Management

Obesity is the most difficult problem. General interventions include:

• exercise:
  • should be commenced before obesity is severe
  • often limited by somnolence and poor muscle power
    
    
• food avoidance:
  • may need to lock food away
  • residential care may permit stricter control of intake

Pharmacological interventions include:

• fluoxetine:
  • may help with obesity and food obsessions
    
    
• human growth hormone:
  • improves the fat to lean mass ratio

Surgical interventions such as gastroplasty are limited by the need to obtain informed consent.