To not see why the paediatrician is concerned?

You sound like you work very hard to provide him with the best possible life / chances in life.

You mentioned he has poor muscle tone - can I recommend you google infant reflexes not going dormant. When a child's infant reflexes have not gone dormant this can affect their brain development and they can demonstrate autistic / ADHD traits. This happened to my children.

For infant reflexes to go dormant a child needs to do some physical movements (as an example like moving down the birth canal, their shoulders touching either side triggers the development of crawling, later the crawling helps them get their bottom half and top half of their body working together - if this doesn't happen you see kids who bring their heads to their plates to eat rather than bring their utensils from their plates to their mouths to eat and they have trouble both sitting still and sitting up straight).

So I have noticed children with poor muscle tone or hypermobility tend to have their infant reflexes not go dormant more than other children.

@Purplevioletsherbert what about a rollito (supermarkets sell loads of varieties) - a piece of cheese wrapped in ham? Lots of protein in that. And if he loves cucumber, a piece of cucumber AND a piece of cheese wrapped in ham. Even one or two before his meds might help.

The two are massively linked. Upper body strength is huge in handwriting. In fact, in the primary school I last worked in, the handwriting intervention class was basically an abs class. They didn't do any writing!
A good exercise is getting him go lay on his back, legs straight and raised about 30cm, arms stretched straight with hands pointing towards his knees. Finally, he has to sing happy birthday to his belly button which forces them to almost crunch as their face is reaching the belly button and the singing forces them to breathe. It's hard but the kids loved this! They'd also do the barrel race, taking turns holding each others legs, as well as a snake race under the chairs. We'd make a row out of chairs and the kids had to crawl under them. It was crawling at first, then they weren't allowed to touch the floor with their knees so it was like a walking plank. We went from a row of 3 chairs at first, to creating a super long loop around a classroom made up of about 30 chairs. Some ended up with six packs at the end of term! Their handwriting was beautiful!

Education wise its important children eat breakfast - but also if you read the small print on the ADHD meds it says 1 in 10 children can have their growth effected (well our meds packet does anyway!).

It's not about him looking good - if your son is growing taller but not putting on weight due to the ADHD meds I'm guessing there will come a point his doctor considers stopping prescribing them. Your son is only 7 - he has a long way to go to reach full maturity both physically but also mentally.

The ADHD meds are also recommended its better to take with food. We always try and take with a meal in our house as my son lost weight he didn't need to lose when he was on meds although pushed his gcse scores up from predicated 5-7s to 7-9s in the actual exams so we just give him meds for exam periods now.

This sounds so positive, I think I really wouldn't worry about breakfast at this stage.

OP if he's built muscle bear in mind that weighs a lot more than fat but takes up less space. DD weighs pretty much the same as she did 4 years ago when she was an obese 11 year old, hasn't grown but is about 1/3 of the size she was. The clothes she wore then are too big for her now even though her weight is pretty much the same! Maybe 4kg less but really not that much. Muscle really weighs a lot and takes up very little space in comparison to fat.

Please don't post photos of your child to prove this sort of thing. Imagine he finds it one day. Please just leave it.

It can cause the meds to metabolise too quickly so they don't last as long. Other than that, it's really dependent on the specific person. The most important thing is to not take them with anything containing vit C!

OP, is he under a dietician or feeding clinic? Sometimes doctors are very knowledgeable in their own areas (eg ADHD meds) but that can be impacted by other issues they aren’t as experienced in.

Your understanding of protein shakes is incorrect. They're used by people who exercise to get lots of protein in the least amount of calories possible. Usually to hit their macros. When you have an overweight child, or anyone really, protein is key as it stops blood sugar spikes that cause crashes and cravings and keeps you fuller for longer. It also helps build muscles which is essential for long term weight loss.

I thought you were not meant to take ADHD medication on an empty stomach as it can cause side effects?

Theoretically they should follow the centile they are when around six to eight weeks of age as their birth centile can be artificially influenced by a number of things. However, when a child is obese, they should never be encouraged to maintain this.

Sorry I edited my post before I saw your reply so sorry, you might want to reread. Honestly I say protein but anything he can keep down helps slow down the meds metabolising and will stop you from having to up doses too quickly. How long has he been on meds?

Any sport with strength training will be super beneficial for him! More muscle= more calories burnt just by sitting. Once his muscle tone is better you will see a huge improvement in his handwriting too! It was incredible to see it in DD.

This is confusing. He is over weight, but the doctor is concerned about him not eating enough. You think his weight is fine, yet are giving him protein shakes (my understanding these are used by body builders to gain weight?). Just by looking at the kid is he chubby or scrawny, or in the middle?

The only reason I'd insist on him having some protein with him meds is because it helps them last longer in my opinion, obv depending on the dosage and type of meds he's on. ADHD meds helped my previously overweight DD get to a healthy weight and start to enjoy exercise, she was previously so self conscious and would refuse to run as she'd find it so embarrassing. She's now a competitive swimmer and much more confident. I agree with you on the nutrition advice too, Drs are notorious at being bad at this!
What I'd suggest if you haven't already, is get him into swimming or any other sport, if he's not already. It's brilliant for self esteem and his appetite will increase. The appetite does return after a number of years on the meds in my opinion but the weight he has lost will probably mean he's a bit more confident in himself. Sports is tough when you're chubby, it's embarrassing to take part! So him looking well and healthy, it's a good time to utilise that. Esp as at his age as lots of sports still see beginners as "acceptable". It gets harder to find a sport suitable for older beginners.

I don't see the issue as long as he's able to focus in school and his behaviour is ok (for him I mean, as in not significantly worse than the afternoon). It's surely positive for his long term health to slim down a bit. Also (I'm just speculating) maybe as he's become a bit slimmer he's a bit more active? My middle child who is also autistic is very overweight and unfortunately does even less exercise than before because it's more tiring for her.