Evaluating Alternatives to the Arkansas BMI Screening Policy: A Public Health and Equity Perspective

Instructions

• Use the three evaluation criteria (Efficacy/Impact, Efficiency/cost, Feasible/ Sustainable) to fully evaluate three of my policy alternatives according to those evaluative criteria. 
• My policy: The Arkansas BMI screening policy.

       My Proposed Policy alternatives:

• 1. Dietician referrals 
• 2. Reframing Parental Reports with Simplified Language
• 3. Parental Seminars

• Write +/- 300 words on each policy alternative. Identify possible opposing views and describe how you might respond to them in a hearing setting. Anticipate the likely concerns of the governing body.
• Evaluate the policy options for their impact on the health and social equity of individuals, communities, and/ or populations.

Bellow you will find an example on ideas you should considered when writing the paper

Example of policy: Smoking Cessation  

1.Policy alternative: Implement “smoke free” policies on all state-owned properties and facilities, including state psychiatric hospitals and outpatient settings. 

Efficacy /Impact: High impact. -A highly effective strategy to reduce cigarette consumption. Policy would impact 100% of the population and have immediate health improvement. -Longer term social and economic benefits, e.g. 

30-40% increase in disposable income.

Efficiency/ Cost: Minimal implementation cost. Costs recovered from reduced cost for maintenance, insurance, and fire safety.  

Feasible/ Sustainable: Does not rely upon funding and would therefore be feasible and sustainable. 

2. Policy alternative: Warnings posted at state facilities regarding the danger of smoking and availability of treatment

Efficacy /Impact: Low impact. Institute of Medicine: “current warnings are inadequate ….and woefully deficient when evaluated in terms of proper public health criteria.”

Efficiency/ Cost: Minimal implementation costs

Feasible/ Sustainable: Does not rely upon funding and would therefore be feasible and sustainable. 

3. Policy alternative: Provide voluntary access to smoking cessation programs coupled with medication therapies.

Efficacy /Impact: Marginal Impact-Limited effectiveness with reported success rate of 10%

-At best, success rate would approach 45% or a level equal to general population

Efficiency/ Cost: Treatment is expensive but offset by Medicaid reimbursements, reasonable fees supplemented by Tobacco Settlement Trust funding

Feasible/ Sustainable: Funding support annualized. Training needs minimal

My Policy

The Arkansas policy regarding mandated obesity screenings in schools and parental reports has been ineffective at addressing the problem of childhood obesity, alternative policies should be considered to amend or replace the current policy.

My Proposed Policy alternatives:

1. Dietician referrals 

2. Reframing Parental Reports with Simplified Language

3. Parental Seminars

Bellow you find my reasoning why I proposed these alternatives. You can expend on these ideas when writing the paper.

Dietician Referrals

The first policy approach is to include referrals to dieticians for all children whose BMI score falls outside the normal range. The impact of this policy is that it would provide parents with an informed source who will provide them with practical information. The dietician’s goal would be to help the parents construct a healthy and practical meal plan, while also providing them with relevant information on exercise and healthy eating habits, such as when (and when not) to provide snacks. According to Thompson & Madsen, one of the failings of the current policy is that parents are often not provided with sufficient information in the current reports they receive.¹ They may understand that their child falls outside the healthy weight range, but without adequate knowledge on what may be contributing to the problem, they will not know how to effectively address the issue. Including referrals for dieticians would be an appropriate approach when addressing this issue, as dieticians will be able to work with parents by helping them develop a healthy meal plan. They would be able to provide information on which foods to avoid, as well as different preparation techniques that can be used to ensure maintaining a healthy diet is both practical and manageable on a daily basis. 

However, the possible unintended consequence of this strategy is that many low-income (and some middle-income) parents may not be able to afford dieticians.¹ As such, this would create an economic barrier for many families. The additional cost associated with hiring a dietician creates elements of socioeconomic inequity, as not every family would have the same level of access to this resource. 

Reframing Parental Reports with Simplified Language

Thompson & Madsen also note that current BMI reports given to reports often include clinical language, which is suboptimal when attempting to convey clear and concise information.¹ Therefore, reframing how parental reports are written by using simplified language, while also including actionable recommendations, would be an appropriate way to address the policy problem. The impact of the policy is that parents would be able understand the information they are receiving from BMI reports. To this end, BMI reports should also be available in a language that is accessible to non-English speaking parents, as one of the main problems with current BMI reports is that they are always sent in English. 

Although simplifying language would help many families better understand BMI reports, there are a few negative consequences of this approach that are foreseeable. One possible challenge would be the difficulty associated with drafting a report that uses simplified language, while also maintaining a tone that is culturally respectful, practical, and informative at the same time.¹ In other words, drafting these reports could be challenging. In addition, BMI reports are currently standardized, which makes them easy to complete within a short period of time. Providing individualized reports would require substantially more amount of resources, particularly if each report had to be personalized to each child’s needs. In theory, this would be an ideal approach, as each family would have a personalized report that provides them with relevant and practical tips for their specific situation. At the same time, the only way this could practically be achieved is if there were ample resources, including human resources, to complete these assessments. 

Parental Seminars

Ruggieri et al. also agree that the failure of the current policy is due to its inability to provide relevant and practical information.² To this end, they suggest that inviting parents to seminars intended to teach them about the health risks of obesity, while also providing them with practical tips they can use to prepare healthier meals, would be one way to address the current policy limitations. The impact of this policy is that it would provide parents with more science-based information on the dangers of childhood obesity. 

However, the possible unanticipated consequence of this policy approach is that parents may fail to attend these seminars even if invited. Some parents may not have time to attend these seminars, particularly if they are busy working, while other parents may not agree with the BMI assessment due to differing attitudes on what constitutes healthy weight and body shape.² The challenge of a parent’s ability to attend could also create more inequity, particularly if the reason they are unable to attend is due to a need to work. In addition, another problem is that parents may not understand the need or importance of the information being presented at these seminars. The purpose of the seminar would be to provide parents with information that will help them recognize the problem of childhood obesity, but without having this knowledge beforehand, many might simply not see the importance of attending such a seminar. As such, this is a well-intentioned solution, but it is not the most practical, as it would be difficult to generate interest in this type of seminar. 

References

1. Thompson R & Madsen K. The report card on BMI report cards. Current Obesity Reports. 2010;6: 163-167. 

2. Ruggieri DG, Bass SB, Alhajji M, Gordon TF. Understanding parents’ perceptions of school-based BMI screening and BMI report cards using perceptual mapping: Implications for school nurses. The Journal of School Nursing. 2020 Apr;36(2):144-56.