Should school nurses weigh in on childhood obesity?

The Australian College of Nursing certainly thinks they should.

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There’s a new push for children to have regular school nurse-run weight checks, but questions over its value remain.

Last week, the Australian College of Nurses put out a new position statement responding to a May report by peak body The Obesity Collective.

It called for funding reform to enable every school-aged child in Australia to have access to a qualified registered nurse and to empower the nursing workforce to identify children at risk of obesity.

As part of this, it also recommended that school nurses routinely measure the height and weight of students, with longitudinal mapping on WHO recommended growth charts.

Queensland GP Dr Bruce Willett, who has been participating in a state-funded GPs in schools initiative for several years, said he had mixed feelings on the proposal.

“Years ago [in Queensland] it was a routine thing for nurses to come through the schools and screen kids for a whole range of things, like hearing and vision, and that was actually quite a good way of systematically doing those things,” he told The Medical Republic.

“And I guess the second thing to say is that we are in an obesity crisis; two-thirds of Australians are now overweight or obese.”

But there has also been a broader shift away from using weight or body mass index as the sole indicator of ill health.

The Eating Disorders Alliance said it had concerns that a school-based program could exacerbate weight stigma and encourage disordered eating.

“Placing emphasis on weight control/reduction in health messaging has been shown to promote disordered eating behaviours, reduce physical activity, and discourage health behaviours,” Eating Disorders Queensland CEO Belinda Chelius said.

Butterfly Foundation CEO Dr Jim Hungerford said the charity often hears that weight-centric health promotion efforts mostly served to reinforce stigma.

The idea of routine weigh-ins also drew criticism from body image advocacy group The Embrace Collective in a Nine Newspapers article this week.

“I think there is a problem with an intervention that’s focused on weight alone and focuses on the individual alone – that’s problematic,” Dr Willett said.

“As any of us who’ve done screening or counselling about weight and obesity [know], it needs to be handled incredibly sensitively.

“If you don’t, you risk making the problem worse – you injure people’s self-esteem and that kind of exacerbates their eating issues, because they kind of go ‘well, I’m [already] fat, what’s the point of trying?’”

The other issue with addressing weight in a school context is that children tend to have little input into their diet.

“[As adults], we’re all responsible for ourselves and what we eat, whereas for kids it really is a whole family issue,” Dr Willett said.

ACN national director of professional practice Karen Grace told TMR that the recommendation to collect weight data from young people was part of a larger effort to prevent chronic conditions.  

“By providing school-aged children with access to qualified nurses, we aim to offer proactive and non-judgmental care that helps families make informed decisions about their children’s health,” she said.

“We understand the sensitivities surrounding body image, and that is why our approach emphasises privacy, respect, and sensitivity in how these measurements are handled.”

Ms Grace also said the college was committed to promoting supportive and stigma-free environments for young people.

“Clinical interventions to support children in maintaining a healthy weight range can potentially reduce the prevalence of obesity in adults, improve long-term quality of life, and reduce healthcare costs,” the ACN position statement said.

“Comprehensive, high-intensity behavioural interventions for childhood obesity, compared with usual clinical care, have been evidenced to reduce the prevalence of overweight children.”