to improving health - may be contributing to weight-based stigma. And anti-fat stigma itself may contribute to poor health outcomes. Poor diet and lack of physical activity among school-age children are certainly pressing public health problems and there is much that can be done in the school setting to address them. But framing these problems in terms of children’s weight - rather than their health - may be a set up for failure, given what we know about the difficulty of achieving significant and lasting weight loss. Preventing children from becoming obese in the first place may be a more reasonable goal, but it is crucial that prevention efforts be evaluated in light of their impact on children who are already overweight or obese as well as those who are not. In this article, I propose a reorientation of school-based anti-obesity interventions to better align them with the “Health at Every Size Movement,” which “shifts the focus from weight management to health promotion…to support improved health behaviors for people of all sizes without using weight as a mediator.” I make specific recommendations that focus on promoting the availability of appealing, safe, and healthy physical activity opportunities and eating options for all children; the cessation of school-based BMI screening programs; and development of privacy and anti-discrimination frameworks to protect the rights - and promote the health - of all children