Obesity, constipation, sleep problems, dysphagia (difficulty swallowing) and epilepsy are more common in people who have a learning disability, but pharmacy staff are ideally placed to offer support:

Obesity

Obesity is associated with increased mortality and morbidity and is detrimental to quality of life. The rate of obesity among people with a learning disability is significantly higher than in the rest of the population. The reasons for this are complex but some contributory factors are that:

• Genetic disorders carry a higher risk of obesity, for example Prader-Willi syndrome
• Hypothyroidism is associated with increased weight gain and the condition occurs in 20 per cent of people with Down's syndrome
• Some antipsychotic medicines such as olanzapine, risperidone, and anti-epileptic drugs (AEDs), including valproate, can cause increased appetite, which can lead to weight gain.

Prevention is the most important strategy to managing obesity and the NHS Eatwell Guide provides information to support people to achieve a healthy balanced diet.

In addition, Easyhealth provides accessible audio information and easy-read leaflets with pictures on healthy eating, obesity and exercise which are suitable for people who have a learning disability.

Constipation

Constipation can be hard to identify in people with a learning disability as they might find it hard to articulate their symptoms. They might present with pain and you might have to ask more about the pain and their toileting habits to determine that the person has constipation.

If a person who has a learning disability asks for advice about how to treat constipation, it is important to establish the causes to see if these can be modified. Causes can include:

• Medicines, for example some psychotropic medicines, iron and some analgesics
• Reduced physical activity due to poor mobility
• Reduced gut motility results in greater fluid absorption in the large intestine leading to constipation
• Poor fluid and fibre intake
• Poor toileting habits.

You should provide initial lifestyle advice, including increasing fluid and fibre intake together with exercise, before suggesting any medicines. If medicines are required, consider bulk-forming laxatives and an increased fluid intake first, unless the constipation is opioid-induced, in which case, recommend an osmotic laxative (or docusate which also softens stools) and a stimulant laxative.

Remember to check if the person has any swallowing difficulties and, if necessary, use dispersible or liquid formulations. In addition, before giving a liquid formulation, ensure that you check that everyone who is administering the medicine is able to use the measure or syringe provided, as some people with a learning disability find measuring liquids difficult.