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Foodsupport_AUS

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Reply with quote  #26 
Most specialists use growth charts either CDC in USA and Australia for example or UK growth charts in the UK. There are very subtle differences. 

Yes as you point out the median BMI changes with age, and gradually increases from around age 5 into adulthood, they then use centiles to work out what is in normal range or not. This is great to see if things are in normal range, and also great to see if kids are growing as expected. A BMI of 16 is the 50th centile if you are around 8. 

One of the concerns I think there is about using BMI is that it can be in the "NORMAL" range ie. not underweight or overweight but this in no way necessarily says healthy. It just says normal range, and may not even be normal for that person. 

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iwanttohelp

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Reply with quote  #27 
Thank you. I have read about these growth and weight charts on here a lot. I dont think there is something similar over here. in the life of a child until the age of 12 there are some examinations parents have to make by a ped. 50% are within the first year. So there is no need for parents to see a ped every year to create such a chart. This of course makes comparison difficult.
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Reply with quote  #28 
With us (UK) there were no growth charts or anything like that. My son only visited the GP very rarely and then for minor illnesses. He was never weighed or anything, and so there was nothing to compare him with when he began to lost weight. All there was was some data from a school PSHE lesson where they calculated the BMIs for some health topic. This is the only reason I know how much my son used to weigh before the ED and that, by the time he entered treatment, he'd lost around a quarter of his bodyweight and - a year into treatment - this had dropped to a third of his bodyweight as he reached his lowest-ever weight. Why did they allow his weight to drop so much after 12 months of treatment that was supposed to be all about putting on weight and getting him recovered? Hmn...  Why indeed?!
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Foodsupport_AUS

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Reply with quote  #29 
Just to clarify - the charts used for height/weight/BMI tend to be standardised for various countries. That does not mean that children in those countries are regularly weighed or measured. I think the only country where visits to a paediatrician and measurement would be seen as routine is the USA. I kept my own records for my D though somewhat irregularly so do have a vague idea as to her height and weight over the years, in Australia we have a "baby book" that is given parents after each child is born. It has growth charts in it and I just happened to fill them in. So having records in many countries of a child's growth is likely to be hit and miss. Incidentally I noticed on the UK growth charts http://www.rcpch.ac.uk/system/files/protected/page/NEW%20Girls%202-18yrs(4TH%20JAN%202012).pdf quite extensive information as to how they are to be used. When it comes to early detection of loss of growth they fail miserably as it suggests an abnormality is only present when crossing more than two sections of the centile chart eg. from 75 to 25th centile. 
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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.
Torie

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Reply with quote  #30 
I can't tell you what is typical, but I can tell you our experience.  This was with CHOP (Childrens Hospital of Philadelphia).  The good docs there consider all the BMI-related information they can get their hands on.  This includes previous height / weight records and also body type of parents and other close relatives.  xx

-Torie

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iwanttohelp

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Reply with quote  #31 
@Torie wow this makes sense! Sadly here its very common that the BMI of 18 is the only goal. If at all.
AUSSIEedfamily

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Reply with quote  #32 
I still go with Charlotte's thoughts.

I hope that those who like BMI are prepared to have the bungey jump instructor use BMI to calculate the strength of the bungey cord & the parachute selection officer choose your parachute?

For those who like it go with it. I will not let any one calculate my BMI for any reason based on Charlotte's view of it.

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iwanttohelp

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Reply with quote  #33 
I dont understand, sorry @Aussie
AUSSIEedfamily

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Reply with quote  #34 
Dear iwanttohelp,

If you have read my posts on this you will see my thoughts. if you research BMI & read all the scientific peer reviewed research that shows it is a totally flawed calculation then you might get to understand my view.

There is absolutely no science to prove that squaring the height of a preson is a scientifically valid mathematical calculation. Even the Academy for Eating Disorders and other eminent bodies agree that BMI is flawed. I want and prefer precise accuracy in any calculation In any calculation especially a medical calculation I dont want an error factor greater than say may be 10% preferably no more that 1% the BMI has an error factor of greater than 40% error!!

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iwanttohelp

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Reply with quote  #35 
What do you mean with "error factor"? BMI is just a number that tells something about the RISKS concerning health, not about the state of health itself. Its more kind of an adjuvant, that says ppl within this range are considered to have less health issues than ppl out of this range. It is nothing absolute nor is the BMI the only issue that matters when it comes to health. If you have an addiction e.g. your health will probably be at risk even if you are at a healthy BMI. Health is like a puzzle.

Lets take a different example: schizophrenia. It is known that some genetics will make an individual vulnerable for this disease. But it is not only genetics! Again, it is like a puzzle. If you are male, a young adult, suffer from some birthcomplications, smoke weed, have some stressful life events, you are at high risk to develop schizophrenia. Your genetics are no destiny and so isn`t BMI.

What would your idea of defining "health" (meaning the less weight caused (!) health risk) weight for generality be? I think the old Broca-Index e.g. is less helpful, as the range of underweight for girls/females is below BMI 18,5.

Greets
AUSSIEedfamily

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Reply with quote  #36 
Dear iwanttohelp,

I agree with this statement of yours BMI is just a number that tells something about the RISKS concerning health, not about the state of health itself

And this

Its more kind of an adjuvant, that says ppl within this range are considered to have less health issues than ppl out of this range. It is nothing absolute nor is the BMI the only issue that matters when it comes to health.

Type this into your search engine "BMI is false"

Then look up this

http://www.telegraph.co.uk/news/health/12141716/BMI-wrongly-branding-people-as-unhealthy-new-research-reveals.html


Then look up this

http://www.huffingtonpost.com/david-belk/body-mass-index_b_7693450.html


http://www.medicaldaily.com/body-mass-index-bmi-calculator-healthy-weight-obesity-372852


If after you read those and still wish to use BMI that is your choice to do and I have no right to change your choice or anyone elses choice and if the others here on ATDT choose to continue with BMI as a measurement for them then thats OK.

My choice is to refuse anyone to use BMI on me or where possible members of my immediate family.

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Foodsupport_AUS

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Reply with quote  #37 
This paper on the other hand is a scientific paper rather than an opinion piece which attempts to assess methods for determining expected body weight in children. It accepts that there are inaccuracies but the upshot of it is, it is inappropriate for many other measurements to be done on a weekly basis, whereas BMI / weight is a very easily determined metric. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269114/

So if a rough goal BMI or weight is determined it is easy to use a scale to assess progress towards this. It is for this reason that weighing will be a part of management of eating disorders for many years to come, just as assessing pulse and blood pressure are. 

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Torie

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Reply with quote  #38 
I don't hate BMI the way some here do, but I agree it is flawed.  For example, let's say you are tall and I am short.  Let's also say our BMI's are identical.  Because of the flawed mathematics, at the same BMI, you will be much leaner than I will.

That is one problem.

Also, If you and I happen to be the same height and the same weight, our BMI's will of course be identical.  But one of us might be much leaner than the other if, say, you are a marathon runner and I am a couch potato (sit around all day). 

My friend gets a note from the school every year warning her that her son's BMI is too high.  He runs marathons and is extremely lean!  Muscle is denser than fat, but BMI doesn't account for that.

If you think of dog breeds, a bulldog is a different shape than a greyhound.  People are not all meant to the the same shape, either.

Hope that helps. xx

-Torie

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AUSSIEedfamily

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Reply with quote  #39 
Dear Torrie

Here is the Academy for Eating Disorders position statement on reporting obesity based on BMI

Position Statement: AED Opposes BMI Reporting and Fitnessgrams in Schools

https://www.aedweb.org/index.php/23-get-involved/position-statements/156-aed-opposes-bmi-reporting-and-fitnessgrams-in-schools

In the state of New South Wales (NSW) in Australia the NSW government teachers have a mandatory duty to report obesity as a Child Protection Issue

http://www.dailytelegraph.com.au/news/nsw/nsw-education-teachers-told-to-dog-in-fat-kids/news-story/43b4131a61b351367c31712656b94cc4

Your choice to use BMI its not a choice for me

My greastest concern & problem with BMI is that insurance companies, hospitals, clinics & other such organisations use an exact precise non-variable BMI number often 18.5 for everyone to determine how sick the indiviual person is and then decide based on whether you are below 18.5 you are sick & can get treatment you are at 18.5 or above 18.5 you cant get treatment or your are deamed no longer sick & are discharged. Even some clinical guidelines refer to a BMI of 18.5 and a whole heap of places use 18.5 and thats it you are in or out based on 18.5 for everyone no exceptions to the exact 18.5 rule at all regardless of all the other clinical material contained in the guideline they just see the 18.5 and say good bye next please!

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Torie

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Reply with quote  #40 
Quote:
Originally Posted by AUSSIEedfamily
My greastest concern & problem with BMI is that insurance companies, hospitals, clinics & other such organisations use an exact precise non-variable BMI number often 18.5 for everyone to determine how sick the indiviual person is and then decide based on whether you are below 18.5 you are sick & can get treatment you are at 18.5 or above 18.5 you cant get treatment or your are deamed no longer sick & are discharged. Even some clinical guidelines refer to a BMI of 18.5 and a whole heap of places use 18.5 and thats it you are in or out based on 18.5 for everyone no exceptions to the exact 18.5 rule at all regardless of all the other clinical material contained in the guideline they just see the 18.5 and say good bye next please!


I agree they need to stop doing stupid things like that.

Do these places acknowledge the DSM?  If not, perhaps that is the place to start. I'm pretty sure that is inconsistent with DSM.

-Torie

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iwanttohelp

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Reply with quote  #41 
Quote:
I don't hate BMI the way some here do, but I agree it is flawed.  For example, let's say you are tall and I am short.  Let's also say our BMI's are identical.  Because of the flawed mathematics, at the same BMI, you will be much leaner than I will.


So what do you want to say? That somebody with a BMI of 21,5 who is tall is leaner than somebody small with BMI 21,5? I dont think so, personal. Being lean is also a matter of bodyfat. Ppl can be "obese" but have a normal BMI (skinnyfat).


There are studies (i can link them, i just have to look up for them, sorry), that show, that when it comes to overweight and obesity BMI is quite accurate. Which means that you can show that a higher BMI correlates with more health issues. Which again does not mean that every person with a BMI above 24,9 automatically is sick.

I often hear that argument that BMI does not consider muscles which weight more. Thats correct. But its a very very small percetage of population in general, who are e.g. "overweight" due to muscles. Most ppl whose BMI is to high have to much bodyfat.

I think i will use BMI as a help to find out if a person is technical underweight or normal weight, which, random fact, is needed to diagnose properly (this is not relevant for parents but for the practioners and the insurances). My part as a psy will always be to help the sufferer to get better mentally and be able to lead a normal life, dealing with conflicts and crisis and grow.

Greez
AUSSIEedfamily

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Reply with quote  #42 
Unfortunately yes they do know of the DSM5 but from the info I have from Australian sources the DSM5 uses precise/precriptive numbers for BMI!!

Here is the info from the Australian National Eating Disorders Collaboration (NEDC) bulletin number 13

Editors Note: 

Welcome to the July edition of the NEDC e-Bulletin. This month we have put together a special edition focusing on the changes made to eating disorders diagnostic criteria in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

We hope you enjoy this month's special edition and if you would like to suggest topics or events to be featured in future editions of the e-bulletin, please contact us at info@nedc.com.au.



http://www.nedc.com.au/e-bulletin-number-thirteen about the DSM5 state that the DSM5 has had this included into it

What are the changes to anorexia nervosa (AN)?

Several minor but important changes have been made to the physical and cognitive criteria for AN:

  • Criteria no longer require the patient’s weight for height to be less than 85% of that expected
  • Cognitive criteria, such as fear of weight gain and shape and weight overvaluation, no longer need to be self-reported and can be inferred by behaviour or by parent report for young people
  • The DSM-IV Criterion D requiring amenorrhea or the absence of at least three menstrual cycles has been deleted.

Body Mass Index (BMI) has been used to specify the level of severity; based on BMI for adults and BMI percentile for children and adolescents. In adults, severity is indicated by:

  • Mild; BMI less than or equal to 17
  • Moderate; BMI between 16 and 16.99
  • Severe; BMI between 15 and 15.99
  • Extreme; BMI less than 15
So from what I read on this info about the DSM5 is that even the DSM5 uses a precise/prescriptive/exact BMI number for everyone.

As Foodsupport identifies BMI is a quick, very easy & simple to calculate formula that almost anyone can do.

So if the DSM5 says mild AN is at a number less than or equal to a BMI of 17 moderate AN is between 16 and 16.99 severe is between 15 and 15.99 and extreme is less than 15 why would anyone do any more than just a BMI calculation to determine the level of illness?

Insurance companies wanting to avoid paying for treatment BMI is not low enough no cover!! 

In government funded & or operated hospitals where staff are over worked & under funded/resourced and have ever reducing budgets and a 4 hour emergency department rule & key performance indicator of triage, treat, admit or discharge rule or explain to hospital management & the government why it took longer than 4 hours. Then go for the simple calculation every time BMI is not low enough your discharged, "Next Please"!!!

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Foodsupport_AUS

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Reply with quote  #43 
As regards anorexia nervosa DSM V does have some prescriptive weight criteria, however of note when the NEDC transcribed those numbers and the criteria they were incomplete. 
This link goes to a full list of feeding and eating disorders. http://chrome-extension://gbkeegbaiigmenfmjfclcdgdpimamgkj/views/app.html  I think it requires a Chrome browser to read as it is a google document. Sorry for those who don't have this. 
This is the paste of the anorexia page.

Anorexia Nervosa Diagnostic Criteria 307.1

Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight.

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Specify subtype:

Restricting type (F50.01): During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

Binge-eating/purging type (F50.02): During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Specify remission state:

In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behaviour that interferes with weight gain) or Criterion C (disturbance in self-perception of weight and shape) is still met.

In full remission: After full criteria for anorexia nervosa were previously met, the criteria have not been met for a sustained period of time.

Specify severity:

The minimum severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived from the World Health Organisation categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.

Mild: BMI 17kg/m2

Moderate: BMI 16-16.99 kg/m2

Severe: BMI 15-15.99 kg/m2

Extreme: BMI <15 kg/m2

 

__________________________________________________________________________________

Note the weight criteria goes up to normal weight ranges, that the severity may be changed according to severity of other symptoms and that if weight is in normal range an alternate diagnosis of OSFED is made. 

 

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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.
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