CDC - Body Mass Index (BMI) Measurement in Schools - Safeguard 9

Safeguard 9. Ensure that resources are available for safe and effective follow-up.

BMI screening programs are not intended to diagnose weight status. Schools can refer students who need follow-up to appropriate local medical care providers.

Actions to initiate a screening program


  • Work with the local medical community to ensure that adequate diagnostic and treatment services are available, staffed by employees with appropriate training, and accessible to all students, including those with low family incomes or without insurance.
  • Identify school- or community-based health promotion programs that encourage physical activity and healthy eating.

School nurses:

  • Be educated, trained, and equipped with the appropriate resources to respond to parents requesting guidance.1
  • A valuable resource during the follow-up period, school nurses can provide parents with a clear explanation of the results and health risks associated with obesity, develop an action plan for behavior change, and connect the family to medical care in the community.1

School health personnel:

  • Establish systematic processes and criteria for referring students to external medical care providers.2
  • Refer students with signs of underweight, overweight, obesity, disordered eating or other diet-related health conditions (e.g., sudden weight loss, eating disorders) to a local medical care provider for diagnosis and, if needed, establishment of management or treatment plans. For example, students classified as obese or overweight after BMI screening require further medical examination to determine whether the student in fact has excess body fat or other conditions related to obesity (e.g., diabetes or prediabetes, high blood cholesterol and triglyceride levels, or early pubertal maturation).3-5

School staff members:

  • Receive guidance on how to recognize early signs of health risks that require urgent attention such as hunger or disordered eating. If a school staff member suspects a student to have these risk behaviors, staff can confidentially refer these students to school health or mental health personnel.

Schools can play an important role in developing and marketing a referral system for students and families.2,6-8 To establish a referral system, school health personnel can identify health-care services and school- or community-based programs that encourage healthy eating and physical activity and address obesity and eating disorders. These services include:

  • school-linked health clinics
  • local health departments
  • universities
  • medical schools
  • outside health-care providers (e.g., private physicians and dentists, hospitals, psychologists and other mental health workers, pediatric weight management clinics, community health clinics, and managed care organizations)
  • community-based nutrition and physical activity providers and services (e.g., dieticians, recreational programs, and cooking classes)

The list of referral services can be based on the health needs of the student population, barriers to health care in the community, past student use of community services, and current community culture. Health, mental health, and social services staff members can assess which services are available at the school and which require outside referral.9 The list can include services that are accessible to all students, including those with low family incomes or without health insurance or transportation. If feasible, arrangements can be made to bring community-based services to the school. With a comprehensive referral system in place, health, mental health, and social services staff members are able to respond to requests from families seeking guidance and increase access to care among students.1


Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C, Thompson D, Grummer-Strawn L. Body Mass Index Measurement in Schools. Journal of School Health. 2007; 77:651-671.external icon

CDC. School Health Guidelines to Promote Healthy Eating and Physical Activity. MMWR. 60(5):1-75 pdf icon[pdf – 973KB].


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  1. Howard KR. Childhood overweight: parental perceptions and readiness for change. J Sch Nurs. 2007;23(2):73-79.
  2. Taras H, Duncan P, Luckenbill D, Robinson J, Wheeler L, Wooley S. Health, mental health, and safety guidelines for schools; 2004. Available at http://www.nationalguidelines.orgexternal icon.
  3. Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations. J Pediatr 1998;102:E29. Epub Sept. 1, 1998. Available at icon.
  4. Himes JH, Dietz WH. Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. Am J Clin Nutr 1994;59:307–16.
  5. Whitlock E, Williams S, Gold R, Smith P, Shipman S. Screening and interventions for childhood overweight: a summary of evidence for the U.S. Preventive Services Task Force. Pediatrics 2005;116:E125–44. Epub July 1, 2005. Available at icon.
  6. American Academy of Pediatrics Council on Sports Medicine and Fitness and Council on School Health. Active healthy living: prevention of childhood obesity through increased physical activity. Pediatrics 2006;117:1834–42.
  7. National Association of School Nurses. Position statement: overweight children and adolescents. Silver Spring, MD: National Association of School Nurses, Inc; 2002. Available at Statements FullView/tabid/462/smid/824/ArticleID/39/Default.aspxexternal icon.
  8. Rose BL, Mansour M, Kohake K. Building a partnership to evaluate school-linked health services: the Cincinnati School Health Demonstration Project. J Sch Health 2005;75:363–9.
  9. Allensworth D, Lawson E, Nicholson L, Wyche J, eds; Institute of Medicine. Schools and health: our nation’s investment. Washington, DC: The National Academies Press; 1997.