Photo by Jennifer Burk on Unsplash

 

Readers, you’ll appreciate this interview.  Dr. Sue Bacsik has a wealth of experience with young women.  She seeks God’s wisdom in how she approaches each patient, each family, each set of questions, concerns, and celebrations. She sees patients in Oak Cliff — Dallas, TX, so check out her practice at Oak Cliff Pediatrics.

Juleeta:  Hi, Sue.  Thank you for taking time to meet with me today.  I know it’s busy.

Dr. Sue Bacsik: It’s not too busy, and I love getting to talk to you about young women.  Ask me anything, and I’ll answer as best I can.

Juleeta: Sounds good. My first question is about how it looks when parents approach you if they are concerned about their daughter’s body image. For example, when parents are concerned about their daughter, what steps do you take in guiding them?

Dr. Sue: Sure.  The first step I take is obtaining a patient’s history and, then, a physical exam.  Also, I screen all of my adolescent patients for depression.  Depression and anxiety are often seen alongside eating disorders, and I want to be on the lookout for that, early on.

 

Juleeta:  Considering your female patients, what age/range do you most commonly hear concerns (from them) about weight?

Dr. Sue:  Actually, I usually hear from the parents if the child is less than 10. I usually start hearing from the girls around 11- 12 years of age.

 

Juleeta:  That seems young, but when I look back at my own adolescence, some of the comparisons I started making between my own body and other girls did start happening in middle school.  Do you have any measures or scientific-based guidelines you use to assess healthy weight for your female patients?

Dr. Sue:  In my evaluations, I use a range of things.  I use height, weight and BMI. BMI = (weight in pounds x 703)/ height in inches squared. Next, I  plot each patient’s information on the WHO (World Health Organization) growth curve. Also, I measure yearly to show growth or lack of growth in my patients. All of these factors help me chart trends, to see if there is an underlying problem or concern.

 

Juleeta: What other factors, besides height, do you use to evaluate healthy weight in your female patients?

Dr. Sue:  Well, in addition to BMI, I consider each patient’s favorite activities.  That information, alone, helps me to determine activity level or physical over-activity, and how they feel about their weight.  For example, I can have a 50% (on height and weight ) adolescent but when asked about how they feel about weighing 115 sometimes I get a response of- “I’m too heavy” or “my target weight is really 98.” I also look for clues in their physical exam and in their affect.

 

Juleeta: Is your approach different when the parents are concerned about obesity vs. when the parents are concerned about their daughter being underweight?

Dr. Sue:  That’s a great question.  I use a similar strategy with both potentially overweight and underweight patients.  I usually start with a calorie diary on a typical day of eating. Sometimes, even more insightful information is revealed when I  talk with a patient’s parents.  It’s important to know more  about the parent’s feelings about the child’s weight. Oftentimes, the mom or dad have similar problems concerning body image or have experienced/are experiencing repercussions from an eating disorder.

 

Juleeta:  What does this overall process look like if a parent is thinking through how many visits might be required to address a potential eating disorder?

Dr. Sue: On the first visit, unless it is a severe case, I keep it positive and give them a few things to work on (diet diary, activity diary, monitoring for co-morbid factors, etc.) with CLOSE follow up in a week. I tell them to throw away their scales at home.  The only time they should weigh is in my office.

In some cases, it’s necessary to send for more labs and pursue counseling referrals, appointments with dieticians, and psych referrals.  We want to address serious concerns as soon as possible in an effort to help adolescents seek the care they need.

 

Juleeta:  Do you have any practical suggestions for healthy family changes?

Dr. Sue:  Yes, I suggest a variety  of family changes.  For example, I challenge parents to prioritize eating together as a family.  No TV during meals is also something I highly recommend.  In addition, family walks/bike rides after dinner help  promote healthy eating habits.

 

Juleeta:  Sounds good.  Thank you for your guidance and experience here.  To wrap it up, do you mind sharing any printed guidelines you use?

Dr. Sue:  No problem!  I hope this helps.

The Role of the Pediatrician in Primary Prevention of Obesity

Identification and Management of Eating Disorders in Children and Adolescents