Saturday, February 8, 2014

A Weight Off

Naomi began gaining weight rapidly from her first week of life. She gained one pound per week until she was six weeks old. She had enormous cheeks that weighed her down and rolls upon rolls on her baby thighs. When she was a little over a year old she began to slim down, and for the next five years we didn't worry about her weight at all. She ate like a horse, but she was always a healthy size.

When she was six years old Naomi was diagnosed with celiac disease. An intestinal biopsy revealed that her intestines were badly damaged, limiting her body's ability to absorb nutrients from her food. I reasoned that that must be why she ate so much. After we removed gluten from her diet, her intestines healed, and she began to absorb nutrients, but her appetite didn't decrease. When she packed on nearly 20 pounds that first year I reevaluated our diet. I removed many of the gluten-free starchy snacks that were filled with sugar and made fresh fruits and veggies available at all times for snacking. We talked about some healthier eating habits with Naomi, encouraged her to exercise more, and for about a year we held her weight steady.

Then without warning in October of 2012 Naomi began to gain several pounds per week. I took her to doctors worried that she was retaining water. They were alarmed as well, but couldn't find a physical cause. Her kidney and liver functions were sufficient, her heart was fine, and her thyroid function was normal. It was a mystery.

Matt asked me one day if I had been drinking more coffee. I admitted I had. We figured together that that was the reason our liquid coffee creamer was suddenly empty again. We stopped by the store on a Sunday afternoon, on our way home from church and I ran inside for another bottle of creamer. On Tuesday morning when that 32oz bottle of liquid coffee creamer was suddenly empty, I realized where Naomi's drastic weight gain had come from.

Fortunately, when I confronted her, she admitted to having a habit of drinking the creamer when no one was watching. I grilled her then: what else was she hiding from us? She admitted to drinking pancake syrup from the bottle, eating brown sugar from the canister, and a host of other "snitching" behaviors I had been clueless about. When I scolded her and told her how much she was hurting herself, she was clearly remorseful. Looking at her then I realized that she had readily admitted to this problem, because she knew she needed help to overcome it. For her, it wasn't so much a discipline issue as it was an addiction issue. Decisive action was necessary.

I bought a new cabinet, rounded up all the items Naomi had ever been tempted to snitch, stored them in the cabinet, and then installed a combination padlock.

The coffee creamer was trickier, since it had to be refrigerated. I considered putting a lock on our refrigerator, but that would have added a huge amount of stress to my life as I spend so much time cooking. I considered buying a small locker to store in the refrigerator for a few key snitchable items, but in the end I opted for talking with Naomi seriously about the dangers to her health when she drinks coffee creamer and putting a poison label on the bottle as a reminder.

I also posted on the refrigerator a list of healthy eating habits that encouraged Naomi to eat small portions and healthy snacks, not snitch foods when I'm not looking, and exercise more often. And these measures helped… for awhile.

Last spring Naomi's weight held steady again for several months. The weather was warm. She was active and motivated to be healthy, and the numbers on the scale stayed steady. She was clearly overweight, carrying about 88 pounds on the 4 1/2 foot frame of a nine-year-old girl, but at least she wasn't gaining anymore.

But this fall it began again. Something about the cold weather, or being homebound, I'm not sure what, but she just lost control again. She no longer snitched unhealthy foods, she just ate and ate and ate the healthy foods I served. I gently reminded her, I scolded her, I sometimes limited her meal portions, but she would cry--tears and all--that she was still hungry, and I wasn't sure how to respond to that.

I didn't want her to be self-conscious. I never wanted to make her looks the issue. I didn't want to add guilt to her addiction, and I didn't really understand what drove it. I had her thyroid checked at least four times. It was fine. And Naomi and I both grew increasingly frustrated.

Naomi at her highest weight in December
By last December she had gained another ten pounds, topping the scales at 98 pounds, and putting her BMI into the obese category. At the same time her kidney function continued to decline. She has only a small amount of function left in her small, scarred kidneys, and they can only filter so much body mass. The extra weight she was gaining was only speeding their demise. So I had to be honest with her, and I had to take drastic measures.

Matt and I finally sat down with Naomi in December. We explained that we were going to show her some tough love. We told her that because we loved her we could not let her continue to gain weight, to hurt her kidneys, and to risk developing diabetes. We told her that we were taking control of her eating to help her, and that if she trusted us and followed our plan it would be difficult, but worth it. We told her she would be served one helping at each meal, and that was it--absolutely no second helpings, no matter how hungry she felt. We told her she would have one small snack in the afternoon, but nothing after dinner at night. We told her she would need to play actively every day, ideally for one hour, even if she didn't feel like it. She cried, she argued a little, but then she accepted it. And I think she dared to hope that it would help.

The first week was hardest. Old habits die hard. It is hard to walk away from a table not quite feeling satisfied. It is hard not to return to the kitchen when you are bored or feel a little munchy. It is hard to get off the couch, put on all your snow clothes, and get booted out into the cold when you feel sluggish. But we worked together. She needed a calcium supplement with every meal now because of her failing kidneys so I bought a minty flavor. She got in the habit of finishing her meal, drinking a big glass of water, popping a minty calcium in her mouth, and leaving the kitchen. She said the mint taste helped to get the taste of dinner out of her mouth so she wouldn't want to keep eating, the water made her feel more full, and staying out of the kitchen always helps. After one week, her weight had dropped from 98 pounds to 97, we showered her in praise, and she glowed with pride. Now she wanted to stick to the plan.

In mid January, when we learned from her new kidney doctor that Naomi likely has Bardet-Biedl syndrome, we finally understood why this had been such a struggle for her. BBS causes obesity by damaging the receptors in the brain that are supposed to receive the satiety signal called leptin. Unable to receive the signal, the hypothalamus believes the body is starving and ups its signals to increase food intake and decrease activity. Naomi constantly receives hormonal signals telling her body to eat and rest, which is a huge obstacle for any nine-year-old child to overcome. I didn't waste any time in explaining this to Naomi. She was actually relieved to have someone explain what she had been feeling. Then I commiserated with her that it wasn't fair that she would have to fight this her whole life. But I made it clear that it wasn't an excuse not to fight. Her other option was to give in to the cravings, be morbidly obese, speed up the time to kidney failure, likely develop diabetes, and die early. She decided too that it was worth the fight.

In about seven weeks since we began this program, Naomi has lost a total of seven pounds, dropping her weight to 91 pounds and placing her BMI out of "obese" and into "overweight." I can't tell you how much I've layered on the praise. She feels very proud of herself and she should. She has more energy, her favorite clothes fit again, and her self-confidence has grown. She knows she can set a goal, work hard, and achieve results. We have set a target weight of 83 pounds because that would be the highest BMI allowed in the "healthy weight" category for a girl her age and height. If she sticks to the plan, she should arrive at her goal in about two months.

Beyond saving her kidneys and pancreas, she's learned a life-lesson. Life has dealt her an unfair hand, but she can choose to take control of as much of her health as possible, and she can enjoy the glow of accomplishment when she has.

Naomi and Emma after haircuts, and after Naomi lost seven pounds

No comments:

Post a Comment