Uncool clothes. The wrong friends. Bad skin. No date.
Navigating the social land mines of adolescence can be stressful enough, some say, without kids also having to worry about officials measuring their fat.
Bills working their way through the Maryland General Assembly this year would require public schools to screen pupils for signs of heaviness and then send the results home to parents in a "health report card."
But opponents - who include the state's major medical and psychiatry organizations as well as parents groups - doubt the value of such testing and say it would be as esteem-boosting as a round of schoolyard dodge ball.
"It further accentuates the idea that weight is of extreme importance," says Dr. Harry Brandt, director of the Center for Eating Disorders at Sheppard Pratt. He predicts that some young people would feel bad enough about their body grades to experiment with the sort of unhealthy behavior that leads to anorexia or bulimia.
"The reality," he says, "is that kids come in all sizes."
The bill's backers say the unfortunate reality, however, is that kids are increasingly coming in one size: XXL.
Because obesity in the United States is getting worse, they say, it makes sense to nip budding weight problems early and to teach kids the difference between reaching for apples and grabbing bags of Cheetos.
"You can't be a good learner if you've got a bad diet," says Sen. Paul G. Pinsky, a Prince George's County Democrat and longtime proponent of getting healthier foods into schools. He says he's baffled by the fire his legislation is drawing.
"Why do people want to block this?" he asks. "I don't get it."
Pinsky's bill and another one pending in the Senate would require local schools to calculate each pupil's body mass index, commonly known as BMI. The number is a way to gauge whether people's weight is appropriate for their height.
Pinsky might better understand the brouhaha if he could see the look on the faces of two Eastern Technical High School seniors told last week that elected officials were considering calculating kids' fat.
"It's kind of like against basic human rights!" cried Katie McKay, taking in a high school basketball game in North Baltimore with her friend Ashley Anderson. The pony-tailed two of them look as though they've never had a weight worry in their lives. And yet, they're appalled.
"You're gonna have the sort-of-overweight kids and the really skinny kids and they're all gonna feel bad," McKay says.
"I actually think it will make kids more depressed at school," Anderson agrees. She thinks a better idea would be for schools to offer confidential weight-loss programs for students who want to slim down. That and fixing the cafeteria's "disgusting" lunch choices.
"It's all fattening," she says. "I think the fries should just be gone."
If Maryland institutes BMI screenings, it would join a handful of states that have started the practice, including Pennsylvania. In 2003, Arkansas became the first state to require its schools to chart BMI.
Parents in Arkansas did not take kindly to the fat measurements. In fact, last year state lawmakers tried to have the law repealed. According to the Arkansas Democrat-Gazette, during the first year of the screenings 13 percent of parents said their children had been teased at school because of the program. This year the taunt-monitor dropped to 9 percent, the paper reported.
More disturbing for some Arkansas officials: The BMI testing has not put a dent in the state's number of overweight kids.
Across the country, an estimated 16 percent of young people between 6 and 19 years old are overweight, according to the Centers for Disease Control and Prevention. In the adult world, that statistic balloons to 65 percent.
The CDC figures that, in Maryland, 29 percent of low-income children between 2 and 5 years old are either overweight or at risk of becoming so.
School officials nationwide are pulling their hair out trying to reverse the trend. If it's not BMI report cards, then it's banning bake sales or hauling out vending machines or rethinking fitness classes.
A deadline later this year for schools to come up with "wellness policies" in order to preserve their federal school lunch funding has only heightened the frenzy, says Dr. Frank Greer, chairman of the American Academy of Pediatrics' committee on nutrition.
"Every organization I know of has a task force on obesity," Greer says. "We really don't know if it's going to make any big difference."
The physician wanly praises BMI tests in schools, if only as a way to measure whether or not any of the other initiatives are working. But sending home report cards, he guesses, will be a bust.
"We don't have any idea how parents are going to use the information, or if it will mean anything to them," Greer says. "My suspicion is that many of them will just overlook it. The parents who would be concerned about it are probably concerned about it already."
The two bills before Maryland's legislature would require schools to calculate BMI measurements, but they take different approaches on how and when.
Pinksy's proposal would require schools to get the BMI information and screen for diabetes at the same time they test for scoliosis - which usually happens at least once between the sixth and eighth grades. His bill would also force school cafeterias to cut back on selling a la carte fatty foods and to put fruit and non-fried vegetables on the daily menu.
The other plan, sponsored by Sens. Gloria G. Lawlah and Gwendolyn T. Britt, both Democrats from Prince George's County, would initiate BMI tests for pupils in first, third, fifth and eight grades.
In both bills, a parent's note would excuse a child from the screenings.
Doctors, vendors ally
State organizations that have jumped to protest these efforts include the Maryland Chapter of the American Academy of Pediatrics, the Maryland State Medical Society, the Maryland Psychiatric Society and Maryland PTA.
For Pinsky's bill, the doctors have formed an unlikely alliance with food and beverage vendors who don't care so much about BMI tests but would hate to see their lucrative snack machines banned from campuses.
Maryland PTA President Mary Jo Neil says her organization is all for making kids healthier, but there are "just too many questions looming on this one."
She's worried about kids' privacy, how schools will pay for the tests and what will become of the data. "How are they going to do this?" Neil asks. "In some schools, they don't even have a nurse."
A lobbyist for some of the medical organizations says pediatricians would hate for anyone to assume that by objecting to the BMI tests, they're pooh-poohing the perils of obesity.
"You've got the right issue," Pam Kasemeyer says, "just the wrong approach."
Schools are no more equipped to handle the screenings than children are equipped to handle the results, says Kasemeyer. Only a doctor's office, she adds, offers the privacy and professionalism such medical tests require.
Physicians, she says, "think the potential for harm is great."
Pinsky throws his hands up in exasperation at such statements. He says he wonders whether what doctors are really worried about is losing business.
"Give me a break," he says. "You take the weight and you take the height and you put 'em on a chart and then you send it over [to parents]. How harmful is that?"
Christine Duray, a recovering anorexic who works in the state comptroller's office, swung past a recent Senate hearing on Pinsky's bill. She didn't want to testify. The idea just worried her.
"If I was already teetering on the edge of an eating disorder, this would push me right over the edge," she says. "There's already competition enough in high school."
If the nation is being weighed down by generations of fat kids, government officials have no one to blame but themselves, figures retired teacher Aloha McCullough, who was also checking out the basketball game at Polytechnic Institute/Western High.
That's what they get for eliminating physical education classes, she says with a tsk-tsk shake of her head. Nothing, she jokes, will keep kids in shape better than having to take a required post-gym shower.
As for this BMI business, she declares that rather silly.
"Everybody is constantly bombarded with all this weight stuff," she says. "Wherever you look - on TV or in the magazines - it's all thin people and talking about how you can get skinny.
"I think we get a little carried away with how we're always throwing it in people's faces."
To calculate your body mass index, go to http:--www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm
Key provisions of the Senate bills creating obesity report cards:
Would measure the body mass of all first-, third-, fifth- and eighth-graders within 90 days of the start of school and mail results to parents in a confidential health report card.
Parents could refuse to have their children tested.
Aggregate results of the BMI tests would be reported by school and grade to the state education department.
Would add a diabetes screening and body mass index test to the existing screening students get for scoliosis between sixth and eighth grades. If a student's BMI is above the 85th percentile or below the 5th percentile for his or her age and gender or if the student shows signs of diabetes, the parents would be sent a copy of the screening reports and information about the findings.
Parents could refuse to have their children tested.
Would require reviews of all foods sold on school property and require local boards to prohibit the sale of foods with minimal nutritional value during the school day. Middle and high schools would be required to offer at least two fruits or non-fried vegetables in any location where food is sold.