Juliana has to learn what a “normal” appetite is

After a lifetime of high-carb eating, which overwhelmed Juliana’s system before she was 3, she doesn’t know what her “normal” appetite is.  We’ve been paying a lot of attention lately to whether she feels hungry; whether she feels full; and whether she feels overfull.  We’re trying to learn how much she has to eat to not be hungry and to maintain her energy level depending on what she’s doing.  If she’s running a lot, playing soccer and then refereeing a soccer game, she might need to eat more than if she has a sedentary day.  But we want her to eat no more than she has to so that her weight will continue to drop.

A well-functioning appetite should make these adjustments automatically.  Juliana’s appetite has been elevated for so long that she has to concentrate to tune in to the new information she is getting from her body.  She also has to get used to the fact that a smaller quantity of food is adequate.  A high carb diet produces extreme hunger in a sensitive individual, and I believe it is truly painful, especially for a child.  She still has a bit of fear of being hungry if she eats a smaller amount of food.

She was very hungry on the Packard program, so that is one of her touch points.  She should not be that hungry, ever.  She should try not to feel stuffed ever either.  She’s started eating her meals a lot more slowly than she used to–I think this development is mostly unconscious, but it helps her to avoid eating more than she needs.  She’s not starving when she sits down to eat, as she was on a high carb eating plan, so it’s more possible and easier to eat slowly.

We try a Low Carb eating plan

Lots of disparate information was clicking into place in my head and pointing to a low carb eating plan. Juliana’s reaction to my research was precious.  She commented to her dad, mama’s been reading books again…  I do have a tendency to research.  Nonetheless, she was game.  We embarked on a low carb eating plan.  After 5 days, at her next weekly weight check at the Packard program, she was down 3.5 pounds.  (The first thing that happens on a low carb diet is that you dump retained water.  Many people find that they feel and look less puffy and bloated eating low carb).

The Packard people were a little startled.  They immediately ascribed the weight loss to Juliana exercising more, since her total of red foods was the same.  The most Juliana had lost in one week up to that point was 1.5 pounds.  By the calories in/calories out logic, she would have had to have burned an additional 7000 calories to explain the additional two pounds of weight loss, which she hadn’t come close to doing.  7000 calories is 10 hours of running at 10 minutes a mile.  She was exercising more, but not an extra hour and a half of running every single day. I knew exercise couldn’t explain the sudden drop in weight, and had high hopes for the controlled carbohydrate eating plan.

We enroll in a kids weight control program

After Juliana hit 168 pounds at a height of 5′ 4″, I went looking for a kids weight control program. I found one at Lucile Packard Children’s Hospital at Stanford University. It was near my house, and started at the end of January. It was expensive and not covered by insurance, but I wanted help. Juliana was in the habit of asking my permission to eat things–usually sweets or seconds. I never said no, but would try to guide her choices–“I wouldnt have the cookie because we are going to a party later and you’ll probably want something there.” I wanted to cut myself out as the middleman. I wanted her to be in charge and empowered to control her own intake. The Packard program is designed to do that. Juliana met with the Packard staff, learned about the program, and we both agreed to try it together.

The Packard program is based on the standard calories in/ calories out model.  Kids are taught to switch to lower calorie foods, control their portion sizes, and increase their physical activity level.  Children are thereby supposed to burn more calories than they consume and lose weight.  The Packard program first ramps down on higher calorie foods. Then it ramps up on physical activity.

Foods are evaluated for their caloric density, that is calories over grams of weight: c/g. Foods with caloric density over a certain threshold are red. Below a lower threshold are yellow, and below the lowest threshold are green.

Green foods are things you may eat in virtually unlimited quantities. It’s a short list, and includes things like broccoli, romaine lettuce, and spinach. Yellow foods are go-slow foods–usually still healthy, but watch your portion size. Whole wheat bread, pasta, chicken, starchy vegetables like sweet potatoes, eggs. Red foods are junk foods, like soda or candy, or fast food, but also meats if they aren’t low in fat, full fat cheese, and nut butters.

Eating more than two servings per meal of a yellow food also makes the third portion into a red, to try to control for meal size. The kids were taught the visual cue of a serving being equal to what would fit in the palm your hand.

Some of the kids started out eating 100 or more red foods per week. They had fast food, soda, and juice regularly. Juliana topped out at 35, the week she was on a trip with her school and had no control over her food. Even so, we reduced the number of reds she ate. We eliminated maple syrup on her whole wheat French toast, substituting applesauce. She cut out the 100 calorie fudge bars she liked for dessert. I started cooking with almost no oil–a teaspoon for six servings was a “yellow”, more than that a red. I started making mostly vegetarian bean soups and stews, carefully using my teaspoon of oil to sauté garlic and onion. In a few weeks, she was down to eating only 4 or 5 reds a week.  (The Packard program didn’t recommend even trying to go below 18 reds per week, because they wanted goals to be challenging but doable—they didn’t think 18 reds or fewer was doable enough).

After six weeks, the Packard program starts to ramp up on exercise. Different activities have different point values, and you try to increase your exercise points while you decrease your red foods. Juliana had always exercised, but she began to do even more.

Did she lose weight? Yes, she lost 6 pounds in 10 weeks.   I didn’t find that rate of weight loss very impressive, considering how few reds she was eating and how much she exercised.  Then she stalled, gaining back half a pound at the weekly weigh-in. And meanwhile, she was almost always hungry, despite eating every few hours. I would pick her up from school, and before she said hello, she would gasp, “do you have a snack?”

The Packard program confirmed for me what I had been saying to anyone I thought could help–compared to the other overweight and obese kids in the program, her eating habits had been super healthy, and now were even healthier, and she exercised. If the Packard program was going to work for her, shouldn’t she be steadily dropping weight eating only 4 reds a week and exercising a minimum of 30 minutes a day at a medium intensity? But she wasn’t. She was also having a hard time because she was frequently hungry.   I went looking for something better.

She won’t grow into it.

Wait for them to “grow into their weight.” This is one of the more misleading ideas out there. As Juliana grew older, I kept hoping this magic was starting to happen, or looked like it was going to start happening. I had been a bit pudgy as a child, and had a growth spurt and slimmed down when I was about eleven. I thought it was worth waiting to see if Juliana had a slimming growth spurt before trying something else, because I was worried about creating an eating disorder.  

As a result, we spent years on the wrong track. I only went looking for a structured weight loss program when Juliana’s weight at age 13 exceeded even a healthy adult weight. I realized that even if she grew to my height, she would still be overweight. Looking back, I realized that I had probably never been overweight, and certainly not obese as a child, as Juliana has been.