Mentor
Registered: July 31, 2007
Posts: 3,634
| Posted Yesterday at 09:54 AM | Reply with quote?#1? |
Dear Mods,? Disclaimer: this thread refers to kids who are weight restored to the correct range, who have sustained this weight for a number of months and who are thriving because "state" is great. It is meant as preventative not corrective. Would love to get the experts' advice on what should happen when growth stops. Maybe, it could be an addendum to the most excellent article on weight restoration?by Dr. O'Toole?? On the forum we say that kids need to continue on their weight gain trajectory into their 20's. What does that mean? ie: my child, who has tracked mostly in the 75th percentile most of her life, stopped growing at 15. We know from wrist scans that her bones are completely fused and that her full height will be what it is now. So, does that mean that she needs to continue gaining weight [whether intuitively/on her own or by us pushing weight] so that she can continue on that 75%tile until she is in her 20's? For her %tile, she would have to continue gaining about 3-4 lbs every year until she is 20.? I asked Dr. O'Toole that question at the conference and I am confident that I ?understood her to say that if she was fully grown (as per evidence of bone fusion) then she could stay at her current range of weight. She said that the brain does continue to grow and the body continues to mature and there is some weight gain that occurs in the 20's and in the 30's. I asked, so we don't have to continue pushing weight up to try to keep up with their curve? She said no because she was fully grown.? Then, Dr. Katzman in her presentation said that bone growth continues to occur into the early 20's.? Now, how do we know when this weight gain in the 20's is supposed to occur? Is it possible that some kids relapse in college because the maturity kicks in and they are not compensating for that weight gain in the early 20's?? It would be lovely to get some clarification on this issue so that we know what to do with these kids who have reached full height. | |
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Mentor
Registered: May 08, 2012
Posts: 1,329
| Posted Yesterday at 11:59 AM | Reply with quote?#2? |
| I'm not a mod, but this sounds like a good time to take out the "State not weight" card. If there are ED behaviors and thoughts, perhaps that might be evidence that weight needs to go up ??? YP | |
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Mentor
Registered: July 31, 2007
Posts: 3,634
| Posted Yesterday at 01:29 PM | Reply with quote?#3? |
| YP,? Anyone can weigh in on this thread, it is not just for the mods. What I meant is that I think we need some professional guidance on the issue and the mods and FEAST board have access to our FEAST advisors. I wholeheartedly agree on state not weight and Dr. O'Toole is clear about that. In our conversation, I gave her the update on dd. Told her at the 75%tile range she has great state and is definitively in recovery mode. The fact that she has stayed relapse free (other than two dips in weight) for 5 years is a testament that she is at the correct target weight. But, state issue aside, my question is more of a preventive nature rather than a corrective one.?We do use state as our measuring stick. It is what tipped us that d had lost weight a couple of months ago. This question is crucial for those of us who have sent or are sending our kids to college/uni. Would love to send dd at her correct range. If it is artificially inflated, she won't sustain it. If it is under where she needs to be, that puts her at risk for a relapse. That is why I would love for the experts to weigh in on this issue of the growth curve trajectory. Here at ATDT we love to use our children's growth curves as guidelines, but is it STILL applicable to continue on the upward trajectory once they are fully grown, just as we did when they were growing? | |
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Registered: Aug 14, 2011
Posts: 309
| Posted Yesterday at 01:46 PM | Reply with quote?#4? |
| I have been wondering about this too. It's curious that growth charts would show an upward curve into the 20's if most teen girls stop growing at 15 or 16. This seems to me to be pretty critical information. Experts, please weigh in! | |
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Mentor
Registered: May 08, 2012
Posts: 1,329
| Posted Yesterday at 01:58 PM | Reply with quote?#5? |
| True--it is hard to use "state not weight" if one's kid is away at college!!! Hard to put that one in a contract ... YP | |
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Registered: Oct 08, 2012
Posts: 111
| Posted Yesterday at 02:57 PM | Reply with quote?#6? |
| Maria, thanks for starting this thread. ?My d is moving into this area as well. ?I don't believe she will grow in height anymore. ?When the N went over the chart with me, it made sense to stay on the trajectory, however, they never took height into consideration. It doesn't seem like weight should go up dramatically from 15-20, for instance, if the height has stayed the same. ?I agree that they will naturally gain weight in their 20s, but I hate to overshoot the goal when she is 15 and make her carry weight she doesn't need. ?I know, I know, weight doesn't matter, but to a 15-year-old girl it really does and she is doing beatifully already being at a weight she is somewhat uncomfortable with (ed or no ed). | |
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Registered: May 17, 2012
Posts: 119
| Posted Yesterday at 04:01 PM | Reply with quote?#7? |
| I know that bringing up BMI might be controversial, because everyone is different.? However, it might be helpful to know that the CM & E (is that right?)/Maudsley video does say that most adults' healthy BMI is between 20 and 24.? That's still quite a range, but at least it's a starting point.? Since my D? reached her full height several years before the restricting started, it was obviously easier to figure out her target weight range. | |
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Mentor
Registered: July 31, 2007
Posts: 3,634
| Posted Yesterday at 04:23 PM | Reply with quote?#8? |
| I am also referring to a range (don't know what constitutes a range, 3-5 lbs? 5-7 lbs? not sure - not a number.? Our d has naturally continued putting on weight, from initial weight restoration at 11, and reached her highest weight during the summer (right before she turned 16) when she had the last growth spurt and grew 1/4 of an inch. If she were to stay stagnant at her weight as a 16 year old until her 20is, her percentile would be lower than 75th tile. The only time that she has fallen below her %tile has been because of unintentional weight loss (twice). Both times state suffered. However, in both cases it was a result of weight LOSS not maintenance.? New question, at what age does BMI become a more significant factor than growth curve? | |
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Mentor
Registered: Sept 05, 2007
Posts: 769
| Posted Yesterday at 04:28 PM | Reply with quote?#9? |
| Well, I wouldn't think that it would be useful or advisable to try to feed someone who is X years old into the weight they are supposed to be or predicted to be when they are X+Y years-later?old. Children change weight and height every year, but you don't W/R a 10yo to the 15yo target. Similarly, I can't see how it would be necessary or advisable to send your 18yo off at a weight that would be healthy for them at 25yo. There are no "growth charts" per se for people over 20yo. In the US, the Metropolitan Life Insurance tables are often used, but they are problematic for very short or tall people, young adults, or very old people as they really only apply to men and women between 25-59yo, and REALLY only document the average weights of people with the lowest mortality rates during those ages (see this page for a discussion of the issues:?http://www.halls.md/ideal-weight/met.htm ).? I did a quickie lit search over lunch and came out with ZIP about this, so what follows is my musings based on what I have read. Taking away age, your body has a predetermined "weight potential", just like it has a height potential. Adequate nutritional stores are crucial during those years when growth rate is steepest on the S curve (notice that growth curves show gradual change until 2, super accelerated change from 2-15, and then sort of flatten out. That is a classic S curve, and all kinds of growing things, people, populations, number of bacteria in a petrie dish, follow that pattern naturally). So, at every stage of rapid growth, your body's weight will tend to precede the height. That is why when they are kids, you are chasing a moving target. Normal growth means weight and height are shifting SEVERAL times each year. But once growth has?plateaued (flattened out on the S curve), that dynamic ALSO changes. Weight doesn't need to be stored in the same way, and caloric needs adjust to current state and usage, rather than anticipated pre-programmed growth. I would predict that a YA in strong recovery is able to eat to the much slower demands of 20-25yo growth, as long as zie is eating when hungry (or eating enough to feel full) and getting good variety.? If your YA remains the same weight, but their STATE goes wonky ED-wise, probably calories are insufficient to their body's needs. I would think the appropriate triage would be A) ensure that there are no purging behaviors and no skipping - in my mind, these are the largest dangers facing the YA transitioning to independent living B)?Assess whether activity has changed, and adjust meals up if needed.?If eating is healthy (no skipping, adequate nutritional content and variety, no ED behaviors), THEN you might need to adjust the weight range up. I think Cindy Bulik has some evidence that binge behaviors in adults are tied to trying to maintain a lower weight than genetic potential?weight, so I'd be particularly suspicious if binge or binge/purge behaviors developed, that weight might need to go up a bit. | |
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Mentor
Registered: Sept 05, 2007
Posts: 769
| Posted Yesterday at 04:40 PM | Reply with quote?#10? |
| Attention! Healthy at Every Size PSA! Technically, BMI is only a measure of Adult height-for-weight. I think the original work included 21yo+, IIRC.?BMI should NEVER be used for kids, and the fact that it is, is a gross mis-application of the measure. It was intended for use assessing the nutritional status of ADULT populations. While BMI may have it's place as a bit of screening information,?BMI is NEVER appropriate as a singular measure of health for an individual. BMI will be inaccurate for very short, very tall, very muscular, or differently abled people.? Labs such as renal and endocrine panels, hematology, vital signs (heart rate, blood pressure, respiratory rate), ability to carry out daily function, emotional and mental health are ALWAYS appropriate measures of health. | |
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Mentor
Registered: Oct 30, 2011
Posts: 2,574
| Posted Yesterday at 05:07 PM | Reply with quote?#11? |
| Agree with Irishup and that BMI is a faulty indicator.....it does not measure leanbody/fat mass. This is where genetic determination and other factors come into play. Along with the tendency to be shorter or taller we all each have genetic tendency to develop or not develop lean muscle mass. Some will have larger percentage of slow twitch fibers as opposed to others will have larger percentage of fast twitch.......You cant really measure this accurately except in a submersion test or by autopsy and who wants to go through that inconvenience. Right? I know your D is very athletic Maria and my guess is that she would have more muscle mass than a sedentary girl of the same height. Would she weigh more, yes likely but she should. I guess I would be interested to hear what tools there are to give ranges for growth once growth plates have fused. But with all the genetic variables in body composition and the inherent difficulties in measuring........I don't know if its really possible... Will be interested to hear from an M.D....Perhaps you can email Dr. O'Toole a follow up, or Dr. Peebles. | |
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Mentor
Registered: May 08, 2012
Posts: 1,329
| Posted Yesterday at 07:12 PM | Reply with quote?#12? |
| I spent some time talking to Dr. O'Toole at the conference, and learned that she does not read this forum. She did say tat she would be happy to answer questions, though, that come up here if someone lets her know about it. This could be done by email, but another way would be to Dr. O'Toole the question as a comment on her blog, to her entry on determining ideal body weight. I'm confident she will answer. Then, share the answer here!!!! That way, the question and its answer will get more "air time"!! YP | |
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Registered: April 26, 2011
Posts: 2
| Posted Yesterday at 07:38 PM | Reply with quote?#13? |
| YogurtParfait_US?- I can confirm that Dr. O'Toole takes a lot of care of read and answer as many comments to her blog as possible. We are currently upgrading our comment software as well, to make it easier to share individual comments rather than simply an entire thread. I would also add that I am happy to facilitate communication to Dr. O'Toole in any way I can. I do try to read this forum as much as I can (and link to it), as there is simply nothing else like it on Web. We tell every parent who will listen to log in and join the conversation. Morgan | |
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Moderator
Registered: Feb 28, 2009
Posts: 2,508
| Posted Yesterday at 08:16 PM | Reply with quote?#14? |
| I have no medical/research "credentials", but what I have noticed is that when a person (female or male) reaches full height during their teens, their bodies then fill out as they become older and become a more mature shape. I never got taller after age 13 (did not have an ED), and I certainly didn't stay that same weight as an adult. | |
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Mentor
Registered: July 31, 2007
Posts: 3,634
| Posted Yesterday at 09:10 PM | Reply with quote?#15? |
Irish, your explanation is AWESOME! Morgan, Thank you so much for passing this along to Dr. O'Toole.? This whole thing came about from a query that I put out because when discussing my d's target range a few weeks ago (from a dip in weight cause by medication and pneumonia), I was advised that she should continue gaining weight to make sure that she?stayed on her 75th%tile trajectory until she was in her 20's. That would mean a gain of about 4 lbs every year. If that happens naturally, as per Irish's description, then I don't think that is a problem. BUT, I questioned the wisdom of artificially pushing d's weight up 3-4 lbs every year when we know in a measurable way (wrist X ray) that she is done growing. That is why I approached Dr. O at the conference. What she said makes total sense to me. However, I am asking if we can get some sort of official guideline because we don't want to be advising people here to keep pushing their kids to continue gaining in order to stay at X projected growth curve, once they are done growing, if that is not necessary. Thanks a bunch in advance! | |
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Mentor
Registered: May 09, 2011
Posts: 597
| Posted Yesterday at 09:13 PM | Reply with quote?#16? |
| Like AnnieK, my impression of this issue is totally personal and non-professional. ? I would think that once a child stops growing in height during adolescence, it would be reasonable to expect a 1-2 lb. weight gain every year or two into the early 20's (I'm thinking women here - it might be greater for men). ?I think the brain, bones, and other organs might still be growing. ? Just subjectively, it seems that young women are bigger than adolescent girls. I've been comparing pictures (on FB) of my daughter's friends from H.S. to college, and they (non-eating disordered) have ALL grown in size (not necessarily in height). Of course, this is all anecdotal- would love an expert to weigh in (no pun intended). | |
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Mentor
Registered: July 31, 2007
Posts: 3,634
| Posted Yesterday at 09:29 PM | Reply with quote?#17? |
| No doubt, Papyrus. Just in terms of athletics, college athletes are SO much bigger than most HS kids, particulary the guys. But, I don't necessarily see a WHOLE lot of differences at school, for instance, between sophomore girls and senior girls (15 - 18). So, I do think, as Dr O said, there is this growth in the early 20's, which is when they?are in?college. YIKES! That brings up a WHOLE other can of worms. They will need to put on weight right when they are away from us. Phew! | |
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Registered: Oct 16, 2012
Posts: 116
Registered: May 17, 2012
Posts: 119
| Posted Yesterday at 10:13 PM | Reply with quote?#19? |
| Just as an individual example, my D had reached her full height by age 16, at which time her BMI was 21.2.? From age 17.5 until age 19.5, it was 21.6.? After the ED (early stages AN, dropping below 90% of prior weight but not below 85%) she is now back to BMI of 20.6 (she turns 21 in one month).? Her state is good, but it was only restored at her current weight -- not even 1 pound lower (which is why I want her to gain a few pounds). Obviously, I never calculated or charted D's BMI before -- only did it after the weight loss. Of course, every case is different.? But in general, as a child?grows up, it would be normal for the BMI to increase.? I just looked at an NIMH?study in the "Hall of Fame" posts, that found that adolescents with EDs who were discharged at a BMI of greater than 17.5, did better than those whose BMI was below 17.5. I do realize that BMI has its limitations.? It was helpful for me, because my D is a young adult. | |
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Mentor
Registered: Sept 05, 2007
Posts: 769
| Posted Yesterday at 10:36 PM | Reply with quote?#20? |
| marilyn, I think what you did makes perfect sense. Lacking growth charts for YAs, it makes perfect sense to use other measures. Calibrating target weight in an adult from *their own* historical BMI is pretty much the same thing as using height/weight growth percentiles in kids. The key is calibrating to the individual. When clinicians target an individual to a populational measure - like median growth percentile - or to some arbitrary cut-off - like a BMI of 18 because that is the minimum "normal" - THAT is when you run into problems. But BMI is often used this way, instead of the way you used it.? So summary: | |
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Mentor
Registered: Feb 01, 2011
Posts: 2,668
| Posted Yesterday at 11:51 PM | Reply with quote?#21? |
| Here is a thought that my H and I have had about this: The consequences to your health of being even 20 to 30 pounds overweight in life are MUCH lower than the results of being underweight, especially for this group of people with eating disorders. I would feel much more confortable sending my child off to college with 10?"extra" ?pounds....and there is absolutely nothing wrong with it. I know this sounds a bit simplistic....but to me is makes sense. | |
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Mentor
Registered: Oct 30, 2011
Posts: 2,574
| Posted Today at 05:17 AM | Reply with quote?#22? |
| I think that is right on mamabear | |
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Mentor
Registered: July 31, 2007
Posts: 3,634
| Posted Today at 06:35 AM | Reply with quote?#23? |
| For some perspective, my d's BMI is 23. This is not about whether there is something wrong with our childrern being X lbs "overweight".
Mamabear, I agree with you in principle but you are still re feeding a growing child. My question comes from the perspective of a child in recovery for 5 years, who has stopped growing, and who by following her hunger cues lets her body put on the weight it needs to. Her weight may be stagnant for months or even a year, sometimes she goes over her % tile at other times she stays close to her lifelong %tile but it continues to go up slightly. Should I artificially put weight on her to follow a fixed percentile number? That is what is at the heart of this question. | |
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Registered: May 17, 2012
Posts: 119
| Posted Today at 07:44 AM | Reply with quote?#24? |
| Maria, Your daughter is 16, has been fully recovered for 4.5 years, and has a BMI of 23. So, have you charted her BMI percentile, as well as height/weight?? If not, I might consider doing it (for the past 4.5 years), just so you have another piece of data.? Ultimately, I would go with your gut.? And what Dr. O'Toole said.? It seems to be me that you can treat your D at this stage as though she is healthy, until she shows otherwise.? Your antennae will pick up the signs that something is amiss, I feel sure.? If she had never had AN, would you try to put weight on her now?? Clearly not. | |
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Mentor
Registered: July 31, 2007
Posts: 3,634
| Posted Today at 09:30 AM | Reply with quote?#25? |
Marilyn,? Yes, I ?have gone by her growth curve all along. Also, state has always been a good indicator for us. I simply used the BMI as point of reference for others, not us. I am not concerned about my child at this point. I'll rephrase my query for those who might be joining in late to the thread.? I feel like it would be good to have experts weigh in on whether, in general terms, if the following are in place for a child who has stopped growing: state is excellent aka no sign of ED behavior or anxiety If?growth is done, should WE push weight to X range so that child can continue on the projected growth curve. ie: for my child 75% - 76%th percentile until they are 20-21?. To stay in her projected growth curve, she would have to gain about 3-4 lbs per year on an upward basis until her 20's. I don't have a problem with that happening if that is what her body needs to do. However, I sought the experts' advice before I artificially?(as in me feeding her extra calories as opposed to her eating what her body naturally tells her it needs) bump up weight to keep up with her pediatric growth curve.? | |
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