We are the champions, my friends.
Bud had a great visit with his pediatrician today. I've been in high-anxiety mode since late summer, when, as the result of a much-needed switch in the timing of his medication, Bud's appetite kicked into overdrive and he gained 11 pounds in three months. Shortly after that, the news was full of reports that this sort of rapid weight gain was not atypical for children on this type of medication. Typical or not, though, it was dangerous for Bud and his doctor warned that it could cause him to develop diabetes. At that point, Bud's diet got an overhaul.
And it worked. As of today, Bud is back to the height/weight ratio he had in the summer and his BMI is within the normal range. Of course, we need to stay focused and stay on course, but today it's feeling really good.
I'm loathe to give advice on this sort of thing, because I suspect it's a "your mileage may vary" kind of issue, but I also imagine that there are lots of parents out there Googling things like "autism medication weight gain solutions" as frantically as I was a few months ago. And maybe something that worked for us will spark an idea for somebody else. So...
First, the most significant turning point in my thinking about Bud and food came when his doctor explained to me what the medication was doing in Bud's brain. Up to that point, I thought that the medication had simply increased Bud's appetite, and that the solution lay in finding foods that would fill him up and stay with him without adding too many calories to his diet. So, I focused on foods that were high in fiber, but it seemed that no matter how much he ate, he never felt full.
The reason, his doctor explained, is that the issue was not really one of hunger. A side effect of his medication is that it basically deactivates the trigger in his brain that tells him when he is full. So, even when his body is satisfied - indeed, even when it is OVER-filled - Bud will still feel hunger.
Suddenly, I understood why my boy was eating a pound of bananas in a single day.
I asked the doctor what other parents had done to combat this. She said that, in honesty, those that had been most successful had gone the route of using locks - locks on the cupboards; locks on the refrigerator.
I pictured my kitchen as a fortress. I imagined how it would feel to Bud. I imagined how confusing it would be to my dad, who is already struggling enough with confusion. And then I dismissed the idea.
Instead, I focused on devising a plan that would let Bud feel like he was eating all the time. I reasoned that, since he would feel the same level of hunger no matter what he ate, the important part was to make him feel like he was always able to have something.
And so evolved Operation Always Be Eating:
- I used the Weight Watchers approach to choosing foods, trying to find low fat/high fiber substitutes for the foods Bud liked (Fiber One pancakes instead of Aunt Jemimah, fat free American cheese instead of regular - that sort of thing).
- I made sure there were some things that would keep his mouth busy that he could always help himself to - sugar-free Popsicles and sugar-free gum were ALWAYS available in large quantity.
- I stopped buying fruit juices and started buying single-serving bottles of water, which are just more fun for a kid to drink than a glass of water from the tap.
- I bought sugar-free juice packets to mix in to the bottled water, and while I'd prefer that he had less artificial sugar in his diet, sometimes you just have to choose the lesser of the evils.
- I found low cal, low fat treats he liked and didn't keep any high-fat, high-cal treats in the house. The biggest score? Cool Whip Free. Almost no calories, and he feels like he's eating ice cream.
- I learned that portion control is a key to success. As long as Bud was having the same KINDS of foods, he didn't make a fuss about the quantity. One piece of toast was just as good as two. A small banana was as good as a big one. Using smaller plates and bowls helped to make it SEEM like he was having just as much as ever. 100-calorie snack packs were valuable because they had built-in portion control AND had the added benefit of not leaving an open bag of something that would be easy to steal from. I also did a lot of splitting 100-calorie packs (creating two 50-cal pretzel bags or three 33 1/3 cal mini-muffin treats.)
- I learned that if Bud needed to feel like he could always be eating, I had to rethink the "three meals a day" approach to food. So, breakfast became the thing that happens over the course of the morning. Lunch became the thing that happens over the course of mid-day. Items that would once have been presented together as a total lunch "package" were metered out instead, piece by piece, hour by hour.
- I also learned that some things need to stay as they are. His weekend cheese pizza from the local pizza shop? The thing he loves more than anything else? It stays the same, in frequency, size, and drippy, greasy content.
And so far, so good - or, so says the doctor's scale. I have to say, in some ways, the autism-driven preference for sameness works to our advantage. Now, when given a choice, he will choose to buy the Weight Watchers ice cream treats instead of the higher-calorie (better tasting) versions. Because he likes what he knows, and now, that's what he knows.
Bud has also been a trooper about it. We've talked a lot about healthy eating. He's working at it. He's still stealing food now and then, but not to the same degree. He's becoming a partner in the process - and I have to think that the medication he's on - the one that's causing the problem to begin with - has also been instrumental in helping him regulate enough to be more thoughtful about his food intake.
It's still a daily concern and I still have to monitor it closely. But for today, it feels like a victory - and I'm going to eat it up.