My son has mild Tourette’s syndrome, obsessive-compulsive disorder, and type 1 diabetes. Over the past two years, he eats uncontrollably, has had tremendous weight gain, currently is 5 feet 3 inches tall, 165 pounds, and his blood sugars are all over the board. He wants to be slim but seems unwilling to self-regulate eating. Is there a specific diet, such as Atkins’, that could help? Is there a relationship between insulin and serotonin that might be triggering constant overeating?

Your son’s Body Mass Index (BMI) is a little over 29 kilograms per meter squared, which is in the obese category. While diet seems like such a simple and obvious remedy and sometimes achieves short term results, the end results have been uniformly disappointing. The Atkins’ high protein, low carbohydrate approach has achieved some results in dedicated adults; but, as you point out yourself, his motivation has to be compromised by the complications of Tourette Syndrome and obsessive-compulsive disorder (OCD), both of which incidentally are thought to be autoimmune-based, like type 1A (autoimmune) diabetes. (See Hoekstra PJ, Kallenberg CG, Korf J, Minderaa RB. Is Tourette’s syndrome an autoimmune disease? Mol Psychiatry. 2002;7(5):437-45.)

There has been a great deal of publicity lately on the way fast foods and lack of exercise have induced a substantial increase in obesity in the North American population generally, and the bad effects of this, though real, are indeed long term. For that reason, your son may soon benefit from some of the intense research being carried out on a spectrum of new hormones that are now recognised as affecting appetite. I think that success in treating weight problems will come when the intricacies of the actions of hormones like leptin, ghrelin and PYY have been more fully elaborated. PYY is already in clinical trials in Britain with some initial success.

If before these factors are better understood there are real problems with obesity such as difficulty with breathing on lying down then I think you should talk to his doctor about the possibility of surgery. It has not been encouraged in children, but at present it may be the only long term effective therapy available.

DOB