When Meds Increase Hunger: Supporting Kids Beyond “Just Eat Better”

 In both clinical practice and community conversations, one theme comes up again and again: How do we support kids when the very medications that help with mood, sleep, or behavior also drive intense hunger and weight gain?

This isn’t a niche problem — it’s a common, under-recognized challenge that plays out daily in homes, schools, and clinics. Parents and doctors alike often find themselves watching kids struggle with a seemingly insatiable appetite, especially for hyperpalatable “junk” foods, and feeling stuck between symptom relief and long-term metabolic health.

Let’s be clear: this is not about lazy parenting or just poor food choices. It’s about neurobiology, medication effects, access, and support.

What’s Really Going On?

Many of the medications we use to support autistic and neurodivergent youth — especially antipsychotics, mood stabilizers — can increase appetite significantly. That increase often isn't a gentle nudge toward more food. It's a loud, biologically driven demand for calories, often in the form of high-reward, fast-digesting foods.

Add to that sensory-based food preferences, emotional eating, or difficulties with interoception in autism (the ability to sense internal states like hunger or fullness), and we’re looking at a perfect storm.

The Role of Medication in Appetite Support

Why aren’t we doing more medically to help kids regulate hunger when it becomes dysregulated by the medications we prescribe?

Honestly? It's a great question.

Metformin is often my first-line option. It’s safe, well-studied in pediatric populations (including in autism and antipsychotic-induced weight gain), and effective at supporting insulin sensitivity and appetite stabilization. Yet it’s still underused — likely due to outdated stigma around “treating weight” in kids or discomfort with off-label prescribing, despite strong clinical reasoning.

But metformin isn’t the only tool in the box.

Depending on the individual profile, I also consider:

• Topiramate, which can reduce appetite and impulsivity
  
  
• Naltrexone/bupropion (Contrave), particularly in teens with emotional eating patterns
  
  
• Carefully selected stimulants, which can help rebalance hunger cues and energy regulation
  
  
• GLP-1 agonists (e.g., semaglutide) in very specific cases of severe metabolic disruption or insulin resistance
  
  

Each of these requires thoughtful, individualized use — but they’re valid, evidence-informed options that deserve more attention in pediatric and neurodivergent care.

Meds Can Support Healthier Choices — Not Block Them

One thing I’ve seen again and again in my own practice: when medications are used well — with the right dose, timing, and monitoring — kids actually become more able to make healthier choices. They feel more regulated, more in tune with their bodies, and more available for participation in lifestyle-based interventions like nutrition support or movement programs.

This is the opposite of the old narrative that medications "get in the way." When thoughtfully prescribed, they often open the door for kids to engage more meaningfully in their health.

Dietitians and Movement Matter — But Can’t Always Do It All

Of course, behavioral supports, sensory-informed dietetics, and strength-based movement programs are hugely important. Building muscle mass, reducing inflammation, and diversifying nutrient intake have clear benefits.

But let’s also be real: these supports can only go so far when kids are dealing with high appetite drive, low interoceptive awareness, sensory sensitivities, or burnout. Saying “just eat healthier” without addressing biology is like trying to put out a fire with a watering can.

A Call for a More Nuanced Approach

Families shouldn’t have to choose between symptom relief and metabolic health. And kids shouldn’t be blamed for responding exactly how their brains and bodies are wired to respond.

We need a better conversation — one that acknowledges the complexity, centers neurodivergent needs, and uses all available tools (medical, nutritional, behavioral, and relational) to support long-term health.

Let’s stop asking kids to “try harder” and start helping them feel better.