DD is Very Overweight

[SteveBuscemisRheumyEye]

I posted this in SN parenting but I think it might get seen more here

DD is 10 and Very Overweight. I know exactly why she is overweight but really struggling to address the problems.

She has ASD and an extremely limited diet (all beige, not a single vegetable and only strawberries). Portion sizes are too big but she freaks out if she doesn't have the amount requested. Have tried gradual reductions but it doesn't work. She's set in her patterns and I just don't know how to break them.

Absolutely loathes physical movement.

I'm failing her and I don't know what to do. I'm so fucking tired - she still cannot sleep on her own and right now I could just cry.

So as not to drop feed, I was an overweight child who later developed an eating disorder. My mother had an ED throughout my childhood, so that's something else I'm anxious about.

@Rainbowclimbinghigh we have one but she stopped using it and now refuses

I'm so sorry, OP, it sounds so tough. I have one who is good avoidant but without the ASD which just adds to your stress and the complexity.

On the activities front, is she into collecting/recording things at all? Would geocaching be something that might make her more willing to walk - particularly if you start with driving to/taking very short walks to nearby caches, and then building up?

Hi OP, I'm so sorry to hear your struggle.
It sounds like you have put so much thought into this and are really trying to find a solution for longer term benefits for your daughter.
First of all well done for all you have done so far.
It must be hard working for CAHMS and everyone thinking you must be perfect and have all the answers.

Do any of your local pools have sensory friendly sessions?
Doing a cosmic yoga session together?
Does she like animals? Do you have a friend with a dog that you could take for a little walk and then build up longer over time?

I hope you find some solutions that work for her.
Also, I feel your schools rule about squash is very strict. Your poor daughter getting heat stroke!

What’s the rest of her life like? Does she enjoy school, have special interests etc…

My ASD teenager has become much better with food once the anxiety and stress decreased in the rest of their lives.

i made the whole family watch the BBC documentary about the dangers of processed food - it helped. The school they attend has really good food and that has helped widen the range of food eaten. Its been a really gradual process.

As you know people with autism can often not know when they are hungry and if they are full so normal dieting advice doesn’t work with the ND.

You know you need to set up new patterns of eating and need to find a way to get DCs buy in into the process.

What about a social story in a ppt? If no LD's this might be a less intense way of you explaining it to her and giving her time to process? I've used them for example with girls with ASC who are phobic if certain things. Can cast from laptop to Tv and sit alongside and watch it. Lots of visuals?

Start with all the things you love about her? Pictures too. Then move into the hard bit.

Explaining the 'science of food' the amount she eats, what will happen is she keeps it going? Almost a cross between a social story and narrative therapy? So sentences like 'Mum know how important it is for you to see the same amount on your plate every night. I know you find change hard. Mum understands and really wants to give you the same amount. But if mum does, you will put more and more weight on until people will bully you and you won't be able to l move/ could have to go to hospital etc. So what mum was thinking was...' and then give some options so she has control? Pick one? Reduce size by 10% etc? Change one meal a week etc?

After she has time to process, write in mum will come back and ask you in 2 days what answer you are willing to try. I know it's hard having a change like this but mum is here with you and we will work it out together, because we love each other'

Something along those lines? I know not a traditional social story as not written 100% from her perspective? Could put pictures of each meal in and that might help her choose the reduction etc?

I'm also a psychologist and it all goes out the window with our own kids. And there's this extra pressure that you should know what to do. No you shouldn't, she's your wee girl and she's unique and you're too close to it to be both her mum and her psychologist. It's not fair. I feel you.

You may have already tried some of this, but...

With regards to gradually reducing portion sizes, understand it's trickier with certain numbers of chicken nuggets etc, but obviously potatoes comes in different sizes, so that's probably an easier place to start? Start with one that's a couple of millimetres smaller and then obviously the amount of tuna and mayonnaise will also reduce accordingly...

Can you water the mayonnaise down? Obviously start off very gradually so it won't be noticed...

Have you tried using smaller plates? Obviously difficult if you have patterned ones, but easier if you just have generic white ones...

Has she got a bike/scooter?

It could be issues with interoception which are common in people with ASD, if she cannot sense fullness/satiety due to this then the rigidity around portion sizes might be linked as she 'knows' she needs x-amount for a meal therefore no other amount will do.

I would really recommend pushing with the OT referral as this is exactly the sort of thing they can help with. In terms of exercise I'd be looking at her proprioceptive and vestibular needs and tailoring activities to those, for example one of my DC loves to spin and loves to swing/propel so he has a wheeled square body board that he can lie on and use his hands/arns to spin or to drag himself around on, he loves a sling-swing that again he's using his core muscles to propel and he engages with these because they satisfy a sensory need.

I wouldn't go changing anything at all until you've gotten management advice. If you go tinkering with her food by substituting bits, hiding things, making swaps, etc then you're going to damage her trust in her meals being the same and it could have the opposite effect of making her even more rigid and controlling over food. Don't push her into meltdowns over food either for the same reason.

Absolutely not. That's why getting help from a dietitian makes sense. Presumably you can see professional distance can only help the situation. Not at all ashamed that I have seen a clin psy with two of my three kids. I think it's good parenting.

@SteveBuscemisRheumyEye What does your daughter eat when you go on holiday?

It will be the not moving that would worry me. You must get her out of the house and think of lots of different things to try. It will only take one thing that she enjoys to get a hobby started. Try a different thing each weekend till you find something

My ASD child would be beyond distressed if we tried a different thing with her each weekend! Generally speaking a consistent routine and introducing necessary change gradually with lots of notice is the way to go…

Hi op. Your DD sounds very similar to mine. Mine is almost 10, very restrictive with food, arfid suspected but never diagnosed, asd diagnosed a couple of years ago.
she hates anything that resembles vegetables or fruits. She hates anything that makes her break a sweat and she is very controlling over what she will do and what she will eat.
We recently acquired a dog in the family. DD could not love anything more than she does the dog and we’ve found she will walk anywhere for any amount of time if it’s for the dog.
Food we can’t do anything about, and neither did cahms or paeds or anyone else even when she hadn’t eaten a single solid item of food in 6 months, but walking and chasing around with the dog is helping a little.
What are your DD’s favourite things to do? Is there anyway to incorporate activity in to it? If it’s crafts could you do a treasure hunt of supplies for a specific activity a few times a week? Does she like YouTube or tiktok? Practice one of the dance routines? Random acts of crochet kindness? Make little crochet things together and go for a walk to plant them all for finding?
Do feel free to pm me just for moral support of a parent who’s been there/still is if you like. It’s hard worrying if you’re doing the right thing for them.

Could you get smaller plates, bowls etc so it’s not necessarily obvious if her portion size is smaller?

I haven't read the full thread but basically came to say the same as @mamahibou

You know she needs to eat smaller portions and the barrier to this is her rigid thinking and expectation of how much will be on her plate- probably also alongside sensory issues about needing to be very full to feel satiated.

Have you tried a very autism focused approach in the same way you would change any routine and replace any unhelpful behaviour with a more helpful one?

Maybe you could take photos of the new portions and put them in a book for her to look at for a while before you change them. You can talk through them with her, explaining that they are the amount of food her body needs. You could combine this with a social story/ narrative as mamahibou suggested to help her understand and accept the new portion sizes. You could change one meal a week on a schedule so she knows the plan and it doesn't happen all at once. You could also plan for there to be a distraction at the end of the meal (bubbles in the garden, screen time, low-calorie lolly to suck- whatever works). The meltdowns are more than likely to be temporary- just until the new portion sizes are what she expects.

I work special education in behaviour and pastoral support (have qualifications) and have an autistic ds.

Firstly being qualified and doing a job doesn't make it any easier when it's personal! My ds had a breakdown over school anxiety and you'd think I could avoid that!!

Secondly I've worked with a pupil who was like this with food. What you say about everything else in life being anxiety driven rings a bell because we were eventually able to get from him that he liked a routine of food because he knew whatever else happened that wouldn't change and throughout the day it would be the secure thing he knew what to expect with.

What helped him change this (it just happened rather than us addressing it because we are not camhs trained!) was when I did a lot of work on zones of regulation with him. Once he managed to cope with other areas of life this need for total control in other areas lessened.

Unfortunate the beige diet didn't change but that's not uncommon!

I think you need to forget food/ exercise and get to the root cause of why she feels the way she does. At the moment you are focusing on the sticking plaster and ignoring the wound

private child psychologist, you’ll wait too long on nhs. Start there.

Ho developed is she? My, then, 11 year old measured overweight as she had got a more womanly figure, hips and a bum. Her weight didn’t change much (saying that neither did her height she only got to 157cm) but her bmi as an adult is now healthy. It was just the way she developed.

Sorry to hear that, I did have my doubts suggesting it since she has ASD but some do have quiet sessions for children with ASD. Honestly it must be so frustrating for you especially considering your job etc. I hope someone manages to suggest something helpful.

Really feel for you @SteveBuscemisRheumyEye it is a hard place to be.

Don’t despair- you can make small incremental changes over time with lots of prep.

You've had lots of suggestions. I wanted to add one more…. if at all possible can you swap the Nesquick drinks out? So go for the hi lite brand (0 calories)? The drinks x2/day are adding in a lot of empty calories.

in some ways I feel like you have painted yourself into a corner saying you would never hide foods or make secret swaps, because the risk is if she finds out you have then meltdown and if you offer her a alternative being fully transparent- meltdown. What is the right thing to do?

So you could put the hilight chocolate powder into a nesquick package. Start with swapping a little
out at at time, so you’re just making indiscernible changes. Could you try that?

I would do it. Because the health risks of having an overweight child outweighs the issues around being sneaky. I think….? Is this the crux of it?

Could you look at low calorie hot chocolate as an alternative to the Nesquik?

The ASD makes it so hard but wondering if she would accept some limited swaps if introduced gradually ?
Off the top of my head, home made pesto using lemon juice and not oil, tuna Mayo made with a mix of Mayo and natural yoghurt.

Depends on her particular profile with regard to swaps. My DC can be presented with a plate of what are, to my eye, identical looking and tasting chicken dippers and they'll be able to tell you exactly which ones are Birds Eye (the only ones they'll eat). Beans, they can tell you exactly which ones are Heinz. They know which yoghurt is the Smart Price yoghurt. They're hyper-aware of texture, taste, smell, etc and that translates into NASA level precision when to comes to stuff like food.

I just wanted to say an enormous thank you to every single person who has commented on this thread. I thought I was going to get my arse handed to me but without exception, everyone has been really kind and empathic. It's made a real difference and has given me a real boost.

Thank you 🙏🏼

Glad the thread has been helpful for you.

How is she at school? Does she have friends?

I'd go the specialist even if you have to pay privately. They may have better ideas be able to get to the bottom of what's bothering her about food.

I'm ND, OCD, ADHD and my diet is probably odd as I tend to eat the same things for quite awhile and then go off them for awhile. But here I am 60 and quite healthy. I do take medication too.

As for exercise, I tend to like sameness in it. I will do a certain aerobic video many days. I like trackers for counting steps. Weight training has a sameness to it. Marching does too. Stretching, some types of slow yoga. None of these things are noisy either. Not much to remember like sport.
Just some suggestions for exercise that may suit ND.

So 10.4 and 8.4