Question:
My daughter is now 36 years old. She is married and lives independently with support people who come in to their home and help with finances, doctor appointments, exercising, and cooking. Typical for a person with Down syndrome, she is only 4′ 8″ tall. Over the years, even with trying her best she has continued to gain weight. Currently, she weighs 153 lbs. Over the years, she has tried all the different ways to lose weight (Weight Watchers, Jenny Craig, John Cena, etc). Right now she is very motivated to lose weight because she feels unhappy about the way she looks and feels. What is the best plan for her to have lose weight and keep it off for the coming years. I am aware that it will get harder as she gets older since her metabolism is slow and will get slower with age. She knows to eat fruits, vegetables, healthy proteins (fish, grass feed beef, chicken, etc.), and low fat dairy products. However, the desire to eat bread is very strong. And the desire to eat a hamburger and fries or pizza is very strong. Right now she is frustrated because the woman who helps her plan her meals and cook suggests not eating ANY foods that are bread products. She believes once she does this for a long period of time that the cravings will go away (I am not sure this is a possible or realistic approach). The man who is her physical trainer and guides her on foods to eat tells her to eat a bagel once in a while and learn to eat those foods in moderation. This mixture of information is frustrating her to tears. In your experience, what would be the very best plan to lose weight and keep it off?
Answer:
Weight loss can be challenging for anyone, whether they have Down syndrome or not. The question about your daughter is a common one for many people.
Here are a few basic starting points:
- What works for one person doesn’t always work for another. No one plan fits all.
- Consider starting with an assessment of problem areas. Are there times of the day or night when she eats more, does she eat in response to stress or boredom, are there particular foods that are a problem? For example, you indicated bread is a desired food.
In our experience with people with Down syndrome, we have generally not found restrictive diets (e.g. severely restricting carbohydrates) to be successful with long-term weight loss. Building a healthy dietary approach to food has been more likely to be successful. Incorporating regular exercise into the plan helps prevent regaining weight and adds fitness to the overall health plan.
As described in more detail in the resources below, here are some basic tips:
- While we do not recommend eliminating or severely restricting carbohydrates or any particular food group, we do recommend reducing processed foods (many of which contain sugar and other processed carbohydrates) as much as possible. In your daughter’s case, particularly since she likes bread, I recommend eating whole grain bread rather than bread containing refined grains. One of my lines is, “Most of us could dramatically reduce our processed foods and still not be on a low carbohydrate diet.” Healthier alternatives that are unprocessed or “less” processed are available.
- Drink plenty of water and other fluids that don’t contain sugar or artificial sweeteners. Weight gain can occur if thirst is quenched by eating food or drinking fluids that contain calories, sugar, or artificial sweeteners.
- Review portion sizes. Again, using the example of bread, consider combining a smaller portion of bread with a protein and fat. Balance and portion control can be very successful.
- Review the other facets of eating. Does she eat too fast which can lead to eating larger quantities? Does she eat when she is bored or anxious? Are there other go-to activities that can be built into her routine, so she turns to them to address boredom and stress rather than eating? As with addressing many habits/behaviors, directing someone to something rather than away from something can be more beneficial. For example, someone might conclude from looking at their eating habits, “I tend to eat in the evening after dinner because I am tired and bored. Instead, I will head to bed (and out of the kitchen) earlier and read.”
- Consider a form of recording food intake. This has been shown to be effective in people without Down syndrome (I am not aware of a study in people with Down syndrome). There are a variety of apps (e.g. Lose It) that can be used. Similarly, programs like Weight Watchers use “points” as a way to get a sense of how much is being consumed. Studies (done in people without Down syndrome) have shown that people will eat less even if they are doing nothing other than recording what they are eating.
- Participating in the food preparation and cooking processes can be beneficial, too. Planning meals that are made from healthier food selections and preparing them can bring good nutrition into the daily routine.
- Add exercise to the schedule, at least 5 days a week. Rather than “finding” time for it, we encourage putting it on the calendar/schedule as one would an appointment. Losing weight by exercise alone is not possible for most people. Some people actually eat more and gain weight (“it is easy to out-eat your exercise”). However, coupled with the healthy approach to eating noted above, exercise can promote healthy weight maintenance and overall improved fitness. Exercise has many benefits for physical and mental health.
Lastly, consider making it part of the lifestyle of the entire family. It can be challenging to make changes when only one person in the household makes those changes. The health and wellness of the entire family or household can be promoted by participating in the recommendations included above.
Other considerations that we won’t address here include factors that can contribute to weight gain such as medications and other health conditions. These should be assessed as part of the overall approach to working towards a healthy weight. There are also physiological considerations regarding weight, much of which is just now beginning to be understood. As we have continued to learn more, there has been more discussion on addressing weight through the use of medications and surgery. While I won’t discuss those here, they may be approaches to consider and discuss with your health care provider, especially if there are health complications from obesity.
Resources
Article on Low Carb Diets
Visual Resources