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AUSSIEedfamily

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Dear All,

I had the pleasure to meet our darling Charlotte on this forum she was the first person to reply to my very first post.

Charlotte has infected me with her views of the Body Mass Index or BMI formula to calculate the state of a persons body health and a person mental health state. Charlotte hated BMI!! I also hate it.

I have finally convinced one of the psychiatrists at one of our major teaching hospitals that BMI is a bad calculation for the determining health of a person especially the mental health. She now advocates for state not weight and if others in the hospital insit on a BMI for discharge her response is typically a mid twenties BMI

Its a two hundred year old formula developed by a population analyst with not a single medical qualification at all and it leaves out a whole heap of basic body composition stuff and body type stuff. We have moved on from the horse and cart days and the 1800's standard medical treatments so why do we stick with a two hundred year old formula that has absolutely zilch medical science or evidence to proove its validity to be applicable to measuring the state of a persons health.

Here is an old post I cant bump up

http://www.aroundthedinnertable.org/post/state-not-weight-query-5515175?highlight=charlotte&trail=75#gsc.tab=0

and this one of mine that Charlotte responded to

https://www.aroundthedinnertable.org/post/what-does-bmi-mean-for-eating-disorders-6535755?pid=1279639681#gsc.tab=0

And here are peer reviewed medical news articles

http://www.medicalnewstoday.com/articles/306129.php

http://www.medicalnewstoday.com/articles/265215.php


Nick Trefethen, Professor of Numerical Analysis at Oxford University's Mathematical Institute, in a letter to The Economist explained that BMI leads to confusion and misinformation.


Warm & Kind thoughts to all

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Foodsupport_AUS

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Reply with quote  #2 
The concept of State not Weight is fraught with its own issues. For all of the flaws of BMI it is probably no worse than many other methods of calculating appropriate weight for height and is probably better than many others. The biggest problem is the association of a particular arbitrarily chosen BMI range for a an assumption of healthy weight. 
We can't however have it both ways. If we want our children to gain weight then at some point there is an assessment of what is an appropriate weight (note appropriate - not "healthy"). They will likely maintain they are perfectly happy and functioning at a lower weight. If they have other physical markers of normal health should we be pushing them further? How do we assess that? 

This chart has been used before to look at where anxiety goes in respect to weight. So if anxiety is less at 90% weight for height why don't we stop there?
How do we know we are at 90% if we don't use BMI or some other measure? What measurements do we use to determine a "healthy"weight or even a "healthy" state? Physically healthy and biologically healthy may not be mentally healthy. What happens when they are at significant odds with one another?
Some centres such as Center for Balanced Living like to use things such as  body composition assessment for determining ideal weight. Again things such as percentage body fat, muscle and bone are still arbitrarily decided as normal though there is probably more evidence than for just using a scale and tape measure. Healthy is indeed a very difficult thing to measure. 15977454_10211625965554988_3800344317553448423_n.jpg


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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
toothfairy

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Reply with quote  #3 
Thank you both for your fabulous posts.
Thats all exactly why I love this so much.......


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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
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Reply with quote  #4 
Thanks, FoodSupport.  I wanted to say something similar - I just wouldn't have said it as well so you saved me a bit of time.  xx

-Torie

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AUSSIEedfamily

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Reply with quote  #5 
Dear Foodsupport,

I respect your view and your opinion and it is for each indiviual person to evaluate any way of measuring the body & decide for themselves what it is that works for them. However I still see Charlottes words from one of her posts on the topic of BMI stating "BMI is for calcultating insurance premiums" and I dearly appreciate her words of wisdom its sad that our Darling Charlotte is not here to contunue her words of wisdom.

Interesting that you mention the Centre for Balanced Living and the Body Composition as I have had long discussions with Doctor Laura Hill about how they use their DEXA body composition scanning machines. DEXA is short for Dual Energy X-ray Apsoptiometry. DEXA is capable of measuring fat, muscle and bone and is able to calculate reletave amounts of each tissue type in a persons body

Toothfairy not sure if you are aware that the C in C&M ED Productions is C for Charlotte Bevan the Charlotte in the posts I mention.

https://www.changemakers.com/innovations4health/entries/new-entry-123

Mary saw a film made with Xtranormal, she immediately saw the potential for rapidly and cheaply producing videos for education in the field of eating disorders. Charlotte jumped in feet first and C&M was born. We started to make short information films about diagnosis and treatment for eating disorders, using the medium and set up a channel on You Tube to help distribute these and links to other specialist eating disorder films. In February 2011, C&M were approached by Professor Janet Treasure, Head of Eating Disorders team at the Maudsley Hospital, London to make short films that would help train parents and carers, to aid in the treatment of eating disordered patients.

Here are some of Charlottes words from previous posts

There are a couple of problems I have with the whole weight obsession thing.  I really think I don't know have to go on another rant about BMI but, just in case anyone missed my last million rants, BMI was never ever ever ever ever ever meant to be used to by clinicians as a measure of physical or mental health.  EVER.  It is a population screen that is full of false positives and false negatives, not a clinical tool and, quite frankly, should not be being used by clinicians.
 
If you have a clinician who is calculating your child's mental and physical health based on BMI, they are using the wrong diagnostic tool
 
The body mass index (BMI), or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat.
 
BMI was explicitly cited by Keys as being appropriate for population studies, and inappropriate for individual diagnosis.
 

BMI has been used by the WHO as the standard for recording obesity statistics since the early 1980s. In the United States, BMI is also used as a measure of underweight, owing to advocacy on behalf of those suffering with eating disorders, such as anorexia nervosa and bulimia nervosa.[citation needed]

BMI can be calculated quickly and without expensive equipment. However, BMI categories do not take into account many factors such as frame size and muscularity.[15] The categories also fail to account for varying proportions of fat, bone, cartilage, water weight, and more.

Despite this, BMI categories are regularly regarded as a satisfactory tool for measuring whether sedentary individuals are "underweight", "overweight" or "obese" with various exemptions, such as: athletes, children, the elderly, and the infirm.

One basic problem, especially in athletes, is that muscle weight contributes to BMI. Some professional athletes would be "overweight" or "obese" according to their BMI, despite them carrying little fat, unless the number at which they are considered "overweight" or "obese" is adjusted upward in some modified version of the calculation. In children and the elderly, differences in bone density and, thus, in the proportion of bone to total weight can mean the number at which these people are considered underweight should be adjusted downward.

The medical establishment has generally acknowledged some major shortcomings of BMI.[18] Because the BMI formula depends only upon weight and height, its assumptions about the distribution between lean mass and adipose tissue are not always exact. BMI sometimes overestimates adiposity on those with more lean body mass (e.g., athletes) while greatly under-estimating excess adiposity on those with less lean body mass. A study in June, 2008 by Romero-Corral et al. examined 13,601 subjects from the United States' Third National Health and Nutrition Examination Survey (NHANES III) and found that BMI-defined obesity was present in 21% of men and 31% of women. Using body fat percentages (BF%), however, BF%-defined obesity was found in 50% of men and 62% of women. While BMI-defined obesity showed high specificity (95% of men and 99% of women presenting BMI-defined obesity also presented BF%-defined obesity), BMI showed poor sensitivity (BMI only identified 36% of the men and 49% of the women who presented BF%-defined obesity).

Secondly, weighing is a cultural thing.  Here, in the UK and in Australia and NZ, we are not weighed every time we visit the doctors.  For medical purposes, I was weighed prior to Georgie being born (March 1997) and then not again, until July 2010 just before my breast cancer operation


Er....

BMI is a tool for calculating insurance premiums.  I will now SHUT UP or I will take over the whole thread with mad rantings..xx



OK I caved and did some searching for some old BMI rants.

First - from the film State not weight film (as approved by Professor Treasure)

Promised BMI rant
 
But, as a general rule, isn't BMI used as a recovery indicator? I am particularly thinking of the 18.5 BMI of the diagnostic criteria.

Good question, Sue. BMI is not an accurate measure, as BMI ranges contain both false positives and false negatives. Giving an exact number BMI is a nonsense really. Each patient is different and requires a different weight to recover. Also neither buleemia or Ednos have a BMI diagnostic criteria. It is only used for anorexia and only as a diagnostic criteria, not as a indicator of recovery. The focus on BMI has distracted clinicians from the real process of recovery. Wayt is only part of recovery. 

Right. I thought that the healthy weight range for BMI started at 18.5

You are right , Sue. The WHO's minimum healthy BMI is, indeed, 18.5. However, you should bear in mind, that this is the level at which the diagnositic criteria has been set for a diagnosis of anorexia. It should not be confused with an indication of recovery. Remember, Just because an eating disorder sufferer attains a BMI of over 18.5, it is not a recovery indicator. There are very few people, who are healthy, at that BMI level. They tend to be people, who are exceptionally lean and fit, say, a marathon runner. The average, healthy, BMI range is higher. That is the healthy weight range, for the majority of the population. However, eating disorder patients are not average. For example, there are some anorexia patients, who need to keep their BMI at 24, or above, in order for the anorexia symptoms, not to reoccur. There are some buleemia patients, who need to keep their BMI at 25 or above, in order to be at optimum function.

The 18.5 BMI criteria is being dropped from the D S M 5. I suspect, because of the rigidity of a set number. There are plenty of eating disorder patients, who are critically, and lethally ill, at a much higher BMI. BMI is, at best, a population screen and not an accurate mathematical formula - remember all those false positives and false negatives. These are just numbers, Sue, and quite meaningless in recovery. Recovery is not about numbers. There are so many factors inverwoven with the weight issue. You are aiming for a state of mental health rather than a recovery weight 

Right. You are saying, that there is no correct BMI, for a patient. That in fact, BMI is not a measure of the patient's recovery or mental health. You are also saying, that the W H Os figure of BMI 18.5, is a diagnostic criteria for anorexia, not a recovery indicator. That the BMI 18.5 is being dropped from the new DSM 5. That Recovery is not about numbers on a scale as there are so many other factors interwoven




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Foodsupport_AUS

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Reply with quote  #6 
Sorry ED Dad, perhaps I am not making myself clear. I agree that BMI is a poor tool for assessing a "physically" healthy weight for anyone, but was trying to point out that when looking at simple tools that none of them are much good. Body composition is becoming more easily available and cheaper, however are we going to do this sort of testing for everyone? Further, those figures for bone, muscle mass and fat mass are still a little arbitrary, a bit like choosing a BMI of 18.5 -25 as a healthy range. 

The other part of the equation is this, there are numerous parents on this forum who will swear that a certain weight seems to be essential for their child's physical and mental well being. There are numerous reports of when someone got to X weight that it was like a cloud lifting. So if X weight is so important, why not BMI?  What happens when the child grows, clearly the child would need to be X + now Y kg. How do we work this out? Is it the body composition that made all the difference, X percentage of fat, Y of bone, Z of muscle? Down the track do those percentages need to be maintained, or if they change how so? How does any of this impact on mental health? 

If we throw out the BMI/weight - how are we going to assess a healthy weight for any individual? How do we determine physical recovery? If there is weight loss after being apparently recovered but someone appears well, does that matter? Do you have any suggestions? 
To say State not weight--how are you determining state?





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mjkz

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Reply with quote  #7 
I have to agree with Foodsupport_AUS.  Why anyone would focus on just one aspect of weight or state is beyond me when it seems evident that you need to take a more holistic view and consider all facets.  I think you have to consider weight, BMI, state, menses, etc.  Taking just one part and focusing solely on that does not work. For anyone who has been in this struggle, you get to a good BMI and you know that the brain healing lags behind so you can have a kid who is "healthy" via BMI standards but still very sick by state standards.
AUSSIEedfamily

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Reply with quote  #8 
Dear mjkz and foodsupport,

Yes the total holistic view is essential and every part of the body is essential and yes health for any individual is not easily measured with one single simple formula.

The difficulty I have with the BMI is exactly as Charlotte as identified is has a huge and significant false positive and false negative range. Its accruacy capacity is less than 50%. Imagine a pregnacy test that only got it right in less than 50% of the women who used it, especially if those women then had to take medication that caused damage to the Feotus. Imagine a cancer test that got it right in less than 50% of the tests done.

The peer reviewed science published by the people I have identified, clearly shows the evidence that BMI is at best measuring a persons obesity status in less than 50% of the times its used.

The phsychiatrist I mention has had to over rule her emergency department colleagues who wanted to send home a person who was seriously/critically physically medically unwell (not far off dying) at a BMI of 24.

This emergency team just used the BMI to process the person within the 4 hour processing rule which is mandated by our government.

However what this team was not aware of is the close circle of clinicians that had worked to get the person to go to the emergency department and had given the psychiatrist a heads up that the person was going to the emergency department and to intervene to ensure she was admitted and not sent home. The emergency team used a BMI of below 18 for admitting ED patients despite the situation they had a extremely good clinical guideline at their finger tips that I have played a part in reviewing that detailed a whole range of medical measurements.

There are many occasions where in my home state emergency department doctors have sent a critically ill person home based on BMI alone and not measured anything else!!

The weight of a person is highly relevant & vital to measuring a person and should always be part of the health measurement equation. However its the process of dividing the person's weight by the square of the height of the person that causes the huge/significant inaccuracy. Some of the worlds best mathematicians have examined this process and identified its levelof accuracy is below 50%

Yes you are absolutely right that measuring a person's mental health on the basis of their physical/medical health is difficult and most likely not a good process and possibly not acheiviable.

Yes I do have ideas on alternatives use all of the indicators shown in the attached document and I am interested that this document from the government in the Australian state of New South Wales  does not mention BMI.

My now recovered ED D does not use scales at all in her personal fitness business she uses many of the physical measurements that have been demonstrated to give a far more accurate measurement of obesity.

I have recently retired from an occupation in Plant/Machinery safety and safety inspection and I had to use many engineering safety formulas to determine whether the item was safe or needed special safety features and protection. Less than 50% accuracy in engineering safety would never ever be acceptable so I am not sure why a formula that at best gives an accuracy of less than 50% is used for measuring a persons health state and/or mental health state. I would hate to be in a plane where the pilots fuel load calculation was less than 50% accurate!


 Warm & Kind thoughts to you all.


 
Attached Files
pdf 20160331 DRAFT Guide re admission IP tx for EDs.pdf (19.98 KB, 33 views)


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Torie

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Reply with quote  #9 
Quote:
Originally Posted by AUSSIEedfamily
The difficulty I have with the BMI is exactly as Charlotte as identified is has a huge and significant false positive and false negative range. Its accruacy capacity is less than 50%. ....

Yes I do have ideas on alternatives use all of the indicators shown in the attached document and I am interested that this document from the government in the Australian state of New South Wales  does not mention BMI


I took a glance at the document you attached, and with all due respect, I have to say that the indicators listed are, individually, pretty bad for diagnosing ED.  Worse than BMI in many cases, I think.

I want to be clear that I am all in favor of getting the word out about BMI's flaws and limitations.  But I'm not in favor of eliminating it.  Otherwise, I fear we will be hearing from new members who tell us their ED kid was sent home at BMI 12 because "We don't go by that any more."

Best, 

-Torie

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Foodsupport_AUS

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Reply with quote  #10 
First line of the draft guidelines - Low bodyweight or failure to achieve expected gains.

How is that going to be assessed? Almost certainly by BMI. If someone presents to anywhere and weighs 50kg that person may be of normal weight for height, underweight, or obese. Anywhere on the scale. Without taking height into account the number is meaningless. With only a tape measure and a quick calculation it is possible to have a rough idea as to whether this person is more likely to be of normal weight, overweight or underweight. It should never be the sole means of assessing health, but then again there are very few assessments that on their own indicate a critical state. So weight (including BMI - until something else comes along that we can use) is going to be part of that assessment. 

I am interested in what physical measurements your D uses that you state have been shown to be a far more accurate measure of obesity. Waist hip ratio and absolute waist measurements are the only easy assessments. 

This quote from "why BMI isn't the best measure for weight or health" explains why at present we still use it anyway. 

So why is BMI still the preferred way to measure weight and evaluate obesity? For one, it’s a relatively easy measurement for doctors to take during an office visit. Taking a person’s height and weight and plugging it into an equation produces a number that informs doctors about whether their patients are at high, low or no risk when it comes to weight-related health problems.

But there may be better ways to measure body fat that provide more useful readings on how likely a person’s weight will contribute to chronic health problems. CT scans and MRIs can provide a clearer glimpse at the body’s make-up by separating out fat from muscle, for example. But these are expensive and involved compared to stepping on a scale. Other types of scans, including dual-energy X-ray absorptiometry (DEXA) images, which are normally used to measure bone density, can also distinguish between fat from bone and muscle mass, but are also costly.

On the more practical level, some researchers have been pushing for using waist circumference or even wrist circumference to gauge potentially harmful weight gain and fat depots, but the evidence supporting this measurement and its ability to predict future health problems isn’t definitive enough yet.

So without a viable way to change how we measure body fat, for now, BMI is the best option. The study authors argue that perhaps doctors should rely on not just assessing body composition but measuring hormones and biomarkers in the blood or urine, for example, to get a better handle on abnormal processes that may contribute to obesity and chronic disease. And until such tests become available, BMI may still prove useful yet — if doctors combine BMI with a comprehensive evaluation of their patients’ medical history and lifestyle habits to get a meaningful, if not yet perfectly precise picture of their weight-related health.



Edited to add: I have just found this great article which discusses the pros and cons of various methods to assess body fatness. I don't think anyone here thinks weight or fatness should ever be the sole measure of health, but it is definitely one which needs to be considered. https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/how-to-measure-body-fatness/


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AUSSIEedfamily

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Reply with quote  #11 
As before I respect and accept your views ideas and opinions so please if you dont like what I put here thats OK with me and if you want to continue with BMI thats OK too. We are all different with different views and ideas. My preference though is to stick with Charlotte Bevan's view of BMI "a formula that gives a huge inaccuracy of false positives and negatives and is usefull only to calculate insurance premiums". My preference for any medical measurement in the 21st century is an accuracy rate as high as possible and as close to 100%.

For those here that wish to continue with relying on BMI for their off spring my hope is that they are fully aware of its deficiencies and flaws and accept its use on that basis.

In my home town in Western Australia a DEXA body scan during week days costs in Australia dollars $140.00 with a dietician consultation $90.00 without a dietician and $120.00 without a dietician on weekends.



Here are interesting studies on DEXA scanning and BMI

http://radiology.ucsf.edu/blog/dxa-beats-bmi-using-x-ray-exam-measure-body-composition-fat-loss

https://www.ncbi.nlm.nih.gov/pubmed/19360011

http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.101/full




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AUSSIEedfamily

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Reply with quote  #12 
Here is one interesting page on BMI & eating disorders

http://randyschellenberg.tripod.com/anorexiatruthinfo/id19.html

Now I will end my discussion on BMI for ever and leave it alone & let each person make their own choices

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Reply with quote  #13 
Thank you for the articles. I particularly like the full length Newfoundland article which shows clearly the difference between things such as BMI and body composition testing. I am sorry if you are feeling offended by my comments. My goal is to put forward some robust reasons why BMI is still so widely used, and I suspect will be for some time to come. It is not to say that BMI is in any way a perfect measure, nor that it should ever be used as a sole determiner of health. 

Using things such as DEXA or MRI do give much better ideas as to percentage body fat, we don't have any idea as to how that fits with long term health or mental health either. Those normal ranges have again been arbitrarily defined.

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AUSSIEedfamily

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Reply with quote  #14 
Dear Foodsupport_AUS,

Not offended at all. Robust respectful discussion is often beneficial even when there are opposing views, ideas and opinions and even when at the end of the discussions there is agreement to disagree.

Our darling Charlotte even though I never had the opportunity for a face to face or voice to voice meeting, lit a flame in me about this forum & F.E.A.S.T that still burns bright today. She especially lit a big flame regarding the use of BMI and its problems. Being a person who in my occupation as a Machinery/Plant inspector (now retired) used formulas that were needed to be absolutely accurate every time any time and all the time, especially to decide public safety and worker safety. Inspections that included; major power house boilers, hospital boilers, major petrochemical/petroleum/oil/gas instalations and all sorts of cranes, elevating work platforms and lifting equipment there is no room for a margin of error greater than may be at most 1%.

You may recall the gas pipe explosion on Varanus Island back in 2008 ( http://www.abc.net.au/news/2012-05-24/varanus-gas-explosion-report-released/4031146 ) fortunately it was a pipe that exploded not something I did inspections of and not one of the pressure vessels that I had inspected and reported on.

You may now see why my attention to detail and precise accuracy pervades my perspective. Workers lives and the lives of those near by to the equipment I inspected were at risk if I got it wrong.

From my perspective I believe lives are currently lost because of the use of BMI, either lost through death or lost because the person does not get the treatment they particularly needed and their illness becomes severe and enduring like two feasties here in my home town.

Thanks to this forum there is debate about eating disorders, there is support, comfort, understanding, compassion and empathy for those fighting these illnesses that they can find no where else.

There are those here on this forum now that need more of the support, comfort, understanding, compassion and empathy rather than the & my debate about BMI so it is for those reasons I sign off on my BMI discussion

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Reply with quote  #15 
I, too, am a scientist by nature.  I hate crummy metrics.

The BMI problem is a tough nut, though.  Take my d for example - her BMI was never in the "underweight" range and yet, ED raged.  What we need is a little pop-up indicator to tell us how much is enough for each particular kid, because mine (for example) was really ill at a leanness level that would have been fine for the next guy.  And I do mean leanness - not BMI - this is a kid who can't afford to be lean.  It wouldn't matter how you measured it - my kid's score (for BMI, leanness, whatever) would have said she was OK.  And yet, she wasn't.  (She doesn't need to be "overweight," but she sure does need to be "average.")

To me, that's the biggest problem with BMI: some of them need to be average (at least), while others are OK being lean (to a point).  

Her doctor could not - would not, did not, still can't - wrap her head around the fact that my d needed to get back up to average - a little below average is not OK for her.

But it wouldn't have helped one whit if she had measured leanness by some other name.

-Torie

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Reply with quote  #16 
I want to scream and yell when I picture our CAMHS nurse getting out that damn cardboard wheel which she'd twiddle around to work out my (former rugby playing) son's latest BMI before TELLING HIM, all smiles and congratulations, that he'd reached a 'healthy weight' - while inside I was yelling "NO!!! NO!!! NO!!!"
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Get free PDFs of my past blog posts 2011 - 2016: http://bevmattocks.co.uk/blogspdfs.html (Easier to read; more linear than clicking around the blog itself.)

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Reply with quote  #17 
uuggh same here, I had such a battle over this!!

My S is like Torie's D.
He was at his lowest BMI OF 16.8....at that point everybody was congratulating him on how fab he looked....uuggh...

Yep that bmi was so fab that HE HAD SEVERE PURGING ANOREXIA, and dementia had practically set in, he had lost him memory and was so so ill.....

Like that , then to be told  by an anorexia trained professional, that 19 is great but 18.5 is ok for us is just insane...of course he was always going to be on the cusp of relapse at that bmi, its not exactly rocket science!
I was NEVER EVER ASKED THIS QUESTION, BUT he had never been a "small child" for his age...

When will the professionals get their head around the fact that anorexia /bulimia, and any other ed can be present at ANY bmi/weight...and that bmi 19 is not a recovery indicator.

I was just like Batty in that room listening to the same congratulations....as he relapsed the next week, after he started throwing his lunch away the next day again, he was still so ill....crazy system..... is just so so damaging ...uugghh


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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
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Reply with quote  #18 
I forgot to mention, now that I am on a rant, that my S highest weight was 50 kg, with his illness he lost 10kg.

Nobody ever ever asked us these questions, nor was he brought back to 50kg, even though he should have been brought back to over 50kg....as he had grown in height.

If I hadn't found this forum I would never have got my kid to recovery, by pushing him back to his original weight and more , with a view to keep gaining through his teens and possibly early 20's.

I cant understand that in this day and age that there are not rules and regulations that these "professionals" should follow, or else it is malpractice...

grrrr, sorry this is always one to get me going.........,,


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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
Torie

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Reply with quote  #19 
Quote:
Originally Posted by toothfairy
then to be told  by an anorexia trained professional, that 19 is great but 18.5 is ok for us is just insane...


Aside from everything else, AN is a really expensive illness to treat.  I think about how much money we are saving them* by treating at home, and all we ask is that they not undermine us, and even that is too much to ask ...

Arrrrrrgh.  xx

-Torie

*OK, in the US, we aren't saving "them" money, but still.

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BattyMatty_UK

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Reply with quote  #20 
Oh Torie - Ugh. I've been venting about this very subject with my EMDR therapist today. He is well versed in evidence-based treatment for eating disorders (as well as PTSD / EMDR) and I've been venting about the nurse and her chuffing BMI wheel, but mainly about the fact that they dis-empowered me / undermined me for so very, very long... too long... causing so much damage.
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Bev Mattocks, mother of 23-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver. Please do check out my blog: http://anorexiaboyrecovery.blogspot.co.uk/

Get free PDFs of my past blog posts 2011 - 2016: http://bevmattocks.co.uk/blogspdfs.html (Easier to read; more linear than clicking around the blog itself.)

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Torie

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Reply with quote  #21 
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Originally Posted by BattyMatty_UK
... I've been venting about the nurse and her chuffing BMI wheel, but mainly about the fact that they dis-empowered me / undermined me for so very, very long... too long... causing so much damage.


I'm still thinking about my "the uninitiated" thread, and what key points I would convey if I had the ability.  Maybe it would help to have a few statistics showing how hard it is to treat this vile illness (average length of stay, dollars per day, etc.) and then when they come back home, it's all on us parents.  And THEN, we are undermined at every turn.  Aargh.  xx

-Torie

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toothfairy

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Reply with quote  #22 
I like this !
https://www.psychologytoday.com/blog/hunger-artist/201402/recovering-anorexia-how-and-why-not-stop-halfway

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Son,DX with AN, (purging type) age 13 in October 2015 ,  (4 months immediate inpatient) , Then FBT at home since.and making progress every day. He is now in good recovery, and Living life to the full like a normal teen. We are not completely out of the woods yet, but we can see the light at the end of the tunnel, thanks to ATDT. Hoping to get him into full recovery and remission one day at a time.
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Reply with quote  #23 
Dear toothfairy,

I like it too!! Thanks for finding it!

Now back to my quite time on BMI

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BattyMatty_UK

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Reply with quote  #24 
For those of us whose children were always treated as outpatients, I always used to think this - and still do: They only see our child for 60 minutes a week. We are with our child for the other 10,020 minutes of the week. They don't see what goes on OUTSIDE the consulting room - and often the very second we LEAVE the consulting room. We do. Also, no-one knows our child as well as we do - certainly not them. How can they?

I can still picture our CAMHS nurse looking over at me and saying (in front of my son) that because I looked very slim, then it followed that my son's 'natural physique' would be slim i.e. a slim physique would run in the family. Conclusion? My son was pretty OK as he was. (What a surprise, ED loved that!!)

What she didn't know, however, was that my slim physique (sadly another casualty of the ED years) was a result of pounding the treadmill and weights at the gym for an hour a day, 7 days a week, on top of a very strict calorie-controlled diet...

Oh, and my son used to be a prop forward in his school rugby team with a physique like a brick outhouse.

So, sorry nurse, but the skinny boy in front of you is very, very sick.

Ugh, don't get me started on all this BMI, undermining, etc nonsense or I won't stop!!!


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Bev Mattocks, mother of 23-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver. Please do check out my blog: http://anorexiaboyrecovery.blogspot.co.uk/

Get free PDFs of my past blog posts 2011 - 2016: http://bevmattocks.co.uk/blogspdfs.html (Easier to read; more linear than clicking around the blog itself.)

'Friend me' on my Facebook page: https://www.facebook.com/battymatty76
iwanttohelp

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Reply with quote  #25 
Just out of interest: if you consider your/a child to be underweight, is it the BMI for adults you use (like below 18,5) or that one for children? I ask because we often have patients who are "in between" like age 14-17 and it depends a lot if e g a BMI of 16 is underweight or not. Some peds allow our outpatients to remain at BMI 16/17 at that age, others dont, so its tricky depending on the very person we have to work with.

The question just aims for what is common in your health system, not if its appropriate or not to use the BMI. As often said, BMI is also what is used to set a goal weight in Germany.
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