Day 14: Weight

At a work thing last week a colleague mentioned (during the buffet lunch) that she had read a research report about buffet behaviour. The study had found that people tend to consume more at a buffet than they would otherwise; repeatedly filling a small plate with one or two items amounts to more, in the end, than measuring out a single portion on a larger plate. We are, it seems, not as good as we think we are at controlling our consumption when faced with choice.

Imagine, then, how challenging a buffet meal must be if you have a disability which makes it difficult to self-regulate? Dylan’s autism and learning disability mean that he needs guidance with portion size and support to recognise when he has ‘eaten sufficient’ (as my Grandmother used to say). After years of training Dylan not to take food from cupboards I no longer have locks on mine, but it is not uncommon for families and residential settings to continue to use these with some adults.

Dylan may have learned not to snack between meals but he will eat whatever is available to him at meal times. If I misjudge the amount of pasta I need to cook, for example, Dylan will want (and expect) to eat the amount which I set aside. I long ago realised that I couldn’t present ‘sharing plates’ (of bread, for example) at family meals as Dylan would not be able to resist his urge to take all. Instead I measure out an appropriate individual amount and present it on a side dish. But if do this just for Dylan, and use a sharing plate for myself and daughter, Dylan takes ours as well as his own. At home, then, I rarely prepare ‘buffet style’ meals.

Unsurprisingly, when confronted with such arrangements at events outside the home (parties for example) Dylan behaves as if all his birthdays have come at once. He makes repeated visits, at high speed, to whichever plate of food he has most interest in; canny and determined, my wily boy also ensures that access to his favoured dish is blocked to others. The buffet meal at a party might keep Dylan occupied but I dread it, knowing how difficult it will be to prevent him from over-eating. ‘It’s only at parties though mum’, my daughter once pointed out. Eating too many veggie sausages, crisps and jacket potatoes is not very good but far worse things are consumed to excess by other young men of Dylan’s age. And Dylan is lucky; naturally lithe, there is no need to worry about his weight – or at least there wasn’t until he left school two years ago.

Within six weeks of Dylan’s transition to adult care he had put weight on. It was so noticeable that his respite home manager mentioned it at Dylan’s annual review. I assumed, at first, it was the change in routine and that the weight would be temporary. When Dylan continued to gain, I enrolled him in a gym and suggested he begin a daily exercise routine at his day centre. This made no difference, however. I puzzled as to how it could be that Dylan was exercising during the day and bouncing around at home in the evenings but still developing his waistline. When I started Dylan on a low-sugar diet (not because of his weight but to test a possible link with aggressive behaviour) and he still gained weight I was perplexed. I found it hard to look at photos of Dylan taken a few years before; maybe this is what happens to some boys when they hit adulthood?

This summer, three weeks into Dylan’s transition to residential care, I thought he looked lighter as I dressed him one morning. I hadn’t been in the habit of weighing Dylan but that morning I decided to try. It would be good to monitor Dylan’s weight as he transitioned into care, I told myself. And besides I needed to – I’d noticed a weight chart in his residential Care Plan.

I suspect that the weight I recorded that day was already lower (at just over 12 stones) than it would have been had I weighed Dylan three weeks earlier. Because since then I have weighed Dylan regularly and each time (with the exception of today) his weight had fallen; Dylan has returned, quickly and easily, to the size and shape he once was and seems fit, alert and comfortable in his body again. When I weighed Dylan this morning the scales showed more or less the same weight as the previous reading so perhaps (after losing half a stone or more) he is plateauing. I’d be happy with that and Dylan should be too; he was looking pretty good, I thought, when we were out walking yesterday.

Dylan may have lost the weight due to being more active or because of the emotional impact of his move to residential care but my guess is that it is due to him no longer having access to the daily buffet at the day centre he attended. Perhaps I should have realised this at the time but I was so focused on other aspects of Dylan’s care I didn’t make the link. I understand that a buffet is provided with the best of intentions – to allow choice, for example, and promote independence – but the need to guide an adult with learning disabilities to a healthy lifestyle can be in conflict with some applications of  ‘independence’ and the DOLS (Deprivation of Liberty) guidance. Given Dylan’s lack of capacity to understand the consequences of a poor diet, he needs support to prepare healthy meals and eat sensible amounts. For Dylan, this means clear and consistent boundaries – not easy to establish in the context of a buffet meal.  Perhaps the next time I’m at a work thing I should try it 🙂