How to think about child fatness and health (autistic 7 y.o.)
April 21, 2024 6:35 PM   Subscribe

CW: fatness, neurodivergence, disability, parenting

My child (autistic+ADHD, PDAer, 7 years old) has gotten markedly fatter in the last year. This has coincided with a few things: burning out of school and staying home "homeschooling", being on an SSRI (fluoxetine aka Prozac), vastly increased screen time, vastly reduced outdoor time, and increased between-meal hunger and snack frequency.

Regarding his eating: it is very well possible that earlier (while he was still in a regular school routine), he had been hungry before and not eating enough, owing to lack of time, stress, and interoceptive difficulties. In terms of the specific foods he eats, he is a little picky and gravitates to processed/carby food when hungry but not more than average for a kid his age.

During this year, he has gone from being what would be described as a skinny kid to what would be described as a fat kid, so it's been a very rapid and noticeable shift. His former pediatrician called out his BMI (we "fired" her for mentioning it in front of him, but not for mentioning it to us).

We do not comment to him on his weight or body at all, ever, and we rarely comment on his eating except sometimes to steer him away from overindulging on processed food to less-processed food, especially when he is asking for his third afternoon snack.

I don't know how to think about this weight gain. On the one hand, I know that the general discourse on fatness (including in the medical establishment) does far more harm than good. On the other hand, my main concern is whether this rapid weight gain at a young age can cause permanent health effects, especially if it continues or grows further.

And then, what to do about it? The lifestyle changes I mentioned above are not within our control, owing to his neurotype. So even if this weight gain *is* long-term bad, is it something we have to just radically accept, as we have accepted other changes in our expectations? But I at least want to be clear-eyed about what the costs and benefits are.

Important note: if you do not have insight beyond "common sense" on both neurodivergence and pediatric health, please refrain from commenting. (Being parent to an autistic kid or internet research does not count as insight, unless you have spent a lot of time learning rigorously from trusted sources. If you lean towards ABA or behaviorism please refrain from commenting. If you are unsure whether you have standing to comment, please refrain from commenting.)

Insights from autistic people and fat people (esp those who were fat as kids) especially appreciated.
posted by splitpeasoup to Health & Fitness (36 answers total) 4 users marked this as a favorite
 
Coming at it from a slightly different angle (and from personal experience), being a fat kid/teenager will only magnify whatever social challenges your child has now, both in terms of friendship/romance and in terms of whatever extent you hope he will be able to interact independently with service providers and the like as he gets older. This is not just, but it is a reality. Your kid is probably going to have to fight to have his dignity respected throughout his life, and being overweight or obese will make it harder.

You didn't give a lot of details, so please accept this in the spirit of someone only making suggestions that may be irrelevant given the broader context she doesn't have. Does homeschooling have to entail dramatically reduced outdoor time? Because, even putting weight aside, lacking physical skills and stamina will hamper him throughout life. Increasing his physical activity will benefit him (and help offset health concerns) even if it doesn't make him skinny. If you can find an activity he enjoys, it may also help with mood (personal experience: not guaranteed, but sometimes).

SSRIs can also cause weight gain, so it's possible you may want to discuss with his new doctor one of the antidepressants that do not, such as bupropion (note: not a doctor, do not know specifically whether bupropion is suitable for pediatric patients).
posted by praemunire at 7:27 PM on April 21, 2024 [11 favorites]


Best answer: Hi, fat as a kid here, definitely a big part of my identity. Gained weight substantially in 4th grade and 7th grade. I am fat-and-fit as an adult in my 40s. At any age, I would rather be fat and getting fatter on meds, using screen time and food to cope with mental health crisis, than to have someone messing with that precarious balance just for a lowering of my risk profile of developing potential future health problems. Mental health is more important to keep stable and working here. I have seen the level of panic, fear, anxiety, dissociation, and other terrible mental states that kids with autism and PDA can experience and it is very hard to deal with.

If you all are doing what you need to to get by and to cope this year, and next year, then don't let weight gain mess with any stability or safety that your kid feels right now.

Not everyone who becomes fat at any age will stay fat their whole life. If they are fat their whole life, that doesn't mean they will have health issues that are caused by becoming fat as a child. Being fat also doesn't mean you won't have friends or romantic partners in your life.

I just want to say it is important that you treat your kid's mental health as the priority here. There are kids that gain weight due to medication and mental health conditions and now might have increased risk profiles for heart disease and diabetes or other things, but you know, flag it and move on. Go to the doctor regularly. Treat it like you would a risk factor you can't control, like air pollution.

Maybe in three years your kid will discover LARPing and increase his cardiovascular health because he's running around the woods, maybe next year you will be able to go for a family walk every day without panicking, maybe in two years he will be able to reduce some screen time once a week because he will hang out with a friend. There is time here, and radical acceptance of who your kid is and what he needs right now is going to keep him on a path to flourishing.
posted by lizard music at 7:43 PM on April 21, 2024 [23 favorites]


Best answer: This perspective is as a former neurodivergent kid who was sensitive to weight stuff and had some rapid weight gain due to medication.

What I will say is that if you start trying to "fix" this, no matter how much you try to be positive and supportive, your kid may infer from the combination of your behaviour and societal messages that you see their weight as a "problem to be fixed", and connect your positively intentioned efforts with the world of negative stuff out there. I'm not sure exactly how to explain this, except to say that it doesn't really matter how subtle you try to be, if you're doing something with weight loss or prevention of weight gain in mind, there's a good chance your kid will know that's what you're doing. I'm pretty sure my parents mentioned weight one single time, and in the gentlest possible and unspecific way, but I knew from their approach to food and exercise.

That isn't to say that you can't encourage health. But it's possible to be healthy and fat. And the entire cultural narrative about weight and health is full of misleading, harmful, prejudicial, cruel, unscientific nonsense. You can't change that, but you can decide whether to fight against it or tacitly (and unintentionally) endorse these messages by treating weight itself (rather than health) as a problem to be managed.

Can you consult a dietitian to develop a plan for a diet that will be nourishing and meet your kids needs? I won't question the situation about activity and outside time at all, but if you can continue to explore possibilities for movement and exploration without pushing in a harmful way that could help. I've heard maybe OTs can help with this kind of thing.

Good on you though for protecting your kid and trying to find the right thing for them.
posted by lookoutbelow at 7:52 PM on April 21, 2024 [13 favorites]


On posting, I heartily endorse lizard music as to prioritizing mental health. I don't have proof of this (besides my own burdens), but I'd argue significant stress and trauma in childhood is a worse lifelong health risk and life limiter than physical activity and diet.
posted by lookoutbelow at 7:57 PM on April 21, 2024 [4 favorites]


This isn't something you can or should fix beyond checking with his prescriber about medication side effects. Kids self-regulate well around food, parental dietary restriction or perceiving your child as "overweight" are robustly associated with future weight gain (controlling for actual body size), and any focus on this is profoundly likely to be counterproductive to any mental or physical health goals you might have for him. Loving acceptance of him, and firing weight focused doctors, is indeed the way to go.
posted by shadygrove at 8:49 PM on April 21, 2024 [2 favorites]


Best answer: I was fat enough as a kid that other kids used to follow me around the school playground singing the jingle from the Kimbies commercial at me. My mother and her brother both ran to fat, as does my own brother, though my sister has always been pretty much the opposite.

Seeing how distressed I got from being bullied about my weight, Mum started taking me to a local dieting support group. It wasn't Weight Watchers but it worked the same way - everybody weighed in on arrival, and we'd all congratulate each other on our progress, commiserate about our setbacks, and swap tips and tricks for counting and cutting calories. It worked pretty well for Mum - she ended up on the cover of one of the organization's monthly magazines - but did basically fuck-all for me.

One of the consequences of attending that group was that our household stopped eating proper bread (my doctor having offered the opinion that "it's the bread you're eating that's making you fat"). What we got instead was this horrible cardboardy high-protein allegedly-bread from Cynthia Margareth. I hated it. All it did was elevate real bread from something to make a sandwich out of into an object of fanatical desire.

Being a fat kid also left me loathing and detesting all forms of sport because they were just plain exhausting. At school I would not play outside at lunchtime, I'd retreat to the library, becoming a much more voracious consumer of books than I'd ever been of food. Mum signed me up for tennis lessons at one point. I hated them so much.

I kept getting fatter until my late twenties, at which point I topped 150kg and found myself unable to walk from my workplace to the lunch shop at the end of the block and back without puffing and wheezing. It occurred to me that this was no way to live, and after catching myself in the act of seriously considering signing up with Jenny Craig, I clipped myself over the ear and just dealt with it. Spent the next two years eating less food than was satisfying while also ramping up physical activity. Got to the point where I was commuting the 15km each way from home to work by bicycle and feeling super fit. It never stopped being a grind, but the results were deeply satisfying.

Embracing a low-expenditure bicycle-based lifestyle kept most of the weight off for about eight years, until I got roped back into the IT industry for a lucrative gig in Germany and ended up going mad, an experience I've written about elsewhere on this site. Since then I've gone through repeated cycles of getting substantial amounts weight off, enjoying the increased mobility and reduced pain and fatigue for a few months, becoming burned out by the side effects of keeping the weight off, then gaining it all back again with interest.

At 62 I'm fatter than I've ever been and even though I fully understand that being ashamed of that is uncalled for, I still have enough body shame to make me resistant to seeking any kind of medical attention to an extent that frustrates the crap out of ms flabdablet. Me as well if I'm honest.

That said, I'm convinced that far more of that body shame originates from having been bullied about my weight at school than from anything Mum did to try to "fix" it for me, regardless of the fact that those attempts most likely did play into how hard it's subsequently been for me to keep it under control in later life. In the 1970s, very few people understood that there were serious negative long-term consequences to yo-yo dieting young, so I certainly don't resent any of the help that Mum tried to give me even though it has ultimately proved counterproductive.

What would have worked better than tennis, for me, would have been boxing. If I'd been given the opportunity to train up in the skills required to beat the living shit out of any of my bullies, I'd have been falling over myself to go to those sessions. And I'm pretty sure that if I'd adopted regular structured exercise as a childhood habit because I'd wanted to, I'd have ended up much more physically fit for much more of my life than I have.

As a parent, I've concentrated much more on supporting my kids' self-directed choices of activities that support their physical fitness than on their weight. I have not taken the same approach as my own parents, where some form of organized sport was held to be a thing that kids must participate in for Health Reasons whether they wanted to or not. Such organized sport as my kids have participated in has all been driven by them, not by me, and they've loved it.

When my kids have sought my opinions on the subject of fatness as they have from time to time, I've been completely transparent about my own experiences with it and let them draw their own conclusions. And if there's one thing that I'm proud of having taught my kids, it's that if they're being bullied for being fat then the problem is not the fatness, it's the bullying. Also that kicking a persistent bully square in the nuts and then grinding their face into the dirt is not something I would ever punish them for, school policy be damned.

Your kid's weight may or may not be a problem but the thing to keep in mind at all times is that if it's a problem then it's his problem, not yours, and assigning appropriate priorities to solving it is not only his responsibility but his right. This is harder to see at 7 than it will be later on, but from the way you've framed your question I think you're probably pretty much onto it already.

Regarding his eating: it is very well possible that earlier (while he was still in a regular school routine), he had been hungry before and not eating enough, owing to lack of time, stress, and interoceptive difficulties.

As a fat man I can assure you that the connection between weight gain and "over" eating is much, much less simple and straightforward than it's almost always made out to be. Weight gain is not so much about how much and what kind of food we stuff in our heads as about the internal processes that regulate all of that.

Medications that affect the CNS almost always affect the gut as well. If your kid were my kid and I'd seen a big weight gain after starting a new psych med, I'd be far more inclined to give the med the side-eye than to hypothesize about situational food availability, and I'd be working with my prescribing doctor to explore alternatives and/or mitigations.

Parenting is hard because it doesn't ever come with do-overs: every kid is new and different. Stay focused on what kiddo is telling you that he needs (as opposed to wants) in whatever ways such tellings manifest, support his mental health and physical fitness as best you can, and you'll parent as well as it can be done. Best of luck to you and yours.
posted by flabdablet at 9:57 PM on April 21, 2024 [28 favorites]


Best answer: I am autistic and fat, and come from a fat family. I don't have answers, but three thoughts.

a) the kid knows how you feel about fatness, you might think you are hiding it, but you are not, and it is causing stress.
b) One of the hardest things for me, is how little Autism has allowed me to connect to my body. I am dyspraxic, have no awareness of my body, and I retreated away from it as a child. I wish I knew my body better as a kid, my folks tried, but it was really difficult. I think one of the things that helped as an adult, is bodily neutrality---namely that I have a body, and if I am going to stay alive, then I am going to have to handle this problem of a body. I found the bodily positivity movement isolating.
c) Autistic people's life expectancy is 39 years old and they are 28x more likely to kill themselves. https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00195-3/fulltext This is for a variety reasons including stress. That has to be considered.
posted by PinkMoose at 10:03 PM on April 21, 2024 [9 favorites]


Also, flabdablet is correct about pysch meds.
posted by PinkMoose at 10:04 PM on April 21, 2024 [2 favorites]


if you can continue to explore possibilities for movement and exploration without pushing in a harmful way that could help

If kiddo is all about the screen time, would he perhaps be interested in stuff along the lines of Wii Tennis or Dance Dance Revolution?

Little ms flabdablet, also a screen fiend, has been super pumped about Wii Tennis while her netball-necessitated knee reconstruction heals up.
posted by flabdablet at 10:12 PM on April 21, 2024 [3 favorites]


Best answer: Just as a data point, I'm autistic, and have been on SSRIs (including Fluoxetine) and they made me gain weight, and also (not sure if related) made me have to eat snacks between meals.

It felt as if my blood sugar level was being affected, I felt "hangry" much more quickly (anxious and irritable because of hunger).

Those emotions went away almost instantly when I ate something sweet.

I stopped the meds for unrelated reasons, but I also dealt with the situation by learning about other ways to regulate my emotions. Not so much because of weight gain, but because eating to regulate emotions didn't seem sustainable.

I learned about using stimming to self regulate.

While I was still on the meds I made sure I had healthy, high protein, high fat snacks available because eating less and having mood swings because of meds-induced hunger was not an appealing option.

Psych meds often work differently for autistic people, so watch out for non standard reactions. I ultimately had to stop all SSRIs and SNRIs as they just didn't work for me.
posted by Zumbador at 10:36 PM on April 21, 2024 [6 favorites]


I don't hanve an answer to your question. I've seen a lot of kids with stuff, and a lot of kids without any diagnosed stuff. Yeah, the kids with stuff seem to tend toward the chunkier, but that's likely muti-causal, and not universal. What follows is...related advice, I guess?

So, when I was the OT for the fully self-contained, mostly ASD classroom in the elementary school, one of the early things I noticed was that when kids got their choice time menu, if iPad was on there, they chose iPad, and it didn't help their emotional stability. We added in a "movement choice" icon and menu. It helped.

Kids, and I think neurodiverse kids especially, get weird and disregulated about screen time. If you can find things that he likes to do with his body, that would be good to swap in for some of that screen time on a variety of levels.

Give what you've described, I'm going to guess he's more of the "ignore my body and hope it will go away" type of ASD kid, rather than the "intensely in my body and using it constantly" kind, and talking about how this is the body he gets, and it has and will change, but he can make choices that will affect how it works for him (things he can get it to be able to do, for example) (in whatever is appropriate language for his understanding.)

So, even if it's going in the hallway and repeatedly jumping to see how high he can reach, and if it's higher than last week and feeling the push through his legs and everything else, that is something. And something is better than nothing.

I have a lot of empathy for doing what you need to do to get throught the day/week/hour (like, seriously, I would always push back on colleagues who would go all "if they would just" about parenta), but if you get stuck in that mode, it can be 5 years from now and the thing you always meant to implement, but never got around to isn't going to be any easier with a teenager. So, any baby steps you can take as far as involving him in experiments to see how food affects his mood, implementing family walks, anything (not everything. Any one, achievable thing) is good.
posted by DebetEsse at 10:39 PM on April 21, 2024 [5 favorites]


He is a little young for this, but it wouldn't be unheard of-- kids just prior to puberty tend to gain weight, then lose it as they grow upward and into adult bodies. It could be that and also meds.

Worth trying out lots of sports and outdoor pursuits but also wait and see. If he grows up to be a fat and healthy adult with many varied experiences, loving parents, and maybe a physical hobby or sport that sticks, that's great.
posted by blnkfrnk at 10:40 PM on April 21, 2024 [3 favorites]


It's been my observation that parental focus on a child's weight can harm a child quite badly. I think it's better to focus on developing healthy habits (especially with respect to screen time and physical activity).

Executive function is and will likely continue to be a challenge for your kiddo. IMHO there is great value in establishing family structure and routines that will help your son manage this challenge while he is still a kid. Once he enters adolescence, he will likely fight his parents' sage advice more. For example, make sure family rewards don't always (implicitly) revolve around food. Be intentional about what food is purchased during the weekly shop. Encourage your son to assist in an age appropriate manner preparing family meals. Tie in home school lessons (e.g. math, trying food from the culture he is studying in social studies) with family meals. It's important that he finds some sort of physical activities that he enjoys doing before puberty. (I would throw in a quality martial arts studio as a place that is often nuero-spicy friendly). You might want to consider ways to have homeschooling involve less screen time. Consider having a family screen time/media policy that sets the house hold up for success.
posted by oceano at 11:56 PM on April 21, 2024 [1 favorite]


Best answer: Fat people can be incredibly healthy, especially if they engage in regular movement and exercise. Neurodivergence can make activities like group sports or common hobbies a lot more difficult, but focusing on developing physical skills can really help us throughout our lives by keeping us more in touch with our bodies and all kinds of related benefits that have nothing to do with weight. Things like balance, emotional equilibrium, making new experiences more achievable, practice with focus and more.

It’s really hard to get into this stuff as a neurodivergent adult (especially one with proprioception issues like me) and I really wish I had been helped by the otherwise very caring grownups in my childhood to be more active. There was so much stigma around being even slightly chubby as an awkward and clumsy girl when it came to any physical activity that I just basically shut down, and nobody pushed me on it because I clearly had other problems to focus on. But a lot has changed in the subsequent decades and in hindsight I know everyone was trying their best.

So I think body neutrality is an excellent angle to take. Please try to release yourself from judging your own body, as well as that of your child’s, because believe me, everything you say and do about yourself he is seeing as a reflection on himself.

Explore options for movement that he can get into. Since you mention adhd it’s likely that he will have a bunch of phases in what he is into. I personally find videogames are often great for this because they can serve my desire for deep focus but after a couple weeks or months I’m suddenly totally uninterested and I drop the game, only to become fascinated by a different one with new rules and techniques to learn. They are just similar enough that the barrier to entry is low but different enough to feed my desire for newness. There are a lot of games that encourage movement and exercise. There are walking games like Pokémon go, which might be a great way to also get outdoor time, or rhythm games that encourage lots of exertion but can be played entirely in private. If video games aren’t his thing, there are so many other options to explore. It’s not all team sports or sloth. If any of the playing he does has any kind of movement, encourage and build on that. But because of the phase thing, probably don’t go all-in on something that requires long term commitment or tons of specialty equipment. But heck maybe he would be really into those ninja gyms and you’ll end up building a course in your backyard. You know your kid best. Just aim for variety, encouragement, and seeing every kind and amount of movement as a positive thing. Even stuff like helping with chores around the house counts.

Also, kids need to eat a lot. They are literally growing their skeletons! It’s wild in there. If the things he eats aren’t causing digestive distress or allergies, let it be. Have a variety of options available and encourage tasting new and different things when he is calm and curious, and model this in your own eating. Work on different ways he can feel hunger and communicate to you about it, because a neurodivergent kid might have trouble realizing he is hungry, or knowing when it is and is not okay to ask for food, or how best to do so if he doesn’t have words or doesn’t have a clear procedure. Maybe he would like really set meal times, maybe he needs a bunch of little meals because of how his energy and focus fluctuates. If he is asking for lots more food during certain times of day maybe shorten the interval between meals or introduce a big snack. These are all things he can work on figuring out with you, just please leave weight and food choice stigma out of it entirely.
posted by Mizu at 12:02 AM on April 22, 2024 [5 favorites]


I think I would focus less on weight/nutrition and more on activities. A less sedentary lifestyle could help for both mental and physical health, and building that habit now is probably easier than later.

Two specific suggestions: I like Ring Fit Adventure for making moderate exertion more engaging. (You'll need a Nintendo Switch, plus the game itself.)

For homeschooling, are you incorporating exercises that include gross motor skills? I don't mean for PE, but stuff like 'make the shape of this letter with your body', putting numbers on the floor and having him jump to the right answer for a sum or multiplication, etc.
posted by demi-octopus at 12:33 AM on April 22, 2024 [3 favorites]


I just listened to an episode of adhd for smart ass women (she’s very cheerful which can be a lot but she’s truly a delight) where she interviewed Caitlin Doherty who has autism and adhd and does movement therapy for neurodivergent people. I got a LOT out of her conversation on different ways to approach movement and health and neurodiversity, including childhood.

I would rather be fat even in a fat phobic society than have an eating disorder so YAY you as parents for firing that doctor and putting your kid’s health first.

Reframing movement as being happy and strong in our bodies should be the big goal I think. My similar to yours kid thrives on physical activity and of course hates it and would like to be in bed with screens all day eating crisps.

She is a string bean and actually malnourished because of food sensory issues so we are working on cooking food she likes because she’ll eat if she’s cooked the food - get him involved in making food that is NOT calorie focused but just whole food from prep - Apple pie and homemade ice cream if he made it from scratch beats pop tarts for overall nutrition. We don’t have a lot of snacks just in general beyond fruit and cheese because the youngest had big dental issues so we had to get rid of snacks, but I mostly just made my kids buy their own snacks early on with pocket money and they were too cheap to buy a lot of junk food when they could get free fruit and sandwiches instead. But food is - I would talk to a specialist because food in a household is several different people’s food issues colliding and food stuff is emotionally tough.

With my kid for movement, she will move if other people are involved. We had occasional success with team sports where she liked the other people, but it really is tough unless you are a sporty person who can do activities at your kid’s speed. My older kids were sporty as children and entirely self-motivated to go out and do physical activities, with a bewildered parent trailing after with books in hand.

Now I have to force myself to go for long walks and find walking and outside activities so that my kid will tag along for her mental health, and I think the age you have - they will still love spending time with you. Start small - play cards in a park on a picnic blanket and stroll around. Try geocaching. Add a nature/outdoor unit for homeschool to go look at nearby geography. Don’t make it fitness, make it nature and outdoor family time.
posted by dorothyisunderwood at 1:52 AM on April 22, 2024 [7 favorites]


As everyone here mentions: Focus on the surroundings and not the weight.

The weight is the outcome of the lifestyle that you and your family live. And it seems very clear that your current lifestyle and routine does not really work to have a healthy child, whether we define healthy as being physically active, or mentally healthy i.e. less screen time and more socialization with peers, or independence.

Again, there is no victim blaming of the child here, but it is clear that this setup that you and your family unit have does not work for your child. I am unclear why a 'homeschooling' routine would necessitate hours of long screen time, when the child is seven. One could build effective routines around taking long walks outdoors, or being obsessive about doing things in the gardens. I am neurodivergent, and as a child I would get completely obsessed learning skills in sports and being outdoors for hours upon end. Very bad at playing in a team, but very good on certain skills like taking free throws.

I would gently ask you if you are the right person to be 'homeschooling' your child (which is fine if you are not, most of us aren't, and that's why we have educators and teachers), because the problem here is not your child's weight, it's the lack of physical activity and too much screen time. I think you need to think about your setup and routine, whether it be moving to a more friendly neighbourhood which encourages outdoor play and activity, or identifying a homeschooling routine that has a significant component outdoors.
posted by moiraine at 3:13 AM on April 22, 2024 [17 favorites]


Also to add: I know you mentioned in your post that the lifestyle changes are not within your control, but I would encourage you to push on the assumptions that have led you to make that statement. Many things are within your control. Yes, your child may not be able to go to a normal school, but they can be outdoors for a siignificant period of time with the right structure and routine. If your area has it, there are special schools. And your child should be able to thrive within a routine with less screen time, with the right resources and planning from your side. Obviously this requires some work and prep from you, but based on your post, and lacking further information about the severity of autism, this seems feasible.
posted by moiraine at 3:27 AM on April 22, 2024 [6 favorites]


Check if you have any forest schools near you. My kid did forest school for two years instead of kindergarten (disaster even the hippy ones) and it was amazing. It’s child-led learning and exploration where they basically spend the day in a forest doing what seems random but ends up weaving together a lot of different learning at individual paces.
posted by dorothyisunderwood at 4:58 AM on April 22, 2024 [4 favorites]


Lastly (I will stop I promise!), in my previous comment, I referred to a 'normal school', and I meant that in a quote-unquote way. I have made peace with the fact that I would not be considered 'normal' and that term is not derogatory to me, just a statement of fact, but I appreciate that other people don't always feel that same.

Also, many (all) of your posts regarding to your kids are, worryingly, about screen time and video games. A lot of the advice given in your previous post still holds. Being neurodivergent is not an excuse to give more screen time, probably the opposite actually. You are a parent. You are their executive function that decides on appropriate screen time limits.

All kids are somewhat lacking in executive function skills, some more so than others, and not many kids, neurodivergent or neurotypical, is going to say, "Well, I had too much screen time than is good for me and future me, so I'm going to stop." But you, as their parent, have that ability, and you have to implement these limits.

I recognise these comments are not to do with weight, but as mentioned, weight is the outcome of lifestyle choices. You seem like a caring parent who thinks about what their kid eats, but not sure whether you are connecting the dots between screen time and weight gain?
posted by moiraine at 5:54 AM on April 22, 2024 [10 favorites]


weight is the outcome of lifestyle choices

I am so, so sick of this thought-terminating cliche.

It's horseshit. People who don't run to fat have bodies with appetite regulation subsystems that work properly. People who do run to fat don't. There's no "choice" involved in the operation of those systems, just biology.

Yes, it's possible to stack on weight by choosing to, just as it's possible to take it off by choosing to. But maintaining either of those choices over time involves running a ceaseless intentional battle against one's own regulatory mechanisms - mechanisms that psych meds, among others, frequently mess with.

I have been "kindly" informed, again and again, my whole life, that if only I'd make "healthier lifestyle choices" then I wouldn't be as fat as I am. This is not helpful, it's cruel. I hate having to haul this much bodyfat around; it makes everything harder. I've been fat, and I've been lean, and lean wins. It just does. And I'm not a stupid man. So if it were purely a matter of choice, why the hell does anybody think I'd be failing to make those choices?

I'll tell you why I don't make "healthier lifestyle choices" in order to drop weight: it's because doing so is fucking exhausting, and every time I've done it, the more exhausting it's become and the fewer months I've been able to keep sustaining it. For those of us who run to fat, "healthier lifestyle choices" come with burnout. So I don't need to have been diagnosed with PDA for my response to this particular "helpful" advice to have become a resounding FUCK OFF.

And if I'd known as a kid what I know now, I'd have said exactly that to my doctor, and quite possibly to Mum as well. Which I hope is a helpful thing to have shared with anybody interested in how to think about fatness and health.
posted by flabdablet at 6:42 AM on April 22, 2024 [18 favorites]


Perhaps consider reframing this: would you send your child to a school where they got little to no physical activity, gained an enormous amount of weight rapidly, and were on screens all day? As the mother of an autistic child, I would pull my child from that school in a heartbeat.

If the issue is that you're in short-term crisis mode and just getting through, then I wouldn't worry about any of it.

But what you describe seems to be the exact opposite of what most kids on the spectrum need, and the isolation you describe (from school, from the pediatrician) can't be good for your family as a whole. It's so stressful to raise these kids; sounds like you all may need more IRL support. That's where I would start, then worry next about all the other stuff.
posted by luckdragon at 6:56 AM on April 22, 2024 [11 favorites]


The reason it's good for most people, kids included, to exert ourselves physically on a regular basis is not that doing so prevents fatness, because it absolutely doesn't. It's that regular exercise is the single biggest contributor to overall health for most people, whether they run to fat or not. There is a lot of human biology that depends on stuff getting properly moved around by and in skeletal muscle.

Physical fitness strongly supports mental resilience as well.
posted by flabdablet at 7:00 AM on April 22, 2024 [10 favorites]


Best answer: I don’t think that at 7, there’s any kind of health emergency here.

I think the reasons for the gain are something to delve into, preferably with your next knowledgeable pediatrician, because the medication may be a reason.

I would say that 7 is an important time (certainly not the only one) for activities and sports. This is an age where it’s great for kids to be working on their proprioception, balance, eye-hand coordination for things like throwing, etc it gets a little harder later, both developmentally and because they tend to get more self-conscious.

If you channel your concerns about food into just getting outside and enjoying walks (walk on things like parking barriers or logs), tossing the ball around or kicking it around, playing low-key tennis, etc. (choose the activities for your child) together, you will create a family bond and a mind-body connection that will come in handy later.

I got this advice after my oldest had a very emergency surgery where he was in a lot of discomfort for a few days, and then stopped talking and only wanted to focus on screens. It was really, really smart advice. I got similar advice after a weight gain later. It’s not about calories or anything like that, it’s about feeling good in your own skin.
posted by warriorqueen at 7:02 AM on April 22, 2024 [5 favorites]


Best answer: I have definite ADHD, but almost certainly autism as well (as judged by my therapist - I just haven't bothered going for testing b/c my insurance won't cover it), including the interoceptive challenges and sensory issues. I am coming at this from the perspective of someone who was average to thin as a kid, but am now objectively fat.

Have you worked with an occupational therapist around food stuff? I only ask b/c for me, I am very sensitive to food textures (mushy/slimy is a big no), but also struggle with things that requires lots of chewing to eat. So I do better with grilled or broiled vegetables. Fruit cut into bite sized pieces. Trail mix. Your kid will obviously be different, but may be helfpul for steering your kid towards healthier choices.

Also, don't underestimate the impact of medications on weight gain! I will say that Wellbutrin is an antidepressant that tends to not cause weight gain (and has some ADHD benefits), but obviously a lot will go into picking a medication for a kid that young.

One other thing to consider: For me, b/c of the challenges with interoception, sometimes I'm hungry and don't realize it. Sometimes I think I'm hungry but it's actually not hunger. I don't know what to do about that, though.

I do know that time spent outside can be really helpful for ADHD. I saw a study about this once, but I also just know personally, being outside really helps, although mostly if I'm out in nature. So at a park or on a hiking trail. too many cars/people/etc can just be overstimulating.
posted by litera scripta manet at 7:14 AM on April 22, 2024 [3 favorites]


Best answer: There is intense desire in your original post and in the comments to blame activity level and food “choices” for your child’s body weight, when it is screamingly obvious that the most likely cause is his medication. But since it is also obvious that your child’s mental health is more important than his weight, it feels like everyone is trying to find other explanatory factors that would be more acceptable for you to actively address.

As someone who has been a neurodivergent fat person all of my life, I strongly believe you need to release this impulse immediately.

You are so close, and I really applaud you for your actions so far and for asking this question. You are still deprogramming yourself from our culture’s anti-fat bias and that is incredibly difficult. But what we know for sure is that fatness is not a reliable indicator of anything. It is important for your child to eat enough calories and nutrients (supplemented as need be) so that he can grow, and to move his body for the health of his heart, lungs, and own body awareness. Body size and fatness has nothing to do with those needs.

It does sound like his physical activity has decreased recently, and I think ideally you would find ways to help him be more active in his body. HOWEVER. I fear, based on my own experience, that any encouragement from you in this area will read to your son as inducement to lose weight (even if unspoken) since that is the overwhelming cultural message of the purpose of exercise. And I think this is more harmful than allowing your child to have a less active period of his childhood.

As a neurodivergent fat person who has spent decades painstakingly building a positive relationship with my body, with food, and with exercise, I really really really encourage you to keep doing the work of letting your anti-fat bias go. Your child’s body size is nobody’s business but his own. No one can control it, not without destroying things that are infinitely precious, and no one should want to. Compliance with a bigoted and biased standard is not worth it.
posted by CtrlAltDelete at 8:52 AM on April 22, 2024 [8 favorites]


Best answer: One aside: I believe you when you cite the lack of activity, but also a lot of kids really puff up in advance of a monster growth spurt around this age. So on top of everything else you may be in for one of those years where you go through 3 shoe sizes and his pants are chronically too short.

Anyway: Does he have an OT already?

I am a late-diagnosed ADHD GenX, and I now have a LOT of clarity on my childhood (and then adulthood) eating for hunger versus eating for dysregulation. Eating is one of the crappiest - as in low-quality returns on effort - forms of regulation. But you can't take that away without introducing and habitualizing better - and appealing! - alternatives.

I have always run large and am now quite fat, and the fat is fine but I am out of shape and it is really limiting. If I could build my ideal world for when I was a child, it would have been a world where fitness wasn't about size and was entirely about personal records - if you can only walk 1 lap in 20 minutes in April, try for 1.5 in May, etc. I lucked out a bit with my elementary school, which was private and so not forced into the more awkward curricula, and we had two "recess" breaks a day - one with a PE teacher who was largely games-oriented (by games yes kickball and stuff, but we also did a lot of creative running-around games) and one after lunch just to get our ya-yas out and shake the crumbs off. This is likely the ONLY reason I did as well as I did in elementary school (and got the classic girl-ADHD comments on my report cards but never any flagging for assessment), along with small classrooms.

Outdoor time and exercise time ARE important to child development as well as nervous system regulation. When you say The lifestyle changes I mentioned above are not within our control, owing to his neurotype., what lifestyle changes do you mean? I'm not sure if you're saying, for example, that the PDA is why he can't be persuaded to go outside and play, or why you can't reduce screen time? This is why I'm asking about an OT, who can help teach you how to do at least some more of that stuff as well as be kind of a kid's ally in making it more palatable and...cool, for lack of a better term. I do think that creative physical play is something all kids but especially ND kids need, with ND kids needing more support understanding how to invent creative play. It's not going to come without some coaching.

As far as what he's eating, I'd apply some basic principles of Intuitive Eating here to deduce that his meals and snacks aren't keeping him full (especially with medication-related disruptors to his hunger cues), and instead of restricting anything actually add on protein as a "partner" to those compelling carby snacks. So yeah, have the chips, but also some cheese or a chicken finger or some meatballs. If he's hungry enough to eat something more like mini-meals numerous times a day, prep those for quick eating and just make them a little protein-heavier. Get some fiber in there too. Treat this as not a fatness problem but a "not getting satiated" problem, and then work on the regulation augmentations, because if the kid is just plain hungry all the time of course that's going to create additional dysregulation, so he needs to feel something like full to be able to move on to other regulation techniques.

As far as physical goal-setting, it's totally possible to talk about fitness goals without body-shape having a damn thing to do about it. Be shaped like a Picasso, but be able to jog up a flight of stairs without getting winded. Be flexible enough to look at the world from up high and down low and rolling around. Be a person who uses body movement to make yourself feel calm and able to focus. Be a person who regularly uses their eyes to see further than the TV screen, who can study birds and lizards and cool rocks.

And I know homeschooling is a resource tax on you, as a person who probably already has a full day of things to do, and it can be really hard to be a PE teacher and home OT and line cook at the same time, but again I think this is where an OT might be able to help you do some of this more efficiently.

Sudden weight changes are always important to keep an eye on, and I appreciate your sensitivity in your concerns. I think there are good and smart and supportive ways to focus on capabilities that aren't fatphobic or shaming and are ultimately more critical to "health" as an all-around benchmark than just a scale, it is good news that you're looking for them.
posted by Lyn Never at 9:05 AM on April 22, 2024 [9 favorites]


It would be helpful to ask your son's OT (if he has one) about how best to address the weight gain. Eating like this in a short period of time seems to indicate he is regulating himself with food. OTs are great about thinking through how to substitute that regulation strategy with something else.

The concern here is about health. Excessive weight gained in a short period of time is not good for his heart, liver and his bones. This could impact his adult health and lifespan if this continues on the same or upward trajectory. However, the root of the problem isn't the eating as much as why he is eating a lot.

During the evaluation process, the OT might notice things like he has issues with certain sensory challenges and try to put in routines to help address them slowly. This is not ABA. I have to caveat this by saying it is important to get a good OT! OT is not just about fine motor skills.
posted by ichimunki at 9:50 AM on April 22, 2024


Fat Talk by Virginia Sole-Smith is a fantastic book, and I highly recommend it to everyone.

It sounds like you’re a thoughtful and supportive parent, and your kid is lucky to have you! I don’t have the kind of expertise you’re seeking so I will refrain from offering any advice.
posted by maleficent at 10:57 AM on April 22, 2024


CtrlAltDelete: There is intense desire in your original post and in the comments to blame activity level and food “choices” for your child’s body weight, when it is screamingly obvious that the most likely cause is his medication.

Quoted for emphasis. I know you switched pediatricians but did you discuss this with his psychiatrist? This is an overwhelmingly common SSRI side effect.
posted by capricorn at 1:21 PM on April 22, 2024 [5 favorites]


Best answer: I'm autistic. Burnout [as an adult] made my sensory sensitivities way worse. Sensory sensitivities may be contributing to why your kid isn't enjoying outdoor activities.

Sound - road noise is HELL. Does your kid have a good pair of earplugs or noise-blocking/cancelling headphones that he enjoys wearing? If not, experiment with this. Before I found out that I'm autistic I had no idea how badly the noise was affecting me.

Bright sunlight - is your kid always the one squinting in family photos? Get him some decent sunglasses and/or a hat that blocks the glare (but make sure these are comfortable). This can be a game-changer for enjoying time outside.

Tactile stuff - this one is huge. Are his clothes actually comfortable for him to move around in? Same with shoes; I had huge difficulties finding shoes and socks! toe seams are evil! that didn't cause me terrible pain when walking in them. Do his shoes fit properly? Does sweating in his clothes make them feel awful? (More breathable or lighter-weight clothes may be more comfortable.) Does his sunscreen feel or smell or taste terrible? Find something that isn't as horrible, or shift to morning or evening activities. Are mosquitoes or other bugs an absolute nightmare for him? Maybe avoid evening activities in that case.

Smell - motor vehicle exhaust stinks. So does air pollution in general. So do the neighbors' cigarettes/barbecue/cannabis. Does your kid have a place to play that is relatively free from smells?

Environmental allergies - these also suck, and can make physical exertion extremely unpleasant. If your kid has them, investigate treatments (but be aware that powerful drugs like Benadryl have nervous-system side effects).

Trauma triggers or phobias - don't expect your kid to enjoy playing at a dog-infested park if they're afraid of dogs (the same goes for other kids).

I noticed that no-one else had mentioned specific sensory sensitivities and how to accommodate them, and these are things that are really hard to conceptualize if you don't experience them yourself. Even if you *do* experience them yourself, it's all too easy to assume that everyone else also experiences the world that way, and it's really hard to conceive of ways to accommodate them when you're a 7-year-old and simply don't have the experiences to draw from.
posted by heatherlogan at 4:17 PM on April 22, 2024 [8 favorites]


One last thing: hydration. I spent most of my elementary school years chronically dehydrated because I was unable to use the washrooms at school (a combination of sensory stuff and fear of being assaulted by other kids) and thus restricted my water intake to avoid peeing in my pants. Some autistic people have trouble sensing when they're thirsty and thus wind up not drinking enough. Chronic mild dehydration really saps one's energy and makes one feel generally bad, greatly reducing one's enthusiasm for physical exertion.
posted by heatherlogan at 4:22 PM on April 22, 2024 [1 favorite]


Best answer: As an autistic adult with PDA, I'd encourage you not to focus on your kid's food intake. When I was a kid I ate a lot of carbs as comfort food and for mood regulation. I'm sure you know this all too well — given years of experience as a PDA parent — but my mom trying to limit/discourage my comfort eating made me dig in my heels and get stubborn about it, and even develop some mild obsessive eating and food hoarding behaviours.

Honestly, the best thing my mom did for me food-wise was to give me choices and capacities that I could then access — when *I* was ready to. She cooked new and different types of foods for us to try when I was little, but she would also cook my favourites often, which made it easier for me as an autistic picky eater: I felt safe trying new things because I knew something I loved was going to be coming up next.

She also helped me get all the basics of cooking down when I was a teen, not as Something I Had To Learn — which would have triggered my PDA — but just bit by bit, when we were hanging out together in the kitchen. That made it so much easier to make (self-directed) dietary changes as an adult, because I had the capacity to cook new foods instead of just falling back on what I knew out of executive dysfunction overwhelm.

It's tough to parent PDA, and it's tough to have PDA! Even as an adult, when I try to steer my own eating habits in a new direction, some part of my brain gets stubborn and it has the opposite effect. So I would reiterate what works for me as a PDAer: don't pressure, don't limit; give choices, teach skills (in a casual, no-pressure way), and be patient with letting your kid choose self-directed behaviours when he's ready for them.

This includes choices surrounding more outdoors time, more social time, and extracurriculars, which is what I think it would be good to focus on, instead of food and exercise. I would've loved being homeschooled as a kid, but even introverted as I was, I think I would have needed some regular (self-chosen) extracurriculars to stay happy.

heatherlogan's suggestions about reducing sensory sensitivities to enable him to do things he might otherwise avoid are great. That definitely describes my challenges as a kid, and I can totally understand why your kid might be living a screen time-heavy, mostly-indoors life right now — that was what I felt like I wanted, especially when I was burned out, and I would often oppose my parents' suggestions to get out more, see friends, do physical activity, etc. ... but it definitely wasn't good for me in the long run. So I would encourage you to look into occupational therapy for sensory sensitivities, and autism-friendly therapy to help him deal with fear or anxiety that might be preventing him from adding new experiences to his life.
posted by fire, water, earth, air at 4:28 PM on April 22, 2024 [2 favorites]


Best answer: There is intense desire in your original post and in the comments to blame activity level and food “choices” for your child’s body weight, when it is screamingly obvious that the most likely cause is his medication

Hi. I'm a fat ADHD adult who was a fat ADHD kid, but I think there's some things here that are a little more complex than "Fat good/fat bad" that it's important to tease out. It can be a mixture of things, but it's going to be nuanced.

First: the desire towards snacking when agitated is a chemical, physical desire, not an issue of willpower. How do I know this? Because as an adult, I currently control it with medication. I don't know if they can do it for children because it has some side effects, but trust me: if I take my medication, I don't feel the need to snack when agitated or unhappy. When I don't take my medication, I do. It is simply a physical urge, not a mental choice. I suspect probably there's some deep seated biological things that does for survival - like prepare you for hard times - which is why it's hardwired in. But that means just trying to control the behavior will not work. The only other way you can control those urges is by trying to supplant the behavior with something more addictive. There are few healthy things that are more addictive. Video games - screens - are one. Ignore everyone telling you to 'just get your kid outside'. Outside is not addictive enough to counter the impulses towards self-destruction.

If you are willing and able to spend money, what can work is inside physical video games - like virtual reality style ones that require you to physically move around while still having addictive components.

Second: it is so, so easy to fuck up medication to turn a medium-fat kid/ young adult into a mega-fat kid. Trust me. I was said kid. And there is a huge difference between a kid who feels fat but is only about twenty to thirty pounds overweight, and a kid who feels fat and is fifty to seventy pounds overweight. And it impacts you lifelong in major ways. Health ways - it fucks up your joints majorly, longtime - and social ways. Do not just assume that it will work itself out. If it's medication related, and you don't check into it now, it can fuck things up lifelong. I had metabolism issues for literal decades because of some bad medication I was on for two years. I currently am now on medication I am told I will have to take for the rest of my life to fix it. Just because it's sometimes healthy to be fat doesn't mean every fat is healthy.

Third: This is anecdatal, but for some of us, there really is something where bread and sugar seem to absolutely fuck us up in ways they don't fuck up other people. I changed my diet to what I will call a modified keto diet, where I didn't actually do keto but I just like, didn't eat bread and ate meat and fat and vegetables and didn't add sugar to things, and I dropped weight like a stone. I still ate food and wasn't sad about it. After a while of not having sugar or sugar substitutes, I realized that sugar had been like a drug in my system and I had been reacting to it in weird ways. It is worth just checking if this is the case - but don't do it just for him, do it for the whole family, as a 'just to see' if you do it.
posted by corb at 5:13 PM on April 22, 2024 [3 favorites]


If you fired the pediatrician for mentioning BMI, was this the doctor who prescribed SSRIs in the first place? If you don't have confidence in that doctor, it seems worthwhile to get a second opinion on the medication they prescribed.
posted by TheophileEscargot at 4:04 AM on April 23, 2024 [3 favorites]


Best answer: I sincerely hope that your kid's psychiatrist knows how to distinguish autistic burnout from depression. They sometimes co-occur, but they are biochemically not the same thing, and attempting to treat autistic burnout by itself with antidepressants is usually counterproductive.
posted by heatherlogan at 6:43 AM on April 23, 2024 [3 favorites]


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