How do you teach portion control?

I'm at my wit's end and need some advice. My daughter is 19 and has schizoaffective disorder (lives at home). A physiologic brain abnormality as well as a side effect of her medications resulted blocking of the "I'm full" signal to her brain. She never feels full. She has been overweight most of her life, but in the last several months she has put on another 40 pounds. She is 5' 9" and now weighs 260 pounds.

Her biggest downfall is she is clueless when it comes to portion sizes. She can inhale a 9-serving plate of pasta and sauce in one sitting like it was an appetizer then forage through the cupboards 30 minutes later looking for more. On the up side, she is exercising regularly and is slowly increasing the intensity and duration of her workouts. However, the more she exercises, the more she eats.

She desperately wants to lose weight and begs me to help her achieve this. So far, I have tried teaching her how to measure her food and estimate portion sizes by comparing them to familiar objects, measured her food for her, and enrolled her in Weight Watchers with me for six months in which we attended weekly meetings and worked together daily on portion sizes. We continued on our own after that, trying both the core plan and the points system.

She has met with numerous doctors, private counselors, and dieticians over the last several years. She has undergone hypnosis and uses other guided imagery techniques. She has tried multiple (one at a time!) appetite suppressants, both medicinal and herbal, but they either did not work or else interacted with her medications and triggered manic episodes with frank psychosis/hallucinations.

I stopped buying junk food and try to keep the pantry and fridge stocked with healthy whole foods. We have drastically cut down on fast food and other prepared/processed foods. I even bought smaller dishes hoping portion sizes would shrink to fit the dishes. She just eats out of serving bowls instead.

Unfortunately, she now works at a grocery store and eats anything she can afford during her breaks at work and brings more junk home with her after work. Whenever she feels restricted at all in her calorie intake, she compulsively binges 3000-5000 calories or more at a time.

She has tried keeping logs of everything she eats. However, because she cannot estimate portion sizes, she cannot accurately record her calorie intake and still does not understand how much she is taking in.

What else can I do to help her get her eating under control?

Whoa, talk about a difficult situation.  My only recommendation is put locks on the cabinet and fridge.  It may seem harsh, but if she's really at risk for serious health effects, you need to step in and do something.

By putting locks on the cabinets, you control when she eats and how much.  It might suck for a while, and the grocery store job might conflict things, but it's an effort.

You left me scratchin' my head on this one.

Get your daughter to quit her job to remove her from unlimited quantities of garbage. Find her a job somewhere that doesn't sell food.

Doing so will give you more control over her eating. The truth is, she knows she is eating too much, but wants to eat more nonetheless. Personally I don't see what you can do other than place her on a very strict calorie restricted diet.

To put it simply, it sounds as if your daughter is a compulsive overeater that needs intervention. Simply teaching portion sizes, using smaller bowls or limiting unhealthy food will not be effective. You may have to go as far as locking up food and only allowing her specific 'doses' of healthy foods.

It may sound extreme, but your situation sounds as if it is necessary.

The fact she has gained 40 pounds in a few months is extremely dangerous and is evidence that she is addicted to food. The fact that this is caused by a brain abnormality does not matter. Persons with Prader-Willi symdrome have a similar problem. The only treatment is strict restriction of the amount of food they are allowed to eat.

I have the same issue (well, the portion control one anyway) with my husband.  I have started giving him 1 serving (according to the package) of each item for dinner.  Then, if he's still hungry, I give him another "one serving" portion. 

This makes him more aware of what a "serving" is and makes it easier to track in the log books.

My sweetheart has problems with portions. We are buying a scale this weekend to help him learn. Maybe buying a scale will help? She might find it interesting to weigh things...Maybe?

My boyfriend also has no idea what a portion is, but it's not nearly as extreme as this. He can get full, he's just a pig!

I actually used to work with people who had a disorder called Prader Willi.  PW actually causes this exact symptom - they never feel full. It actually takes people affected to such an extreme that they will eat toothpaste, fruity shampoo, garbage, anything that could even be mildly classified as smelling, tasting or looking like food. So take heart, there are actually parents whose kids are harder to control! In the end, I agree with the PPs. Lock the cabinets, the fridge and get her a job that has nothing whatsoever to do with food. Keep her in a separate room while you're preparing food and then give her her meal and let her eat it. Start out with meals that are closer to what she's used to and work your way down to reasonable portions. She might yell and scream, but talk to her before you start the new plan, make sure she agrees to it and then go for it. 

I'm really sorry for your situation, just keep on trucking! 

I signed up to Jenny Craig last year to learn portion control.  This helped me so much!!  You could consider it.  They give you a weeks worth of food at each visit.  And you shop for things like fruit, lettuce, spinach...  the fresh stuff.  (Yogurt, milk)

 This would help - there would just be less in her cupboards. 

first of all, i think she's really lucky to have such a supportive mother...

I have experience with psychiatric meds and eating disorder through family. i think you're daughter's in as much danger physically/mentally as someone with anorexia. that she's eating out of serving bowls says a lot. I'm guessing her pdoc tried other meds which didn't work... I don't think that jenny craig or weight watchers is going to do anything..  pretty positive.. i personally think that before she gains even more weight or possibly turn to bulimia, an inpatient eating disorder program would be really helpful. they have hospitals and wonderful treatment centers with psychiatrists who can monitor her meds while helping her "relearn" her eating habits. and she wouldn't be able to access all those extra food. insurance should cover everything. best of luck to you and your daughter.

You have done so many really great things for her already...you need to just sit back and give her a chance to look at it for herself.

She is 19 and altho she has a really troubling diagnosis, she will have to learn to live w/it.

Let her be the one in control and if it means that she appears out of control for a while (and that may mean a long while), so be it. Your role has to change. Be supportive and continue to encourage her and be a role model for her in making healthy choices. But, she is an adult. She can learn to function w/in society's norms even w/her diagnosis. She may even turn out to be one of the coolest people you will ever meet!

Based on the things you've said, you are a great mom...now it's time for you to extend that unconditional love even further and believe in her enough so that she will begin to believe in herself.

I really think the two of you will get through this in the right way!

I think Sharon's comments were right on.  I'd just like to add that it is difficult to watch our adult kid's make their own- at times very bad choices.  If they don't have the chance to figure it out now though -when will they. It helps me to think to myself that I've provided the best advice that I could and I still try to set a good example. 

 I'm not sure how much of your daughter's issue has to do with a physical ability to not feel sated.  Is it a side-effect of her meds?

Lastly, if there is not a physical/medical reason for the overeating, she will be the only one that will decide to lose the weight.  I don't think any of these successful folks on CC have lost until they made the decision to do so.  I commend your efforts as a very caring mother, but she will need to make the choice-if it is within her control.