News from Shape Up America!
February 2007
Shape Up America! Newsletter


School-based BMI Screening to Prevent Childhood Obesity
by Ann Johnson, MSN, CSN
In 2005, the Institute of Medicine released its report Preventing Childhood Obesity: Health in the Balance stating that childhood obesity is a critical national health problem which requires an immediate population-based preventive approach to curb the ever-increasing number of overweight children. A solution to the obesity epidemic will require action on the part of families, schools, industry, communities, and government. Five years prior to the release of this report, school nurses and administrators in a school district in Pennsylvania had already launched a school initiative to address the issue of childhood obesity.

In the fall of 2000, the East Penn School District in Emmaus, PA, set in motion a process to establish a wellness program for students. At the center of the initiative was a plan to expand annual growth screening, which consisted of measuring each child’s height and weight, to include:

  • calculating individual Body Mass Index (BMI) for each child
  • determining each child’s BMI percentile for gender and age
  • reporting the information to each child’s parents by means of a letter mailed home

The goal was to increase awareness of childhood obesity and identify individual children who may require further assessment by their family healthcare provider. The district has accrued six years of experience screening and reporting BMI percentiles to parents, an initiative that was initially met with criticism and resistance. Data collected each year indicates a decrease in the mean number of students with BMI percentiles ≥ 95%. Because of the success of the program, I would like to share our rationale, strategies, and materials so that other school communities may utilize them.

The U.S. public school system provides an ideal setting for population-based health screening of children and adolescents. The purpose of this screening is to increase the level of health in the population by identifying early on those individuals who may require individual attention for a specific problem, before it requires an intensive and costly intervention. A health screening is meant to be the catalyst for further assessment, not a definitive diagnosis, nor a solution. Mass screening of children may also reduce disparities in access to health care. In many instances, contact with the school nurse is the only time a child sees a healthcare professional, particularly in the mid-childhood and adolescent years.

Precedence exists for school-based mass screenings: 70% of states require annual vision and hearing screening of all students; 45% screen for scoliosis; 17% require oral health screening; and 26% routinely measure height and weight, and sometimes BMI.1 The screening, tracking and reporting of BMI can identify a problem that has the potential to negatively impact every aspect of a developing child’s life. Schools generally have facilities and health personnel trained to conduct health screenings with accuracy and confidentiality. To conduct BMI screening, the school may need to purchase stadiometers and digital scales to increase accuracy of measurements. Tools to calculate BMI and plot BMI percentile are readily available free of charge online or for purchase. Age- and gender-specific BMI percentile charts are available from the Centers for Disease Control and Prevention.

We have found that a cumulative, annual report of a student’s height, weight, and BMI with percentile range is an effective means to communicate important information to parents. Parents of overweight or obese children do not always recognize their child’s weight status and many are unaware of the adverse consequences of overweight.2 There is evidence that parental notification of height, weight, and BMI status increases awareness and the probability that they will take action to help their children, although it does not necessarily increase the probability that parents will make changes in lifestyle.3

A recent study found considerable parental support for school-based BMI screening and written parental notification programs. Almost all of the parents who received a BMI letter reported reading all or most of the letter, indicating that an individualized letter is an effective means to engage parents in reflecting on their child’s health status.4 The letters utilized by the East Penn School District to notify parents of their child’s BMI status have proved to be a useful tool in increasing parental awareness and in tracking a child’s development over time. If community resistance is anticipated, parents may be offered the option not to be notified of their child’s screening results. This may prevent unintentionally alienating families who may be most in need of supportive health advisement.

A school-based BMI screening program must occur within the context of partnerships with parents, healthcare professionals and the community. It is critical to enlist administrative support in order to develop a sustainable wellness program to support the screening process. A BMI screening program should be preceded by a multi-faceted educational drive to inform parents of the purpose and rationale for the screening. Schools need to be prepared to develop comprehensive resources -- including lists of qualified health care professionals -- for referrals of children and their parents once a problem is identified. Conversely, parents and older students can become advocates for changes in their schools and communities that will support healthy eating and increased physical activity for children. Ongoing educational efforts based on current research and treatment developments must be made available to families and students to support changes in lifestyle.

Editor’s Note: An article on the East Penn School District’s BMI screening program was published in the November/December 2006 issue of Nutrition Today. To purchase a copy of “School-Based Body Mass Index Screening Program” by Ann Johnson, MSN, CSN and George A. Ziolkowski, PhD, go to

Ann Johnson, MSN, CSN, has been a school nurse in the East Penn School District for the past 9 years.—Finding Health through Weight Management
by Jody Cole, MA
The Office of Disease Prevention and Health Promotion (ODPHP), Department of Health and Human Services, along with other Federal agencies, works to increase awareness of the disease risks associated with both childhood and adult obesity via numerous national initiatives. The Office also encourages healthy behaviors with the goal of achieving and maintaining a healthy weight., a consumer health information web portal linking to government, nonprofit, and professional resources, is one of the ways that the Office promotes these prevention messages. can help you at various stages of your weight-loss or weight-maintenance journey. It provides checkups for those who are curious about their weight and its effect on their health, information for those who want to eat right, lose weight and increase their physical activity, and support for those who want to maintain their present weight. You may also sort the information in by your gender, age, and ethnicity.

Checkups for weight and weight-related problems can be found in the online checkups section. Here you’ll find the National Heart, Lung, and Blood Institute (NHLBI)’s Body Mass Index Calculator. Just key in your height and weight, and the calculator will compute your BMI for you. Under nutrition in the Online Checkups section, you’ll also find NHLBI’s Portion Distortion Interactive Quiz. This helps you to visualize portion sizes that, in turn, can help you manage how much you eat. Test Your Food Label Knowledge to see how much you know about how food labels can help you stay healthy and maintain your weight. The Dietary Guidelines for Americans 2005, issued jointly by the Department of Health and Human Services and the U.S. Department of Agriculture, recommend physical activity as well as good nutrition in order to maintain a healthy weight. links to Shape Up America’s own Physical Activity Selector. Select your weight, activity, and the amount of time you’ll be performing the activity to calculate the number of calories burned.

For information on how to eat right, lose weight, and increase physical activity, links to many Federal and nonprofit organizations and resources. A Healthier You, based on the Dietary Guidelines, offers practical tips for eating right to lose weight, and includes recipes sorted by the amount of time needed to prepare them. The USDA Center for Nutrition Policy and Promotion features the MyPyramid Tracker, which allows you to track both your food intake and physical activity. And the President’s Council on Physical Fitness and Sports sponsors

On the Center for Food Safety and Applied Nutrition of the U.S. Food and Drug Administration (FDA) web page is Information about Losing Weight and Maintaining a Healthy Weight, which provides support for continued attention to weight management. The Weight Control Information Network of the National Institute of Diabetes and Digestive and Kidney Diseases provides tips on being Active at Any Size and on Weight Loss for Life.

These are just a sampling of the many resources you can find in the resources from the Federal government and other reliable nonprofit and professional organizations. Try the tools to see how you might improve both your weight and your health. Or look up a new healthful recipe for dinner. Track your progress with the trackers. And encourage your family and friends to work with you toward maintaining a healthy weight.

Editor’s note: To cut back on food intake, which is the most important strategy for weight loss, visit the SUA cyberkitchen.

Jody Cole, MA, is Project Director of the National Health Information Center.

Improving Your Ankle Mobility
by Michael Roussell
In our exercise and physical activity articles, we often focus on exercises such as bodyweight squats, lunges, and split squats because they work large muscle groups and allow you to get in an effective workout in minimal time.

However, if you are having problems with ankle mobility and flexibility, these movements can be very troublesome and awkward. This month, we will look at an exercise you can do to improve your ankle mobility and make your lower body movement more effective and less painful.

Before you start increasing your ankle mobility, it is important to determine your baseline flexibility. To do this, stand facing the wall with the toes on your right foot about 3-4 inches from the wall. Keeping your heel on the ground, bend your right knee and touch it to the wall. If this is easy, then move your foot back so your toes are 4-5 inches from the wall and repeat the stretch. Once you determine how far back from the wall you can perform the stretch and touch the wall without lifting your heel, it is time to move to the next step.

In the second part of this exercise, you will need a tennis ball. Place the ball on the floor and gently roll your right foot back and forth over the ball. Start at the ball of your foot and roll back to your heel. Repeat this movement several times, progressively applying more pressure on the ball. This movement is shown in the video. Once you have sufficiently massaged the tissue on the sole of your foot (60-90 seconds), repeat the stretch test described above and observe how much further you can complete the stretch without having your heels lift off the floor. Next repeat the stretch test, massage, and stretch test with the other foot.

This make-shift massage will gradually loosen up the tissue on the bottom of your foot. Studies of human anatomy have shown us that this tissue runs from the bottom of your foot and up the back of your lower leg. So by loosening up the tissue on the bottom of your foot, you will loosen up the tissue on the back of your lower leg and ankle, allowing you to squat deeper with greater ease. If you have stiff ankles, repeat this exercise everyday until your mobility increases. Then eventually perform the sequence once a week to maintain flexibility.

If you now go back to perform bodyweight squats, lunges, and split squats, you should find that they are easier for you to perform.

Author's note: A special thanks to Bill Hartman, C.S.C.S. for showing me this movement sequence.

Our Stories
Below are two stories submitted to Shape Up America! that describe what motivated these individuals to lose weight and how they are progressing on their weight-loss journey. If you would like to share your personal story and be an inspiration to others who desire to lose weight, simply use our new story submission system on the SUA website.

Ken describes how a serious illness motivated him to lose weight through diet and exercise and hopes that others don’t wait until danger strikes before taking the important steps to improve their health and well-being.

I have struggled with my weight since I was a small child. I've tried every fad diet there is. I tried the Atkins Diet, the Grapefruit diet--you name it, I tried it. I would have some temporary success, and then it would become too difficult to maintain and I would stop the diet and go back to eating my old way.

In August 2006, I was struck down by pancreatitis. My doctors told me it would be imperative that I drop at least 200 pounds. At the time I weighed 426 lbs. In January 2007, I reached 313 pounds. The first 60 pounds were a result of not being able to eat for three weeks. For the last 60, I have used a calorie counting system along with an exercise program which I started several weeks ago. I hope that others do not have to have a threat of death to motivate them, but unfortunately, if you are 100 pounds overweight, you are in danger of dying. Please look at my story and realize that I could have done this long ago and saved myself some considerable pain and my family some terribly fearful moments.

Patricia from Chicago turns the mirror inward and begins her journey to losing 163 pounds through weight-loss surgery. She tells us that having the surgery is less about anatomically changing one’s digestive system and more about making life-long, sustainable lifestyle changes.

The realization that I am just one of millions of Americans challenged with being overweight does not intimidate me. In fact, it motivates me! You see, just a few months ago, I shed the label of being “obese” by having exceeded a total weight loss of 163 pounds following successful weight-loss surgery in January 2005. At 344 pounds propelling me through life, I am now compelled by my life and enjoying every minute of this journey.

Like so many of you, I have spent my lifetime struggling in a physical package that competed with my life goals and dreams. As an overweight child, I enjoyed playing sports, including softball and volleyball, but had to work twice as hard to gain the physical endurance to play well and compete with the other kids. I was always picked last because what the other kids saw was the chubby girl not the hard-working, competitive athlete. The pain of being socially excluded always loomed and ultimately was insulated by the layers of fat that I began to accumulate. This vicious cycle propelled me into adulthood and presented even bigger challenges.

As I entered college, weighing in at 220 pounds, I was determined to become a registered nurse. I knew the childhood experience of having lost my father to heart disease when I was 8 years old played into this decision, along with a strong desire to help people since I seemingly couldn’t help myself out of the depths of my own weight issues. As I reflect upon this now, I realize that I was merely deflecting my own failure in managing my weight into the positive of helping others with their own health challenges. The mirror is a powerful thing...I chose at that moment to turn it outward and stop looking inward... Read more...

Recipe of the Month
Try this recipe as a tasty dip for raw vegetables.
Serves 12


  • Cooking spray
  • 1 cup onion, chopped
  • 1 cup carrots, chopped
  • 2 tsp. lemon rind
  • 3 garlic cloves, minced
  • 16 oz. white mushrooms, chopped
  • 2 Tbsp. water
  • ½ tsp. dried thyme
  • ½ tsp dried marjoram
  • ½ package (8 oz.) fat-free cream cheese
  • 2 Tbsp. fat-free Parmesan cheese, grated
  • 2 Tbsp. parsley, minced
  • 1 tsp. salt
  • ½ tsp. black pepper


  1. Spray medium skillet with cooking spray. Heat skillet over medium heat. Sauté onion, carrot, lemon rind, and garlic until tender. Remove from skillet.
  2. Spray skillet again and add mushrooms, water, and herbs. Cook over medium heat until mushrooms are wilted and liquid is absorbed. Cool.
  3. Process cream cheese, Parmesan cheese, and half of the mushroom mixture in food processor until smooth. Stir in onion mixture, remaining mixture and parsley. Season with salt and pepper.
  4. Refrigerate 3 hours and then spoon into serving bowl. Serve with assorted vegetables or whole wheat pita chips.

Nutritional analysis per serving: 30 calories, 3 grams protein, 5 grams carbohydrate, 0 grams fat, 0 milligrams cholesterol, 1 gram fiber, 230 milligrams sodium.

Source: 5 a day recipe.

phone: 406-686-4844

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Editor: Adrienne Forman, MS, RD

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