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Hi Everyone! Miss you all!
Hi everyone, ditto!
Rebecca: Can you talk about how you present this to the patient. We all have different experiences with this narrative.
The Body Is Not An Apology is an excellent book that I sometimes recommend
How does this approach take into consideration of all the negative health effects of obesity
What about objective measures of recovery other than weight- ROM in females, hormones in both males and females, cognitive recovery?
@khalida excellent book recommendation - agree.
@Neville - we recommend looking at all of those objective measures, of course. However, in a disease in which those (pubertal arrest, cognitive rigidity, hormonal suppression) all occurred in the context of weight loss, they generally do not return to normal without significant weight gain, just as in our lower weight patients. So this is just about setting goal weights for weight restoration with that truth in mind. Of course if someone is well earlier than we expected, it is typically not in any way difficult to get them on board with slowing weight gain. A healthy weight IS where there body, hormones, and brain work best.
@debbie - this is one we should discuss as I need to more hear what you are looking for 🙂
can we see that last graph re: trans care?
I have a question for Jonathan- How do we set goals for the Anorexic patient that presents peripubertally. Specifically the trans males who are trying to avoid the “girl curves”
How to present to parents, but also how do you present to pediatricians, who I have found really struggle with this idea that larger bodies are also healthy bodies
@harvey (1/2) - this takes a frameshift, and is a controversial topic, so bear with me. There are many of us in the weight regulation field who would argue that many of the complications you refer to (eg OSA, diabetes, hyperlipidemia, etc) can meaningfully improve without weight loss but with changes in behavior, and that mandating weight loss as a metric of 'success' in larger bodied patients often sets them up for frustration and failure, as weight loss is so rarely a successful long-term outcome for larger bodied patients who do not have anorexia. However, the truth is that atypical AN is just as severe as 'regular' AN, and anorexia is much more likely to kill our patients, even in their young adult years, if they do not reach recovery, while larger patients can live a long life, even if they have complications like OSA, diabetes, lipid issues, etc.
@harvey (2/2) CDC-backed studies have shown that BMI's of 25-37 are actually at the lowest risk of all-cause mortality for adults, so some of the dogma around weight and BMI does not even match the literature we have.....while anorexia and atypical AN have a high mortality rate at young ages. We are always balancing all aspects of health, and again - I am not suggesting that you robotically go to the highest weight in a possible range IF someone is well at a lower weight, but the point is that our largest patients with anorexia still deserve to experience a full recovery, and weight gain is a part of that - and if we as providers are nervous about weight gain ourselves in these patients, it really undermines their ability to succeed.
But Blockers are not available for some of these kids who are just toying with this and may not be out to their families
Giosi Di Meglio
Also, maybe a comment on what to do about a patient who was higher weight, no known highest number, but we don’t have a previous growth curve.
Thank everyone for the excellent talks.
Thanks...great presentation. Miss you all.
this was fantastic, thank you!
Yes. Sorry. I should hav put the word healthy in quotes. Agree Rebecka!