A Clueless Medical Professional

[ang2bmd]

I hate to nitpick, but muscle mass isn't "converted" to fat. You may lose muscle and gain fat, for various reasons, but there is no "conversion" strictly speaking. The body isn't able to convert different tissue types(one mostly made of protein e.g. muscle and the other adipose e.g. fat) like that...

For all practical purposes we are saying the same thing...when you spend your day talking about binkies and poopie you sometimes forget to put the technical stuff back in for the adults but my point remains that this professional in the article may have lacked tact but she is unfortunately probably technically correct

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[ang2bmd]

BMI is garbage for anybody that has any significant amount of muscle mass. I am 6" 220 lbs and my bodyfat is around 10% and I am classified as obese according to the BMI charts

You are correct....body fat % is a much more accurate measurement for the part of the population with large muscle mass. The majority of these people are men since estrogen just doesn't allow building this mass with ease and most women who are this lean are not overweight even by BMI.

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[dbronstein]

Uh...having been at the old park a couple of times, it seems that ex-athletes gaining weight is gender neutral.

Colorado State started a program a few years ago to help football players adjust their eating habits after they stop playing. It's a very difficult transition when you are used to eating many thousands of calories a day and then stop the exercise that burns all those extra calories.

 

[dbronstein]

For all practical purposes we are saying the same thing...when you spend your day talking about binkies and poopie you sometimes forget to put the technical stuff back in for the adults but my point remains that this professional in the article may have lacked tact but she is unfortunately probably technically correct

Obviously we're only getting the mom's side, but if what she claims the NP said is accurate - “Tell me Riley, how can you explain all of this weight you’ve gained?” - it has nothing to do with the long-term risks of losing the muscle mass and such. Maybe the NP was going to use that to get into a more nuanced discussion about it, but according to the article, the mom cut her off, so there's no way to know.

I'm an NP and my experience in pediatrics with the weight/height charts is that the BMI percentiles are crap. They are heavily skewed toward weight and don't fairly account for height. A kid who is at the 90th percentile for height and weight should be at the 50th percentile for BMI because he/she is proportional. But the BMI chart will put them up around the 75-90th percentile.

 

[1bucketmom]

Body weight is only 1 measure and should be considered with multiple factors before jumping to a health issue conclusion. A good % of her gain at that age is due to general growth so a non-factor.
The Obesity society talks a lot about the lack of knowledge primary care physicians have on addressing weight related issues as many only use weight and the good old BMI as their point of reference. Additionally, there is inherent bias against truly overweight patients. They typically don’t get all the care they need as the assumption is obesity is the main problem. Don’t get me wrong, obesity is an issue as it leads to plenty of co-morbidities and mortality issues.
I could go on and on about this topic as I play with endocrinologist, nephrologist and cardiologist daily.
The bottom line .... this girl doesn’t look as if she has a weight issue. The approach was tactless and unprofessional.

 

[Vertigo]

Another medical professional here - yes, truly wish I was a fly on that wall to hear both sides. I know parents at my kids’ schools get irked just when the school nurse sends home the annual BMI letter and their kids fall into the “overweight” or “obese” category which may or may not be true. It is truly a difficult subject to address with parents but yes, there is a tactful way to do it. Diet, exercise, weight gain or loss have always been addressed at my own kids’ visits, as well. Honestly, I’d be way more concerned if the NP didn’t address the weight gain - it could indicate numerous underlying issues - hypothyroidism, PCOS, pregnancy (and yes, teenage girls can hide pregnancy weight gain extremely well), etc. Maybe she was very direct about it and as a health professional you really need to tailor your conversation to your patient population, but it absolutely would be negligent not to have addressed it.

 

[chinamigarden]

As if young female athletes don't have enough issues to deal with. It sounds like the mom put the nurse in her place.

https://www.msn.com/en-us/health/wellness/mom-fights-back-after-nurse-body-shames-her-13-year-old-daughter-she-is-ignorant/ar-BBNbzhP?li=BBnbfcL

I don't have a problem with the question, maybe the tone or context might change my mind. But if a kid goes from the 25th percentile for weight and is now 75% (for example) its well within the medical professional's position to ask do you know why? If the kid says, I am working out, lifting weights, and have gotten a lot stronger with more muscle then I used to have, great answer and we move on. But if the kid says I have no idea I haven't changed a thing, then perhaps the doc might want to do some testing. Body composition and changes are often medical issues, there is no shaming in asking that question. Unless I missed something the Nurse said.

My DD was always a twig and we just thought it was her high metabolism and active lifestyle. Nope it was type 1 diabetes and celiac disease. Fortunately we were able to get both under control. Questions about body weight aren't always because someone is making a judgement.