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School nurses to weigh and identify kids at risk of obesity under contentious plan
School nurses would weigh students and identify those at risk of becoming overweight under a controversial proposal by the country’s peak body for nurses to curb rising obesity rates.
The Australian College of Nursing is calling for the “normalisation of collection and discussion of height and weight data of all children” to help students maintain a healthy weight through diet and exercise.
But the plan, which calls for every Australian student to have access to a suitably qualified nurse, has drawn criticism from body image experts, who say weighing children could lead to shame and stigma.
Lisa Chalmers, director of health and wellbeing at Barkers College, SydneyCredit: Flavio Brancaleone
Karen Grace, national director of professional practice at the Australian College of Nursing, said nurses could play an important role in reducing the number of Australian children and adolescents considered to be above a healthy weight. Currently, 26 per cent fall into this category.
“Nurses are perfectly placed to help identify when further help is needed and to refer to a GP or dietitian,” she said. “This is about chronic disease prevention later in life.”
She said a regular screening program, where students’ weight and height measurements were collected, would allow nurses to reach out to students and their families who might need help to achieve a healthy weight. These measurements would be plugged into World Health Organisation-endorsed growth charts, which take into account different ethnicities, according to Grace.
She said the screening program would be adjusted according to the age of children, with older children afforded privacy to ensure they didn’t experience shame.
“When you have a baby you religiously weigh your baby to make sure they are growing... then we lose track of those measurements,” she said.
“We are well-placed to do those regular check-ups and make it a part of growing up.”
She said nurses could also combat weight stigma.
“We used to use words like ‘overweight’ and ‘obese’, but we now want to role model positive language. We talk about how you maintain a healthy weight rather than using words like obese,” she said.
Dr Zali Yager, executive director of body image advocacy group The Embrace Collective, said focusing on young people’s weight, weighing them, and identifying young people as ‘overweight’, often led to feelings of shame and stigma.
Yager, who is also an adjunct associate professor at the Institute for Health and Sport at Victoria University, said this could also lead to psychological harm, eating disorders, avoidance of physical activity and healthcare as well as weight gain.
“I support the idea that ensures every school-aged child has access to a qualified nurse but suggest that this should be to support their health, not focus on their weight,” she said.
“The US is currently rolling back their widespread BMI screening programs because they were not helpful in changing weight, but very harmful for children’s psychological health.”
Lisa Chalmers, the director of health and wellbeing at Barker College in Hornsby in Sydney’s northern suburbs, supports calls to have a nurse in every Australian school.
“They are ideally placed to identify and intervene early to avoid that chronic health trajectory,” the school nurse said.
She said obesity was a complex issue influenced by food intake, social media, junk food advertising and our sedentary lifestyles.
Body image expert Zali Yager says the cost of hating one’s body can have many negative impacts.
But Chalmers said focusing on weight and height measurements could lead to body image concerns and make parents feel judged.
“We don’t have scales in our health centre,” she said of her school’s approach to health and wellbeing.
“We talk about how students can get the best out of our brains and bodies, how certain foods make them feel rather than look. We don’t focus on physical appearance.”
Dietitians Australia president Tara Diversi said dietitians were experts in nutrition and the most appropriate professionals to be delivering weight, nutrition and body image support in schools.
“We need to be mindful of the unintended consequences of weight-related initiatives in schools may have on children, families immediately and in the long term,” she said.
In Victoria, all primary school students have access to a nurse through the state’s Education Department, while the Victorian Secondary School Nursing Program is available to approximately two-thirds of government high school students.
In Victoria, school nurses no longer routinely weigh and measure children unless their parents flag health concerns. The routine weighing and measuring of Victorian students was removed from the school entrant health assessment about eight years ago.
“Victorian government schools have access to a range of teaching, health and wellbeing resources that promote healthy eating habits, increase students’ activity levels, and improve their physical and mental health and wellbeing,” a Victorian Department of Education spokesman said.
In NSW, there are 106 wellbeing nurses who provide services to over 400 NSW public schools.
NSW Health Department guidelines state that population screening for health and development is not within the scope of their work in schools.
The collective said being overweight or obese was linked to more than 30 diseases, including 17 types of cancer, cardiovascular diseases, musculoskeletal conditions, type 2 diabetes, dementia, asthma and chronic kidney disease.
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