I met Madelyn for the first time last month in clinic. Six months prior, she was an otherwise healthy 14-year-old girl. One afternoon, Madelyn’s phys ed teacher led a gym class aimed at completing fitness and health assessments on all of the children in the grade. One at a time, each child was asked to step up and onto a scale to measure weight.  Then height and abdominal girth were measured with a tape measure. Finally, body fat composition was measured using body fat calipers. The gym teacher would do a quick calculation and then state, out loud in front of all the children, each student’s body mass index and body fat composition results. Then, each student was required to perform a number of fitness challenges to assess strength, endurance, flexibility, etc.  At the end of the class, reports were handed out to each student with a list of specific goals for improving overall fitness and health. The children were then dismissed.

The students scrambled out of the gym and then formed a huddle frenetically comparing each others’ results. Madelyn (ordinarily a private and reserved child), caught up in the moment, shared her results and compared with the others. Realizing that her BMI was above average, and noting how many of her peers were thinner than she, Madelyn felt a sudden and overwhelming wave of anxiety, shame, and self-loathing.  She ran to the bathroom, locked herself in a stall and cried as she looked carefully at the information and health recommendations on her card.

Your BMI score puts you in the “overweight” category, approximately 1 kg away from “obese.”  To achieve a healthier weight, it is recommended that you lose at least 6 kilos.  You can achieve this by exercising more each day and choosing lower calorie food options (fruits and vegetables) instead of high calorie options (fatty meats, fried foods, and items with added sugar).

6 months later, I met Madelyn for the first time: severely malnourished, dehydrated, in cardiovascular shock and in need of an emergency hospital admission to save her life.

It turns out that Madelyn took strongly to heart the recommendations she read that day on her fitnessgram. Within a few weeks, Madelyn was skipping breakfast, eating only salad for lunch, and asking her mom to cook carb and fat-free meals for dinner.  Up at 4:30 a.m. every morning, she completed two hours of cardio on the basement treadmill before walking 3 miles to school.  At recess, she got special permission from the gym teacher to work out: 200 sit-ups, 100 push-ups, 200 squats.  She walked home briskly in the hopes of arriving early enough to complete another hour of cardio before dinner. After dinner, she felt overwhelming shame for eating too much and, if no one was around, she’d force herself to vomit whatever dinner remnants might still be in her stomach not yet digested. If she wasn’t able to vomit that night, she counted the calories digested, converted them to minutes of cardio and woke up that much earlier the next morning to make them up.

The weight melted off and the more she lost the more driven she was to lose more. By the time I met her, Madelyn was 25 kilos (55 lbs) and barely alive.

Unfortunately, eating disorders programs across North America regularly care for patients with stories shockingly similar to Madelyn’s.  Often children presenting with eating disorders report life events that trigger their illness.  All too often these triggers turn out to be some form of irresponsible health message coming from school health and fitness program.  Health professionals in the eating disorders community would corroborate this as do some small-scale scientific papers.

Children (along with their parents) should discuss the health implications of parameters like body weight, body height, and body fat composition with credentialed and competent health care practitioners, not with school educators in gymnastics classes.  Sorting out health issues relating to weight and body shape can be complex, challenging and high-risk, especially for young adolescents. Gym teachers, school principles, and class teachers simply do not have the training, experience nor expertise to assess and manage these medical problems.

I am troubled by the growing trend of health and fitness assessment programs, similar to what Madelyn experienced, that are rolling out across the United States.  “Fitnessgrams” are being handed out to children in Iowa, Texas, Georgia, New York and many other states. Amazingly, though school boards across America are avidly embracing this Fitnassgram model for health and fitness education in schools, there remains absolutely no evidence, whatsoever, that these programs are doing anything to help improve the health and well being of students.  The real risks, I fear, far outweigh the theoretical benefits.

For Madelyn’s sake, and for the sake of the other vulnerable adolescents like her, let’s leave childhood education to our educators and health care provision to our doctors and nurses.

After 1 month in hospital, Madelyn has gained back 5 kilograms, stabilized her condition and looks forward to discharge from hospital, hopefully in the next 2-3 weeks.  But only then starts what is likely to be a long and tedious battle to overcome her anorexia and earn back the life that she lost.

Dan Flanders is a pediatrician in Toronto, Ontario, Canada, and can be reached on Twitter @drflanders.

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