Saturday, January 12, 2008

Anorexia and target weights

Doctors do a lousy job, overall, at setting target weights for people recovering from anorexia. Most set them way too low, so the patient never reaches or stays at a weight high enough to heal from prolonged malnutrition, and relapses.

Now a new study published in the International Journal of Eating Disorders suggests a different measure of recovery: resumption of menstruation.

As nearly any pediatrician or parent can tell you, this is a bad idea. Really bad idea. Some girls never lose their periods no matter how much weight they lose. Some get them back while they're still significantly underweight. Getting your period back while you're in recovery is a good sign, but it's no litmus test of health.

In fact there is no single measure of restored health. Some clinics use body composition analysis, which takes into account not just a person's weight or BMI but also the percentage of lean and fat tissue in the body.

I think the best measure is mental health, and parents are well-placed to judge it. They know what their child was like before anorexia, and they know when their child is "back." I've heard countless stories of teens who reach the weight the doctor sets and still aren't better, or who get their periods back despite still being in the grip of anorexic delusions and obsessions.

When I saw my daughter's anxiety around food and eating was pretty much gone, I knew she was close to full recovery. Don't settle for anything less.


Emily said...

I'm not sure that parents are the best judge of recovery. Certainly my parents were not the first to know about my sister's illness, and they're definitely the last to let go of it now that she's independent (of anorexia, of them) again. Parents are just too emotionally involved to give an objective judgment on anorexia recovery.

Harriet said...

Hi emily,

Parents are well placed, but not necessarily the only or best judges. But . . . the reality is that they often are much more tuned in to what's going on than doctors, especially if doctors are going by BMI charts or numbers on the scale.

Anonymous said...

And lets not forget that other hallmark of lack of menstruation, having a penis.

Harriet said...

Too right!


Anonymous said...

I agree and disagree. I think body comps are a more useful measure than BMI & weight charts, definitely.
But I don't think mental health is necessrily the best measure. I've known some whose mental health returned when they had gained some weight, but were still fairly emaciated. And I've known some to get to their goal weights, still be mentally unhealthy, but after a few months maintaining, their mental health returned.They didn't need to keep gaining during those months, their minds just needed more time.

Harriet said...

Maybe I wasn't clear in the first place.

I agree with you, anon, that mental health by itself is not a definitive measure, any more than menstruation, weight/BMI, or any other single measure. I was trying, clumsily, to say that mental health indicators like a normalized relationship with food, reduced anxiety/obsessiveness, and return of the pre-AN personality should be part of the measures of recovery. But every person is different and recovery will take a different shape for everyone.

So, we're in agreement there.

Unknown said...

Parents are pretty much told to turn off their intuition, and their rights, when a child is diagnosed with an ED.

If the illness was diabetes we wouldn't say parents aren't qualified, we'd teach them the signs and help them understand the measurements. We'd encourage parents to step UP their intuition at whatever weight and see what no clinician can - as I believe Harriet is saying.

Anonymous said...

without the correct mental state, then it doesn't matter how much weight i gained or lost. nothing was ever the "right weight", but when i began to feel better & recover mentally, i was in a different state, & i could maintain that feeling & be confident about it. your blog is amazing, by the way.
thankyou for standing up about the issue. it's nice to read something that i can relate to, & also agree with.

Harriet said...

Andrea, good for you for recognizing that. I'm so glad you are in such a good place.

Anonymous said...

I am glad this came up because i use to have an ED and i have always been very skinny and the clinic accually set a goal weight for me i have never been close to or would have been able to get tl.(for me). recovery varies from person to person but just becuase you reach a certain weight does NOT mean you are all of a sudden better. Just eating a normal diet helped me. you know when you are "back" when your personality comes back, having energy, and not being so anxious around food. its a personal thing.

Harriet said...

hi anonymous,

Recovery certainly has personal aspects, but it's also important to listen to your clinic. What my daughter found was that she had to get to a weight she'd never been, either, before she began to feel truly recovered. There is some evidence to suggest that recovered anorexics do need to weigh more than they might otherwise have weighed. Starvation may change a person's setpoint, just like chronic dieting and binging can change a setpoint too.

I'm glad you're feeling better. Now what I want for you is to have no anxiety around food at all, and to have the full and happy life you deserve. :-)