How to stop teen’s progression from chubby to obese

By Pediatric Psychologists Wendy Ward and Elizabeth Pulliam

This week’s “Food for Thought” answer is by pediatric psychologists Wendy Ward and Elizabeth Pulliam. Both practice at the University of Arkansas for Medical Sciences and Arkansas Children's Hospital. The university and medical center are among the 14 sites in the Autism Speaks Autism Treatment Network (ATN). Dr. Pulliam co-authored the Autism Speaks ATN/AIR-P Exploring Feeding Behavior in Autism: A Guide for Parents.

Like many kids with autism, our son has always been somewhat overweight. What scares us is we’re seeing him go from ‘chubby cute’ to obese as he approaches adulthood. The older he gets, the harder it is to keep him physically active and away from food. How can we get him on course for a healthy life?

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

Thank you for reaching out. Your concerns are warranted and shared by many families in the autism community. In 2014, research by the U.S. Centers for Disease Control found that nearly a third of adolescents with autism are severely overweight, compared to 13 percent of typically developing children.

We know that several factors contribute to the problem. They include a tendency for reduced physical activity and poor nutrition. In addition, weight gain is a common side effect of certain behavioral medicines. If your son is taking medications to help with challenging behaviors, you may want to discuss his related weight issues and possible alternative medicines with his physician. The Autism Speaks ATN/AIR-P tool kits on behavioral medication decision-making and their safe and careful use can help guide this discussion.

It’s also important that your son’s healthcare team screen him for possible medical conditions that might be causing his continued weight gain. While uncommon, such metabolic issues can be serious. So they should be considered and ruled out before starting a weight control plan.

Autism-related eating challenges to keep in mind

We know that helping children establish healthy eating habits and activity routines is crucial for preventing obesity in adulthood. However, we also appreciate that autism can make this more challenging on several levels.

A strong need for routine is common with autism. It can make it more difficult to break out of unhealthy patterns of eating or inactivity.
Autism often involves sensory issues and oral-motor weaknesses. Both can contribute to a highly selective diet. Such diets tend to consist primarily of processed foods high in fat and carbohydrates, rather than healthier and less caloric fruits and vegetables. Over the years, such a diet commonly leads to weight gain.
Many people affected by autism experience what we call hyperphagia. This is an intense desire to eat that goes beyond true hunger. Given unchecked access to food, someone with hyperphagia may eat almost constantly. In our practice, we’ve noticed that as children grow into adolescents and young adults, the amount of time they spend unsupervised tends to increase. As a result, unchecked overeating may likewise increase.

Age-related challenges

In addition, it’s typical for adolescents to become less physically active in our society. As teens, their interests tend to shift from the playground to video games, texting and television. There’s also a noticeable decline in recreational sports and physical activity at school. High schools don’t provide “recess,” and their sports programs become increasingly competitive. This can be especially difficult for teens with autism, many of whom have less developed motor and coordination skills.

It’s also true that we all experience a slowing of metabolism as we get older. That means your teen with autism may be burning fewer calories – even at rest – than he did when he was younger. All of this makes that transition to adulthood an at-risk time for increasing weight.

Meeting the challenges with family participation

The good news is that it’s never too late to establish healthy routines that can become healthy habits for a lifetime.

Please keep in mind that the best way to change your son’s habits in a healthy direction is for your entire family to make these changes together. This generally begins with parents setting good examples in regard to what they eat, when they eat, where they eat and how they eat.

For example, you may establish a routine and rule that your family has dessert on Fridays, after dinner. Everyone follows the rule. Consider removing dessert items from view and reach during the rest of the week.
Another new routine could be to use a particular spoon or set of spoons for serving portions at mealtime. The idea is to select a size that provides an appropriate portion. You would couple this with a rule such as: "One spoonful of each food – vegetable, protein and starch – with seconds only of vegetables or protein."
We also suggest a routine and rule of eating only at the table. No more eating in front of the television or computer.
Scheduling meals and snacks is going to be important as well. You may need to remove access to foods during “not eating” times. Visual supports can be especially helpful in reducing food-related anxiety while guiding someone with autism through the day’s eating schedule.

Also, be sure to include physical activity into this daily schedule. And make it fun! It often helps to involve others in establishing a physical activity routine. This can be as simple as walking with friends around the neighborhood. Or perhaps you family would enjoy joining a birding or hiking club. Your church or local recreation center may have sports teams that welcome all participants – regardless of ability.

We hope these tips will guide you in helping your son achieve and maintain a healthy weight and lifestyle that will serve him well through adulthood.