Teaching portion control to overweight teen

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?

You have your work cut out for you.  Here are some articles she might want to read

About.com Nutrition - Portion Sizes

edited to add:  What does 200 calories look like?

Thanks a bunch!  Maybe these visuals will help her.

I realized that this was posted in the wrong forum, so it has been reposted under weight loss.  

if you haven't already, i would invest in some 8" plates.  any meal should fit easily on one, without stacking.  and it doesn't look like you've skimped.

Battling the same thing with my daughter, although she doesnt eat more than 3-4 times a day, she eats an excess amount each time & refuses to watch portion control. (I totally blame myself as i had the same problem & am just now adjusting to correct portions)

Any ideas on how to get them to stick to it & lay off the junk food??? 

I know how frustrating it can be to try to teach someone about portion control and then have everything I say go in through one ear and out the other.

Here's an idea, although if your daughter is as stubborn as my sister is, it'll be very hard to make her understand...

The color BLUE has been proven to suppress appetite.

1. Buy a decent sized dinner plate in the color blue... tell your daughter to visually divide the plate into four (4) quarters.

2. Fill one quarter with one (1) or two (2) decent portions of protein (such as boneless skinless chicken, meatloaf, beans, etc.).

3. Fill another quarter with a carb (such as rice, baked potato, handfull of nuts, maybe a fruit, etc) [if she eats rice, make sure it's brown rice, as white rice has much more carbs and converts into almost pure sugar. I'm from Hawaii and my entire family eats rice with every meal of the day, so its very difficult for us but hopefully you don't have that problem!]

4. Fill the other two (2) quarters with fruits and vegetables (preferably vegetables, as they have less carbs, especially if she's already chosen a fruit for her carb quarter).

They say that if you use a blue plate, and possibly a blue table cloth, it could suppress your appetite. And tell her to chew very slowly, savor the flavors, and drink PLENTY of water before, during, and after her meals. Milk is also a great drink during mealtime. It's filling, and healthy (but watch for the milk fat percentage!).

Hope this helps. In the end, no matter what you do, only SHE can help herself, nobody else. She's 19, she should know well enough that if she wants to lose weight, she has to really push and motivate herself because, unfortunately, you can't do it for her!

What the last poster said about chewing food slowly... perhaps if she chewed every bite x amount of times?  It would make her meals last longer, hopefully tricking her mind into feeling more satisfied.

On thing that's helped my family understand and practice portion control is the ADA Portion Control Plate available for $3.00

http://store.diabetes.org/products/product_de tails.jsp?=&FOLDER%3C%3Efolder_id=2534374 302024137&PRODUCT%3C%3Eprd_id=84552444176 3725

Thank you all for your wonderful suggestions.   I don't feel so stuck any more, and I can see we have more options than endless nagging.  The portion control plates look fabulous--never seen them before, but I just ordered a stack of them.  
Thanks again everyone!

What about pre-portioning a lot of the stuff she normally eats?

For instance, take her regular box of cereal and put it into a bunch of individual serving bags, measuring each.  Have her help you so she can see you use the measuring cup - 1 cup of cereal goes into the baggie.  Mark it 1 Serving on the outside.  Or even have her do it with you supervising.  That way she has to go through the motions of measuring out a single portion.  Repetition builds familiarity.

Then, remind her of what an appropriate serving would be.  Maybe put a chart on the wall of what the right amount of servings of various things she should be eating per day so it's right there.  My boyfriend's son has ADD and is bipolar, and that's one of the things the psychiatrist tells us to do - put his rules and whatever out where he can see them all the time.

She just has to count out how many servings she wants to eat.  However many bags she grabs is how many servings she is getting.

That way, if she wants to binge, she's going to see just exactly how many servings she is having - rather than just filling up a big bowl and convincing herself it's really not that much.  If she has to grab 6 or 8 bags and empty them each into a bowl, it's going to be hard to deny that she had 6 or 8 servings. 

Obviously, this wouldn't work with some things, but you could do it for a lot of convenience foods around the house - chips, cereal, fruits and veggies, etc. Pretty much anything in the pantry or fridge that is available for grab and go.