Obesity has become a global epidemic. Worldwide, obesity rates have more than doubled since 1980 and they continue to rise, especially in children with special needs, writes Dietician Denise Fair.
While so much effort has been made by governments, schools and health care groups around the world, childhood obesity continues to climb at alarming rates. It is estimated (1) that 35% of women and 31% of men are considered seriously overweight or obese, while the figure for children between the ages of 6 and 18 is 15%. The prevalence of obesity is even higher in children with special needs. When compared to their peers, the obesity rate in girls with special needs is 23% while it is 14% in girls without disabilities. Similarly, for boys the prevalence is 21% for those with disabilities and 17% for those without.[(1) US National Health and Nutrition Examination Survey (NHANES):
Obesity in special needs children, aged 12-18
67.1% of teens with autism spectrum disorder were overweight or obese.
86.2% of teens with Down syndrome were overweight or obese.
18.8% of teens with cerebral palsy were overweight or obese.
83.1% of teens with spina bifida were overweight or obese.
39.6% of teens with intellectual disability were overweight or obese.
The prevalence of obesity in children with disabilities is a concern since they already have more obstacles to overcome than their peers, either physically, mentally or both. Obesity adds another layer of issues, from the physical to the emotional. Children with special needs may be ostracised by their peers and being overweight can add an additional stigma, increasing their risk of both isolation and depression. In addition, extra weight puts a physical strain on joints and muscles, potentially reducing mobility. This is an added dimension for children who may already have issues with movement and physical activity, and which may lead to more weight gain. Obesity can also pose challenges for caregivers as it makes it harder to help children with their daily tasks such as bathing and toileting. Lastly, obesity increases the risk of secondary health problems, such as diabetes, asthma, cardiovascular disease, sleep apnoea, some cancers, stroke and osteoarthritis.
While it is well known that being overweight and obese is bad for health, many caregivers struggle with how to balance the need for nutrition and the way to “diet” their children. Finding this balance is tough for the average child, but things can be more complicated for special needs children who may have behavioural issues, sensory and textural issues and self-regulation problems. For these kids, their relationship with food is much more complex and harder to manage.
Behavioural issues are common in special needs children, with the most prevalent relating to food being aversions or the avoidance of particular foods based on appearance, texture, colour or food group. Such issues can make it harder to get children to eat the right foods and in the right amounts. Some children may have increased sensory sensitivity causing them to be particular about smell, temperature and even lighting. Anxiety around food and phobias surrounding new or unknown foods are common and can greatly limit dietary choices. For these children, getting them to eat a balanced nutritional meal can be extremely challenging. Most food aversions tend to be around green and red foods, fruits, vegetables and healthier foods, while safe foods tend to be white bread and starches, fried meats and junk foods, making the chances of becoming overweight even higher.
On top of these complications comes the parent-child dynamic. Many parents report they don’t want to deprive their children of any happiness that food provides them. They don’t want to “fight” over food and food choices as they struggle with other more “important” behaviours. Parents often use foods and sweets as rewards or as a calming agent. While this is understandable, it is important that parents know they aren’t necessarily doing their children any favours by approaching food in this way, and they can contribute to a worsening in the behaviour and even a higher risk of obesity.
While it is common to think that a child who is overweight has “too much nutrition” many such children have micronutrient deficiencies. These deficiencies may impede their development and cause deterioration of secondary problems arising from the underlying disability. A proper, well balanced diet can actually improve many symptoms in special needs children, such as concentration, mood swings, fatigue and anxiety.
Challenges to finding the balance
So, how many calories a day does your child need? What about protein, fat, vitamins and minerals? The nutritional requirements for special needs children differ according to their underlying disability and from child to child. Start with considering the child’s age and size. To prevent obesity it is important to determine calorie requirements. While some children require a similar amount of calories as their peers, many require fewer calories due to varying degrees of physical activity levels, lower metabolic rate and lower level of cognitive function. These children are more prone to weight gain as their intake requirements are much less, however they often have micronutrient deficiencies due to lower total volume of food. Ensuring adequate intake of vitamins and minerals is essential for growth, development and overall health.
Digestive issues are very common in special needs children. Many have food intolerances, allergies, gassiness, diarrhoea or constipation. Any of these factors can influence a child’s requirements and may alter food choices. Ensuring adequate fibre intake helps with bowel regulation, improved digestion and improves good bacteria in your colon. Children who want to stick to safe and plain foods like white rice and white breads have a very limited diet. They tend to overeat on certain foods, especially starchy foods, increasing their risk of obesity and micronutrient deficiency.
Some children have problems with the simple act of eating. The ability to chew and swallow may be difficult for those with physical, mechanical or coordination problems and a diet of softer foods is needed. A large number of soft foods are high in calories, however, while nutritious foods like fruits, vegetables and meats tend to be more difficult to eat. It is important to find ways for these children to get the balanced nutrition they need through soft foods. Items like low-sugar yogurts, soft cheese, pureed fruits and steamed vegetables are all good options.
Contributing factors to obesity in the special needs child
Genetics – some diseases have underlying issues that cause weight gain.
Behavioural issues – textural, auditory and other sensory issues leading to food selection/rejection.
Barriers to exercise – the need for specialised equipment, poor coordination and mobility, and physical, sensory and cognitive deficits can prevent a child from being active.
Medications – 75% of special needs children are on medication, some of which can cause weight gain.
Mechanical/physical issues – chewing or swallowing difficulties, digestive issues and food intolerance are all more common in special needs children.
Genetic issues must also be considered as some disorders mean a child has a predisposition to overeat due to the damage done on the weight regulation part of their brain, as found in Down Syndrome, Prader Willi syndrome and spina bifida. These children struggle greatly as they remain hungry all the time. Weight gain and weight maintenance become daily struggles for parents and caregivers.
Lastly, medications are known to influence weight, increase appetite and affect vitamin and mineral absorption. Prednisone, prescribed for allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders, is known to increase protein requirements and cause an increase in appetite, while Risperdal, used to treat Autism and also as an anti-depressant, also increases appetite, and some types of seizure medications affect calcium, vitamin D and folate metabolism. Special consideration must be taken for children on such medications for extended periods as weight gain can easily get out of control very quickly.
When determining the nutritional needs for a child with special needs it is important to take into account all the issues, including: the underlying disease/syndrome, specific energy requirements and activity levels, physical or mechanical issues and behavioural issues. Consulting with a health care professional and a dietitian will help make sure your child is getting all that they need to grow and develop, while managing any symptoms and overcoming specific challenges.
Tips for parents on how to control kids’ weight gain
Start early – It is easier to prevent unhealthy weight gain than to lose unwanted weight and break unhealthy eating habits.
Tough love – Parents decide what and when to eat, children can decide whether they will eat.
Know your portion sizes – Learn what the proper portion size is for your child and stick to it as portion sizes are typically way too large. An easy guide is: a fist full of starches and a palm size of meat (child’s hands, not parent’s). Load up on fruits and veggies.
Start with vegetables – For kids that are big eaters make a habit of having cut vegetables on the table before meals. A hungry kid is a lot less picky.
Finish with vegetables and fruit – If your child is still truly hungry after a meal they will eat them.
Get kids involved – Let them help with meal planning, grocery shopping and preparing their lunches and snacks. They will be more likely to follow a diet plan if they are part of the planning.
Mindful eating – So many kids eat in front of the TV or computer or are otherwise distracted. When kids (and adults) don’t pay attention to what they are eating they are more likely to overeat. Meals should be at the table with no distractions.
Change as a family – Set clear limits on treats, candy, snacking, exercise and screen time for everyone – including siblings and parents. Be a good role model.
Allow occasional treats – Kids need to learn that all foods fit into a healthy balanced diet. Allow them to have treats and discuss with them that these are OK every once in a while.
Offer variety – Even if you don’t think your child will eat it. Make sure they have choice and “scary” foods should be seen regularly. If they get used to seeing it, they will be more likely to try it. However, do not become a short order cook. Make a meal plan and stick to it.
Keep junk out of the house – Save sodas, juices, high-fat snack foods for special occasions out of the house.
No juice or grazing between meals – This is the number one reason why kids become picky. Only offer water between scheduled snacks and meals.
This article was updated April 2019.