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Understanding Weight Dysregulation © 2018 SPOON 1 UNDERSTANDING WEIGHT 19 DYSREGULATION Module Overview Total Time: 35 minutes Learning Objectives • Explain what weight dysregulation is. • Understand the causes of weight dysregulation in foster children. • Demonstrate understanding that healthy children come in many sizes. • Discuss guidelines for caregivers to promote health at every size. • Demonstrate understanding of how to interpret growth charts of children. Topics 19.1 About Weight Dysregulation 19.2 Health at Every Size 19.3 Understanding Growth Charts Materials SUPPLIES ACTIVITY SHEETS HANDOUTS o PowerPoint slides o Flip chart o Markers o 25 Sticky notes o Speakers o Growth Charts (5 o Questions to Ask a o “Health at Every Size: copies) Professional Poodle Science” video (2:49 min) embedded into PowerPoint or link: https://bit.ly/2ET6X2Y Prerequisite • Module 1 (Nourished and Thriving Children Overview), Topic 1.2 • Module 3 (Overview of Nutrition for Children in Foster Care), Topics 3.1 and 3.3 Module 19: Understanding Weight Dysregulation © 2018 SPOON 1 ABOUT WEIGHT DYSREGULATION 19.1 Supplies: • PowerPoint slides • Flip chart • Markers • 25 Sticky notes 10 Activity Sheets: • None minutes Handouts None • Learning • Explain what weight dysregulation is. Objectives • Understand the causes of weight dysregulation in foster children. Introduction • Introduce the topic by explaining the Definition of Weight Dysregulation from the Trainer's Notes. • Tell participants that children have a natural way of growing that is right for them. They are born with the ability to regulate the amount they need to eat to support this growth. Children often do not start gaining weight, losing weight, eating too much, or eating too little, for no reason. Something is causing it and we must identify what it is in order to address it. It is crucial to understand that often the core reason for weight dysregulation is not eating fast food and too many sweets. There is more to it than just the foods that children eat. Causes of Weight Dysregulation Group Activity • On a flip chart, draw a 4x5 table (4 columns and 5 rows). Above the table write Learning ‘Causes of Weight Dysregulation'. Label the columns with the following Activities categories: ‘Psychosocial’, ‘Environmental’, ‘Medical’, and ‘Dietary’. • Divide participants into four groups and assign a category to each group. • Distribute markers and five sticky notes to each group. • Ask participants to think of five factors within their assigned category that can lead to weight dysregulation in children (i.e., factors that could result in children gaining or losing weight at a rapid pace). • Ask participants to write one factors per sticky note and to come up to the flip chart and place their sticky notes in the squares under their assigned category. • Once all of the squares have been filled, or after 5 minutes, review the responses with participants. Summary • Provide additional information on Factors that Could Lead to Weight Dysregulation using the Trainer’s Notes. Module 19: Understanding Weight Dysregulation 2 © 2018 SPOON Definition of Weight Dysregulation • Weight dysregulation is a term used to refer to when a child's weight is moving at a pace that is slower or more rapid than what is typical. • The more commonly used terms are ‘overweight’, ‘obese’, and ‘underweight’. However, these terms can be confusing and stigmatizing for parents and children. Many children labeled as ‘underweight’, ‘overweight’, and ‘obese’, on growth charts are in fact healthy. • We use the term ’dysregulation’ because weight gain in foster children (also in children outside the system), whether slow or fast, is a complex issue that can be influenced by a range of dietary, environmental, genetic, medical, and psychosocial factors and their interactions. This makes it hard for some children to ‘regulate’ their weight. Factors that Could Lead to Weight Dysregulation Weight is not as simple as calories in, calories out. Two children eating the exact amount of foods may gain weight very differently. Genetics largely determine the shape and size children grow into. And while dietary factors are important to keep in mind, it is often the psychosocial, environmental, and medical factors that play the biggest role in weight dysregulation. Psychosocial factors • Stress and trauma caused by Childhood Adverse Experiences (ACEs), which children in foster care will unavoidably experience, often result in an unhealthy relationship with food, a disrupted sense of hunger and feeling full, an challenging behaviors around mealtimes that could lead to overeating or undereating. Some Trainer’s factors that cause trauma and stress in foster children include the following: Notes o Food insecurity (being stressed about not getting enough to eat may lead to food hoarding and overeating) o Low household income o Abuse o Neglect o Parental drug use o Family dysfunction Environmental factors • Lack of mealtime structure. • Food restrictions, regardless of the reason, can cause fear of going hungry and result in overeating when food is available. Any food restriction, even when mild and well-intentioned, can have the opposite effect. When we say to a child, "eat your vegetables before dessert," "how about carrots instead of cookies," "you only get two bites of this cake," "eat this because it's good for you..." we mean well and it may seem positive, but we are putting pressure on a child. And any time we put pressure on a child, it usually backfires. • Being rewarded, soothed, or reprimanded with food may cause emotional eating or overeating. • Unresponsive feeding (feeding that is not based on children’s hunger and fullness cues) disrupts the child's ability to internally regulate food intake and grow appropriately. • Misinterpreting a child’s growth when looking at growth charts may lead to under- estimating or overestimating how much a child needs to eat to support their growth. Module 19: Understanding Weight Dysregulation 3 © 2018 SPOON • Lack of physical activity. Medical factors • Medications like steroids, seizure medications, antidepressants, psychiatric drugs, and birth control for teenage girls may cause increased or decreased appetite or have weight gain or weight loss as a side effect. • Feeding difficulties due to developmental delays or disabilities (e.g., cerebral palsy, Down syndrome) may lead to limited food intake. • Heightened oral sensitivities can lead to limited food intake. • Dysregulated eating and eating disorders. • Problems with digestion or absorption of food. • Celiac disease and Crohn’s disease affect the gut and can cause children to have poor weight gain. • Severe acid reflux especially in children with neurological issues and low muscle tone. • Hypothyroidism (under-active thyroid gland) or hyperthyroidism (over-active thyroid gland) are endocrine conditions that affect the body’s metabolism, causing rapid or slow weight gain. • Genetic or metabolic disorders may affect weight gain (e.g., Prader-Willi Syndrome). Dietary factors • A diet that is not adequate and well-balanced with essential nutrients including vitamins, minerals, carbohydrates, fats, and proteins may lead to delayed growth or rapid weight gain. o High intake of sugary and fatty foods may lead to rapid weight gain. This can be a result of food hoarding, emotional eating, and lack of access to other types of foods, among other reasons. o Low intake of protein and calories may lead to slow weight gain. This can be a result of dysregulated eating, picky eating, and poor appetite, among other reasons. • Portion sizes that are too large or too small for what children need. • Participants will be able to define weight dysregulation. Evidence of • Participants will be able to list three factors that may lead to weight dysregulation Learning in foster children. Module 19: Understanding Weight Dysregulation 4 © 2018 SPOON HEALTH AT EVERY SIZE 19.2 Supplies: • PowerPoint slides • Speakers “Health at Every Size: Poodle • Science” video (2:49 minutes) embedded into PowerPoint or video link: 10 https://bit.ly/2ET6X2Y minutes Activity Sheets: • None Handouts • None Learning • Demonstrate understanding that healthy children come in many sizes. Objectives • Discuss guidelines for caregivers to promote health at every size. Introduction • Tell participants that in order to address weight dysregulation, it is important to understand what is typical when it comes to children’s weight and size. Tell participants that people often think they can tell who is healthy or not by looking at the child’s weight. The video gives another perspective on the link between weight, health, and wellbeing. Health at Every Size Video Learning • Show the video Health at Every Size: Poodle Science. Activities • Facilitate a group discussion by asking the following questions: o How does this video apply to children? o What key messages did you take away from the video? o What can caregivers do to promote wellness and health at every size among their young children and teens? Summary • Summarize the activity by referring to Healthy Children Come in Many Sizes and How to Promote Health at Every Size in the Trainer’s Notes. Module 19: Understanding Weight Dysregulation 5 © 2018 SPOON Healthy Children Come in Many Sizes • It is important to remember that healthy children come in many sizes. Children who are fed regularly with a balanced diet, who sleep well, who are active, and who are attached to loving adults are likely to grow in a healthy way, whether big or small, tall or short. Children will eat, move, and grow in the way that is right for them, if we trust them and let them. • Foster children come with varying experiences around food and feeding, which may have influenced their current weight. Their environment can override their internal regulators for hunger and satiety. It may take them a while to trust that an adult will let them eat as much or as little as they want and to discover their own feelings of hunger and satiety. With time and appropriate support from their caregiver, these children will start showing signs that they are able to regulate their food intake, which in turn may or may not affect their weight and size but will enhance their wellbeing.
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