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maize

Disordered eating in teen boy?

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Please don't quote.

Does anyone have experience with eating disorders and teen boys? 

I am concerned about my 13 year old; he is skipping meals frequently and claiming to not be hungry. I suspect a combination of OCD and a problem with recognizing hunger signals (he's not the only one in the family with either issue). Thing is, he is right in the middle of a major growth spurt and is also physically active--he should be eating large amounts of food and I am seriously concerned about what is going to happen to his body and brain if this continues. I don't think (?) he is in full blown anorexia but I'm afraid he is headed that way.

If I can get him to start eating he will eat large helpings, it is the skipping of meals that is a problem. Today he refused to eat any breakfast. When I picked him up after two hours of karate I brought him a six inch sandwich from a local shop and he ate that; he hasn't eaten anything since and refused just now when I told him he needed to eat. He's grouchy and irritable, probably due to low blood sugar.

Any insight or resources for dealing with eating disorders and teen boys?

Edited by maize

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(((Maize)))

I don't really have any experience, but I would start quietly keeping track of his food intake.  If he has OCD tendencies, I absolutely would not have him start counting calories, but I think that you need to know what you're dealing with.  I would keep a journal for a couple of weeks or a month and then take him to the doctor if the food intake is not within normal range.

I would also push healthy snacks to try to boost his blood sugar.  I had this issue.  My mom would often offer me a piece of cheese in the afternoon if she suspected my blood sugar was low (i.e. if I was a miserable grump).

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With my meal-avoiding kid, I found that low-effort food worked best.  Low effort as in I didn’t even ask him what he wanted - I just made something I knew he liked and handed it to him. Sort of like your sandwich from the local shop - food is there with zero effort so they eat it.  Even waking to the kitchen seemed too much trouble for him some days  

I figured my kid was using his mental energy in just coping most of the time and didn’t have anything left for interacting about food. These days, he lives on his own and eats a limited variety of food, all of which can be made with little mental effort.  He is healthy and doing well. 

I would not secretly track his eating - my kid would have resented that greatly. Providing easy food was the key for us during the growing years. 

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I'm not an expert, but I think most eating disorders center on a disordered view of self.  This sounds concerning, but eating disorder isn't exactly what it sounds like.  OCD sounds like a definite possibility.  I would definitely take him to the doctor, and in the meantime, I would keep handing him food.  I worried about this possibility in my 15 year old, but her issue is mostly pickiness.  She's never eaten in the morning, even as a baby/ toddler.  She will drink a big glass of chocolate milk.  But she doesn't like any food that is convenient to pack for lunch, and she doesn't like the school lunches, so many days she's not really eating until dinner time.  She's an emotional mess, and it's absolutely an issue, and I really haven't figured out a way to address it, but traditional eating disorder therapies wouldn't be appropriate, because her unwillingness to eat is not stemming from self image but from pickiness.   (She eats a wide variety of foods, so avoidant/ restrictive isn't really the right term either.  She just hates sandwiches/ salads.  She likes leftovers, but there's no way to heat them up at school and she doesn't like them cold.  So she'll pack some granola bars and some chips, but it's not really FOOD.)

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Coach gave a handout on eating for athletes, I combined that with a visual daily food plan and would occasionally point out the boxes that hadn't been checked.  

Whole foods are key, as is convenience. 

If anyone is encouraging him to restrict in order to resculpt his body, you should have a male he respects talk to him about how to build muscle. 

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13 minutes ago, AK_Mom4 said:

With my meal-avoiding kid, I found that low-effort food worked best.  Low effort as in I didn’t even ask him what he wanted - I just made something I knew he liked and handed it to him. Sort of like your sandwich from the local shop - food is there with zero effort so they eat it.  Even waking to the kitchen seemed too much trouble for him some days  

I figured my kid was using his mental energy in just coping most of the time and didn’t have anything left for interacting about food. These days, he lives on his own and eats a limited variety of food, all of which can be made with little mental effort.  He is healthy and doing well.

 

This.

Very similar with one of my kids, plus myself. At a minimum, easy to prep/grab food that is protein-based, but more effective for us was me doing like AK_Mom4 and just handing him the food I felt he would eat.

Erica in OR

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DS14 (night owl) doesn’t usually eat until after 10am if he wakes up earlier than lunch time. DS13 (early bird) can eat breakfast 30mins after waking up.

For my kids, I try to have food after their tennis sessions and after 3hr classes. They are hungry and want food so as long as it’s not something that they hate the texture of (they don’t like Subway), they would eat up.

Another thing I do is leave finger food for them on their shared area around 3pm when they are studying. They would just reach and grab a bite. They are used to food every 3hrs.

ETA:

My kids didn’t have big appetites everyday during growth spurts. Some days their food intake is their normal amount and some days it is high.

Edited by Arcadia
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Is he interested in having a healthy body in regards to any sports he's involved in (like karate?).  My ds had vaguely similar issues, although his interest in being healthy and strong for sports guided any OCD, etc., issues he was also dealing with.  So, he knew what was good to eat for the sports he was in, and kept on a very strict diet for that.  I just made sure to have lots of it and available to eat anytime.  

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Dc's friend was anorexic in high school. He wasn't hungry, forgot to eat, and didn't like meat, so very little protein to help with blood sugar, growth, etc.  He was very active, and it wasn't healthy. If someone handed him food, though, he'd eat it, and if easy-to-eat food were on the table, he'd help himself to some.  I suggest you make sure your ds has ready access to nuts, cheese, hard boiled eggs, and prepped raw veggies with hummus for calorie- and protein-dense snacks, plus whatever easy foods you can make available for meals.  

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I think there's a difference between "disordered" and just plain disinterested. My son has always been on the thin side, despite being an athlete who trains 15-20 hrs/wk. He would never purposely restrict calories, and usually has no idea how much he weighs, he's just not really interested in food. He doesn't enjoy eating unless it's something really pleasurable (and generally sweet) like cookies or ice cream, although he can also mindless munch through a bag of potato chips without thinking. But to him the typical breakfast foods, sandwiches, meat-&-two-veg dinners, etc., are just... substances to be input once in a while in order to not die. If I make him a burrito or a sandwich or I put dinner in front of him, he'll generally eat it, but if I ask if he's hungry he'll almost always say "not really," even if he hasn't eaten anything for hours. He's not pretending, he really doesn't feel hungry. He rarely eats more than 2 meals a day, even in college where he could eat whatever he wants whenever he wants it, with no effort, essentially for free (meal card with unlimited swipes).

Anyway, all that to say that your son may just not be particularly interested in food; he may just see it as a chore that needs to be done a couple of times a day, but not something he's very enthusiastic about. I would just make things you know he likes and hand it to him, like you did with the sandwich. If he won't eat a meal, see if he'll drink a smoothie. I used to make DS smoothies with almond milk, banana, peanut butter, ice, and a big scoop of chocolate protein powder, so at least I'd know he'd gotten a decent amount of calories and protein. And provide healthy snacks to munch on while doing other things (reading, TV, school work): sliced apple & peanut butter (peanutbutter, Greek yogurt, and a little honey makes a great dip), granola bars, nuts, carrots & ranch, pita & humus, etc. Some people just naturally prefer "grazing" versus eating big meals.

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Any chance of PANDAS? Two symptoms are OCD and refusal to eat. 

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I will relate a conversation that took place in our house a few years ago:

Quote

 

Me: [DS], do you want a snack?

DS: NO, I'm hungry!

Me: [laughs]

DS: What?

Me: You're so hungry you couldn't hear my question. I was offering you food.

DS: Oh.

 


We got him some food. He was too hangry to deal with the question.

I've been surprised when sometimes adults tell me that their kids never seem to eat anything--but I see them asking their kids if they're hungry/want food and the kids saying no, rather than adult putting food in front of them and child refusing to eat it. From what I see of kids, those are two really different offers.

So my first thought is that asking might get you a refusal in the same instance when handing him food would be accepted. Hungry people can be crummy problem-solvers. I know I am, and it turns out that DS is too, even when the problem is that we're hungry.

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On the days my DS is MOST active, he just plain isn't hungry.  It drives me bonkers, but he has zero appetite and will skip meals.  Today is one of those days.  He dances hard from 9 am until 1:30 pm with no break.  He eats some of a yoplait yogurt flip and a Bolthouse Farms smoothie before dance, and then a protein bar during if he  feels like he's lost his energy.  Afterwards... Forget it.  Most athletes/dancers seem to crave carbs after a workout, but not my DS.  He starts to feel nauseated if he eats much.  

He KNOWS this is not good, and we've been trying to identify protein-rich foods that he will tolerate eating on these days.  He doesn't eat eggs, sadly, or I think it wouldn't be so much of a struggle.  He also greatly dislikes greek style yogurt- we've tried the extra protein yoplait, but they all taste chalky to him.  Protein shakes are a big no for the same reason. Today after dance he ate a few bites of cut up fruit and about four bites of orange chicken.  He has to perform tonight and will take some beef jerky along as a snack.  He loves peanut butter and related things, but he dances (meaning lifting and touching) with girls highly allergic to peanuts and nuts, so those are avoided as much as possible.

Oh.  And my DS pretty much never eats breakfast.  I don't blame him- I'm not big on breakfast myself. Sometimes he will grab a granola bar, though sometimes he does wake up hungry and has a small bowl of cereal with milk. 

I don't think it resembles an eating disorder in the least. It's not ideal for sure, and we're trying to work with it, but I would have never thought to think in a disordered direction.

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7 minutes ago, Lady Marmalade said:

On the days my DS is MOST active, he just plain isn't hungry.  It drives me bonkers, but he has zero appetite and will skip meals.  Today is one of those days.  He dances hard from 9 am until 1:30 pm with no break.  He eats some of a yoplait yogurt flip and a Bolthouse Farms smoothie before dance, and then a protein bar during if he  feels like he's lost his energy.  Afterwards... Forget it.  Most athletes/dancers seem to crave carbs after a workout, but not my DS.  He starts to feel nauseated if he eats much.  

He KNOWS this is not good, and we've been trying to identify protein-rich foods that he will tolerate eating on these days.  He doesn't eat eggs, sadly, or I think it wouldn't be so much of a struggle.  He also greatly dislikes greek style yogurt- we've tried the extra protein yoplait, but they all taste chalky to him.  Protein shakes are a big no for the same reason. Today after dance he ate a few bites of cut up fruit and about four bites of orange chicken.  He has to perform tonight and will take some beef jerky along as a snack.  He loves peanut butter and related things, but he dances (meaning lifting and touching) with girls highly allergic to peanuts and nuts, so those are avoided as much as possible.

Oh.  And my DS pretty much never eats breakfast.  I don't blame him- I'm not big on breakfast myself. Sometimes he will grab a granola bar, though sometimes he does wake up hungry and has a small bowl of cereal with milk. 

I don't think it resembles an eating disorder in the least. It's not ideal for sure, and we're trying to work with it, but I would have never thought to think in a disordered direction.

The OCD tendencies push things much more towards eating disorder territory.

Also, a  lot of the mental health disruption associated with eating disorders seems to be the result of the effects of starvation on the brain. You can induce many eating disorder symptoms simply by starving people (research on what happens when you starve people was done following WWII, starting with healthy male study participants who rapidly developed many psychiatric problems). So--if it isn't an eating disorder, it can certainly develop into one if caloric restriction is too low.

 

ETA has your son tried these drinks https://www.chobani.com/products/blended/?format=Drink we love the pina colada flavor.

Edited by maize

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1 hour ago, maize said:

So--if it isn't an eating disorder, it can certainly develop into one if caloric restriction is too low.

 

I have bought ice cream or gelato at times for my kids when my kids have no appetite. Even my oncologist told me to go for ice cream if that’s the only thing I could eat. 

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I'm on a bit of a posting break but breaking that commitment for this.

Anxiety led to disordered eating (skipping meals) in my teen boy, but was not primary disorder.  Celiac also at play, plus the anxiety disorder. 

I've had to treat him food-wise like a toddler - only make him things he likes (can change from week to week), must provide the food ready to eat, make the plate look tempting, prioritise calories, eat with him, let him eat in bed...it's actually quite hard work when you are expecting a teen to be able to manage their own food intake during the day.  Best of luck helping him with this.

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If you’d gotten him a 12” sandwich do you think he would have eaten that?

 I stepped back a lot from what, where, and when I thought my Ds “should” eat to accept what, where, when he will eat.  Currently In practice this seems to mean a lot of pizza and Blt sandwiches and tacos and quesadillas eaten out of hand, standing up, or while watching a movie. Plates and tables seem to cause loss of appetite.  

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If you’d gotten him a 12” sandwich do you think he would have eaten that?

 I stepped back a lot from what, where, and when I thought my Ds “should” eat to accept what, where, when he will eat.  Currently In practice this seems to mean a lot of pizza and Blt sandwiches and tacos and quesadillas eaten out of hand, standing up, or while watching a movie. Plates and tables seem to cause loss of appetite.  

 

Also i too find handing a piece of likely tolerable food to dc works better than asking “are you hungry”

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