Question:
What are your thoughts about medications to treat obesity in a patient who has not been significantly successful with diet and exercise but is still trying? Examples: orlistat (Xenical, or Alli in lower dose), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), semaglutide (Wegovy). Also a new FDA-approved “medical device” called Plenity, a hydrogel that expands in the stomach but isn’t absorbed from the digestive tract. Thanks, looking forward to hearing your thoughts.
Answer:
Obesity and overweight as measured by body mass index (BMI) are more common in people with Down syndrome (DS). BMI, the measurement commonly used to assess weight status, is a calculation based on height and weight. A score of 18.5 to 24.9 is considered normal, 25-29.9 is “overweight,” 30-34.9 is class 1 obesity, 35-39.9 is class 2 obesity, and 40 and above is class 3. However, there is ongoing study and discussion as to the accuracy of BMI as a measurement in people with DS as noted in an article called “Assessing Down Syndrome BMI and Body Composition“ and another article called Body Composition and BMI Growth Charts in Children with Down Syndrome. For now, BMI is the measure commonly used.
For a person with DS, weight management can be as challenging or even more challenging than in others. An article called Weight Management in Adults with Down Syndrome, summarizes some of the issues and approaches to weight management.
However, the difficulty of weight management and the frequent failure despite great effort have led to the exploration of other treatments.
One study, Sleeve Gastrectomy for Youth With Cognitive Impairment or Developmental Disability, looked at weight loss (bariatric) surgery for adolescents. Eight of the participants had a cognitive impairment (CI) or developmental disability (DD) including three with Down syndrome. The study concluded that “Bariatric surgery may be a helpful tool for adolescents with severe obesity and CI/DD. They could benefit from the surgery as much as those with typical development and having CI/DD should not be used as a criterion to deny surgery.”
Unfortunately, we were not able to find a study (or studies) describing the use of weight loss medication in people with DS. There are several medications available for weight loss but the knowledge of their use in people with DS is limited.
We have treated a small number of adults with DS with weight loss medication with some success. We think it is reasonable to consider medications for some individuals, especially when other methods have not been successful, particularly if they have health complications related to obesity. When the decision is made to consider a medication, a careful review of the medical history is warranted to help in the selection of the correct medication. The appropriate medication will vary from person to person. For example, some medications may be concerning for someone with gastrointestinal concerns, some for a person with history of anxiety, etc.
obesity_medicationsIndividuals taking medications for appetite and weight loss need to be monitored closely. We recommend working with a physician who is familiar with using weight loss medications and if possible, also in caring for people with DS. A provider who is affiliated with a university medical system who specializes in weight management may be an option. A physician who is familiar with medications for weight will be aware of the contraindications.
Obesity is often more complicated to treat than “eat less and exercise more” which has been a standard for treatment for many years. Further study of obesity both in people with and without DS will hopefully improve our understanding of cause(s) and treatments.
Additional information on medications for weight loss can be found on the Mayo Clinic website and Obesity Medicine website.