Failure to Gain Weight May Indicate Anorexia

When most people think of anorexia, they think of weight loss. But often the first clue isn't losing weight, it is a child failing to gain expected weight.

Not All Weight Loss is Good

We live in a culture that not only encourages weight loss, it assumes all weight loss is good, even in children. But the truth is that children should not lose weight. Even for children who have been medically determined to be above their healthy weight range, the recommendation is to slow the rate of growth, not lose pounds. This fact is, unfortunately, not well-known. (read about Ideal Body Weight)

Children are always in the process of growth. Not just weight and height, but brain, bones, and reproductive system. Most children stay on a very steady "growth curve" after their 2nd year (You can track your child's history with this chart). For the majority of children, the progress will remain steady at average percentiles. Some will naturally stay at high percentiles all their life, others at low ones. Concern, however, should be triggered when a child fails to stay on their growth curve or starts to outpace it. A child who has always tracked at the 75th percentile, for example, may be malnourished if they fall to the 50th - an average weight class.

Parents are not usually looking for these developmental milestones, however. We make a general note of changes, but because we are involved in the day-to-day life of a child, we are unlikely to notice a failure to gain weight or height. Yet this failure to gain can indicate nutritional deficiencies and, in some cases, the first indication that a young person has fallen into disordered eating or an eating disorder.

Weight Loss During Puberty Cause for Concern

Puberty is a time of rapid change: hormonally and socially. But few parents know that this is also a critical time for weight gain and not generally in a straight line. Children often fill out and then shoot up in stages. Girls, who are in a critical phase of reproductive development, need to gain a significant amount of weight and increase their proportion of body fat in order to mature properly. If they fail to fuel themselves properly through this phase, they can delay puberty and suffer bone loss and long-term reproductive problems. For those with a predisposition to an eating disorder - anorexia or bulimia or binge eating disorder - the danger of being undernourished is that the mental illness will be released like a genie from a bottle.

Alert To A Lack of Change In A World Concerned with Obesity

Being alert to change comes naturally, and our society is hyper-focused on fears of weight gain, but parents and pediatricians need to be alert to a lack of change and be concerned and not laudatory when children lose weight.