I remember the first time a patient of ours was “caught” wearing weights. I was examining her with her mother and a young resident pediatrician in the room. I noticed that her weight was up, but she looked terrible! So I thought to myself: back to basics, re-examine her carefully in case you have missed some physical sign, maybe she has grown in height and weight has not caught up…..so I repeated her physical exam with an eye to re-assessing her pubertal development.

I asked her to lie down on the exam table and that’s when I saw it: a large, hard lump in her vaginal area. I immediately had her sit up and she began to cry, which made the young resident (who had also seen it and was scared for her) begin to cry. It turns out to have been her father’s coin collection. She had carefully taped those coins to her inner thighs, each week a few more, to make up for what she thought was her approximate weight loss plus some. She and her mother had driven two hours to see us each week, the young girl sitting on what had to have been a very painful lump.

So, as always, this patient was my teacher. But what exactly had I been taught? That eating disordered patients will wear weights to falsify their weight? And what else?

Yes, it is true that young patients with anorexia nervosa will sometimes wear weights to try and falsify their weight, if they think they can get away with it. I bring this up here to accomplish several things: to alert parents and doctors to the fact of weight-wearing and to discuss how it needs to be handled based on what’s actually driving it. How can we help keep our children safe from the temptation of such behavior? After all, if a child’s weight is sinking and the doctor is unaware, it is only a matter of time before the child will wind up in the hospital.

How is it done? Over the years I have seen dumbbells tied to a strap, worn under the arm, held tightly within the armpit; weights within bras; flat weights duct taped to the waist; small weights (desperate!) tied to the hair or hidden within an up-do; weights taped to the thighs; those held like a tampon in the vagina and the above mentioned coin collection. This is not the kind of thing you would think of if you hadn’t seen it done. And I have seen very young patients do it as well as older teens.

How do we manage this at the Kartini Clinic? Every patient is weighed in a gown. Before they step on the scale we have them do two jumping jacks, to dislodge any potential weights described above. If there is any question or concern we may pat them down. It’s imperfect. As recently as last week a patient slipped past the medical assistant wearing weights strapped to her thighs. But being aware is being prepared, or forewarned is forearmed! And how much easier is it to wear weights at the general pediatrician’s office where they are weighed in their street clothes…….

But the real issue is why? Why do some children go to such uncomfortable lengths? The answer is desperation. And because it is desperation we need to handle it with quiet firmness but never scorn or anger. When a child with anorexia nervosa who is being treated in a family-based program engages in secret behaviors designed to lower their weight, their anxiety begins to mount. On the one hand they are compelled to try and push their weight down, on the other hand they are fearful that they will get caught and stopped. They are rarely hardened deception artists, rather scared and desperate children whose eating disorder is pulling them in two directions. They want their parents and team to trust them, but they can’t keep from acting in a way that defies that trust. It is more humane to design the program to make it hard or impossible to cheat than it is to catch them doing it.

So be aware of weights, folks, this awareness is just one of many ways to keep your child safe. It is a symptom of desperation, remember that.