How can we stem weight gain related to behavioral meds for autism?

This response is by developmental pediatrician Daniel Coury, medical director of Autism Speaks Autism Treatment Network (AS-ATN). Dr. Coury is also the chief of developmental-behavioral pediatrics at Nationwide Children’s Hospital, in Columbus, Ohio.

Our son has developed diabetes, and we know it’s from the weight he gained since starting behavioral medicines. We’ve tried everything to manage his appetite, and it’s tearing us apart to think we’re trading his health for his ability to function in school. What can we do?

You’re not alone experiencing this difficult situation. Some individuals with autism have challenging behaviors that can’t be managed by behavioral and environmental strategies alone. In these cases, medication may be an appropriate part of an overall treatment plan.  We discuss this decision and associated issue in the Medication Decision Aid Tool Kit and Autism and Medication: Safe and Careful Use. You may find one or both guidebooks helpful.

Behavioral autism medicine causing weight gain

Unfortunately the medicines approved for treating autism-related “irritability” (tantrums, moodiness, aggression) frequently cause increased appetite and weight gain and, sometimes, diabetes.

It sounds like you’ve already tried the first-line approach to managing his weight gain. This includes healthier food choices, reducing portion size and increasing daily exercise. Sometimes this needs to involve removing high-calorie foods from the home entirely or locking refrigerators and pantries. Family activities such as walking and riding bicycles can help reverse unwanted weight gain as well. In fact, many parents find that increased physical activity has the added benefit of reducing their child’s problem behaviors.

Admittedly, food restriction and increased exercise can prove particularly difficult for some individuals who have autism. For these and other reasons, diet and exercise aren’t always enough. And when these usual strategies fail, many parents find themselves in the difficult position you describe: Feeling like they are choosing between their child’s health and a medicine that helps their child function.

It’s this “we’ve tried everything” situation that has spurred the AS-ATN’s interest in a diabetes medicine called metformin.

Metformin for autism

In recent clinical trials, metformin reduced weight gain and diabetes risk in adults with schizophrenia who were taking the same medicines commonly prescribed for autism-related behavior problems. These include Risperdal, Abilify, Seroquel and Zyprexa. In studies involving more than 800 participants, investigators found that metformin produced an average weight loss of nearly 7 pounds per person.

But while metformin has been studied in adults, we have limited information on its effectiveness in children. Furthermore, it’s never been studied in individuals with autism, who often respond differently to psychoactive medicines.

For these reasons, four AS-ATN sites are joining forces to carefully study metformin in children who have autism and problematic weight gain related to behavioral medicines. Treatment will be provided at no cost to participating families, with doctors following all participants to monitor benefits and potential side effects.

I believe this critical study has the potential to improve the health of thousands of children with autism.

This study is being funded by the U.S. Health Resources and Services Administration, as part of AS-ATN’s role as the Autism Intervention Research Network Physical Health (AIR-P).

Thank you for your question. Please let us know how you and your son are doing.