The National Child Measurement Programme: Opt out of the shame-and-blame game
The National Child Measurement Programme (NCMP) in the UK is set to restart this autumn amidst fear mongering and unhelpful discussions of child weight gain during lockdown.
The primary objective of the NCMP is to collect data for National Statistics reporting and Public Health England by weighing children in Reception and Year 6 (ages 4–5 and 10–11 respectively) and determining their Body Mass Index (BMI), an outdated measurement that has been proven again and again to be flawed and not an accurate measure of health. A secondary outcome of the NCMP is a letter sent to parents, informing them of their child’s individual weight category. Some local authorities will also offer a referral to a “weight management programme” or a general follow-up with parents; however, this is not consistent across the country.
We believe that the current system of weighing children in school is not fit for purpose and has the potential to be a contributing factor towards negative body image and poor mental health in childhood and subsequently in adulthood, too.
In July 2020, we responded to the Women and Equalities Committee’s call for evidence for their enquiry into body image with information about #PlayNotWeigh, our 2019 campaign to raise awareness of the NCMP and to make parents aware that they could opt out of the scheme. During that time, we ran a short survey to gain a general opinion on how useful parents felt the NCMP had been for them and we gathered individual responses on whether parents felt that the NCMP had had a negative impact on their family. Results showed that 77% of parents responded that they felt the current system of weighing and measuring children in school had not been helpful to them or their child, and 26% of parents felt that the NCMP had a negative impact on them or their child.
Included in our 10-page submission, we shared some of the individual responses we received:
“I am surprised that there is not more concern about the effect of this on the mental health of children. Children are already bombarded with images of what they ‘should’ look like and this just seems to be adding further pressure. Eating disorders have the highest mortality rate of all mental illnesses so it’s not something to be taken lightly.”
“I feel it is generally inaccurate and sends negative messages about body image and also can be confusing and worrying for parents who already offer their children a healthy balanced diet and exercise. One of my children came back as overweight and he doesn’t have a scrap of fat on him. It also doesn’t take into account how children grow, which in my experience is often out and then up. My eldest child asked for a long time afterwards about everything he ate — is this healthy? Am I allowed this? etc etc and I don’t think it’s healthy for a young child to have that frame of mind.”
“We got a letter home to say that our daughter was rated as borderline obese, that she was 3 percentile points away. She has a small frame and is short compared to other children but is muscly [sic] as she is constantly on the move, she’s very physical. Consequently she’s very heavy which is why she came out as borderline obese. You just have to eyeball her to know that she is not. I was incredibly angry that the focus had been on sending home a letter containing a single digit that said nothing about her health or fitness, but which clearly communicated ‘you are not parenting this child well, please take better care of her’. I was also incredibly angry that had I been inclined, I could have shared this letter with her and caused her to be preoccupied with scales rather than health and fitness. I won’t give permission for her to be weighed again, nor my second daughter.”
“I received a letter saying my daughter was obese. I never told her but I did take her to the Dr and handed her the folded letter and just said I’d received this letter — what did she think. Across the top of the letter I wrote in red pen ‘do not tell my daughter what this letter says’. The Dr was brilliant and we had a very coded conversation about how stupid she thought the whole thing was and all she was interested in is if the child was active and happy.”
On 9 April 2021, the Women and Equalities Committee published their report, ‘Changing the perfect picture’. Aligned with our stance on the NCMP was the eating disorder charity Beat, which stated that “this programme focuses on weight, not health, and can lead to poor body image and is a risk to children who may become vulnerable to developing an eating disorder.” We were encouraged to see that the report strongly recommended an urgent assessment of the programme’s need and its consequences:
“Weighing children in primary schools under the National Child Measurement Programme is likely to cause harm to children’s mental health and could hinder the development of a positive body image. This is particularly damaging for Black children who are more likely to be incorrectly placed in the overweight or obese categories. We recommend that the Government urgently reviews the National Child Measurement Programme to ensure it is not creating undue body image pressures in children. The Government should urgently assess the need for the programme and seek other ways to collect this data.”
Our hope that the government would take the inquiry’s evidence-based recommendation to heart was extinguished when the House of Commons released their responses to the inquiry’s report on 23 June 2021. With regard to the NCMP, they cited two studies (Grimmett, Croker, Carnell, & Wardle, 2008 and Falconer et al., 2014), the latter of which explored the benefits and harms of providing parents with weight feedback via the NCMP. Their response stated that both [studies] showed that “body image, self-esteem, weight-related teasing and restrictive eating behaviours did not change as a result of being measured or providing feedback for overweight children”.
Their response also asserted that “Public Health England (PHE) has a rigorous approach to reviewing the National Child Measurement Programme (NCMP) on an annual basis, which includes extensive review of evidence and consultation with stakeholders including families, and healthcare professionals across the fields of psychology, weight management, mental health and eating behaviours.” Whilst the date of this year’s annual review is not the public domain, we find it disconcerting that recent and robust evidence runs contrary to the somewhat-dated evidence the government has cited in support of the NCMP. Specifically, there are two studies, both of which were published in 2020, prior to the government’s response to the inquiry.
In November 2020, results from a US-based randomised-controlled trial (the gold standard of research) over a three-year period with over 28,000 students from grades 3–8 (ages 8–13 years) found that BMI report cards sent to parents do not change the weight status of students and can increase weight dissatisfaction. Further, over one-third of students were distressed by being weighed at school, findings that run counter to the studies the government has been leaning on. In another study, published online in May 2020, found that “parental identification of child ‘overweight’ and ‘obesity’ is associated with worse child mental health, independent of child body weight”.
Focusing on weight in childhood can cause children to feel negatively about themselves and their bodies. Poor body image and a preoccupation with weight increase the risks of food restriction and developing eating disorders later on. In a 2015 study, food restriction in 5-year old girls was correlated with weight bias favouring thinner bodies, with almost half of the girls expressing an internalisation of the “thin ideal” and 34% intentionally restricting their food intake.
The sharp increase in children suffering from eating disorders is a worrying trend. According to the recent Children’s Commissioner’s report on the state of children’s mental health services, published in January 2020, there has been a 50% increase in children accessing services for eating disorders, up from 2016/17 and it isn’t only older children and teenagers who are at risk. The teacher’s union NASUWT published survey results in 2017, revealing that teachers had encountered children as young as 4 who were struggling with eating disorders.
We believe that the current system of weighing children in school should be stopped and fully reviewed for its efficacy and negative impact on children’s mental health. We would like to emphasise that mental health is equally as important as physical health in children and weight stigma in particular can have long lasting negative consequences to emotional wellbeing and quality of life. Children who are preoccupied with their body size and weight are at a greater risk of developing disordered eating and eating disorders later on.
The evidence is clear — we need a better, holistic-centred approach of monitoring and supporting children’s health — a far cry from the government’s current tick-box exercise of shaming children and blaming parents.
What can you do?
If you’re a parent with a child in Reception or Year 6, you can opt out of having your child being weighed. Exercise this right.
Share this information with other parents and encourage them to do the same.
If your child is not in Reception or Year 6, or you are not a parent, consider sharing this article through your social media accounts. Knowledge is power.