What does the law require?

Education Law Sections 903 and 904 require a system to assess the prevalence of childhood obesity throughout New York State. In addition, Regulations §136.3, effective July 1, 2018, the Commissioner of Education requires a health examination form or health certificate (completed by the private provider) or a health appraisal form (completed by the district medical director)  for students at school entry (pre-K or K), and in grades 1, 3, 5 and 7, 9, and 11. The health form, health certificate, or health appraisal form must include an assessment of Body Mass Index (BMI) and weight status (based on BMI-for-age percentile). This information is used to report data to the NYSDOH to assess childhood obesity in New York State.

How are BMI and WSC data collected?

Each year, 50% of public school districts are notified that they have been selected to report aggregated student weight status category and health conditions information to the NYSDOH electronically, using the Health Commerce System (HCS). The five boroughs of NYC are not required to collect BMI/SWSC information. School staff, predominantly school nurses, aggregate the numbers of students in the following six weight status categories based on sex-specific BMI-for-age percentiles:

• Less than 5th percentile
• 5th to 49th percentile
• 50th to 84th percentile
• 85thto 94th percentile
• 95th to 98th percentile
• 99th and above

If the provider only documents the WSC as an actual percentage (i.e., 90th, 90%, or 90), can the nurse place it in the correct Weight Status Category range (i.e., 85th to 94th percentile)? 

Yes

What is the Health Commerce System (HCS), and how do we get accounts?

The HCS is a secure internet site that allows confidential data to be sent to the NYSDOH electronically. To use the HCS, a school district must create an account to enter and submit the data to the NYSDOH. Accounts may be set up online. Account setup information is available on the New York State Center for School Health (NYSCSH) Website.

Note: School staff who have used the HCS to submit immunization, absenteeism, or student weight status categories should use the same account.

At what grade levels are BMI/SWSC health data collected?

Data are collected from health examination forms, health certificates, or health appraisal forms provided to the school in the PREVIOUS school year. Forms for students submitted when students were in grades Pre-K/K, 1, 3, 5, and 7, 9, & 11 are used as documentation for students currently in grades 2, 4, 6, and 8, 10, & 12. 
Schools will be required to report aggregated student weight status category data for either Pre-Kindergarten or Kindergarten based on a student’s official school entry and student number assignment. If students attended Pre-K in the previous year, the mandated exam form from Pre-K would be used to report for those students currently in Kindergarten. Additional information on how to report Pre-K/K students is available on the WSC Data Reporting page at the New York State Center for School Health’s (NYSCSH) website on the Data Reporting page.

Is there a resource to tally the number of students in each of the weight status categories?

The State Health Department developed instructions and reference materials, including tools for school staff to tally the number of students in each weight status category by grade group and sex, the number of students in the 99th and greater BMI-for-age percentile, and with each health condition. These tools can be utilized when individual health exam forms, health certificates, or health appraisal forms are received, as examinations are conducted, or after all school physicals have been completed. Instructions and reference materials are available on the New York State Center for School Health (NYSCSH) Website: School District Tally Sheets.

Can tallying be done as forms are received or physicals are performed rather than retrieving files to tally after notification that our district was selected?

It may be helpful to districts to tally all physical examinations as they are received so that the data are available if needed. This data may also be used internally to monitor health and wellness at the district level.

Who reports the data to NYSDOH?

Each school district must identify who will report data for the entire district, known as the Role of the (“School District Nurse Role” or “School Data Reporter”) and the person in the HPN Coordinator Role who must assign them to that role in their HCS account.

Who calculates WSC/BMI?

Only a student’s healthcare provider may perform and complete a health certificate, and only the school medical director can perform and complete the health appraisal at school. A school medical director may write a policy stating that the school nurse may calculate the BMI and determine the weight status category. The school nurse may then document this information on the health certificate form for the provider if requested

What is the nurses’ role in calculating Body Mass Index (BMI) and determining weight status category (based on BMI-for-age percentile)?

A school nurse may calculate BMI SWSC if delegated to do so by the school medical director using the CDC- BMI Percentile Calculator for Child and Teen.
A school medical director may write a policy stating that the school nurse may calculate the BMI and determine the weight status category. The school nurse may then document this information on the health certificate form for the provider if requested. 

What happens if a student’s private healthcare provider doesn’t return the form or if it is incomplete? Who is responsible for determining BMI and weight status category?

If the health certificate is incomplete, it would be advisable for the school nurse to return a copy of the form to the family for the family’s private healthcare provider to complete. If the parent fails to provide the required health certificate, the information should be added as part of the school health appraisal conducted under the local district.

Is there a sample notification about the reporting requirement which includes opt-out information for parents?

Yes. Sample parental notification and opt-out information is provided on the NYSCSH website in English and Spanish under Data Reporting. Schools may provide notice to parents via the school website, school newsletter, registration packet, and/or other reasonable means. It is suggested parents/guardians receive this notification by January 2nd of each calendar year to allow time to respond, as the survey will be due for submission by January 31st of each calendar year.

Does the legislation require that BMI or weight status data be reported to parents/guardians?

No, the legislation does not require reporting of BMI or weight status category to parents/guardians. 

How should parents/guardians be informed if a weight issue is identified during a health examination at school?

If a concern about a student’s weight status is identified during the health examination performed at school, it should be handled in the same manner as other health concerns identified during the health appraisal.

If the school is aware of a medical condition that is not documented on the health exam, should it be counted on the BMI/SWSC form?

No, unless documented on the health exam, information cannot be counted on the BMI/SWSC reporting.

If a school utilizes an electronic health record system that automatically calculates the BMI and it differs from the documented BMI on the health exam, should the school use the health exam value or the EHR value?

The law requires that the BMI and weight status categories reported are from the health form, health certificate, or health appraisal form. 

Why is BMI and weight status measurement important?

Obesity prevalence data of school-age children and adolescents at the local and state levels is used to understand the severity and distribution of obesity among youth of various ages in different regions of the state. This is a critical first step in targeting resources for childhood obesity and can be used to evaluate whether actions taken by school districts are effective.

Where can I find Student Weight data once it is released from NYSDOH?

Student Weight data is available on the New York State Health Connector Website through the Student Weight Data Explorer. Use the data explorer to look at data from an individual school district, compare obesity rates from multiple districts, or examine statewide, regional, and county-level trends in student overweight and obesity.

What is the efficacy of BMI? 

BMI-for-age percentiles have been shown to be more sensitive and specific in determining overweight and underweight in children and adolescents than weight-for-age or height-for-age percentiles. Their use also facilitates the early recognition of excessive weight gain. Current recommendations call for BMI-for-age percentiles to be used as a “screening tool,” not a diagnostic test.

Page Updated 7/29/24