Is close enough good enough?

From the season 2 episode “Autopsy”:

Dr. Foreman: Her oxygen saturation is normal.

Dr. House: It’s off by one percentage point.

Dr. Foreman: It’s within range. It’s normal.

Dr. House: If her DNA was off by one percentage point, she’d be a dolphin.

Now everyone is probably thinking “um, and this relates to eating disorders and treatment how?”  But, as per usual, House can be relevant to just about anything 🙂

The quote above makes me think of this perpetual argument I seem to be having with my treatment team about the idea that “close enough is good enough,” particularly when it comes to weight and my meal plan.

Almost every dietitian I have worked with uses the diabetic exchange system.  Under that, a meal plan has a certain amount of exchanges such as fruits, starches, proteins, fats etc.  For each type of exchange, there is a caloric range because, for example, not every slice of bread is the same.  Some are 70 calories per slice, and some are 110.  I have consistently asked “How can 2 slices of bread that equal 140 calories and 2 slices of bread that equal 220 calories both be 2 starches. Shouldn’t the latter be 3 starches?” to which my dietitian replies “close enough is good enough, your meal plan is a range.”

However, that argument never seems to work in reverse.  A starch is supposed to be around 80 calories, and while it is ok to count something that is 100 calories as one starch, she will not let me count something that is 60 as a starch.  But, I respond, isn’t close enough good enough?

Same thing with my weight.  If my weight goes up a bit, my team tells me that it is “just a fluctuation,” and unless it keeps going up, my meal plan does not get lowered.  But, if it goes down, I am then the one who argues “it’s just a fluctuation” while my meal plan is often increased.

To me though, this House quote does a good job of espousing that fine line between being a normal variation and something of concern.  Dr. Foreman says that her oxygen saturation is normal because it is within range, but House points out that a 1% difference can actually be a big deal.  In other words, something can be in technically normal, but it’s the bigger picture that matters.  Why is “close enough is good enough” when it’s over, but not when it’s under?  Because going under is what the eating disorder wants, but going over is actively challenging it.  Everytime I go slightly under, I justify it as “close enough is good enough,” but that’s exactly what it is – a justification for doing what the eating disorder wants.  It may be within range, but it is a slippery slope.  To relate it back to the above quote, it’s as if the DNA was off by 1%, not the oxygen saturation.

That’s not to say I won’t ever argue with my treatment team again about a slight weight decrease being a fluctuation, or that 10 teddy grahams is “close enough” to the serving size on the box of 16.  But, hopefully if I recite “if your DNA was off by 1% (or in this case 6 teddy grahams) you’d be a dolphin,” I will eventually be able to accept that close enough is not always good enough.


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