ADHD meds, loss of appetite and body image questionos

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    • #60322

      Hi, newbie here. My sweet princess has ASD and ADHD. Currently, she’s on Concerta, which is doing her a world of good (her teachers are really thrilled with her work and focusing and organization when she’s taking the meds) for most parts of her life, but doing a HORRIBLE job for her appetite. All her life, I’ve been trying to keep things body positive, and not have her grow up having issues with foods due to either ASD, or emotions. I’ve always told her to eat until she feels she’s done. I let her serve herself, and she eats however much of it she decides to eat. I’ve always been that way with both of my kids…but now, the Concerta is kinda wrecking this, because now she’s NEVER hungry. She won’t eat breakfast, she barely touches her lunch at school, and she keeps telling me she’s not hungry for dinner. I KNOW these are foods she will eat, and has grown up eating. I’m not sure what to tell her. I don’t want her to worry about food, but I don’t want her going without either. Tonight I had to battle with her and ask her to please at least get a little bit of food on her plate to eat dinner tonight, because she needs her strength. She was highly upset by this, and feels like I’m going to start forcing her to eat all the time now. What do I do?

    • #60393

      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.

    • #60504
      Penny Williams

      Here’s some expert advice on what to do when your child doesn’t feel like eating, due to appetite loss from ADHD medication:

      What to Do When Your Child Never Feels Like Eating

      What to Do When ADHD Meds Ruin Your Child’s Appetite

      ADDitude Community Moderator, Author & Mentor on Parenting ADHD, Mom to teen w/ ADHD, LDs, and autism

    • #61940

      My daughter (10) is on Concerta and I had to take her off for a couple of months over summer to fatten her up again, because she lost 2 lbs (she’s barely 50lbs and can’t afford to lose any weight). Since going back on them, we have had more conversations about the importance of nourishing her body and brain. First thing in the morning I grab her meds and a protein bar and take them to her room (she’s seriously cranky before and after her meds) for her. If she takes her meds and eats her protein bar then I will play a level of Super Mario with her on the Wii before she gets ready. By the time we’re done this the meds have kicked in and her behaviour is better and she is more successful at getting ready for school. I then stuff her lunch kit full of non perishables (last year I threw away so much food so I don’t pack her much “fresh” stuff anymore). She has protein bars, fruit bars, cereal bars, fruit cups, cheese strings, pudding and yogurt. Some have also suggested beef jerky as a high-protein food if your daughter likes that. I pack her lunch kit full so that she can choose what appeals to her that day – it increases the chances she’ll actually eat at least something.
      She eats some of her dinner, some nights more than others… but as the evening goes on she becomes hungrier and hungrier. When she first started meds I thought this was an excuse to not go to bed, but it’s not. She is ravenous at night so I usually send her to bed with a Cliff bar (protein bar) and other snacks. She also knows she can get up and have something from the snack drawer in the fridge if she’s still hungry.
      I know she’s eating a lot of protein bars and other packaged stuff but at least she’s getting the calories into her now.

      I would talk to your daughter about the effects of her medication on her appetite. It doesn’t have to be about her body image but about nourishing her body so she can grow strong and have physical and mental energy for her days.
      That’s my two cents! I’m new to this too, but it’s working for us this past month since school started!
      Good luck!

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