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Ask a CHOC Doc: How can I safely gain weight?

Question: I am underweight, and don’t feel like eating sometimes. I am tired of not being able to gain weight. I tried talking to my doctor about it, but she didn’t give me a chance to explain; all she said was to eat more. When I was diagnosed with depression I wouldn’t eat as much and a part of that stayed with me I suppose. I don’t get hungry even when I want to eat. There is this supplement called Apetemin that helps people gain weight by making you feel hungry and slowing down your metabolism. Would you recommend it? -Anonymous

Answer:

Identifying and maintaining a healthy weight is an important discussion, and a common one I have with teen patients. Here’s what I usually discuss with my patients:

  1. How to determine a healthy weight

To determine whether someone is medically underweight, doctors use a tool called Body Mass Index, or BMI. This is a calculation that uses height and weight to estimate how much body fat someone has. Doctors use it to determine how appropriate a someone’s weight is for a certain height and age. There are online tools to help you calculate your BMI at home.

BMI is the most common measure about what weight is appropriate for someone’s height—but there are exceptions to this guideline. BMI is not always the best measurement for everyone. To determine a healthy weight for you, have a conservation with your doctor. Work with them to identify a healthy weight.

  1. How to know when skipping meals is a cause for concern

It’s ok if you skip a meal every now and then because you’re stressed or sick. That’s normal. Some days our bodies are hungrier than others, and that’s ok. If skipping meals becomes a regular thing, or if you’re unable to complete meals on a regular basis, talk to your doctor. If you’re also experiencing stomach problems like vomiting or diarrhea, see your doctor.

  1. How appetite plays into mental health

If this feeling of not being able to eat accompanies sadness, worry or sadness, speak to your doctor. You can also speak to a trusted adult like a school counselor who can help you find a psychologist or other mental health professional. Depression and anxiety are common problems that can cause changes in appetite and eating. These are chronic problems that can have times where they’re pretty severe, and other times where symptoms are not present, but they can still affect your appetite or mood. It’s important to have an ongoing conversation with your physician about your mental health. They can help you find the resources you need, including a psychologist.

  1. Be cautious with supplements

If you are underweight and having trouble eating, your doctor may recommend seeing a nutritionist for recommendations on food and supplements. Always discuss supplements with a provider, as they are not well regulated and need to be taken under the supervision of a doctor or nutritionist.

Appetite stimulants may be prescribed, but can come with adverse effects, including abnormal changes to the immune system, nausea, stomach problems and fatigue.

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-Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s

Explore adolescent medicine services at CHOC

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Olivia’s Journey with Music Therapy

Olivia was unexpectedly born two months premature and spent the first seven months of her life in the CHOC Children’s neonatal intensive care unit (NICU). During some moments of their extended NICU stay, her parents weren’t sure if they would ever get to take their baby girl home.

From the day she was born, Olivia had been exposed to a high level of stimulation in the hospital setting. Despite the NICU’s environment of healing, the beeping of machines, and steady flow of clinicians in and out of her room had overwhelmed Olivia and made her weary of physical touch.

“Even though the doctors and nurses were very gentle with her, and everything was done with her best interest in mind, it’s a natural outcome for someone who has spent their entire life thus far in a hospital to be apprehensive of physical touch,” says Leilani, Olivia’s mother.

The NICU’s developmental team quickly saw that Olivia would benefit from music therapy, and introduced Olivia’s family to Brie Mattioli, a board-certified music therapist at CHOC who specializes in the NICU setting.

Initial goals of music therapy for Olivia included pain management, learning how to self-soothe, and self-regulation. Once her pain improved, she could show more self-expression and even develop preferences for certain types of music. (Her favorite song is “Rise Up” by Andra Day.)

Sometimes Brie’s goal was to help Olivia get to sleep, which is healing. During other sessions, their goals were focused on development and stimulation.

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The calming effects of music therapy was just what Olivia needed.

Afterall, she underwent her first in a series of surgeries when she was just 2 weeks old. During prenatal scans, doctors discovered that Olivia had enlarged kidneys, and at birth they discovered her stomach was enlarged as well. Surgery was a priority. . Under the care of Dr. Peter Yu, pediatric general and thoracic surgeon, Olivia’s intestines were repaired. Another surgery, when Olivia was 2 months old, shortened her lengthy spinal cord.

Olivia also showed traits of Noonan Syndrome ― a rare genetic disorder that affects one in 1,000 to one in 2,500 people. Noonan Syndrome is commonly associated with physical characteristics like atypical facial characteristics and a short stature, and clinical symptoms like heart defects, bleeding problems, feeding issues, developmental delays and malformations of bones in the rib cage.  Although Olivia seemed to exhibit mild physical characteristics of the syndrome, she displayed prominent clinical symptoms.

While she underwent genetic testing for Noonan Syndrome, Olivia’s care team also indicated that she was a candidate for genomic sequencing, the process for determining someone’s complete DNA sequence. Through a partnership with Rady Children’s Hospital, some critically ill infants and children in CHOC’s intensive care units have access to rapid whole genome sequencing. The research collaborative intends to decrease the time between an acute diagnosis and the implementation of effective treatment for difficult-to-diagnose cases. Olivia was genetically tested as were her parents. Two weeks later, the results came in. Neither parent tested positive for Noonan Syndrome, but Olivia did. Since neither parent was a carrier, this meant that Olivia had a uniquely altered gene that resulted in the syndrome.

“When the results came back, we were in disbelief and grieving,” Leilani recalls. “The news was unexpected and heartbreaking. We had never heard of Noonan Syndrome and we had done most of the genetic testing offered during my pregnancy. Our baby was so innocent, and she didn’t ask for any of this. I found myself fast-forwarding to the future and wondered what life would look like for her.”

Music as a journey to healing

While in the hospital, Olivia saw Brie four times a week for music therapy. The more music therapy sessions Olivia had, the more relaxed she became in a sometimes-stressful hospital environment.

“When bodies are relaxed, they heal better,” Brie says. “More opportunities for relaxation mean more opportunities for healing, positive gains and progress.”

In addition to helping patients make progress towards clinical goals, music therapy can provide a sense of normalcy to families in the midst of an emotional time.

“Music promotes a sense of positivity, peace and normalcy in the room,” Brie says. “It wasn’t the nursery they planned to bring their baby home to, but it provides a sense of normalcy to families.”

The practice resonated with Leilani, who had even considered pursuing a career in music therapy in college. While pregnant with Olivia, she would frequently play music, everything from Ed Sheeran to N*SYNC for her daughter.

“My pregnancy was difficult, and music had always been a form of therapy to me,” Leilani says.

Parents and families also benefit from music therapy. In addition to helping patients make progress towards clinical goals, music therapy can provide a sense of normalcy to families in the midst of an emotional time.

“Music promotes a sense of positivity, peace and normalcy in the room,” Brie says. “It wasn’t the nursery they planned to bring their baby home to, but it provides a sense of normalcy to families.”

When Olivia was discharged from the NICU, her parents were given a CD specially recorded by Brie with Olivia’s favorite music therapy songs so she could continue healing at home.

“No parent signs up to be in the hospital for all those months,” Leilani recalls. “But I am so happy that CHOC was there when we needed them. CHOC was the right place for Olivia.”

Learn more about music therapy at CHOC

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The female athlete triad: What you need to know

By Dr. Amanda Schafenacker, pediatric resident at CHOC Children’s

The female athlete triad, commonly called “the triad,” is a significant phenomenon being seen more and more in middle school and high school female athletes. The triad consists of three health concerns: disordered eating, low bone density (osteoporosis), and loss of periods (amenorrhea). While we always encourage children and adolescents to exercise, the triad can be seen in females involved in sports.

The triad occurs when the calories a female athlete is consuming doesn’t compensate for how much exercise girls she’s doing. To make it simpler, the amount the teen is eating is not enough to support the energy needs for daily life plus exercise. This has adverse effects on reproductive, bone and cardiovascular health.

The full triad occurs in 1 percent of all high school girls and 16 percent of all female athletes—but many adolescents may only exhibit one or two of the components, which can still have adverse effects on health. This also means a higher percentage are at risk for the full triad over time if their nutritional habits do not improve.

Disordered Eating

While some athletes may be obsessively counting calories, or practicing other unhealthy weight loss techniques such as unnecessarily restricting food items or entire groups, vomiting, diuretic or laxative use, some athletes may simply be unaware they are not consuming enough calories to support their active lifestyles. When the calorie intake does not equal the calories consumed by the body, the body starts to break itself down, which can lead to problems in different organ systems.

Potential triggers for disordered eating includes prolonged periods of dieting; weight fluctuations; coaching changes; injury; and casual comments about weight from coaches, parents, or friends. Many athletes falsely believe that losing weight will improve their athletic ability and that thinner means faster or more agile, but this is not true. This is dangerous. These ideas are common among dancers, gymnasts and swimmers, but can also be seen among runners, soccer players, and in wrestlers or boxers as athletes fluctuate through periods of “cutting weight” and gaining weight.

Loss of muscle mass happens quickly after you begin restricting food intake. This leads to decreased speed, decreased agility, decreased coordination, and increased risk of injury of muscles or bones.  Parents should be vigilant if they notice significant weight loss, their children restricting food, or purging habits (like inducing vomiting or laxative use), and bring their child to the doctor.

It is important for any athlete to remember, if a coach or family member feels it is necessary for the teen to gain or lose weight, to do so safely with the help of a doctor.

If you or your teen have questions about how much food the body needs to keep up with natural metabolism and athletic activities, talk to your doctor or a pediatric nutritionist to get more information.

Bone Disorders

As teens continue to grow, this is a critical time for bone mass creation. Without enough energy for daily function and exercise, bone growth and strength (also known as bone mineralization) can diminish. Decreased bone mineralization leads to muscle and ligament injuries, or even as bone fractures. Bone growth during the teen years is critical to prevent osteoporosis (weak bones) in adulthood. Peak bone mass usually occurs between ages 20 and 30, but up to 90 percent of bone mass is obtained by the time teens finish high school.

Periods

After the first menstrual period, adolescents’ periods should become regular within one to two years. Going without a period for more than three months is called amenorrhea. There are many causes of amenorrhea in teens, but considering low or inadequate caloric intake is necessary in all female athletes. Without enough calories to support the hormones that cause periods, female athletes may stop having their periods or start having irregular periods. Studies have shown that athletes with period irregularities can be three times as likely to have bone injuries and other muscle or ligament injuries than those athletes who maintain normal periods. The usual treatment for regulating periods is increasing nutritional intake (eating more) or decreasing vigorous activity, or a combination of both.

What should I do if I suspect this is me?

Talk with your doctor! At any sports physical, your doctor should be evaluating you for all of the above. At your visit, you can expect to have your vital signs taken (things like blood pressure, heart rate, weight and height) and have a thorough physical exam performed. Your doctor may ask you to have some blood tests done, especially if you are not having regular periods. In extreme cases, your doctor may have a bone scan done to see how your bones are growing.

What happens if I’m diagnosed with female athlete triad?

The ultimate goals are to restore normal periods and weight safely. Overall, you need to start increasing the amount of healthy calories you consume to get the energy your body needs on a daily basis. Treatment plans often include decreasing exercise while increasing calories in meals. To restore bone density and growth, your doctor may encourage vitamin supplements including vitamin D and calcium. You may be referred to a multi-disciplinary team where a doctor, a dietitian, and a mental health professional can help set appropriate nutrition and exercise goals.

Explore adolescent medicine services at CHOC

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Spring clean your family’s eating habits

By Monika Frauzem dietetic technician, registered

March is not only the kick-off of spring;it’s also National Nutrition Month! Spring is not simply  a good opportunity for traditional spring cleaning, but also an ideal time to make positive changes to your eating habits.

With a greater variety of fruits and vegetables hitting the markets this time of year, it is easier to meet the recommendation of filling half of your plate with fruits and vegetables. The USDA MyPlate program is a model for healthy eating.  For those of us withambitious goals to pursue, focusing on small changes is more realistic. There is no magic recipe; food variety and moderation are key ingredients to healthy eating.

Here are a few easy ways to spring clean your family’s eating habits:

Mindful eating: Focusing on mindful eating helps control portion sizes and lets you enjoy the different flavors of your food. Fruits and vegetables are the most flavorful when bought in season.

Shop outside:  Farmers’ markets are ideal places to shop for seasonal produce.Sustainability and encouraging market development in underserved areas are just two reasons to support your local farmers’ market.  Programs such as the Women, Infants, and Children (WIC) program and the Commodity Supplemental Food Program (CSFP) offer access to more fresh fruit and vegetables to low income families and provide vouchers that are accepted at many farmers’ markets.

Shopping at the local farmers’ market is not only fun, it also supports local businesses. It is a great place to by organic produce, locally baked goods, local cheeses, and oils. Three out of four farmers who sell at farmers’ markets use farming practices that meet or exceed organic standards.

Get your kids involved: Some vendors at farmers’ markets come equipped with recipe cards and are happy to share recipe ideas and give advice on cooking and storing various kinds of produce. They let you know when the season is at its peak and when it is winding down. This is a great way to get your kids involved with learning about where food comes from and to see fruits and vegetables that may be unfamiliar. Samples are often available so you can taste what you are about to purchase—another good way to get your children to try something new!

Meal plan: Allow yourself to be surprised by the selection at the market as well as inform yourself on the seasons for produce grown in your area. If you know what you will find at the market it is easier to make meal plans and a grocery list in advance. This helps you avoid overbuying, and reduces food waste. Check out these healthy meal prep tips for busy parents.

Celebrate National Nutrition Month and the launch of spring by taking time to explore your local farmers’ market with your family and enjoy the goods it has to offer. You might find a new favorite food!

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Kids Health, delivered monthly, offers “healthful” information for parents.

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CHOC Children’s leaders observe International Women’s Day

As the world celebrates International Women’s Day, we are highlighting several CHOC Children’s female physician and nursing leaders. They offer insight and words of encouragement to women seeking to pursue careers in medicine.

Melanie Patterson, vice president patient care services and chief nursing officer

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“When beginning your career in medicine, don’t focus on one trophy. The fields of medicine and nursing have so many opportunities within them; be courageous and try new things. The most important aspect of leadership and of career success is to be kind. Remember to form your own opinion—go into every relationship with your eyes open and stop looking through others’ eyes; they don’t always have 20/20 vision.”

Dr. Mary Zupanc, pediatric neurologist and co-medical director of the CHOC Children’s Neuroscience Institute

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“When I went to medical school, women were not encouraged and it was hard. There were a lot of things that happened that made it very difficult, but medicine is truly one of the most gratifying professions you will ever have.

Every patient is different. I believe that if you really and truly listen, a patient and their family will give you the diagnosis you’re searching for. Everyone’s story is so fascinating, and that makes our work like being a detective. Sometimes I feel like Sherlock Holmes searching for answers. Then once you do find an answer, you need to work with the family to make sure the treatment works for their lifestyle, culture and religion. That makes the work challenging, fun and meaningful.

The best piece of advice that I’ve ever received is to never apologize for excellence. Anyone would want their doctor to strive for excellence – and that goes for any profession.”

Amy Waunch, nurse practitioner and trauma program manager

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“Never underestimate your capabilities; do not shy away from opportunities and always take on new challenges. Believe in yourself but don’t be afraid to ask for help. You may not have all of the answers all of the time, but you do have the ability to learn and grow.

Spot growth opportunities when they present themselves because they are the key learning opportunities. You will know because they make you uncomfortable and your initial impulse will be that you are not ready.”

Dr. Azam Eghbal, medical director, radiology

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“Since I was 7 years old, I wanted to be a doctor and becoming one has been the best decision of my life. As a female immigrant, I was told that I could never get to medical school, which of course motivated and challenged me even more to do so.

The best advice I’ve gotten is: don’t be discouraged about all your falls and obstacles, think about how you can succeed to get where you want to be.”

Dr. Amber Leis, plastic surgeon

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“My advice for women pursuing a career in medicine is to trust yourself! Early on in your career it’s easy to be overcome by feeling like you are not up to the task ahead of you. Your unique qualities will become your greatest strengths, so just keep chasing your passion.

I have great faith that if I stay true to my core principles, the right path will open in front of me. I try not to set specific goals for the future and instead I give my best to where I am. It keeps me focused on what I am doing now, and not distracted by trying to maneuver into some future place.

The best piece of career advice I’ve ever gotten has been ‘You get to choose what kind of person you will be.'”

Dr. Jasjit Singh, medical director, infection prevention and control

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“My advice for women pursuing a career in medicine is to follow your passion! There are few other careers that offer the personal satisfaction and the intellectual rigor that medicine does. Find a good mentor early in your career. Later, make sure your practice partners have abilities that you respect, and the talent to make your shared time together meaningful.

I learned early on that delegation and time management are important, particularly if you want to balance a medical career and family. You can’t always do it all, and prioritization is tantamount to success in all the different spheres of your life.

One of the best pieces of advice that I got was from a mentor during fellowship, who told me “It’s not enough to just be a good clinician.” He showed me the importance of asking good research questions and pursuing new knowledge. He also encouraged my love of teaching upcoming generations of pediatricians!”

Dr. Katherine Williamson, pediatrician

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“I love being a pediatrician. I help take care of kids every day and partner with their parents to help keep them healthy. To me, being successful is loving what you do because then working hard and being motivated to do well doesn’t feel like work; it’s fulfilling a passion.

When asked to give advice, I always say these three things: be yourself, don’t rush, and follow your heart every step of the way. Be yourself, always. No matter how busy or loud life gets, never lose sight of who you are and what you want to do.  Don’t be in a rush. Enjoy the journey because that is where you learn who you truly are. Lastly, follow your heart in every decision you make. When I look back on what got me to where I am in my career, I realize that it was not one or two big decisions that were the deciding factor, but instead it was a million little decisions along the way. And with each of those decisions I followed my heart and my passion.”





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