Educational Administration, Department of


Date of this Version

Winter 12-1-2009


A Dissertation Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Educational Studies (Educational Leadership and Higher Education); Under the Supervision of Professor Marilyn L. Grady
Lincoln, Nebraska: December, 2009
Copyright (c) 2009 Misty Schwartz


It is well documented that there is a worldwide epidemic of obesity in children. To address obesity in children, emphasis must be on factors within family, school, and community environments. Although most parents and school officials are aware of the problem of overweight children, there is little data available to guide decision making about the acceptability of school-based Body Mass Index (BMI) screening and referral programs. As states mandate BMI screening and referral, parental insight is essential to determine the efficiency and effectiveness of BMI notification.

The purpose of this multiple case study was to explore the perceptions of parents whose school-age children received a BMI referral letter stating their child is overweight. Purposeful convenience sampling was used to obtain 21 participants. A detailed description of each case and themes was developed, followed by cross-case thematic analysis. Eight themes and corresponding sub-themes emerged. The themes regarding parental perceptions were: feelings about receiving the letter, causes of obesity, capabilities, barriers, role modeling, primary care provider response, school’s role and health screening process.

Parent’s feelings were categorized into sub-themes of positive/neutral, negative, disbelief, or more than one emotion. Specific and general causes were identified. Capabilities included changes in diet and activity and support/communication. Barriers encountered were: financial, lack of time, lack of control, lack of knowledge, other children and age. Provider responses were categorized into supportive/neutral or negative. Role modeling of their own behaviors and the behaviors of others was identified as significant. Regarding the school’s role, topics included education, increasing activity, responsible snacking and parties, and school lunches. Finally, the process before, during and after the health screenings was discussed.

By receiving a BMI notification letter, parents felt a “seed of health” had been planted. The causes were “rooted” deep in the child’s life. The themes and sub themes took on the form of branches and leaves. From these findings “grew” the implications for parents, schools, health care providers and communities.