Eating Disorders 2

What you do is you take a weight for height chart, find the height, the patient we are talking about is somewhere between 170 and 175 cm. You go down to what the 50th percentile median weight for height is; that’s 55.5 I think, or is it 60? Okay, 60. Then you plot it. On this curve here you have a patient who is about … these are hard to see, whatever that percentile is. I think that’s 50th and this is at this height here. That’s the ideal body weight and that’s the ideal body weight there, and that’s the one that’s based on the height. Fiftieth percent for weight here.

Why don’t growth charts work? Well, what they did was, they took everyone at a certain age and did their height and everyone at a certain age and did their weight, but it’s not the same person who’s having the weight done. So you can have someone very tall and very large, very tall and very thin, very short and very thin, and very short and very … so it really mixes everything up so you can’t say, “Well, this patient is 50th percent for height therefore they should be 50th percent for weight. It works okay around 50th percentile, but you go here to 75th percentile, or 95th percentile probably up there, and you look at that and this is what you would say they would weigh. That’s an awful heavy person. This is what they really should be weighing. Look at the discrepancy. This is using the chart. Remember it was 60. So you should always use a height/weight chart once you get past puberty.

So bulimia; it’s recurrent episodes of binge eating. It’s not going out for your birthday to Cheesecake Factory. It’s more than any normal person would eat during a defined period of time. And a lack of control. That you just eat and eat and eat and can’t control it. Compensatory behavior; now that can be purging. Remember, with bulimia it’s the binge that’s important. How you compensate for it isn’t part of the diagnosis, other than whether you are a restrictor or non-restrictor. Recurrent inappropriate compensatory behavior to prevent weight gain; it could be self-induced vomiting, laxatives, diuretics or other medications. Fasting or even excessive exercise. Once again, if you ask someone with bulimia to draw themselves it’s very interesting to see how distorted the image is. This is just saying that this isn’t anorexia nervosa. How do you tell the difference? Anorexia nervosa are always thin. They may have purging but they don’t always have bingeing. Bulimia always has bingeing but they can be normal weight, below weight, or heavy.

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