Evaluation Of Policy Options
When assessing several policy alternatives regarding BMI Screening and Surveillance in K-12 Schools, it is important to evaluate the cost-effectiveness, mental health tolerance, feasibility, and efficiency. In order to easily compare the overall evaluations, each alternative was rated on a scale of one-to-twenty (i. e. twenty-being the most ideal option).
Cost-effectiveness was defined by whether the cost of the policy alternative was reasonable for government officials (i. e. federal, local, state), as well as for the public school board’s education budget. Mental health tolerance evaluates whether particular programs account for emotional and psychological outcomes. Feasibility refers to whether the proposed solution could lead to the desired outcome after accounting for stakeholders, environmental settings, and other key factors. 40 Lastly, efficiency refers to the likelihood of each program being able to successfully help individuals to adjust their eating habits and to engage in regular physical activity. Each of these criteria are rated on a scale of one-to-five.
Routine BMI Screening and Letter Sent Home to Parents
Although the government officials do not require K-12 institutions to conduct annual health examinations including height and weight measurements, multiple states have legislation policies regarding BMI screening and surveillance. The Massachusetts Department of Public Health recommend calculating BMI statistics by using either the Microsoft Excel software or by downloading the Children’s BMI Group Calculator for Mass. Schools. 41 Both of these are free and easy-to-use. In addition, the surveillance component merely requires that institutions submit annual Essential School Health Service Data Reports in a free, online survey link. 41 Since printing and mailing out “fat letters” costs less than a dollar per an envelope, this option is relatively cost-effective (Table 2).
There is evidence to support that mailing home “fat” letters increases guardian’s awareness of their children’s health problems, but there is no published literature to suggest that this method will help students to lose weight. 42 In addition, sending home these so-called “fat letters” can be detrimental to these students’ mental health. Nemiary et al42 stated that obesity in adolescences has been linked to depression. In addition, ridicule from parents and name calling from fellow classmates negatively impacts their self-esteem and self-worth. 43 Accordingly, this method of notifying schools, primary care physicians, and parents about students’ BMI is unlikely to help children to improve their health.
Implementing Online Nutrition Learning Modules
Hiring an online professor in place of an in-person instructor can save institutions approximately $212,500. On average, Massachusetts public high schools employ 3 to 5 in-person health teachers. With the salary of high school teachers being approximately $58,000, institutions spend over $232,000 annually. Most high school curriculums have students enrolled in health class for a semester during their sophomore year. If a high school enrolled its 130 sophomore students in an online health class using Time4Learning, this cost would be $19,500. Accordingly, this policy alternative showcases significant cost benefits.
Living in an appearance-obsessed culture, girls as young as 8-years-old struggle with “feeling fat” despite having a healthy BMI. 45 In addition, 80% of ten-year-old girls responded that they were “afraid of being fat”. With body dissatisfaction and fat discrimination being a prevalent part of modern society, students are scared to talk to their teachers and even their parents about these concerns. Members of stigmatized groups care a lot about their privacy and are reportedly among the top groups of individuals who seek anonymity online. Accordingly, a computer-based classroom setting would provide students with a safe haven to engage in class modules and ask questions without feeling judged.
Online classrooms that mainly use discussion forums to engage with the course material are associated with higher levels of positive student satisfaction. Several research studies support that implementing online health courses into the K-12 curriculum has promising findings. Kreisel et al46 conducted a study to assess the effectiveness of health and nutrition-related topics using computer-based programming among middle school students. Nutrition-based knowledge among students increased significantly in the online teaching group as well as in the control setting (i. e. in-person lectures). Accordingly, the study reported that replacing in-person health classes with their online-counterparts are equally effective at educating young students not only how to adjust to healthier living, but also how to maintain it .
Group Nutritional Counseling
Reliant Medical Group provides several free nutritional group-counseling options at their 25 sites, located throughout Central Massachusetts and Metrowest. These program options include Diabetes Nutrition, Change Your Weighs, Heart Healthy Eating, and Look Good… Feel Better. Accordingly, these group-counseling sessions are a relatively affordable alternative to one-on-one counseling sessions.
In addition, humans tend to benefit more from group counseling than from other alternatives. Group nutritional counseling not only allows individuals to learn more about healthy dieting and the importance of exercising, but also provides them with companionship. Individuals can develop a sense of belonging by forming strong bonds with other members. Because fellow group-mates have most likely experienced similar struggles, they are more likely to be sympathetic and to provide encouragement. However, this group dynamic does not work for everyone. Individuals who experience anxiety from engaging in social situations may feel unsafe attending group sessions. In this scenario, the on-edge individuals may be too afraid to talk to the nutritionist about their pivotal health concerns. Also, two or more group members may clash with each other. But the nutritionist could just handle the situation by reassigning the individuals to different group sessions. These unfavorable situations are some examples of tradeoffs, however these are uncommon occurrences with easy fixes.
Group counseling provides individuals with social support and empathy, as well as healthy competition. During these sessions, the nutritionists educate individuals about real-world scenarios like how to use portion control and how to make healthy selections when eating out at restaurants. Several randomized control studies reported that group treatments induced a significantly larger weight loss compared to the control groups. In addition, individuals participating in-group sessions were more strongly motivated to maintain their weight loss.
