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Q: My son eats too much, and I am having trouble convincing him to stop eating. (He has a developmental disability.) He claims he needs it. He’s gaining weight, and his appetite is as strong as ever. I have to hide his preferred food items. What should I do?
Nutritionally, there may be no reason for concern if a variety of foods from all the food groups are eaten AND his life stage, Body Mass Index (weight to height ratio) and level of physical activity are appropriate. A variety of foods from all the food groups ensures adequate intake of essential vitamins and minerals to maintain a healthy body.
For an individual younger than 18 years, a body mass index greater than the 85th percentile for age and gender is considered at risk for overweight status; a body mass index greater than the 95th percentile is considered to be overweight.If the individual is an adult, a body mass index greater than 25 is considered to be overweight and greater than 30 is considered to be obese. Overweight and obesity has been identified as a risk factor for many chronic diseases.
Adequate physical activity is important at all ages for development and maintaining a healthy heart and body. For an individual younger than 18, 60 minutes of moderate physical activity or play is recommended daily; and 30 minutes of moderate physical activity daily for adults. Moderate physical activity is defined as a slight increase in heart and breathing rate and possibly a slight perspiration on the skin. An insatiable appetite without corresponding physical activity can increase risk for weight gain, overweight and obesity.
If there is an insatiable appetite and an identified risk for overweight and obesity, here are 10 suggested interventions that may promote a healthier lifestyle:
1) Know the nutritional needs of your son. This may require a consult with a Registered Dietitian. This will give you the daily calorie goal needed to reduce the risk for overweight and obesity and the associated chronic diseases. Review these goals with your son so that both of you are on the same page for “what he needs.”
2) Set a schedule of meals and snack, and post it in the kitchen and bedroom. This will help keep both of you to the schedule suitable for your daily routines. You will know when he ate last and he will know when he can eat next.
3) There are many adverse affects related to “grazing” (mindlessly eating throughout the day). To mention a couple here – grazing interrupts the normal hunger/fed cycle of the body that affects the feedback hormones for appetite, which may lead to an insatiable appetite. Grazing contributes to excess calorie intake and, therefore, contributes to overweight and obesity.
4) Plan the meals and snacks with your son, put it in writing and display prominently. Put the portion sizes next to the food item. This clearly identifies what and how much food is to be eaten and at what time. Having your son help plan meals and snacks may create a “buy-in” affect and gain better compliance to the menus. Planning menus and gaining compliance will ensure we meet and not exceed the daily calorie goal.
5) Identify one place in the house where food and beverages are consumed (i.e., the kitchen table). Allowing him to eat in front of a television or computer or in his bedroom contributes to mindless eating and grazing.
6) Implement the mantra of “Sit Down, Slow Down and Savor the Flavor.” Eating too fast does not allow the body time to recognize the amount of food consumed. It takes about 20 minutes for the brain to recognize the amount of food in the stomach. Therefore, allowing 15-20 minutes after a meal to pass before giving second portions may give him the time needed to recognize he is not feeling hungry.
7) When shopping, only buy what is needed for the menu of meals and snacks. Leave the rest on the shelf. If it is not available in the home, it cannot be consumed.
8) Plan activities to redirect when demand is made for food. Have him participate in the preparation of meals and snacks. Planning physical activities into the daily routine, (i.e., walking 30 – 60 minutes each day), will help burn off calorie intake and may prevent weight gain.
9) Review his preferred foods – are there acceptable substitutions with lower calories and favorable nutrient content? For example, Protein and Fiber can increase satiety (the feeling of fullness) longer. Avoid processed carbohydrates and simple sugars; excessive intake of carbohydrates can lead to elevated triglyceride and cholesterol levels.
10) Review his current medications for appetite stimulant side effects with his primary care physician. Request alternative medications to remove the appetite stimulation. If an alternative is not available, request a change in timing of medication administration so that the peak effect will coincide with meals.