# Empowering through structured boundaries: an integral model for fostering balanced eating and nutritional well-being

## TL;DR

This study identifies successful strategies used by caregivers to help individuals with Smith-Magenis syndrome manage eating behaviors through structured boundaries and empowerment.

## Contribution

The paper introduces a novel model of 'Empowering Through Structured Boundaries' for managing eating behaviors in Smith-Magenis syndrome.

## Key findings

- Successful strategies involve setting explicit boundaries to empower individuals with Smith-Magenis syndrome.
- Four key themes emerged: Fostering Balanced Eating, Structuring Environments, Setting the Stage for Success, and Managing Challenges and Resistance.
- Anticipatory guidance and positive language are effective in reducing food-related disruptive behaviors.

## Abstract

Treating obesity in complex disorders requires individualized health management plans. Effective obesity management in the Smith-Magenis syndrome (SMS) population has multiple inherent barriers related to their cognitive impairments, anxiety, behavioral disturbances, and sleep disorders. However, to date, no research exists related to strategies caregivers successfully employ to help individuals with SMS manage their food intake and mitigate associated behaviors.

We performed a qualitative thematic analysis of group interviews from 23 caregivers representing 21 individuals with SMS. Hybrid thematic analysis revealed that successful strategies employed by caregivers in this unique population revolved around a global theme of Empowering Through Structured Boundaries.

Four themes emerged: Fostering Balanced Eating, Structuring Environments, Setting the Stage for Success, and Managing Challenges and Resistance. Together, our analysis shows that successful strategies utilized by caregivers often involve setting up explicit boundaries, both literal and figurative, that provide choice empowerment to the individual with SMS. Additionally, anticipatory guidance, deflection, and positive language were utilized throughout different contexts.

These data are the first to define and disseminate a variety of successful strategies utilized by caregivers of individuals with SMS to decrease food-related disruptive behaviors.

The online version contains supplementary material available at 10.1007/s44162-025-00145-3.