Weight management is important to every individual. Obesity is associated with excess morbidity and mortality across all populations. Children with Down Syndrome (DS) have a tendency to be overweight, which predisposes them to overweight in adolescence. A number of studies have demonstrated a greater prevalence of obesity in the (DS) population.

• Magge, S. et al. (2007) - Children with DS have significantly higher body mass index, body fat and levels of the hormone leptin, which may explain their increased risk of obesity. DS may predispose genetic resistance to leptin which normally suppresses appetite and regulates body weight.
• Melville, C. et al. (2005) - within the study population, DS females were more likely to be obese than DS males compared to their matched general population controls.
• Rubin, S. et al. (1998) - Measured by Body Mass Index, persons with DS had higher prevalence of overweight than the general population. DS persons living at home were more likely to be overweight than those living in a group home setting.

Safe weight gain management in teens with DS should begin with a complete annual physical assessment. The assessment should also include:

• Thyroid function tests (free T4 and TSH)
• Auditory exam
• Ophthalmologic exam
• Dental exam every 6 months
• Consult with reproductive health specialist experienced in DS care

Hypothyroidism is a condition known to affect as many as 30% of DS individuals before 25 years of age. Symptoms may include: fatigue, lethargy, weight gain, decreased appetite, sleepiness, cold intolerance, depression, etc. Along with free T4 and TSH thyroid antibodies should be tested if hypothyroidism is suspected.

Regular Physical Activity

Regular physical exercise helps adolescents with DS manage their weight while improving their muscle strength, endurance, balance, and coordination. Organized recreation programs can be highly effective ways to motivate teens to enjoy regular physical activity, and to increase community involvement and interaction.

Like any adolescent, the teen with DS will be more likely to engage in regular physical activity if that activity is age appropriate and based on the interests of the teen and family members. Accessibility and availability are also important considerations. Some good choices for adolescents with DS include:

• walking
• hiking
• dancing
• running
• aerobics
• skating
• skiing
• cycling
• horseback riding
• swimming
• weight training
• bowling
• softball
• volleyball
• soccer
• tennis
• golf

Nurses working with adolescents with DS can be instrumental in overcoming barriers to exercise. Teens with DS are more likely to engage in regular exercise if they receive encouragement and instruction from others, and if they have someone to exercise with. Some teens may prefer to exercise with family members, while others are more peer-oriented.

In addition to encouraging the teen to exercise, the nurse can locate appropriate sources of instruction. For some teens with DS, regular group or private lessons offered at a community agency or fitness center will provide the right level of instruction and support. Others may need the services of adaptive physical education instructors skilled in working with individuals with disabilities. Adapted recreation programs, such as bowling leagues or swim programs for adolescents with disabilities, can be terrific sources of instruction and provide peers to exercise with.

All too often, adolescents with Down syndrome are not involved in the decision-making process when it comes to dietary choices. Whether they live at home with family, in a group setting, or in boarding programs, teens with DS should actively participate in their weight management. Joan Medlen, R.D. has developed a "rule of thumb", the following nutrition guidelines work well for adolescents with DS:

• Plan and eat three meals a day
• Eat meals at least every five hours; if meals must be more than five hours apart, plan healthy snacks
• Include three out of the five food groups in every meal
• Include two out of the five food groups in every snack
• Don’t worry about including the "sometimes"/"other" food groups - they’ll end up in the diet anyway
• Take half of the portion you feel like eating. When that’s gone, set the timer for 15 minutes. If still hungry when the timer goes off, it’s okay to have seconds
  
  

• Create an environment that promotes healthy lifestyles, leading by example
• Demonstrate an attitude of complete acceptance, especially if the teen is overweight
• Don’t be obsessed with the teen’s weight, food choices, or the negative consequences of being overweight
• Discuss concerns without being the "food police"
• Don’t ignore the teen’s food preferences
• Involve the teen in menu selection and snack choices
• Teach food shopping and preparation skills
  

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