Reply To: ADHD meds, loss of appetite and body image questionos

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#60393
gentlygenli
Participant

You say your focus is on being “body positive,” but usually that phrase is associated with affirming obesity and overeating behaviors, and it’s usually a euphemism for being “large body positive”. Health is what’s important, and a healthy child’s BMI should be below the 85th percentile, and more sensitive epidemiological studies are showing that below the 50th percentile is even healthier for future heart disease. It should be above the 5th percentile.

I have a child who (off drugs) simply forgets to eat because she’s interested in other things and will dip well into the underweight zone. I have another who would forget to eat during the day and wake up ravenous at night, though not ever underweight. In both cases, I had to nail them down to eat at least twice a day to make sure it happens. In both cases, ADHD meds have allowed them to notice their hunger, and they eat without my fussing at them.

But I have a friend whose ADHD child eats impulsively all the time off meds. He is medically obese. When he went on meds, his intake of food was slashed. He is losing weight, and it’s a great thing.

There are several things you must evaluate before deciding what to do.

First, is your child actually losing weight? If not, there’s no issue.

Second, has it gone on for a month? Loss of appetite is much more common at the onset than with continuing medication. In most cases, it’s very temporary. If she’s been on drugs less than a month, just wait a while. Leave her alone until then.

Third, after a month, is she losing too much weight, or is she losing it too fast? If she’s losing more than 1% of her weight each week, after the first month, unless she is clinically obese, it’s too fast. (If she’s clinically obese, then more than 1.5% is too much.) If she’s below the 10th percentile, then continued weight loss is too much. Otherwise, leave her alone. Chances are that she’ll find a perfectly healthy new stable point.

There is a very small chance that the vast, vast percentage of kids on therapeutic dosages of these drugs end up underweight. If she does lose weight significant amounts, there’s a high chance that she was a compulsive eater before, and her new self-control is likely a good thing.

If your child is over-fat, weight loss in general is good. Forget “body positivity”–we are talking about actual reality. Facts don’t care about anyone’s feelings. More medicated kids with ADHD are overweight than kids without ADHD because they lack impulse control and good executive function.

The fact that you say that you’ve actively encouraged her to “eat until she is done” is a troubling phrase. Kids don’t need this–ever. They need to be encouraged to make GOOD food decisions, not to eat as much as they want of whatever they want on the table. That’s a battle I don’t always fight (because when you have a rare chronic under-eater–and yes, she has the typical extreme pickiness that comes with it–getting a perfectly balanced as well as high enough calorie diet in her can be exhausting), but it’s supposed to be our jobs, as parents. I’m concerned that you’re projecting your own feelings about your weight onto your kid’s rather than being perfectly honest about food.

My advice would be to leave her alone until she’s been on the drug a month. She should continue to join you at meals and eat no more than she wants. Then evaluate honestly about whether her new pattern of eating will result in her being medically underweight or malnourished because she’s refusing entire food groups. If not, leave her alone. She’s not having and food issues. YOU are having issues with her food. And that’s not her problem. It’s yours. If she’s not freaking out because she’s dropped her appetite for a few days, that’s a sign of a better relationship with food than many people have, because she doesn’t have a psychological dependence on constantly eating. The fact that you immediately assume that it’s about body image when the poor kid just isn’t hungry shows that you have a very poor relationship with food personally and that you have likely struggled with weight for a long time before deciding that your solution was to stop feeling bad about it. While feeling bad isn’t constructive, your desire to normalize impulse-based eating in your kids and your fear when your daughter very briefly stops eating much–a perfectly normal reaction as she adjusts to the drugs–is extremely concerning. You’re sending her the message that you can only approve of her if she eats as much as she wants as long as it’s a lot.

I realized that I was giving my kids a crappy example of a healthy adult woman, so I dropped 65lbs, took up running and cross training, and got back under the 28″ waist above which heart risk is elevated. I don’t want my kids to vaguely feel good about their bodies–I want their bodies to actually make them feel good and to be strong and healthy. And I don’t sweat the small stuff.