This is a letter I wrote to CAMHS in June 2011, 15 months into my son's treatment for anorexia: As of last Friday, Ben is now XXkg (BMI XX. However I am concerned that, as a result of last Friday's session, Ben now believes he is Weight Restored and that CAMHS consider him to be physically "recovered". I am hoping he has misinterpreted this message.
I am aware that weight normalisation and BMI are difficult to calculate as they differ for each individual and fluctuate over the day, week and month. I agree that Ben is now within a safe and reasonably healthy weight range, but this is different from being completely Weight Restored. WHO says the minimum BMI for a boy of his age is around 21.5 and the average is between 21 and 25. Ben is below this.
To allow Ben to maintain his weight below normalisation or to "choose" a weight "he feels comfortable with" is to allow Ben to remain ill. It leaves no room for manoeuvre should he fall sick or wish to resume his pre-ED sports regime. Also, the risk of relapse is far greater.
As a guide to the Pre-ED Ben (and not the "fat" Ben he often refers to), he was a keen athlete (see attached photos). He did the Coast-2-Coast Cycle Run, played rugby, did cross country, swam, trained at the gym and won the 1500 metre race at school sports day. Although he did suffer from "puppy fat" as a child, he slimmed down in his teenage years and developed a healthy, muscular, "strapping" physique. To get back to something close to this level, he still has a few more kg to go.
I know that full nutrition and weight restoration alone will not cure the eating disorder, but full recovery will never occur until Ben reaches the correct level of weight normalisation. Periods of time spent at a sub-optimal weight are associated with a protracted course of illness. Also, weight normalisation is only the beginning of maintenance of a moving target as Ben's metabolism changes and / or he grows.
Over the past 11 weeks the Contract has been successful in moving Ben forwards out of a rut and in achieving gradual but consistent weight gain. I would be devastated if, after all we have achieved and are continuing to achieve, Ben was permitted to remain at a sub-optimal weight.
I am aware that it isn’t going to be easy to get Ben to buy into this idea. As you know, he has a deep seated fear of getting "fat". His perception of his body is still different from reality in that he believes he looks heavier than he actually is. He also believes that, at just a few kg extra, all the symptoms he associates with being "fat" will return: discomfort, sweating, body dismorphia, etc.
Ben is aware that we, his parents, don’t agree that he has arrived at Weight Restored just yet. But he is adamant that CAMHS believe he is now at a level where he can maintain and successfully recover. I hope he has got this wrong...