Expert: Ryan Hale - 5/23/2010

Question
Hi. Hope you can help. My son is 18, 6 feet tall, weighs 122 pounds. He has OCD and sees a psychiatrist who is concerned about his weight & thinks he has a severe eating disorder. He is active, energetic (does lots of long-boarding), depressed over losing a 2-year relationship with his ex girlfriend, has been on high honors in High School, and is registered for RIT (Rochester Inst. of Tech) for September. He is afraid of gaining weight - he's been 125 and has recently lost 3 pounds. Personally, I think he's fine, but we just heard about possible heart attacks for this weight (BMI of 16.6!) and even that his school may not let him in being so underweight. It was suggested he go to a hospital but this isn't going to fly! My question is, is it possible that he's really fine? (He's been underweight his whole life). Are my wife's (and others') concerns overkill? What can/should we do?
Thanks for being there. I'm also an Allexperts guy, but for Excel!

Answer
Bob-  His BMI is pretty low and I can see how your physician would be alarmed.  Given his history of OCD as well, it is worth paying attention to the possibility that he has an eating disorder.  To meet clinical criteria, 2 items are considered: how he views eating and weight gain and what his behaviors are like.  It is true that his BMI could cause health problems, a BMI of around 16 is starvation level!  Those who die of eating disorders usually have a heart related problem as the cause of death.  Also, eating disorders have the highest mortality rate of all psychiatric disorders... even higher than depression, especially if drugs and alcohol are involved.  I would look into it if he were my son.