Food dilemma with teens

[Tap]

I know I will get some things wrong in this post, so forgive me if I use the wrong word or inappropriate vernacular. I have wanted to post this question for a while but figured I would be berated for doing/saying things wrong, so please be kind. It isn't meant from a mean place, just the place I am.

 

DD14 is 5'11" and 325lbs (update 335lb, I just had her weigh). She is genetically my great-niece.  Both of her bio parents have weight issues, but are average height and are maybe 5-100lbs overweight). She is on medications that make the situation worse, but honestly she was truly a big girl from birth. My x-husband and I are naturally tall, slim people and so are our bio-kids. I cook from scratch mostly and buy healthy ingredients (whole grains, lots of veggies/fruits, healthy meats etc). I know about nutrition but not diets (using that word in a very generic way)  I also buy some junk food too, but in moderation. It was never a problem with my older kids but for dd14, she has very little self control. This is where I am struggling to find a balance. My personality, and my kids have always been the type to self regulate without much thought. No one was ever forced to eat the meals I prepared, they were always allowed to make thier own dinner instead if they desired. My older kids would have always picked a home cooked meal over a restaurant (unless it was a fancy dinner out). I never had food issues with them, so this is new territory for me, even though it has been going on for several years. 

 

I am in trouble with dd14. She is the complete opposite in most ways and since she was raised with the same standards/rules, I have completely ship-wrecked in regards to her diet. She craves different foods that my bio-kids...for instance I have exclusively bought whole grain/seed/nut breads for 20 years but she refuses to eat anything with a seed, nut or oat on it, so she will only eat white bread. (A habit she picked up in public school /bio-dads). If I don't buy her white bread, she refuses anything with bread. She loves fast food, to the point of asking for it every time we are out. Even lying about the last time she ate, to get me to buy it for her. She completely binge eats. She used to lie to me to cover it up, but in the past year, I have started calling her out her lies(not in a meal way). For example, she will eat a whole family size bag of chips in 1-2 sittings, and then tell me someone else ate them too. But when I check with others, they didn't eat any. Since dh and I divorced, it is harder to blame other people since it is usually just the two of us here (or maybe my son, who rarely eats snack junk food). One reason thigs are getting worse, is that I am encouraging her to cook for herself and to feed herself when I am gone. 

I am finding that she adds a large quantity of fat/cheese/mayonnaise to many foods that don't require it. For instance, she asks me to make fried potatoes quite often. I make them from scratch, but precook the potatoes in the microwave and cook them in a cast iron skillet, because it uses hardly any oil that way. I make them for her before I leave for work, and she eats them with eggs before school. The other day, I saw here get a huge tablespoon of horseradish then mix it with 1/4 to 1/2 cup of mayonnaise. Then she stirred that into the friend potatoes.  😞 I protested but she did it super fast and declared that she ate them that way all the time. I just didn't realize, because I am not there. Today, i asked where the lunch meat had gone that I bought 2 days prior. She ate the entire pound in one day. This was natural lunch meat that cost $9lb!  Then told me she found a great new way to eat it. She is putting the meat in a bowl and using it to scoop up mayonnaise. 😞  No bread, just lunch meat and mayo. I guess I can not buy lunch meat but it was one thing that I thought was helping her make her own lunch. Now I wonder what she was taking to school?  Meat and mayo? She doesn't even need a lunch, but insists on eating constantly, so so she takes a lunch anyways. I make her a hot breakfast every day (often 4 scrambled eggs) and she goes to school 30 minutes later. She is only going to school for 1 hour right now. She is taking 2 sandwiches to eat. She gets up at 7am and is home before 10am. I can make a healthier or lighter snack, but she just waits for me to leave and fills up her lunch box with anything she can find. Or will fill in from the snack cupboard at school.  (Teacher provides snacks even tho they are high school because many of the kids are very low income and don't eat at home). 

I used to always have 3+ flavors of ice cream in the house when the older kids were around. I buy whole milk natural ice cream so my kids were taught a serving is a single scoop. It is rich, so for them, it was never a problem. She will sneak it and eat half a gallon in one sitting. I started buying her her own (milk free versions) but only buying pint size to help with portion control, and letting her know I will buy her 2 per month, so she can eat them fast or slow, but that is the limit. She ate them in 2 days. This past week,  I bought her ice cream and the equivalent amount for ds and I. I  wrote individual names on them, so she couldn't claim ignorance and eat them all. She proclaimed that it didn't matter what I wrote, she was going to eat them anyways. 

Dinners are 1/2 to 3/4 veggies, but that is only meal I am home to actually control what she eats. She sneaks around after I  leave the room or go to bed to get more food.  She only goes to school for 1 hour a day due to extreme behaviors, so she is home for 9 hours a day without me. 

I bought salad dressing for salads but saw the empty bottle on the counter barely 2 days later. In 1.5 days she went through a 16oz bottle, on chicken nuggets. I try to offer here things that include the ingredients she likes to teach her to use them in moderation (like blue cheese dressing on salad).But then it back fires and I am left stumped on what to do. Another example,  I used to have juice in the house, but she will chug an entire pitcher in one afternoon. Literally, chugging glass after glass. I try to buy portion sized items to help guide her, like the juice Capri Suns, but then she just has more at one sitting.  But just like this, salad dressings, and the chips, and the ice cream....I try to not buy (or greatly limit) items that seem to create problems for her, but then she just moves onto something else like mayo on everything. 

I asked the local hospital (OHSU in Portland Or) if they had a doctor who saw children who were obese for eating disorders and they called back and started talking to me about gastric bypass. NONONONONO, I want to help her learn to eat healthy, but I haven't found an local option for that. 

HELPPPPPPP!  Remember, I am not home most of the day. I can't monitor her eating. I don't know what to do! We talk about healthy eating to have a healthy life. We talk about food choices and eating to fuel our bodies. We talk about not binging due to boredom and emotional state, but trying to find healthier alternatives instead. She doesn't see a problem with her size, but also doesn't like being obese. She understands, but doesn't seem to be able to make different choices. 

 

ETA: she refuses therapy of any kind. I need to solve this as much as possible with my own actions/conversations with her. When I say I need to know what to do...I mean it literally. 

Edited October 6, 2021 by Tap

[KSera]

28 minutes ago, Tap said:

I want to help her learn to eat healthy, but I haven't found an local option for that. 

It doesn’t sound to me like it’s an issue not knowing what healthy eating is. It sounds like her food cravings are such that to do so is too difficult for her to do so. I assume causes such as Prader Willi syndrome have been ruled out? That’s really difficult. It seems like at her age, she would have to have motivation to work hard in order to make significant changes like this, from what you said, it doesn’t sound like that is there right now. Other than that, it seems like your primary influence is surrounding what foods are in the house. Seems like a situation that really does require a doctor. Are the behaviors still as difficult as they were, or is the opposition less than when she was younger?

[prairiewindmomma]

Fwiw, the foods she likes are ringing sensory bells for me. She likes cold and creamy (icecream, Mayo, salad dressing) and she likes starchy (chicken nuggets, potatoes, white bread). 
 

I will be super honest—resistant 14yo? Your options are really limited. I would not being buying juice or the like. I would limit the food options I buy. I would also be working on helping her learn to make simple meals that will have some buy in from her if she is willing to participate.

If she is willing to listen, I would talk about healthy plates (half veg, 1/4 protein, 1/4 starch) and I would talk about diabetes and other complications that come from poor dietary management. 
 

Were you talking with these people? https://www.ohsu.edu/doernbecher/meet-our-healthy-lifestyles-team And their out the door recommendation was surgery? I am really upset for you…. They should have someone on their team who is looking at the autism/sensory component and the overlap there. Maybe OHSU lumps that more under feeding clinic SL-Ps?

 

[Tanaqui]

You need to speak to a dietician, and honestly, you need to speak to an SLP or to an occupational therapist who handles food issues. You can be upfront that she's generally resistant to therapy and you're just trying to work out your options. You also need to be clear that she is not really in control of her eating. No amount of you talking to her is going to help, because it sounds like she cannot stop doing this. And honestly, with that in mind, I'd *stop* talking to her about it until you've spoken to a professional - you're not helping and for all any of us know you might be making it worse.

 

Edit: I don't mean to keep on this, but this line keeps running through my head and I thought I'd point it out specifically - you say you "talk about" healthy eating and about not binging due to boredom or to soothe her emotional state.

Firstly, you don't know if she is binge eating due to boredom or to soothe her emotional state, and if she's not, that's a non-starter. Secondly, if she is - let's reframe this. What if she was cutting herself, or abusing alcohol? Normally I wouldn't point to these extreme examples, but it does sound like she is well beyond the norm here. Do you think that telling her "You shouldn't cut yourself if you're upset" or "You shouldn't drink because you're bored" would have any positive effect?

She knows that. At the best case scenario, she's tuning you out entirely. At a worst case scenario you're actively adding another stressor to the situation - she binge eats, she knows you'll be upset, so now she feels even worse and eats some more....

If you can't get her to go to therapy or physical therapy or whatever treatment is appropriate then you should definitely be doing your own therapy to help learn how to handle this. I don't know what's going on with her, but I do know that it sounds like she has very little control over this. Since I don't know what's going on I really don't know the right way for you to speak to her about this, but something in me is certain that talking to her about healthy eating choices is the wrong way.

Second edit: To be clear, what makes me think that she is not in control of her own behavior here is not her weight. The weight is a symptom. What makes me think her problem is much deeper is the lying. She lies to get you to buy her food, she lies when she's eaten more than you'll approve of... unless she is a compulsive liar at all times, this is really bizarre behavior. It would be easier to eat less than to gorge herself on salad dressing and chicken nuggets and then try to deny it.

There may be a physical problem here, or a psychological problem, or both - but either way, I don't think she's able to just willpower her way into not eating so much.

Edited October 6, 2021 by Tanaqui

[kiwik]

Yes.  It probably has little to do with hunger or self control.

[Lecka]

Is she taking any medication?  Do you know if she has a generuc disorder?  
 

Just from talking to other parents — it seems like a lot of times with kids with autism either medication or a genetic disorder can be involved.

 

It can also be hard to add in activity as some kids are resistant to it and just very still.  From talking to other parents — there can be low muscle tone involved with this. 

 

Sensory issues can include not recognizing the feeling of being full.  

 

Also kids can want the same texture and flavor all the time, and not like it when foods taste subtly different from one time to the next.  This can be part of fast food or packaged food preferences — the food is the same every time.

 

I think it’s good to make an effort — I’m not saying “throw up your hands and do nothing.”  But this is something that is hard and parents who are doing everything right can still have the same outcome.  Biological parents and siblings can look totally different, too.  I think it’s likely this is not something a parent is doing wrong.  (Edit — what I mean is,  it’s routine to me to see a family of parents and siblings, and the child with autism is the one who stands out.)

Edit:  I think I have also heard low muscle tone or things like that can make it more tiring to chew, and this can have to do with wanting soft foods, on top of other reasons there might be a preference for soft foods.  

Edit:  I have also heard there are genetic disorders or just variants or whatever, and parents get genetic testing and find out basically everyone with this variant has similar food/weight issues.  

Edited October 6, 2021 by Lecka

[Carrie12345]

4 hours ago, Tap said:

I asked the local hospital (OHSU in Portland Or) if they had a doctor who saw children who were obese for eating disorders and they called back and started talking to me about gastric bypass. NONONONONO, I want to help her learn to eat healthy, but I haven't found an local option for that. 

HELPPPPPPP!  Remember, I am not home most of the day. I can't monitor her eating. I don't know what to do! We talk about healthy eating to have a healthy life. We talk about food choices and eating to fuel our bodies. We talk about not binging due to boredom and emotional state, but trying to find healthier alternatives instead. She doesn't see a problem with her size, but also doesn't like being obese. She understands, but doesn't seem to be able to make different choices. 

 

ETA: she refuses therapy of any kind. I need to solve this as much as possible with my own actions/conversations with her. When I say I need to know what to do...I mean it literally. 

I wish I had real advice. 😔 

That surgery recommendation really freaks me out. My understanding is that that option *requires* willing participation to stick to “the rules” and a solid mental/emotional base from which to proceed. Even if we weren’t discussing a CHILD, it doesn’t sound like this fits the bill at all.

I don’t think there’s a single “normal parent thing” you aren’t doing. You are not in a “normal” situation. I wonder if there’s a therapist that *you can see who can help you sort through ideas?

Healthy eating - even relatively healthy - in this society pretty much requires buy-in. Other than sheer force, I don’t know how one gets around that.

[Pawz4me]

1 hour ago, Carrie12345 said:

Healthy eating - even relatively healthy - in this society pretty much requires buy-in. Other than sheer force, I don’t know how one gets around that.

QFT. We live in an incredibly obesogenic environment.

Add to that that overeating is often rooted in causes that go way, way beyond simple food choices or lack of willpower and . . it's a really, really hard issue to deal with.

@Tap-- Have you raised your concerns to her pediatrician/primary care doctor? Spoken to the doctor (with DD not aware) about your concerns? It sounds to me as if her issues go far beyond food choices or lack of control (which as I said above is the case for many obese people). I do think it sounds as if some genetic testing might be in order, and then (depending on what that shows) a referral or referrals to some other resources. At the very least I think both of you would benefit by outsourcing some of this to a dietician who is used to working with teens. I think you need to treat this like any other medical issue and not assume you have to deal with it on your own. It's not your fault, and it's not her fault.

[Lecka]

I just re-read and saw that she is on medications.  

I don’t know if you are able to have an idea of how much of this is medication side effects, but this is so common and it is really too bad as a side effect, but this medication can truly make a difference in children’s lives when it is needed, and as far as I have known “in real life” it is not prescribed lightly and parents do not take this step lightly.  
 

It’s still worth it to do anything that seems good to do — but this is just not something where you have made some mistake.  

 

 

 

 

[Innisfree]

Absolutely talk with doctors, dietician, OT or someone who deals with food issues. Beyond that, all you can really control here is what's available in the house for her to eat. If no white bread is there, she can't eat it. Ditto mayonnaise, etc.

Will she snack on veggies, if they're put casually on the table near her? Carrots, cucumber sticks, sliced bell peppers, cherry tomatoes? This has always been the most effective way to get vegetables into people here. No comment at all, just available. Chips, mayo, dips not available (though we do have hummus for dipping: healthier than some other options).

I know you deal with huge behavior issues. Would simply not providing any more of the unhealthy foods prompt dangerous behavior?

It's hard to be the healthy person who can't have foods at home that you can manage perfectly well, but if she doesn't have the self control to limit servings, then the only point of control is what you bring into the house.

[DawnM]

It sounds very much like a trauma response.   Many turn to drugs, sex, and other things that make them feel better for the moment.

Is there any history of s*xual abuse? Overeating/staying undesirable can be a reason for wanting to stay overweight.   Please don't actually answer that question on here, it is more of a reflection question.

You may want to explain the cost of the things like the meat and why she can't have a whole pound, but the more you bring up her eating and weight, my guess. is that the more she will feel bad about herself and keep eating.

Does she go to school?   Is there a therapist who works with the school?   You could start with the school counselor and explain some of your concerns.   She/he will talk to her and another voice suggesting a therapist might be good.   sometimes kids hear it better from outside.

Edited October 6, 2021 by DawnM

[Innisfree]

For the lunch meat, I'd buy a cheaper version. She's going to be hungry, and relatively low-fat lunch meat is better for her than the bread or potatoes. Accept that she's going to eat a lot for the time being, and get something cheap. Could you cook a turkey breast over the weekend that she could slice? Or roast a chicken? Much cheaper than sliced deli meat. Or just get the cheap packaged stuff.

[Katy]

Sourdough bread has a lower glycemic index. Freezers can be locked. 

I would explore all medical options including changing medicine and surgery, but start with a dietitian. Preferably one at a children’s hospital. I’m sure there’s a combination of medicine, hormones, and microbiome that make her completely incapable of self-regulation in this area. 

[ktgrok]

3 hours ago, kiwik said:

Yes.  It probably has little to do with hunger or self control.

Well, yes and no. 

Binging like that and constantly needing to eat are often a biological thing, like hunger. It is driven mostly by blood sugar/insulin but also by other hormones from the gut (whole list of them) as well as the gut biome. It's complicated. It IS biological. It is not about self control though, that part is very true. 

If surgery is not an option, is the clinic willing to prescribe medication? Are you open to that?  Might be worth making an appointment to discuss options other than surgery. If it is a weight loss center worth its salt they won't do surgery on someone unwilling to follow the protocols anyway, so it isn't that they will rush her into that. The surgical process starts with full medical evaluations including looking at what medications she is on may be contibuting to the issue, metabolic issues, etc. Then counseling regarding nutrition as well as at least one therapist visit before anyone will even consider scheduling therapy. The nutritionist, surgeon, and therapist must agree she is a good candidate before she would qualify. So it isn't a quick thing where they will have her scheduled for surgery after an initial consultation. 

That said, as someone that had the surgery, it was life changing and I'd do it again in a heartbeat. And younger is likely better. 

Oh, is she exercising at all? Post surgery, when my hormones get wacky and I start having binging and craving urges I find daily moderate exercise of 20-30 minutes helps a lot. Takes about a week, but it helps with the insulin sensitivity for me, making me less hungry. But that wasn't true before surgery for me, before surgery it made me hungrier. Worth trying if she will try. But surgery really does change those gut hormones that control our desire to eat. 

[Farrar]

Seconding everything Tanaqui said.

You really need professional support. And with a problem of this degree, solutions that work for other kids where you talk about healthy habits are likely not just insufficient, but counterproductive. You seem aware that you may be using the wrong terminology. I don't seem anything "wrong" with the way you're talking about these things, but when a kid needs professional intervention and specific strategies, all of us will talk about it "wrong." 

[itsheresomewhere]

8 hours ago, KSera said:

It doesn’t sound to me like it’s an issue not knowing what healthy eating is. It sounds like her food cravings are such that to do so is too difficult for her to do so. I assume causes such as Prader Willi syndrome have been ruled out? That’s really difficult. It seems like at her age, she would have to have motivation to work hard in order to make significant changes like this, from what you said, it doesn’t sound like that is there right now. Other than that, it seems like your primary influence is surrounding what foods are in the house. Seems like a situation that really does require a doctor. Are the behaviors still as difficult as they were, or is the opposition less than when she was younger?

I agree with checking for Prader Willi Syndrome.  Sadly, if it is not an obvious case it is missed.  They now knowledge that you can have a half gene and have it.  If her genetic testing was done 5-10 years ago, they have discovered a lot in that time. I would ask them to take another look. 

[Tap]

I am heading out the door to work so I only have a few minutes to answer. I will lump a bunch of answers here.

Here school is a therapeutic day school, so they are supportive and provide phenomenal counselors, but she refuses to talk about anything with anyone so that option is out as a resource. They also know that the things she brings to school to eat, are picked out after I leave for work.

She saw a geneticist, but they weren't terribly helpful. Mostly because she refuses to have blood draws. They tested her with a cheek swab for one issue, but it came back negative. They are willing to keep seeing her, but since she won't do a blood draw, it really limits what they can do. 

Her medications are managed by a psychiatrist. We have talked multiple times about the weight and med link. (I also work in pharmacy) We have changed her meds a few times to see if that helps, but doesn't make any difference in the long run.  We have not tried weight loss meds because she is very high risk for some other issues. 

I know I need to work with how we talk about things. This is where I know we are at. But she refuses. That only leaves teaching her about nutrition and what a normal portion size is. She is a big girl, so I don't expect her to only eat a portion as described on a box. But, if she has cereal it isn't in a soup bowl, it is in a mixing bowl. ETC 

She doesn't have any known physical trauma, but she has been taunted about her weight since she was little by other children. Add in her autism, behaviors and everything mental, and she has had a very rough life. 

Since it just the two of us now. I have started greatly limiting the food in the house. Things like Juice, chips, ice cream are no longer around at all or in a very controlled, limited way. 

I know that surgery is an option in the long run, but we need to get the way she eats under control and see what happens there first. She needs to at least recognize there is a problem. BY working in pharmacy, I see so many patients who tried surgery and had it fail, because they didn't change how they ate in the long run. 

 

Thank you for everyone's advice. I really appreciate it!

[teachermom2834]

I don’t have any advice even though I grew up around compulsive eating and I chronically struggle with an extra 40-50 pounds. My mother had issues more like you are describing with your dd. 
 

I am just popping in to say I don’t think any of this is your fault or that you have messed up in what you have said and done. This situation is extreme and the root of it is not anything you have said/not said or done/not done. 
 

 

[Lecka]

I have heard of people who have a situation where they decide on sedation for a dental procedure, and then do blood draws during the sedation.

It’s one of those things I would never have thought of, if that ever comes up.  

[ktgrok]

18 minutes ago, Tap said:

 

Since it just the two of us now. I have started greatly limiting the food in the house. Things like Juice, chips, ice cream are no longer around at all or in a very controlled, limited way. 

I know that surgery is an option in the long run, but we need to get the way she eats under control and see what happens there first. She needs to at least recognize there is a problem. BY working in pharmacy, I see so many patients who tried surgery and had it fail, because they didn't change how they ate in the long run. 

 

Yes to both of these. 

The best thing you can do, that doesn't require buy in, is to just limit what is in the house. Can YOU meet with a nutritionis that works with obesity? Again, someone connected to the place that does surgery is ideal, as they really get how obesity works, and they will steer you toward the kinds of foods she'd need to eat if she does have surgery, so win/win. "healthy whole grains" are often not a workable option for those dealing with obesity, as they trigger cravings for more carbs. The obese person truly has a very different metabolism. 

She will not be able to limit portion size when her body is screaming at her for more food. ESPECIALLY breakfast cereal - that's a known binge food for people with weight issues. She can't limit that anymore than an alcoholic can limit themselves to a serving size of beer. 

But, you are also right that she needs to acknowledge the problem, at the least. Being ABLE to eat the right way took surgery, for me anyway. But I did have to want to eat right and know how to do it to make the surgery work. Before surgery I knew the right things to do, but my body was fighting me every step of the way. Surgery let me DO the things I knew I should be doing. So you don't need actual good compliance before surgery, but you do need buy in on the need for it, if that makes sense. Most surgical programs require months of work on that before they do surgery. If you are not being compliant, you don't get the surgery. 

Also, regarding meds, there are a lot of options beyond the old amphetamine approaches - many are based on regulating insulin resistance instead. Have you explored those options? Again, an obesity specialist is the way to go with that, they will be used to figuring out pros and cons of various drugs compared to risk factors, since a lot of the patients they deal with are high risk for heart problems, etc already. 

[Tanaqui]

Note: If Prader-Willis is a possibility - and I'm not saying that it *is*, simply running with that hypothesis - then surgery is going to do approximately nothing. The point of surgery is that you reach satiety before overeating. As I understand it, people with Prader-Willis simply don't reach satiety. Ever. Nothing is going to make them feel full and stop eating because they're full, because there is never going to be a signal.

[WildflowerMom]

Until you can get professional help, can you put a lock on the cabinets and fridge?   What if you prepare her a few sandwiches (just use the white bread, it's fine) and put them in a cooler.  Lock up everything and tell her the cooler is fair game, have at it.   Put plenty of decent snacks in there and if she eats every single thing before you even get home, it's fine.   It's better than a bowl of Mayo, ykwim?   I wouldn't buy anything if it's not something she needs to eat.   She can't handle the temptation and then when she eats it, it's not good for her, so just don't have it in the house.   But def get pro help.   And (((hugs))) tap.  You're doing great!  

[Kassia]

44 minutes ago, Tanaqui said:

Note: If Prader-Willis is a possibility - and I'm not saying that it *is*, simply running with that hypothesis - then surgery is going to do approximately nothing. The point of surgery is that you reach satiety before overeating. As I understand it, people with Prader-Willis simply don't reach satiety. Ever. Nothing is going to make them feel full and stop eating because they're full, because there is never going to be a signal.

This is what I've always experienced but I've never been diagnosed with this.  I can eat and eat and eat and never get full.  Intuitive eating would never work for me.  I have to be vigilant with serving sizes and be hungry much of the time to maintain my weight.  Sometimes (like this week) I am extremely stressed and don't have the strength to stop eating when I always always want more so I eat way too much and then that just adds to the stress.  It's really hard.

ETA - I have hypothalamus dysfunction and am going for an MRI today to rule out a pituitary tumor.

 

Edited October 6, 2021 by Kassia

[TechWife]

11 hours ago, Tap said:

I know I will get some things wrong in this post, so forgive me if I use the wrong word or inappropriate vernacular. I have wanted to post this question for a while but figured I would be berated for doing/saying things wrong, so please be kind. It isn't meant from a mean place, just the place I am.

 

DD14 is 5'11" and 325lbs (update 335lb, I just had her weigh). She is genetically my great-niece.  Both of her bio parents have weight issues, but are average height and are maybe 5-100lbs overweight). She is on medications that make the situation worse, but honestly she was truly a big girl from birth. My x-husband and I are naturally tall, slim people and so are our bio-kids. I cook from scratch mostly and buy healthy ingredients (whole grains, lots of veggies/fruits, healthy meats etc). I know about nutrition but not diets (using that word in a very generic way)  I also buy some junk food too, but in moderation. It was never a problem with my older kids but for dd14, she has very little self control. This is where I am struggling to find a balance. My personality, and my kids have always been the type to self regulate without much thought. No one was ever forced to eat the meals I prepared, they were always allowed to make thier own dinner instead if they desired. My older kids would have always picked a home cooked meal over a restaurant (unless it was a fancy dinner out). I never had food issues with them, so this is new territory for me, even though it has been going on for several years. 

 

I am in trouble with dd14. She is the complete opposite in most ways and since she was raised with the same standards/rules, I have completely ship-wrecked in regards to her diet. She craves different foods that my bio-kids...for instance I have exclusively bought whole grain/seed/nut breads for 20 years but she refuses to eat anything with a seed, nut or oat on it, so she will only eat white bread. (A habit she picked up in public school /bio-dads). If I don't buy her white bread, she refuses anything with bread. She loves fast food, to the point of asking for it every time we are out. Even lying about the last time she ate, to get me to buy it for her. She completely binge eats. She used to lie to me to cover it up, but in the past year, I have started calling her out her lies(not in a meal way). For example, she will eat a whole family size bag of chips in 1-2 sittings, and then tell me someone else ate them too. But when I check with others, they didn't eat any. Since dh and I divorced, it is harder to blame other people since it is usually just the two of us here (or maybe my son, who rarely eats snack junk food). One reason thigs are getting worse, is that I am encouraging her to cook for herself and to feed herself when I am gone. 

I am finding that she adds a large quantity of fat/cheese/mayonnaise to many foods that don't require it. For instance, she asks me to make fried potatoes quite often. I make them from scratch, but precook the potatoes in the microwave and cook them in a cast iron skillet, because it uses hardly any oil that way. I make them for her before I leave for work, and she eats them with eggs before school. The other day, I saw here get a huge tablespoon of horseradish then mix it with 1/4 to 1/2 cup of mayonnaise. Then she stirred that into the friend potatoes.  😞 I protested but she did it super fast and declared that she ate them that way all the time. I just didn't realize, because I am not there. Today, i asked where the lunch meat had gone that I bought 2 days prior. She ate the entire pound in one day. This was natural lunch meat that cost $9lb!  Then told me she found a great new way to eat it. She is putting the meat in a bowl and using it to scoop up mayonnaise. 😞  No bread, just lunch meat and mayo. I guess I can not buy lunch meat but it was one thing that I thought was helping her make her own lunch. Now I wonder what she was taking to school?  Meat and mayo? She doesn't even need a lunch, but insists on eating constantly, so so she takes a lunch anyways. I make her a hot breakfast every day (often 4 scrambled eggs) and she goes to school 30 minutes later. She is only going to school for 1 hour right now. She is taking 2 sandwiches to eat. She gets up at 7am and is home before 10am. I can make a healthier or lighter snack, but she just waits for me to leave and fills up her lunch box with anything she can find. Or will fill in from the snack cupboard at school.  (Teacher provides snacks even tho they are high school because many of the kids are very low income and don't eat at home). 

I used to always have 3+ flavors of ice cream in the house when the older kids were around. I buy whole milk natural ice cream so my kids were taught a serving is a single scoop. It is rich, so for them, it was never a problem. She will sneak it and eat half a gallon in one sitting. I started buying her her own (milk free versions) but only buying pint size to help with portion control, and letting her know I will buy her 2 per month, so she can eat them fast or slow, but that is the limit. She ate them in 2 days. This past week,  I bought her ice cream and the equivalent amount for ds and I. I  wrote individual names on them, so she couldn't claim ignorance and eat them all. She proclaimed that it didn't matter what I wrote, she was going to eat them anyways. 

Dinners are 1/2 to 3/4 veggies, but that is only meal I am home to actually control what she eats. She sneaks around after I  leave the room or go to bed to get more food.  She only goes to school for 1 hour a day due to extreme behaviors, so she is home for 9 hours a day without me. 

I bought salad dressing for salads but saw the empty bottle on the counter barely 2 days later. In 1.5 days she went through a 16oz bottle, on chicken nuggets. I try to offer here things that include the ingredients she likes to teach her to use them in moderation (like blue cheese dressing on salad).But then it back fires and I am left stumped on what to do. Another example,  I used to have juice in the house, but she will chug an entire pitcher in one afternoon. Literally, chugging glass after glass. I try to buy portion sized items to help guide her, like the juice Capri Suns, but then she just has more at one sitting.  But just like this, salad dressings, and the chips, and the ice cream....I try to not buy (or greatly limit) items that seem to create problems for her, but then she just moves onto something else like mayo on everything. 

I asked the local hospital (OHSU in Portland Or) if they had a doctor who saw children who were obese for eating disorders and they called back and started talking to me about gastric bypass. NONONONONO, I want to help her learn to eat healthy, but I haven't found an local option for that. 

HELPPPPPPP!  Remember, I am not home most of the day. I can't monitor her eating. I don't know what to do! We talk about healthy eating to have a healthy life. We talk about food choices and eating to fuel our bodies. We talk about not binging due to boredom and emotional state, but trying to find healthier alternatives instead. She doesn't see a problem with her size, but also doesn't like being obese. She understands, but doesn't seem to be able to make different choices. 

 

ETA: she refuses therapy of any kind. I need to solve this as much as possible with my own actions/conversations with her. When I say I need to know what to do...I mean it literally. 

 

ETA: I hadn't read all of the replies when I posted this, so disregard any questions that you've already answered. Sorry to be a bother by doing that.

This is such a hard spot to be in with a teen.

Truly helping her understand that this is about her health is key.

I think unless she takes control of it, anything you do may turn out to be temporary. Have you spoken with her primary care doctor about it? FWIW, this is not a conversation that I would initially have in front of the teen - call the office and ask for a call back. The primary care doctor should be willing take the lead on referrals for nutrition education & exercise programs during an appointment and then schedule follow ups to monitor her. It is also likely that primary care will want to do some blood work to rule out specific issues and maybe a base line cardiac stress test. Usually at this age a parent is involved in the educational aspect, but the target audience is the teen. I really think a good program is worth traveling for - thinking an hour each way (easy for me to say I know, I have a flexible schedule).

Also, try to keep an open mind about bariatric surgery. It is a helpful tool for many people who would not otherwise be able to improve their health. I have no idea what the guidelines are for teen's getting the surgery, but I do know it is life changing for people of all ages, including teens. There are different types of procedures available - it's not a one-size fits all approach.

I've not been in a situation like yours, so take this with a grain of salt, but I would not lock up or hide food. From what I have observed with family & friends it leads to a lot of conflict, lying & stealing. She probably is hungry - one sandwich for lunch may not provide enough nutrients at this point.  I'm not sure how a registered dietician would approach it but I do know tapering down food intake as a weight loss plateau is reached is pretty common to lead to further weight loss. It would seem impossible to me if I were eating at will and someone told me I suddenly had to start restricting my intake. Reachable, intermediate goals are important, I think.

Does she have a reason for refusing therapy & is it possible to address that concern?

ETA - is this within commuting distance for you? Our children's hospital runs a similar program. You can ask for more frequent follow ups, etc. than their standard (at least you can at ours), the worst thing they can say is no. Ask if they have an exercise component or group cooking or exercise classes for teens. https://www.ohsu.edu/doernbecher/welcome-healthy-lifestyles

Edited October 6, 2021 by TechWife

[ktgrok]

22 minutes ago, WildflowerMom said:

Until you can get professional help, can you put a lock on the cabinets and fridge?   What if you prepare her a few sandwiches (just use the white bread, it's fine) and put them in a cooler.  Lock up everything and tell her the cooler is fair game, have at it.   Put plenty of decent snacks in there and if she eats every single thing before you even get home, it's fine.   It's better than a bowl of Mayo, ykwim?   I wouldn't buy anything if it's not something she needs to eat.   She can't handle the temptation and then when she eats it, it's not good for her, so just don't have it in the house.   But def get pro help.   And (((hugs))) tap.  You're doing great!  

Do not lock up the food. Not without her buy in - you will create even more problems. This is how you get people eating out of the trash can. (yes, this happens in people with binge eating - its fairly common)

[WildflowerMom]

Just now, ktgrok said:

Do not lock up the food. Not without her buy in - you will create even more problems. This is how you get people eating out of the trash can. (yes, this happens in people with binge eating - its fairly common)

Yeah, you do need to talk with her about it and explain why.   I went to school with a girl with prader and other issues and they had to have locks on the fridge and such.   But I'm sure they discussed it with her.   They may have even done something with the trash can, that I don't know.  

[Tanaqui]

The trouble is that this young woman is alone for several hours of the day, and it's already stated she has behavioral issues. That's why I didn't recommend locks myself - I can see lots of failure modes in this situation, none of them pleasant. Eating out of the trash would be bad enough - but what if she started eating non-food items? Or leaving the house and stealing food or trying to get it in some other way? Or turned to destructive behavior to get at the locked cabinets?

I don't know what's plausible here, but I really would not recommend locks unless advised by a professional. Again, even if she won't speak to somebody, Tap can.

[TechWife]

1 hour ago, Tap said:

 

She saw a geneticist, but they weren't terribly helpful. Mostly because she refuses to have blood draws. They tested her with a cheek swab for one issue, but it came back negative. They are willing to keep seeing her, but since she won't do a blood draw, it really limits what they can do. 

 

Do they have a CCLP that can work with her about the blood draw problem? They are very valuable. It might be worth a trip to a children's hospital lab to have the blood work done there. If you do that, call ahead, explain the problem and ask for a CCLP to be present to work with her. You can even call the CCLP ahead of time to let her/him know her typical reactions when she needs labs done. CCLP's are amazing.

[SKL]

Is there any way for her to have something to do during the day, outside the house and away from food, when you aren't with her?  Some kind of physical class/activity in the middle of your work shift?  Working with a fitness coach at the local rec center / YMCA?

I feel like being home alone for long time periods is likely to cause problems one way or another.

[klmama]

Before going to a children's hospital lab, I encourage you to talk with other parents (particularly of special needs teens, if possible) to find out their experiences there.  I trustingly took one of my dc to the local children's hospital lab, thinking they'd do a better job than at the pediatrician's office.  It turned out to be the most traumatic blood draw ever.  Honestly, I've never seen a group of people so totally inept at dealing with children.  Obviously, it may not be that way where you are, but it's worth finding out in advance. 

[prairiewindmomma]

The more I have thought about this.....I know she isn't willing to receive therapy for herself, but are you receiving therapy for you---both to deal with the stress of caring for her, but also finding someone with SN expertise who can help guide you in decision making? 

You don't need to answer here, but if you aren't seeing someone, honestly, I think that's the direction I'd point you in.  I'm looking at my IRL friend group of moms of SN teens who are all moving into early adulthood and all of us are wrestling with big issues. Sometimes we need someone who is looking at the forest from the trees who can say, "You've got bigger issues to deal with than this one" or "here's a resource you might consider" or "That is a huge and legitimate fear over something you can't control. Let's sit together with this for a minute and give you some emotional support."

[hippymamato3]

Does she have low IQ in addition to autism? Is she capable of understanding portion sizes and calorie counts? Just trying to get a better grasp of the situation.

[Longtime Lurker]

9 hours ago, Lecka said:

I have heard of people who have a situation where they decide on sedation for a dental procedure, and then do blood draws during the sedation.

It’s one of those things I would never have thought of, if that ever comes up.  

We do this for DS23 with autism. It works really well. Our situation is different, though, because DS functions at a 2-year-old level so the whole issue of consent is very different. 

[Terabith]

4 minutes ago, Longtime Lurker said:

We do this for DS23 with autism. It works really well. Our situation is different, though, because DS functions at a 2-year-old level so the whole issue of consent is very different. 

I believe one of the issues is that because of her weight, sedation is not super safe, and so cannot be performed for anything other than an absolute emergency.  But the inability to have blood drawn limits a lot of treatment options.  

[Tap]

7 minutes ago, Terabith said:

I believe one of the issues is that because of her weight, sedation is not super safe, and so cannot be performed for anything other than an absolute emergency.  But the inability to have blood drawn limits a lot of treatment options.  

 

8 minutes ago, Terabith said:

We do this for DS23 with autism. It works really well. Our situation is different, though, because DS functions at a 2-year-old level so the whole issue of consent is very different. 

 

13 minutes ago, Longtime Lurker said:

I have heard of people who have a situation where they decide on sedation for a dental procedure, and then do blood draws during the sedation.

It’s one of those things I would never have thought of, if that ever comes up.  

 

 

8 hours ago, TechWife said:

Do they have a CCLP that can work with her about the blood draw problem? They are very valuable. It might be worth a trip to a children's hospital lab to have the blood work done there. If you do that, call ahead, explain the problem and ask for a CCLP to be present to work with her. You can even call the CCLP ahead of time to let her/him know her typical reactions when she needs labs done. CCLP's are amazing.

 

7 hours ago, klmama said:

Before going to a children's hospital lab, I encourage you to talk with other parents (particularly of special needs teens, if possible) to find out their experiences there.  I trustingly took one of my dc to the local children's hospital lab, thinking they'd do a better job than at the pediatrician's office.  It turned out to be the most traumatic blood draw ever.  Honestly, I've never seen a group of people so totally inept at dealing with children.  Obviously, it may not be that way where you are, but it's worth finding out in advance. 

Yes and I agree to all the above.

 

She has her blood draws done at Doernbecher (and attempts at Randall's children's), and they have been amazing. But she is large and violent when someone tries to get a blood draw. She has PTSD from when she was restrained as a little kid. We have to go and do full sedation like the do for surgery. We have tried countless other ideas and they have all failed. Seriously...we have tried all the conventional ways. The only one I have considered but not tried is hypnotism, but that would require her trauma to be resolved before it would work. She won't work with a therapist, so that is out.  The best of the best have tried and she will only do a draw if she is completely sedated. The anesthesiologists are now refusing to do any more sedation for blood draws due to her obesity (breathing risk). That was about 2 years ago and about 25-50lbs ago.  A blood drawn in this case is considered elective, so they can refuse. There is also data that shows that repeated use of anesthesia is not good for the brain. 

[Tap]

7 hours ago, SKL said:

Is there any way for her to have something to do during the day, outside the house and away from food, when you aren't with her?  Some kind of physical class/activity in the middle of your work shift?  Working with a fitness coach at the local rec center / YMCA?

I feel like being home alone for long time periods is likely to cause problems one way or another.

There is no way to transport her. She can't ride with an Uber or such, due to her violence. She has to have someone with her and I am at work. Also, she is in  weird age group where most classes stop at 13 for kids and start at 16/adult. 

Most special needs programs require an adult chaperone for people like her. I can't just hire an adult to accompany her, due to her violence.

[Longtime Lurker]

6 minutes ago, Tap said:

There is no way to transport her. She can't ride with an Uber or such, due to her violence. She has to have someone with her and I am at work. Also, she is in  weird age group where most classes stop at 13 for kids and start at 16/adult. 

Most special needs programs require an adult chaperone for people like her. I can't just hire an adult to accompany her, due to her violence.

Maybe the priority should be increasing the length of her school day. I know this is not at all simple, but it may help at least some with the eating issue and also fill her time more.

[Tap]

4 minutes ago, Longtime Lurker said:

Maybe the priority should be increasing the length of her school day. I know this is not at all simple, but it may help at least some with the eating issue and also fill her time more.

That is the plan! She was suspended twice in the first 2 weeks of school. I think she attended 2 full days over that time and a few half days when she was sent home for her behaviors.  She then refused school for a week or two. Going back one hour a day was the compromise.  We will increase from here, but so far she is refusing any more. 

[Longtime Lurker]

11 minutes ago, Tap said:

That is the plan! She was suspended twice in the first 2 weeks of school. I think she attended 2 full days over that time and a few half days when she was sent home for her behaviors.  She then refused school for a week or two. Going back one hour a day was the compromise.  We will increase from here, but so far she is refusing any more. 

Oh, wow, that sounds really hard. DS has behavior issues as well, although they can't send him home for them. His school is equipped to handle aggressive behaviors and he has an official behavior plan. I think your situation is more complicated since your DD is high-functioning, but also has serious problem behaviors. That is a really challenging combination 😞 

[Tap]

1 hour ago, hippymamato3 said:

Does she have low IQ in addition to autism? Is she capable of understanding portion sizes and calorie counts? Just trying to get a better grasp of the situation.

She does have both. She struggles with this concept, but understands it enough if I base it on logical portions. We have little bowls that used for things like chips, dessert etc. I talk about a small cereal bowlful being a serving of most things.  She will only eat out of bowls, so one regular bowl is a dinner portion.  She has a tendency to grab mixing bowls for many things though if I am not home. 😞 

We talk about mayonnaise for making bread not dry, and being lightly applied. We talk about dipping sauces being one squirt of sauce like salad dressing. etc. We have regular drinking glasses, but she used her own money and bought herself some 24oz plastic glasses (she was with her dad). We talk about those being water glasses. But I have seen her fill it with juice and chug it. I do try to discourage that behavior, talking about sipping juice etc. But she will do it in front of me, just to be obstinate if she is mad at me. She knows I can't really stop her, so she does it anyways. 

She won't weigh or measure. So everything needs to be more general.

I sometimes do little things to make things less convenient. Like giving her a full serving of food, and then putting the rest away. Otherwise, she will keep going back again and again to keep eating. She is always drinking water, so little tricks like drinking before eating doesn't help.

[Tap]

22 minutes ago, Longtime Lurker said:

Oh, wow, that sounds really hard. DS has behavior issues as well, although they can't send him home for them. His school is equipped to handle aggressive behaviors and he has an official behavior plan. I think your situation is more complicated since your DD is high-functioning, but also has serious problem behaviors. That is a really challenging combination 😞 

She is at a full therapeutic day school. They all have an FBA and IEP. Every staff is trained for aggressive behaviors. Only kids with aggression/violence go there. She is often restrained and they talk her down daily from major outbursts. She is threatening more and more and has followed through several times. She once punched a large staff member in the face because he was telling her she couldn't go in a hallway (another student was struggling in there). He was a large man and she just pulled back and punched him. She got suspended the second day of school for threatening to punch principal in the face. She was restrained a few times and she was trying to leave campus. The principal and I are working together to keep her in school, but also working toward residential treatment for her. We need the paperwork to show her escalation and increase in violence. If she wasn't suspended that day, she would have likely escalated and punched someone. The next time that happens she is going to get arrested due to her age/size. 

The second times she was suspending it was for aggression, property destruction and vandalism. She drew up and down a long hallway with a marker and then illustrated several naked people, genitalia and cus words. 

 

Edited October 7, 2021 by Tap

[ktgrok]

5 minutes ago, Tap said:

We talk about mayonnaise for making bread not dry, and being lightly applied. We talk about dipping sauces being one squirt of sauce like salad dressing. etc. We have regular drinking glasses, but she used her own money and bought herself some 24oz plastic glasses (she was with her dad). We talk about those being water glasses. But I have seen her fill it with juice and chug it. I do try to discourage that behavior, talking about sipping juice etc. But she will do it in front of me, just to be obstinate if she is mad at me. She knows I can't really stop her, so she does it anyways. 

She won't weigh or measure. So everything needs to be more general.

I sometimes do little things to make things less convenient. Like giving her a full serving of food, and then putting the rest away. Otherwise, she will keep going back again and again to keep eating. She is always drinking water, so little tricks like drinking before eating doesn't help.

Can you buy light Mayo (NOT the fat free stuff, that stuff is gross, but the Light Hellmans isn't bad)? And Bolthouse Farms dressing is still creamy and yummy but 2 tablespoons is 40 calories instead of 80-120 like regular dressing. And don't buy juice. If she really wants a "sweet" drink buy some crystal light. Yeah, this stuff isn't natural and such, but artificial sweeteners MIGHT be bad long term, but her obesity is a DEFINITE risk short term, right now. So focus on foods that are lower calorie, but similar to what she likes. Smart Pop popcorn instead of chips, light mayo, find a brand of white bread that is lower calorie (some are less than half the calories per slice than others!!!), etc. Getting her lower calorie food is going to work better right now than convincing her to eat less. 

You can find videos, say by Coach Greg on youtube that show lower calorie alternatives where you can get way bigger servings. Not a fix, but it really really can make a difference. 

[Tap]

13 hours ago, ktgrok said:

Well, yes and no. 

Binging like that and constantly needing to eat are often a biological thing, like hunger. It is driven mostly by blood sugar/insulin but also by other hormones from the gut (whole list of them) as well as the gut biome. It's complicated. It IS biological. It is not about self control though, that part is very true. 

If surgery is not an option, is the clinic willing to prescribe medication? Are you open to that?  Might be worth making an appointment to discuss options other than surgery. If it is a weight loss center worth its salt they won't do surgery on someone unwilling to follow the protocols anyway, so it isn't that they will rush her into that. The surgical process starts with full medical evaluations including looking at what medications she is on may be contibuting to the issue, metabolic issues, etc. Then counseling regarding nutrition as well as at least one therapist visit before anyone will even consider scheduling therapy. The nutritionist, surgeon, and therapist must agree she is a good candidate before she would qualify. So it isn't a quick thing where they will have her scheduled for surgery after an initial consultation. 

That said, as someone that had the surgery, it was life changing and I'd do it again in a heartbeat. And younger is likely better. 

Oh, is she exercising at all? Post surgery, when my hormones get wacky and I start having binging and craving urges I find daily moderate exercise of 20-30 minutes helps a lot. Takes about a week, but it helps with the insulin sensitivity for me, making me less hungry. But that wasn't true before surgery for me, before surgery it made me hungrier. Worth trying if she will try. But surgery really does change those gut hormones that control our desire to eat. 

When I asked them about help with life style, behavioral supports, etc. They said they only offer it to those on the path for surgery, so I didn't investigate further. They suggested finding a dietician or behavior therapist. She refuses to work with either. She refuses any raw veggie and will only eat limited fruit. If it isn't at its prime, she refuses to eat any of it. She will eat asparagus and limited broccoli/cauliflower, sometimes corn and that is it for veggies. I hide them in other foods, when I can. Cauliflower hidden in mashed potatoes etc. I use oat milk to make white sauce and she will eat more veggies if I put white sauce or cheese on them. I have to be careful with cheese though, because she was raised to have a sprinkle of cheddar on things like broccoli. If she serves/grates it herself, it is half a cup to a cup of cheese. 

[PeterPan]

18 minutes ago, Tap said:

She is always drinking water,

Have you read about pyroluria? 

8 minutes ago, Tap said:

orking toward residential treatment for her.

It sounds like this would be a good level of structure for her. 

I'm sorry it's hard. It doesn't seem like something normal family structures have the ability to solve. I have one cousin with disabilities who has been institutionalized most of my adult life. I hope you can find answer that brings peace for everyone.

[Tap]

4 minutes ago, ktgrok said:

Can you buy light Mayo (NOT the fat free stuff, that stuff is gross, but the Light Hellmans isn't bad)? And Bolthouse Farms dressing is still creamy and yummy but 2 tablespoons is 40 calories instead of 80-120 like regular dressing. And don't buy juice. If she really wants a "sweet" drink buy some crystal light. Yeah, this stuff isn't natural and such, but artificial sweeteners MIGHT be bad long term, but her obesity is a DEFINITE risk short term, right now. So focus on foods that are lower calorie, but similar to what she likes. Smart Pop popcorn instead of chips, light mayo, find a brand of white bread that is lower calorie (some are less than half the calories per slice than others!!!), etc. Getting her lower calorie food is going to work better right now than convincing her to eat less. 

You can find videos, say by Coach Greg on youtube that show lower calorie alternatives where you can get way bigger servings. Not a fix, but it really really can make a difference. 

LOL I already do most of that. I broke down and bought her Crystal Light about 3 weeks ago. She got made at me for something, dumped a glass on a brand new rug and on the regular carpet.😞 She admits it was on purpose. I now have permanent red stains on the rugs. When she was little, I would only buy clear or very, very light colored items to drink. I need to go back to that. 

[Tap]

3 minutes ago, PeterPan said:

Have you read about pyroluria? 

The geneticist says she doesn't have it. 

[ktgrok]

Will she let you check her urine? The drinking all the time can be a sign of diabetes. 

[ktgrok]

2 minutes ago, Tap said:

LOL I already do most of that. I broke down and bought her Crystal Light about 3 weeks ago. She got made at me for something, dumped a glass on a brand new rug and on the regular carpet.😞 She admits it was on purpose. I now have permanent red stains on the rugs. When she was little, I would only buy clear or very, very light colored items to drink. I need to go back to that. 

Ugh! Yeah, maybe the sugar free lemonade?

[Tap]

20 hours ago, prairiewindmomma said:

Fwiw, the foods she likes are ringing sensory bells for me. She likes cold and creamy (icecream, Mayo, salad dressing) and she likes starchy (chicken nuggets, potatoes, white bread). 
 

I will be super honest—resistant 14yo? Your options are really limited. I would not being buying juice or the like. I would limit the food options I buy. I would also be working on helping her learn to make simple meals that will have some buy in from her if she is willing to participate.

If she is willing to listen, I would talk about healthy plates (half veg, 1/4 protein, 1/4 starch) and I would talk about diabetes and other complications that come from poor dietary management. 
 

Were you talking with these people? https://www.ohsu.edu/doernbecher/meet-our-healthy-lifestyles-team And their out the door recommendation was surgery? I am really upset for you…. They should have someone on their team who is looking at the autism/sensory component and the overlap there. Maybe OHSU lumps that more under feeding clinic SL-Ps?

 

They don't offer anything we haven't already tried. She has had some for of BT almost weekly since she was 4yo. The dietician will only get me so far, because she refuses most food and eats in secret. I have talked to OT/BT/feeding disorders specialists before and they just gave very general advice. She is just so complicated. UGH She doesn't' care about diabetes because it isn't real to her. If she has to go on insulin, she will refuse. She has PTSD level or paranoia about needles. Even weekly injections...not happening. Metformin bothers her stomach too much so she was taken off. Her A1C was 5.6. 2 years ago I am certain she is pre-diabetic now. 

 

[hippymamato3]

We went through a lot of this with my oldest (adopted from foster care at age 10) son. He had all these same behaviors, but no autism diagnosis, and does have low IQ, conduct disorder, reactive attachment disorder, PTSD. He ate anything and everything, as much as he could. He didn't care at all about getting heavy or health issues. None of that made a difference to him. His aggression and violence and property destruction became so bad we did finally get him approved for a residential facility once he turned 19.  Though the behaviors did not necessarily improve, he was not ever going to be able to be safe (to us or anyone else) in a home setting, so this was the best thing for him. I wish you luck. I know the frustration. You can PM me if you'd like. We did utilize locks on some cabinets, but he frequently pulled them off so caused damage in another way that way. *sigh*