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Toss the scales and shred the BMI charts... well, unless you are a boy

Posted Jan 08 2010 4:26am
Just yesterday I was gnashing teeth and venting spleen on two successive phone conversations on the recurrent problem families have with their own health care providers who declare little Susie quite well and ready for independent living based on charted weight measurements while Susie's parents cower in deference to medical advice with rising alarm. The parents know all is not well, but have nothing to base it on but parental intuition - a measurement that ranks with astrology charts and "I heard it on a commercial" as far as credibility.

I truly believe we are consigning another generation of eating disorder patients to poor outcomes, and a generation of children to misery and ill health, based on unforgivably bad science.

It is long past time that we stop using the crude and demonstrably weak measures of weight and BMI, but of course we need an alternative. One that asks the body itself "are you full yet?"

An alternative:
Predicting the weight gain required for recovery from anorexia nervosa with pelvic ultrasonography (full text available online)
Eur Eat Disord Rev. 2010 Jan 7;18(1):43-48. [Epub ahead of print]
Allan R, Sharma R, Sangani B, Hugo P, Frampton I, Mason H, Lask B.
Department of Radiology, St Georges Healthcare NHS Trust, UK.

Target weights are an arbitrary means of determining return to physical health in patients with anorexia nervosa (AN) and lack reliability and validity.... In our sample was a wide variation of WfH ratios and BMI percentiles at each grade of maturity. This supports the view that arbitrary targets for weight, WfH ratio or BMI percentile are likely to be unnecessarily high for some patients and too low for others. We recommend that targets be based upon baseline pelvic U/S grading and follow-up scanning.

No, can't use it for boys. But maybe we can, by using reproductive maturity instead of weight, learn useful things about diagnosis and early intervention and other recovery markers that will help us better serve male patients as well.
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