Boy Scouts of America

We are members of The Church of Jesus Christ of Latter-day Saints. Currently, our church uses boy scouts as the activity arm for the boys' youth activities each week. That is why N is doing so much with scouting right now.

Just recently the Boy Scouts of America released their new health form which is required to be filled out annually by both boys and leaders participating in any activities. Anytime that they participate in "any event that exceeds 72 consecutive hours, a resident camp setting, or when the nature of the activity is strenuous and demanding, such as service projects, work weekends, or high-adventure treks," they are required to fill out "form b." What concerns me is that "form b" is an extended health form with a heavy emphasis on BMI.

Here are two quotes from the form:

"It is important to note that the height/weight chart must be strictly adhered to if the event will take the unit beyond a radius wherein emergency evacuation is more than 30 minutes by ground transportation, such as backpacking trips, high-adventure activities, and conservation projects in remote areas."

"Individuals desiring to participate in any high-adventure activity or events in which emergency evacuation would take longer than 30 minutes by ground transportation will not be permitted to do so if they exceed the weight limit as documented at the bottom of this page. Enforcing the height/weight limit is strongly encouraged for all other events, but it is not mandatory."

There is a doctor's allowance (that basically transfers liability to the doctor) that can override the BMI requirements up to a point. But the basic guidelines suggest that anyone with a BMI in the "overweight" category (BMI of 25 or higher) should not be allowed to participate in the activities listed above. Interestingly, they don't restrict anyone who falls into the "underweight" category.

I have several HUGE concerns with this. BMI is NOT a good indicator of health or fitness levels. It's not even a good indicator of fatness. In fact, the most physically fit tend to fall above the "normal" weight category because of additional muscle mass. My Brother-In-Law who regularly rides his bike 25 miles, is considered border-line "obese" (which is basically where the doctor can't even make a medical exception) based on the BMI scales.

Also, my boys tend to gain weight, grow tall, gain weight, grow tall, etc. If you weigh them right before a growth spurt, you are almost guaranteed that they will not be allowed to participate in the youth BSA activities because of these new BMI guidelines.

My biggest concern is for N. His BMI has traditionally fallen at around the 75% percentile. So that is where we've aimed for his weight gain as he has recovered from anorexia. He is currently above the 75th percentile for height and right about the 75th percentile for weight. In other words, he is right where we want him. However, if we utilize the BMI charts, he is just a few pounds away from being considered "overweight."

It would be completely devastating for him to be assessed using this new BSA "form B" and consequently restricted from participation in many of these youth activities because of being "overweight." In fact, I won't let that happen. I don't think our local leaders will let that happen either. I suspect that they will change activities from being BSA activities to simply "church activities" in order to protect N in particular. They will probably have to do that anyway because I think that 95% of the men in our congregation (potential youth leaders) will fall outside of those BMI guidelines anyway.

Here is a link to the new BSA health form.

4.0

I think this is both good and bad news. After much last minute work, N was able to get straight As (a 4.0) this quarter. It was a personal goal and I'm proud of him for working so hard to achieve his goal. He is very smart -- I've never doubted that. It shows how far he has come from a year and a half ago when his grades were all Fs. But I also don't want these grades to create continual pressure. It's okay if he doesn't get a 4.0 in the future. He definitely doesn't need anymore perfectionist tendencies.

Physical Fitness Merit Badge

Last night N attended a church youth group meeting and worked on his Physical Fitness Merit Badge. I talked about my concerns about the requirements for this merit badge in a previous post found here.

Our previous plan had been to keep N home and work on a modified worksheet (that I had already created). But, N's merit badge counselor checked in with me during the afternoon to let me know about the changes he had made to the requirements. The counselor had rewritten much of the worksheet to accommodate N. He had eliminated the body measuring, anything about weight loss and the emphasis on obesity as a risk for cardiovascular disease. [The Boy Scout program allows for modification of merit badges based on medical needs.] The counselor wanted to know if we had any specific instructions regarding diet. I just indicated that we emphasize eating a variety of foods and staying active. I didn't want him to talk about counting calories or regimented exercise. I also didn't want him to "ban" any foods. The counselor was willing to do as I asked. I was pleased with the changes he had made and I allowed N to go to the meeting.

It went really well. The only hang-up that N seemed to have afterwards was his risk for diabetes. We have a huge genetic diabetes history. He fixated on that for a while last night. I can't take that risk and his awareness of it away. But now isn't the time, either, for him to restrict or exercise with the prevention of diabetes in mind.

I'm thrilled that N was able to participate with his peers for this merit badge. I really appreciate the extra effort that his merit badge counselor gave to help accommodate N's needs.

Good Read

I loved this article in yesterday's Huffington Post by Laura Collins: She's Anorexic and You're a Bad Mother.

Reconsidering

Well, I'm not sure that N is going to end up doing his Eagle Project as I described two posts ago. We're trying to figure out if there is a way for him to demonstrate leadership without having to fully disclose the anorexia to his peers. Unless, we can spin things the right way, he probably won't do it. Right now the idea on the table is to involve the other scouts in fundraising only and label his project as "providing resources for pediatricians" or "pediatrician education" or something like that.

I have to admit that I'm disappointed. I'd like to attach some meaning -- and making a difference -- to this whole experience. But it's not my project, it's his and it's his life and his friends.

Time Travel

N is struggling a bit again. He's probably growing. The last five or six days of school, he's been late. His friends have stopped waiting for him, which is so sad because they really are part of the motivation some mornings. But he was making them late repeatedly. I can see why they would be frustrated. This morning was like a throw back to last year. He even was angry and lashing out.

School is almost over. Most of his teachers have already stopped requiring "regular" work and are instead working towards end-of-year-testing, which actually might be stressing him out. We continue to utilize the magic plate at all of his meals. I may need to magic-plate his snack in order to force some more calories. If we can survive the next two or three weeks, then we'll have the whole summer to address his growing caloric needs at home.

Eagle Scout Project

N is currently considering doing an Eagle Scout project that would involve eating disorder advocacy. He is thinking of putting together informational packets about anorexia and distributing them to local pediatricians and middle-school counselors. He is thinking of including a page telling his story, a list of symptoms and treatment options, a pamphlet with local treatment resources, and maybe the Kartini Clinic DVD. What else could he include?

Previously, as N had thumbed through lists and lists and lists of possible Eagle Scout projects, he just ho-hummed. I could tell that he felt like these ideas wouldn't make much of a difference in the world. After several days of throwing ideas back and forth, he started exploring the idea about helping others with eating disorders. As soon as we starting talking about all the possibilities in this area, he really got excited.

You may remember that N's pediatrician was really unknowledgeable about anorexia. The pediatrician didn't recognize his symptoms as an eating disorder. Once we identified the problem as anorexia and asked for a referral, his pediatrician referred us to a psychologist that deals with children with behavior-disorders (which is obviously an inappropriate referral). As I look back now, I'm also so surprised that the pediatrician didn't immediately order tests and set up a weekly-check-up schedule. At one point when we really needed to have a quick medical work-up, we lucked out and saw a different on-call pediatrician who had done a rotation in an eating disorder clinic. He knew what tests to do and how to read the results. I know that was a huge blessing at the time. Until we found a team at our local children's hospital, N really didn't have the medical attention that he should have had.

Anyway, N feels like it could really make a difference if he provided additional (especially local) information about anorexia to pediatricians like his own. I'd like to help him find a way to do this so that he can maintain some bit of privacy and yet still make a difference. Any suggestions?

Still Good

N is still doing really well. I am still monitoring his calorie intake pretty carefully. In fact, I'm mostly doing a magic plate with him for breakfast and dinner. Though I let him fill his own plate, I'll add to it if I feel like it is deficient. He doesn't resist at all. This is where it is easy to relax and let down my guard. But I just keep relearning that I can't do that.

Doing Well

N had a great day today. He's busy doing his homework and practicing his guitar -- all in anticipation of getting to play some video games. It's the end of the school term. His grades look like they'll all be As. We've really come a long way!

I don't think I'll have to worry about class order (because of perpetual lateness) or unmanageable stress for next year. He has done well, for the most part, with the stressful moments of school this year and he's not really been late at all. Class change was a small challenge, but he has settled in now.

I will have to meet with his teacher in preparation for his health class next year. He will likely need to be excused for the curriculum portion on eating disorders -- not because he can't handle the discussion -- but because it may put him in the precarious position of feeling like he needs to correct the teacher (who may not have current information about anorexia). We also don't want to "out" him by revealing that he is an expert about eating disorders. It's not that we are embarrassed about his being sick -- though it has been an unexpected trial -- but too many people still don't understand the medical origins of anorexia and judge him and our family unfairly. We've been more open about the disease generally, but I don't think a Junior High Health class is the place for full disclosure.

I hope I can educate his teacher about anorexia. I also hope his teacher will be willing to proceed cautiously, especially when addressing any topics about weight and diet. I really wish our kids would be taught more about eating well and being active, instead of the need to be a certain weight.

Improvement

After raising N's calorie intake for several days, he's doing great. He was just a little over-concerned about what he wore this morning. Other than that, I haven't really noticed any break-through symptoms.

Everyday-adequate-calorie-intake seems to be just as important as his weight. His symptoms rapidly disappear once he is getting what he really needs.

Military and Missions

In this post (http://nourishingmyson.blogspot.com/2008/12/fears-of-future.html), I described some of my concerns for N's future. I've done a little research since then. Apparently, the military would reject N because of his eating disorder. Eating disorders are included in the "unwaiverable medical conditions," but they are only documented if they occur after the applicant is 12 years old. I wondered about civilian positions, but wasn't able to find any additional information. This makes total sense to me. In tough conditions, especially those with high calorie expense and low calorie intake, someone potentially relapsing into anorexia could compromise a mission.

As far as him serving a mission for The Church of Jesus Christ of Latter-Day Saints, they do ask about eating disorders on the application. His Bishop (like a Pastor) would attach a letter explaining the terms and severity of the anorexia. Then depending upon his current health, he would be assigned. I hope that he would be asked to serve in a country with good food. :o) I really think he could contribute positively on a mission as long as he didn't have to walk everywhere and struggle to find good food.

He's Growing Like A Weed!

I've noticed another resurgence of anorexia symptoms in N recently. This time it's been a little worst than in the past. And that usually means one (or both) of two things: 1) He isn't getting enough calories or 2) He's lost weight. So I weighed him - 119 lbs, which is down about 1/2 pound. Then I measured him. I was so startled by the results that I measured him again. A conservative measurement shows that he has grown a full inch in the past month. With that much growth, a stagnant weight is just like loosing weight. That explains the up and down struggles that he has been having over the past month or two.

So, we've gone back to a similar routine like when he was really sick. I dish up his plates. He eats it all. I track his calories. It's just been two or three days since I measured him and I can already see a decrease of those pesky symptoms. I just have to be so attentive right now -- especially since he is growing so rapidly.

And just to clarify, these reoccurring anorexic symptoms are so minuscule compared to how sick he was a year ago (at most a "1" on a scale from 1 to 10, with 10 being his worst symptoms ever). I might notice that he is acting a little more self-conscious or emotional. He starts to be a little picky about what he eats. He also might struggle to get going in the morning. Mostly these resurgences don't interfere with his (or our) normal lives. I'm just so highly attuned to these warning signs that I try to address the problem right away.

I continue to be amazed about how consistently important it is for him to keep his weight up. A drop in weight always correlates with an increase in symptoms. At a reasonable weight, he is just like a "normal" 12 year old.

Now he is officially taller than his mom.