My fears over care of athlete
Reading my husband's copy of Pulse I became increasingly anxious at the Three GPs' Views on the case history of an athlete with a BMI of 14.5 requesting gluten-free foods on prescription (November 4).
The fat:muscle ratio of an athlete is normally significantly lower than the norm, ie more muscle less fat. Since muscle weighs more than fat, athletes regularly present with clear features of anorexia with BMIs in the mid 20s. The BMI for diagnosis of classic anorexia nervosa is 17.5, at a level of 14.5
I would be beginning to think about detention under the mental health Act! I would find it almost unbelievable if this girl were seeing her period, although the Pill may mask this, and is almost certainly risking osteoporosis. She is also exercising a lot if not excessively, and any strict restrictive diet increases the risk of an eating disorder.
The history also suggests the classic premorbid personality of the anxious perfectionist. Although all of the GPs recognised that her weight was low, I was disappointed they did not generally see this as a potentially life-threatening situation, when offered a window to intervene.
Dr Sally Carman
Consultant psychiatrist specialising in eating disorders