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lmd24

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Hi Everyone,
I’ve seen a lot of mentions of BMI since I started following this forum several months ago. I’m wondering what you all think about it, because I find it confusing.

I know a healthy BMI is different for everyone, but when I look at the healthy range it’s pretty vast. In your experience what is a realistic BMI for someone recovering from RAN? At BMI of 21 my d is still very very concerned about the number on the scale increasing. Am I wrong to assume this means she still needs to gain?


tina72

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Hi lmd24,
this is a very intersting question, thank you for that.
As others here mentioned before, BMI was an index for insurances and only for statistic comparision of population, not for classification of single persons (as it is mostly used today). It is nearly 200 years old and has severe problems: growth² is in no realtion to the surface of the body. It doesn´t mirror stature, sex and mass of fat, muscles and bones.
Most professionals use it to find a "target weight" because most parents and patients ask "how much must she gain?". That is the wrong question. We should ask "how can I see that she is recovered?". But in the beginning of refeeding we are so fixed on weight and numbers that we all asked that.
To look on your d growth chart and to see in what percentile she was before ED helps you a bit to aswer this question. But in the end it is "state, not weight" and if you see she is struggling at BMI 21 then yes, she might need to gain a bit more to feel better.

So there is no realistic BMI for RAN that works for all patients. Some recover at 21, some at 24, some need even more.
Some wise parents here ask in a post: If you have to chose between your d being healthy and "overweight" and your d being sick and thin, what would you chose?
So I do not look on BMI any more.
Tina72
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Hi lmd24,

Ok , BMI is a bad measure of health/recovery for a person with an eating disorder, but unfortunately many clinicians use it.

It is now well known that it is STATE not Weight as an indicator of recovery.

Let me give you an example of how ridiculous it is for measurement of recovery, from for example anorexia.

Some clinicians will give a target bmi of say 19.

Every single person is different. Anybody can suffer from anorexia at any WEIGHT.
So if  a person  presents with anorexia with a bmi of 24, and they have been restricting and come from a bmi of 29, which is common enough too, it shows that this is so flawed.

Does this make sense?

The person needs to be brought back to their original growth curve, not just some fictitious set of numbers that the World Health Organisation have decided are healthy.
This is not suitable for eating disorders.

My son is a classic example of this. Luckily I knew better!!!

So to answer your question, there is now way anybody here could know what is a healthy bmi for your Daughter from what you have posted. 

I will post a few links for you,
Best wishes,
TF





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toothfairy

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https://www.kartiniclinic.com/blog/post/the-misuse-of-bmi-in-diagnosis-of-pediatric-eating-disorders/
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https://www.kartiniclinic.com/blog/post/determining-ideal-body-weight/
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https://www.kartiniclinic.com/blog/post/setting-goal-weights/
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lmd24

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Thank you Tina and Toothfairy! As always, you give me good advice to consider. :)
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Quote:
As others here mentioned before, BMI was an index for insurances and only for statistic comparision of population, not for classification of single persons (as it is mostly used today). It is nearly 200 years old and has severe problems: growth² is in no realtion to the surface of the body. It doesn´t mirror stature, sex and mass of fat, muscles and bones. 


BMI is a poor marker of recovery for numerous reasons but at least in part because there is so much more to recovery for many than just regaining weight. There is in fact a strong correlation between BMI and fat mass/lean body mass as per this journal article https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-797  . BMI percentile is also a much better marker than weight percentile for children in assessing expected bodyweight, because it does take into account height. None of this says that a particular BMI correlates with a particular severity of disease or state of recovery. 

If we look at long term studies for people after they have  recovered from AN they seem to have an average BMI of around 21 - that is they are towards the middle of normal adult weight range. That doesn't really help the individual which is why things like the post from Kartini above are really helpful. 

So should you aim for a particular weight/BMI? I think the answer is yes and no. Most (perhaps all) lost weight needs to be regained. Kids need to keep on gaining weight into adulthood as part of their normal growth. That is what we should be aiming for, and measurements will tell us that. They won't tell us however if that will lead to recovery or what else is needed to get us there. 


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AUSSIEedfamily

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Dear lmd24,

You may wish to search the 2013 posts and look for BMI in there and you will find some from me with a lot of debate. But there is one person that is well loved and respected in this forum and within the F.E.A.S.T organisation that sadly is no longer with us on earth and is an eating disorder warrier in heaven Charlotte Bevan (dec). Charlotte believed the BMI formula & calculation was just an extremly bad measurement of the human body for any reason at all. Charlotte often stated that the BMI formula/calculation was useful only for calculating insurance premiums and nothing else at all.

The part of the formula that is flawed is the squaring of a persons height. The orginal inventor of the formula goes back to the 1800's. The basis of the BMI was devised by Adolphe Quetelet, a Belgian astronomer, mathematician, statistician and sociologist, from 1830 to 1850 during which time he developed what he called "social physics". He had no medical or medical science training or qualifications whatsoever. There is no scientific research evidence & data at all that proves that squaring the persons height is a valid, correct and is scientifically proven. Its just something he did to make the formula fit his purpose. None of the scientists since have ever questioned or examined the formula. With todays advances in science and technology and instruments to measure the human body and the human condition there are scientifically researched and tested methods that can provide more detailed and accruate measurements that BMI can. Plus the BMI was designed for a whole of population tool and was never ever designed to apply to single indiviuals at all.

There is a great pod cast on the Newplates podcasts with Laura Collins Lyster Mench interviewing Doctor Rebecka Peebles on state not weight.

http://www.circummensam.com/new-plates-podcast.html look for the one on State Not Weight



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One thing many don't realize about BMI is that it is different in children and teens than in adults.

At a certain age, the curve actually goes down, then makes kind of a horseshoe shape and rises, before leveling out in adulthood. A particular bmi may be overweight at one age, then be underweight at a different age.

Also, in order to properly track it in childhood, you need to have a chart of height and weight measurements at regular intervals (monthly is really good), from the youngest age you can start.

Knowing when they move from one percentile to another is more important than the actual changes in bmi, and you need the back info to track that.

Feel free to email me if you would like more info about this.

[smile]
AUSSIEedfamily

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Reply with quote  #12 
Dear pro_recovery,

The WHOLE BMI formula is completely and totally flawed/false in every, any and all applications regardles of child, adolescent, youth, young adult, adult. The factor of squaring the height has zilch/no science behind it at all. It just something plucked out of the sky by the inventor of the BMI formula back in the mid 1800's to make the formula kind of fit a whole of population calculation back in the 1800's. The inventer of the BMI never meant it to apply to indiviual people and it was never designed to be used to measure any one individual person.

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

Here are words from the above post by Charlotte Bevan (dec) the C in the C & M ED Productions piece posted by toothfairy

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


and this one



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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Great thread
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