Advice for dealing with obese teen with emotional disability?

[Anonymous]

OP, what a challenging situation, you sound like you're trying so much! I agree that the situation when you're managing 2 different chronic illnesses can be really complicating. My child has severe asthma and is borderline obese, and the two conditions conflict frequently? Do I have him take those steroids that impact his growth and appetite so that he can breathe? Do I sign him up for the outdoor sport during pollen season, knowing he'll need way more meds to participate? Do we cancel soccer so we can do allergy shots?

Your situation is far more complex than ours, and I imagine it's 10 times harder. You need to make choices that put her mental health first, an punitive strategies like taking away her allowance, or restrictive ones like powerstruggling over food are going to do damage.

Based on our journey (my son is doing well with his weight, holding it steady during his adolescent growth spurt which is resulting in dropping BMI percentiles), here are some ideas. None of them are probably powerful enough to work miracles, but they might help her stabilize her weight gain while you work on the mental health issues. Once she's ready to be your partner on the weight loss she won't be in such a bad place. They might also lay the foundation for some skills that she may be able to use when she comes through the pangs of adolescence which are probably exacerbating the mental illness, or when you find a medication that works.

Here are some ideas, some of the based on what has worked for us.

1) Go see a specialist without your daughter. I saw this person: http://www.drdaisy.com, for my son and really liked her. She's got expertise in both mental health and diet, and gave us lots of good suggestions. Generally when she works with children and preteens she just sees the parents and gives them suggestions. Once kids are in their teenage years she likes them to come, but I bet she could use the younger child model here. She can give you great answers to questions such as "what do I say when she says 'Do you think I'm fat?", and also on how to present meals.

2) Change your pediatrician. Children's Hospital has a childhood obesity program. Even if she wouldn't comply with the program, perhaps she could see one of the pediatrician who works in that program as her general nutritionist. They might be able to help. We actually happened to see one of them (pediatrician/orthopedist who is on the obesity team) when my son had a problem with his knee. It was really refreshing to have a Dr. who knew how to talk about weight. Other specialists we've seen have treated it like the elephant in the room.

3) She likes fruit and pasta. That's a great place to start because they are both healthy foods. One thing that has worked for us has for me to put out an unlimited portion of low calorie foods my child likes So, for example, my child comes to the table for dinner. Before him is a salad, some sliced kiwis and a bowl of mixed berries, all cut up and looking appetizing. He can help himself while I'm finishing cooking the main course (pasta, for example). Then I serve a small portion of the pasta to each of us, with some green beans. My child eats what he wants. If he wants more beans or berries or kiwi or salad than is on the table, I say "Of course" jump up and get it. If he wants more pasta I say "the pot's on the stove, please help yourself" or "I'm afraid this is all I made, you're welcome to fix yourself some more". I never limit the unhealthy food, just make it a little harder for him to get it. Doing this has really changed the proportions that my child eats without me needing to get into power struggle. I also notice that when we go to a restaurant or something, because he's used to fruit and salad with meals he's more likely to ask for them. It's the beginning of a healthy habit.

4) The fact that she's willing to choose diet soda is promising. It seems like on some level she's motivated enough to make the choice she thinks of as healthier (note: she may be wrong, there's a lot of controversy about that, but she is making some effort). Rather than focusing on getting from "bad food" to "good food" focus on making the better choice. Realistically you will never have much control over the diet of a teenager, they're out in the world too much for that. And frankly, if you do all the controlling, she's not going to learn any skills anyway. For my kid, he wasn't going to choose a food he didn't like when he's out on his own, but if there were two foods he did like he'll choose the healthier one. My kid was willing to learn to read labels. He won't pick steamed broccoli over french fries, given the choice, but he will happily substitute half soda/half seltzer for a soda, or get grilled chicken on his caesar salad instead of fried. It's not perfect, but every little bit helps. You can also help her out by buying a variety of "not quite as unhealthy" substitutes and keeping them around so she's experimenting and learning things she likes. So instead of soda, keep gallon jugs of super diluted juice or lemonade in the fridge. It's worse than water, but way better than soda. Think of them as transitional foods.

5) If there are certain tastes or sensations she likes, experiment with increasing the intensity of those sensations in what she eats to satiate her more. I know my kid loves really spicy things, and if I accelerate the flavors he'll feel full happier and come back to the healthy food. So I can replace 4 scrambled eggs with cheddar (a previous favorite) with 3 scrambled eggs whites with a smaller portion of really sharp cheese and a lot of tabasco, and he's just as happy. For your kid it seems like sweet is the trigger. Are there healthy/healthier ways you can up the sweet factor in her meals, like a bowl of fruit salad with every meal, that might make her seem more satisfied.

6) What's her "currency". The thing she'll work for? Can you connect it with exercise in some nonjudgemental way? Not "I'll bribe you for exercise" but "I moved the video games to the attic, so you'll need to climb the stairs each time you want to play" or "Sure, we'll go to the movies but I'd like to save gas" or "You'd like some money, I'll help you set up a dog walking business". In the summer, will she do amusement parks? A six flags season pass was one way I got my kid more active in the summer. Lots of walking there!

7) Are you using food as an "I love you" language? This was hard for us. I am a single parent, working crazy hours, and sometimes I'd stop on the way from work (usually, to be honest to get a snack for me) and pick up a candy bar for him as a way to say "I'm thinking of you". Now, I'll pick up an itunes card instead a pack of cards for a game he plays, or my son likes the singing greeting cards from "hoops and yo yo", so I'll get one and leave it on his pillow for him. Of see if you can get her collecting something that you can use as a reward: nailpolishes, beads, (for my kid it's Magic Tricks, but I don't know what a girl might like), and that might entice her to spend her allowance in a healthy way. . Think about establishing a pattern. If you're out together and she wants to use her money to buy unhealthy food she can (again, stay far away from power struggles), but if she wants a "healthy treat" which can be something that's not food, or something that's healthier like a flavored water or a package of nuts, you'll go halfsies with her.

8) Advocate for her. Overweight kids get so many negative messages, from the world. I'd be very careful about any kind of comments about weight that aren't in the context of a planned discussion (maybe facilitated by her therapist). Stay away from "drive by" comments, and react forcefully in front of her if others make them so she knows you're on her team. If her teachers are sending emails criticizing her diet, they may be making negative comments to her too. I'd reply very clearly that you understand that the comment came from a place of caring, but that you feel strongly that her eating is a private thing, you're aware of it and addressing it with medical professionals, and that you would like them not to involve themselves in it.

Good luck!

[Anonymous]

This child needs to have some more full-time help. As has been diagnosed, she is emotionally unstable and is using food to assuage emotional turbulence. One of the problems is that as she gets heavier, she either feels less attractive or is interpreting reactions to her from other teens and/or other adults as negative and that is probably driving her to eat more. I've seen a lot of people who eat when stressed and this sounds classic.

Someone needs to find out what her emotional stressors are and how to address them and how to highlight them so that she can recognize them and address them herself. Even the most highly rated and successful of therapists are not right for everyone. If she isn't having success with the current therapist, then you need to search for another. For some, they do need medication, but not all overeaters need medication. There are some very good resources through Overeater's Anonymous http://www.oa.org/ and especially through Overweight Teen: http://www.overweightteen.org/content/overweight-teens-overview.html For some, having a forum of like individuals can help. Your teen may find comfort in an on-line forum with other overweight teens, or in a group setting with other overweight teens. Look through those resources and you may find either a forum or group session local to you that may help. From some time ago, I knew a teen much like your daughter regarding exercise and what did it for her was finding another overweight teen who she became friends with and they started walking together where they would share and give each other emotional support and the walking slowly became hiking and jogging. Although both were still overweight when they graduated HS, they were no longer obese and were significantly more healthy. That's where some of the group sessions can help. She might be able to find a true peer and through mutual support they may be able to get past the problems that adult therapists cannot.

Last, I would recommend monitoring her allowance. Rather than cutting it off, perhaps you need to hold her allowance and you can help her buy things with it, to avoid her spending the money on snacks and drinks. Impulse buying and emotional binges are some of her worst enemies and right now, she has no control over those. You need to find ways to keep her from impulse buying/eating but you can still give her an allowance if you just keep it until she needs it and either buy for her or only give it to her when she has a specific need and it going shopping for those things.

Good luck.

[Anonymous]

Anonymous wrote:OP, what a challenging situation, you sound like you're trying so much! I agree that the situation when you're managing 2 different chronic illnesses can be really complicating. My child has severe asthma and is borderline obese, and the two conditions conflict frequently? Do I have him take those steroids that impact his growth and appetite so that he can breathe? Do I sign him up for the outdoor sport during pollen season, knowing he'll need way more meds to participate? Do we cancel soccer so we can do allergy shots?

Your situation is far more complex than ours, and I imagine it's 10 times harder. You need to make choices that put her mental health first, an punitive strategies like taking away her allowance, or restrictive ones like powerstruggling over food are going to do damage.

Based on our journey (my son is doing well with his weight, holding it steady during his adolescent growth spurt which is resulting in dropping BMI percentiles), here are some ideas. None of them are probably powerful enough to work miracles, but they might help her stabilize her weight gain while you work on the mental health issues. Once she's ready to be your partner on the weight loss she won't be in such a bad place. They might also lay the foundation for some skills that she may be able to use when she comes through the pangs of adolescence which are probably exacerbating the mental illness, or when you find a medication that works.

Here are some ideas, some of the based on what has worked for us.

1) Go see a specialist without your daughter. I saw this person: http://www.drdaisy.com, for my son and really liked her. She's got expertise in both mental health and diet, and gave us lots of good suggestions. Generally when she works with children and preteens she just sees the parents and gives them suggestions. Once kids are in their teenage years she likes them to come, but I bet she could use the younger child model here. She can give you great answers to questions such as "what do I say when she says 'Do you think I'm fat?", and also on how to present meals.

2) Change your pediatrician. Children's Hospital has a childhood obesity program. Even if she wouldn't comply with the program, perhaps she could see one of the pediatrician who works in that program as her general nutritionist. They might be able to help. We actually happened to see one of them (pediatrician/orthopedist who is on the obesity team) when my son had a problem with his knee. It was really refreshing to have a Dr. who knew how to talk about weight. Other specialists we've seen have treated it like the elephant in the room.

3) She likes fruit and pasta. That's a great place to start because they are both healthy foods. One thing that has worked for us has for me to put out an unlimited portion of low calorie foods my child likes So, for example, my child comes to the table for dinner. Before him is a salad, some sliced kiwis and a bowl of mixed berries, all cut up and looking appetizing. He can help himself while I'm finishing cooking the main course (pasta, for example). Then I serve a small portion of the pasta to each of us, with some green beans. My child eats what he wants. If he wants more beans or berries or kiwi or salad than is on the table, I say "Of course" jump up and get it. If he wants more pasta I say "the pot's on the stove, please help yourself" or "I'm afraid this is all I made, you're welcome to fix yourself some more". I never limit the unhealthy food, just make it a little harder for him to get it. Doing this has really changed the proportions that my child eats without me needing to get into power struggle. I also notice that when we go to a restaurant or something, because he's used to fruit and salad with meals he's more likely to ask for them. It's the beginning of a healthy habit.

4) The fact that she's willing to choose diet soda is promising. It seems like on some level she's motivated enough to make the choice she thinks of as healthier (note: she may be wrong, there's a lot of controversy about that, but she is making some effort). Rather than focusing on getting from "bad food" to "good food" focus on making the better choice. Realistically you will never have much control over the diet of a teenager, they're out in the world too much for that. And frankly, if you do all the controlling, she's not going to learn any skills anyway. For my kid, he wasn't going to choose a food he didn't like when he's out on his own, but if there were two foods he did like he'll choose the healthier one. My kid was willing to learn to read labels. He won't pick steamed broccoli over french fries, given the choice, but he will happily substitute half soda/half seltzer for a soda, or get grilled chicken on his caesar salad instead of fried. It's not perfect, but every little bit helps. You can also help her out by buying a variety of "not quite as unhealthy" substitutes and keeping them around so she's experimenting and learning things she likes. So instead of soda, keep gallon jugs of super diluted juice or lemonade in the fridge. It's worse than water, but way better than soda. Think of them as transitional foods.

5) If there are certain tastes or sensations she likes, experiment with increasing the intensity of those sensations in what she eats to satiate her more. I know my kid loves really spicy things, and if I accelerate the flavors he'll feel full happier and come back to the healthy food. So I can replace 4 scrambled eggs with cheddar (a previous favorite) with 3 scrambled eggs whites with a smaller portion of really sharp cheese and a lot of tabasco, and he's just as happy. For your kid it seems like sweet is the trigger. Are there healthy/healthier ways you can up the sweet factor in her meals, like a bowl of fruit salad with every meal, that might make her seem more satisfied.

6) What's her "currency". The thing she'll work for? Can you connect it with exercise in some nonjudgemental way? Not "I'll bribe you for exercise" but "I moved the video games to the attic, so you'll need to climb the stairs each time you want to play" or "Sure, we'll go to the movies but I'd like to save gas" or "You'd like some money, I'll help you set up a dog walking business". In the summer, will she do amusement parks? A six flags season pass was one way I got my kid more active in the summer. Lots of walking there!

7) Are you using food as an "I love you" language? This was hard for us. I am a single parent, working crazy hours, and sometimes I'd stop on the way from work (usually, to be honest to get a snack for me) and pick up a candy bar for him as a way to say "I'm thinking of you". Now, I'll pick up an itunes card instead a pack of cards for a game he plays, or my son likes the singing greeting cards from "hoops and yo yo", so I'll get one and leave it on his pillow for him. Of see if you can get her collecting something that you can use as a reward: nailpolishes, beads, (for my kid it's Magic Tricks, but I don't know what a girl might like), and that might entice her to spend her allowance in a healthy way. . Think about establishing a pattern. If you're out together and she wants to use her money to buy unhealthy food she can (again, stay far away from power struggles), but if she wants a "healthy treat" which can be something that's not food, or something that's healthier like a flavored water or a package of nuts, you'll go halfsies with her.

8) Advocate for her. Overweight kids get so many negative messages, from the world. I'd be very careful about any kind of comments about weight that aren't in the context of a planned discussion (maybe facilitated by her therapist). Stay away from "drive by" comments, and react forcefully in front of her if others make them so she knows you're on her team. If her teachers are sending emails criticizing her diet, they may be making negative comments to her too. I'd reply very clearly that you understand that the comment came from a place of caring, but that you feel strongly that her eating is a private thing, you're aware of it and addressing it with medical professionals, and that you would like them not to involve themselves in it.

Good luck!

Not OP- but Wow. It's really nice of you to take the time to type all of this info. We moms have to stick together. Makes me feel better about being a DCUMer.

[Anonymous]

Have you looked at residential programs or therapeutic day schools? If she hates school so much (it sounds like she is in public in an ED class?)---part of the solution could be finding a better fit for her. She might be more comfortable in a more nurturing environment with other children her age with similar problems. (The school system must pay for it if she can't learn in public school-an educational advocate could let you know if there is anything good nearby). Sorry, I know this is way off your original question.

[Anonymous]

Great post, 11:37. I have a child who has been steadily gaining on antidepressants; going to try your kiwi and salad strategy as soon as I can get to Costco (they sell great kiwi).

[Anonymous]

thanks 11:37, these are some really insightful ideas that can probably help a lot of people. I love DCUM sometimes!

[Anonymous]

I think another important piece of this is making friends and finding something that she can succeed in. What is your DD good at? Does she like to express ideas (there are programs that can help her type and access the computer if writing is an issue for her), design things, work with children, listen to music, go to church, etc.? When our DD, who has dyslexia, was having an extreme emotional reaction to going to school (in 2nd grade), I made a list of her strengths and focused on those instead of the dyslexia for a while. Turns out she loves to make up stories; she'd dictate and I'd type, then she'd "package" her story with pictures and bind it up. She's won a few writing contests, and now her aspiration is to be a writer when she grows up. Finding something she can be successful at has made all the difference for DD in overcoming her other issues. I realize this is probably very hard for a depressed person; it helps to have a sense of "purpose" to help her want to make positive changes.

[Anonymous]

Hi - I was very overweight at that age and my mom took me to weight watchers meetings. They used to have special classes for teens, too -- not sure if they still have those. It might help, and it's something you could do with her. Maybe the allowance should be tied to attending those meetings and weight loss instead of attending school for awhile.

Can she take a packed lunch instead of buying food at school? She might still get the snacks, but at least she'd have something healthy and planned with her.

She is finding solace in food, I get that. It's a hard place to be.

[Anonymous]

Can you talk to the cafeteria about limiting la carte purchases in a way that's not embarrassing for her? I find it so frustrating that cafeterias allow kids to buy unlimited amounts of junk food.

I have a similar problem with my MS age son, and we usually send lunch. He wants a big lunch but I can pack it so that it's reasonably healthy and he can avoid the cafeteria line and its temptations altogether.

[Anonymous]

11:37, I am dealing with completely different challenges but your post has helped me think of them in a more effective and strategic way. Thanks so much.

OP, I'm wondering if something like Metformin has been suggested? Might help with the sugar cravings which might have a biological basis.

There were some interesting studies being done at NIMH that you might want to see if DD qualifies for. We got some really good input from clinicians there, better than the private docs had been.

You might want to think about trying Kelly Dorfman as a nutritionist, she gets on well with kids and has a lot of experience with mental and developmental issues. My DD with different issues has made a lot of changes to how she eats sparked by Kelly's guidance. We went in person, but now check in by phone.

[Anonymous]

I feel for you, OP. I have both an sn kid and suffered serious mood, anxiety, food and ocd issues as a teenager. I would start with the medication. Research referenced EEG (rEEG). They are using it in many addiction centers across the nation and there was recently a study done by top universities attesting to its efficacy. It's a way of determining which class or classes of drugs will work according to her brainwaves (that's the EEG part). They measure your brainwaves (a very painless procedure) and then compare it to a database of others who have had success with different types of meds (that's the reference part). I was on and off drugs for twenty years with little success until I did rEEG. It changed my life. I think about 75% of people who use rEEG to determine which drugs will work best for them report significant improvements. After meds, she needs to be in talk and family therapy to deal with the issues that the anxiety masks. Right now, food seems to be her lifeline. She will never deal with that until her anxiety levels are somewhere near normal. Good luck.

[Anonymous]

Some excellent advice here. I want to second the metformin suggestion. A child psychiatrist friend said it is often used with psychotropic medication to prevent weight gain from the meds. Might be worth asking your psychiatrist about - rot pediatrician, or endocrinologist.

Good luck! And hugs.

[Anonymous]

OP here again...

WOW. Thank you all so very much for your thoughtful and helpful replies. I have tried a few of the strategies mentioned (like giving her baby carrots and yogurt ranch dip before dinner). And while I try not to do food rewards, my huband does. Once I caught him sneaking french fries up to her room and he said, I just want to make her happy...which I can understand. But obviously not a good idea.

We are doing family therapy and she has a therapeutic mentor (who, alas, is also very overweight, but they have gone to the gym together a few times, which is great). Love the idea of finding a buddy to walk with..will have to brainstorm on that one. She's in an ED classroom with only one other girl, which is a bummer, and she refuses to mainstream to any classes, so it's hard for her to make friends.

That info on the rEEG is fascinating and I will definitely check it out.

[Anonymous]

OP, there is some research that shows that all may be related. I read it somewhere and pulled this up in a quick Google.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC514841/
If it looks promising you may want to try to get in to see on of the docs or see if there are ongoing studies at NIMH in Bethesda.

There is a different type of metabolic problem having to do with fat metaboilsm that runs in my family, it is also linked to mental health disorders. I think I ran across the metabolic syndrome research in doing research on that. There are biochemical underpinings to so many of these issues.

As someone who has struggled with anxiety and extra pounds, all the best to you and your DD.

[Anonymous]

You know what? You can't control this type of behavior in a teenager.

However, 30 minutes of exercise a day is a treatment for both obesity and depression. i would start with requiring her to do 30 minutes of walking a day. I wouldn't ask. i would require it. It's a medical treatment.

Here's the best health education explanation on the topic I've ever seen.

http://www.youtube.com/watch?v=aUaInS6HIGo