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Sunday Times: "Nurses fight weight test for children"

July 17, 2005 -- Today's Sunday Times (U.K.) includes a story by Sarah-Kate Templeton about the Royal College of Nursing's (RCN) "opposition to government plans to measure and weigh primary school children annually" in order to combat obesity. The RCN argues that these plans are an invasion of the children's privacy and could (in the article's words) "stigmatise fat children." It recommends the use of nurses' drop-in clinics instead. The piece seems to reflect some bias against the nurses' position, and it could have explored the complex issues presented in more depth. But it still presents a good example of nurses' patient advocacy in the public health context.

The article provides basic information on the increasing youth obesity problem in the U.K. It suggests that the new testing plans will entail the return of the "traditional school medical," with results to be "sent home in confidence to the parents of primary school children with advice and referral to specialist services if necessary." The piece includes quotes by John Thain, an RCN advisor on children. He expresses concern about the "low self-esteem" of children with weight problems, and argues that the children should receive support and advice without being singled out. Thain fears that the planned physical examinations will add stress and lead the children to perceive adults as putting them "under surveillance." He admits that the plans could (in the article's words) yield "interesting medical statistics," but he argues that "nurses would do better to run drop-in clinics for overweight children."

The article states that "[h]ealth campaigners dismiss these objections." They point to the clear health threats of obesity and the potential benefits of intervention, including prevention of diabetes and heart disease. Tam Fry, chair of the Child Growth Foundation, and Julian Peto, a London epidemiologist, both label the nurses' concerns "politically correct." Fry also calls the privacy objection "namby-pamby," and Peto adds that it is an "absolutely absurd" argument that "completely contradicts common sense and experience."

It may be difficult for some to see merit in the RCN position, and the article does not help by noting that "health campaigners" object--as if the nurses were not "health campaigners." Nor does it help to allow two of the "campaigners" to pile on with labels that do not address the nurses' concerns. Of course, there is a surface absurdity to the idea that weight is a privacy issue in a classroom context, since it is typically reflected pretty clearly in physical appearance, like race or gender. Yet stigma and self esteem are key factors in patients' seeking treatment and their overall wellbeing, factors that clearly present serious public health concerns, if not issues of "privacy." It is not "absolutely absurd" to argue that the government should have to justify requiring that all citizens undergo health testing, even if the results are kept "in confidence," and certainly if they are not, as the RCN seems to fear. Imagine if the government proposed a program that would require all adults to be weighed in a group setting. Would the "health campaigners" find privacy objections to that "absurd"?

It would seem that the plans deserve to be analyzed like any other mandatory public health testing measure, such as testing for TB or HIV. Weight problems are typically more visible than communicable disease, yet they are not "contagious" in any ordinary sense. So there would presumably be less justification on the grounds that sufferers posed a direct threat to others. It may be that the public health balance would tip in favor of testing with stringent safeguards. For instance, a plan might provide that all children visit a school drop-in clinic at different times, to ensure privacy and minimize the stigma that could be a feature of testing that allowed them to see each other's weights. Perhaps having nurses treat obese children at school walk-in clinics, with ongoing health education for both students and their parents, would be more effective than simply sending home a referral to "specialist services." Indeed, public health nurses such as school nurses are specialists who are well placed to address the obesity problem. In any case, it's probably worth a serious debate that accounts for the complexities of implementing effective public health measures where there are significant conflicting interests. Alternatively, we could just dismiss objections as "politically correct."

The Center commends the RCN for its public patient advocacy as to an important health issue.

See the article by Sarah-Kate Templeton "Nurses fight weight test for children" from the July 17, 2005 edition of the Sunday Times (U.K.).