A few weeks ago, I was talking to a physician about a referral. He let me know that this teenager had lost a significant amount of weight....I'll make up numbers here....let's say she was 5'2 and 120# prior to her weight loss. She lost to 100#, was admitted to the hospital, partially refed, and now will be seen for outpatient follow up. The doctor's stance as not uncommon, and amounted to this: We'll say she gained to 110# in the hospital and this is her new "goal weight," because, in his words, 110# is a reasonable weight for a teenager that is 5'2.
And for me, there's the internal sigh, knowing there's little I can do to override this physician's understanding of appropriate weight, or eating disorder terms, "goal weight." Reality is that very few health professionals, of any discipline, have the opportunity to learn about eating disorder treatment while in training. The main way of learning about ED treatment is through specialty rotations or job placements. So, sadly, the norm is that health professionals are more strongly influenced by the media, and thus the diet industry, than by solid science.
So, everyone knows about those lovely height/weight tables, right? Pick an age, pick a height, and voila! A piece of paper will tell you what you should ideally weight. Okay, well, the name for that table is the MetLife Height/Weight table, and yep, MetLife is an insurance company. So, these were tables designed by an insurance company to protect their interests, and are based in the (flawed) theory that lower weight has lower health consequences. Which is actually completely incorrect, but that's a whole 'nother post.
The theory here is that we can take ALL THE HUMANS IN THE WORLD, and a piece of paper should tell us what we SHOULD weigh. (I hope the sarcasm here is palpable!). This is illogical. So, if you follow that handy dandy piece of paper, yes, the doctor's statement above is "correct." Because that table will say about 5'2, 110# for a female. The problem here is that this particular teenager was at 120# prior to her disorder, so what is to say she SHOULD now weigh less as a result of having a disorder.
What's the real answer?
So, let's make our female teenager above 14 years old. At 120#, she would be in the 25%ile for height and I'll say 62%ile for weight (this is a rough estimate just eyeballing the chart). So, let's say she lost weight and then was hospitalized and now at age 15, she is entering outpatient treatment at 110#. Reality is that her height likely remained the same, because maintaining too low a weight stunts height, which, again, is a whole 'nother post. But, at 15, 110# puts her at the 33rd-ish percentile.
Assuming this teenager had tracked at the 55th-65th percentile throughout her childhood, to now say she is healthy in the 33rd percentile, simply because a height/weight chart says that is good, is irrational. Teenagers are supposed to continue to gain, both in height and weight. But, unfortunately, health professionals, and then parents, often think the child/teenager is "fine" as long as he/she meets the cultural expectations for weight.
To get my point across solidly, let's say that there's a handy dandy MetLife chart for shoe size, or even height for age. So, let's say that at age 16, the chart says I should be 5'4 (average height for women), and a shoe size of 7.5. Well, good news! My shoe size actually is 7.5, so woo hoo! I did it! But, sadly, I suffer from height failure, and am only 5'2 (or 5'3, if the doctor is being kind). But the chart says I need to be 5'4....so, I guess I better get stretching. I better have someone pull on my hands and someone else pull on my legs until I get there, right? Ouch.
That sounds nutty when it comes to height. But my point is that it is equally nutty when it comes to weight. If a child/teen has always tracked at the 95%ile for height or weight, then they are HEALTHY at 95%ile, even if our society begs to differ. And, if they have always tracked at the 5th%ile, then they are HEALTHY there, which our society fully supports, at least with respect to weight.
Now, parents, please do not now go demand your child's height/weight records from their pediatrician. You don't need to drive yourself nuts analyzing it. Just know that that reference point is available, and is much more accurate than a chart created by an insurance company. Parents, keep your focus on helping your child eat when he/she is hungry and stop when he/she is full. If your child does this, he/she will maintain his/her natural weight, well, naturally.
But, health professionals, if you are relying on the MetLife tables, or the other handy dandy estimates that are out there, please reconsider. Humans should be judged against their own history (growth charts), not an average of people put into table form (MetLife Height/Weight chart).
I don't have kids, but this post makes so much sense to me. In high school (with a rampant eating disorder going on), I was given the MetLife standards by my health care science teacher. Those numbers have been ingrained in my head ever since, and I've always compared my weight to that blasted chart. I wonder how many other teenagers in my class fixated on that chart, and have judged themselves accordingly?
ReplyDeleteYes, I suspect those charts have done plenty of harm, as do most charts that try to summarize humans in one number, or even a range of numbers. Of course, you also identify the risk of health classes that pass on this information as if it is truly meaningful, worrying a good number of junior high and high school students.
ReplyDeleteI thought you might find this video interesting and a little sad. This was done in the school district I teach in, but not my school. There have been huge pushes lately in schools to promote healthy eating and exercise to battle childhood obesity. I'm trying to do what I can as a teacher to promote intuitive eating, but it's hard when even your job wants you to teach things like reading and comparing nutrition labels and counting calories to elementary age students. It makes me want to create some type of program that teachers can use in schools that is less focused on the numbers.
ReplyDeleteOops I forgot the link.
ReplyDeletehttp://www.davis.k12.ut.us/Page/52359
Krista, my reaction is so mixed to what they are doing. I can tell it is well-intentioned. But likely comes from a place of not understanding the RISKS associated with taking this approach. I know this is a big push in public schools, and I wish dietitians with knowledge of intuitive eating could be involved, but of course that would cost the school district more money. Teachers have little to no education in how to truly teach about nutrition and eating disorders, so their well-intentioned efforts can, likely, do some good, and some harm. It is just sad how obsessed our society is. I wish I could remember the study I heard about related to nutrition labels; I don't remember the details, but I know the bottom line was that nothing has gotten better, and perhaps things have gotten worse, since the advent of nutrition labels. And, now I hear it will soon be nationwide that restaurants have to post nutritional info, in spite of data showing doing so has done nothing to "improve" consumer choices. So frustrating that the obsession is what is reinforced, rather than listening to one's own body.
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