Grading the “Good” Body: A Poststructural Feminist Analysis of Body Mass Index Initiatives

Abstract

This article analyzes discourse surrounding Arkansas's legislation requiring public schools to measure students' body mass index (BMI) annually and to send the scores to parents on children's report cards. Using poststructural feminist sensibilities, I explore the tensions experienced by parents, children, educators, and policymakers as this mandate was debated and implemented. The discourse illuminates salient issues about disproportionate disparities in health status that exist in communities with fewer resources, and the potentially unintended gendered consequences of health policies. I explain three dominant threads of discourse: How the economic costs of childhood obesity opened a policy window for the legislation; the presence of tensions between freedom and social control; and how BMI discourses inscribe ideological visions of bodies. Ultimately, the analysis offers insight into the discursive nature of policymaking and how class and gender are implicated in health interventions.

Notes

¹Used as a screening tool by public health agencies since the 1980s, the BMI is a ratio calculated by dividing an individual's weight in kilograms by his/her height in meters squared (Ellin, 2006). A BMI score of 18–25 is considered to represent normal weight, while individuals with a BMI of 26–30 are considered overweight and a rating above 30 indicates obesity (U.S. Department of Health and Human Services, 2001).

²The report and subsequent medical studies characterized obesity as both physical and economic issues, linking the condition to heart disease, type 2 diabetes, stroke, and cancer (U.S. Department of Health and Human Services, 2001).

³Following the Surgeon General's 2001 report on obesity, some school districts in Pennsylvania and Florida began to send notices home to parents if their students' BMI exceeded a healthy weight range (Freking, 2002). Legislators in California proposed taxing sugary soft drinks, and other states limited access to vending machines in schools (Freking, 2002; Rowett, 2002).

⁴Under the legislation, Arkansas school personnel were required to measure students' height and weight during annual assessments, and then calculate each child's BMI using the Center for Disease Control (CDC) recommendations. This formula divides the child's weight in pounds by their squared height in inches, and multiplies the result by 703. Students are categorized as “overweight” when the BMI is equal to or exceeds the 95th percentile for their age and sex. “At risk for becoming overweight” represents a BMI between the 85th and 95th percentile; “healthy weight” indicates a BMI between the 5th and 85th percentile; and “underweight” represents a BMI that is less than the 5th percentile. Public health institutions, such as the CDC, typically do not use the term “obese” when referring to children (ACHI, 2008).

⁵The ACHI, a “nonpartisan, independent health policy center” supported by the University of Arkansas for Medical Sciences, the Arkansas Department of Health, Arkansas Blue Cross & Blue Shield, and Arkansas Children's Hospital, was tasked with implementing Act 1220 after the legislation passed in 2003 (ACHI, 2008).

⁶In addition to the BMI report-card provision, the legislation prohibited in-school access to vending machines in elementary schools, required school districts to publicize the amount of revenue earned through competitive food and beverage contracts, created a 15-member state child health advisory committee, and mandated school districts to establish local committees on nutrition and physical activity. The state-level committee was tasked with developing additional wellness policy recommendations, such as physical activity or nutrition standards for schools, for the Arkansas Board of Education (Dishongh, 2003).

⁷For example, the initial ACHI reports on the BMI assessments found the number of students classified as overweight and at-risk was disproportionally higher in African-American and Hispanic populations than among Caucasians (Smith, 2006a). While elements of the discourse addressed cultural reasons, such as methods of preparing food, for the disparities in communities of color, few policy solutions addressed the socioeconomic factors that influence such gaps.

⁸U.S. First Lady Michelle Obama recently declared schools to be “on the front lines in the war against childhood obesity” (Ferran, 2010).