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Preventing and coping with weight gain in special needs patients

Patients with intellectual disabilities often struggle to control their weight.

The medications prescribed -- antipsychotics, sedatives, selective serotonin reuptake inhibitors (SSRIs) -- can cause weight gain, but other factors including genetics and the patients' environment also may a play a part in this problem.

A nonverbal patient on the autism spectrum was prescribed several medications to control his aggression as an adolescent. One of them was risperidone (Risperdal), which linked this drug and several others to weight gain in a 2009 study from the Journal of the American Medical Association.

By the time he was 23, this patient weighed 320 lbs and was still taking risperidone, even though his aggressive behavior had receded, explained Alice Kuo, MD, PhD, of the Ronald Reagan UCLA Medical Center, in Santa Monica, Calif.

Kuo said the psychiatrist, who inherited her patient from a previous physician, never questioned the previous doctor's judgment and continued to refill the risperidone prescription for years.

Kuo, who spoke at the American College of Physicians Internal Medicine meeting in May, said she took her patient off risperidone and got him "fixated" on the treadmill. He lost 15 lbs almost immediately. That patient is still battling with his weight, but Kuo said she meets with him regularly to keep him on track.

Kuo said some psychiatrists treat children with an "it's-not-broken-so-I-haven't-fixed-it" mindset. Primary care doctors may need to be more assertive in pushing a total health agenda instead of deferring all of their care for autistic patients to psychiatrists.

On the other hand, some patients require antipsychotics.

"You can't make behavioral change around healthy lifestyle behaviors when everything is dysregulated," said Brooke Sweeney, MD, of Children's Mercy Kansas City. Sweeney works with a psychologist at a clinic for special needs children with obesity.

Many of the children she sees need atypical antipsychotics to be successful and function in school, Sweeney noted, adding that she prescribes metformin and other hunger-suppressing medications. However, "it's tough because, in kids, [those drugs] aren't well-studied for that purpose."

Each of these clinicians also teaches patients and families ways to eat healthy and introduces them to new physical activities.

Read the full story via MedPage Today.

Learn more about the Weight Management Program at Children's Mercy.