Obesity Management in Autistic Adults: Toward a Neurodiversity-Informed Approach

Autistic adults experience substantially higher rates of obesity compared with neurotypical peers, contributing to markedly increased all-cause mortality. Despite these disparities being independent of intellectual ability, gender, or support needs, existing literature disproportionately concentrates on children and/or individuals with intellectual disability. Consequently, obesity management in autistic adults as a whole remains an under-addressed topic. This clinical review explores the intersection of autism and obesity through a biological, pharmacologic, and experiential lens. We review neuropsychiatric factors that influence eating and physical activity, including sensory processing differences, executive dysfunction, and stress response. We also examine physiological differences relevant to obesity risk, including circadian differences, gut microbiome, and inflammation. In addressing intervention, we highlight high-prevalence co-occurring conditions, including sleep disorders, gastrointestinal disorders, allergies/asthma, and hypermobility syndromes, as modifiable obesity risk factors. Given high rates of psychotropic use in autistic adults, we discuss their role in both obesity risk and treatment, as well as interactions between psychotropics and obesity pharmacotherapy. We then outline autism-specific considerations for optimizing both psychotropic and obesity pharmacotherapy. Finally, we emphasize a neurodiversity-affirming approach to lifestyle modification, prioritizing collaboration, sensory and executive-function accommodations, flexible dietary strategies focused on macronutrient ratios and micronutrient sufficiency, and individualized physical activity that accounts for motor, sensory, and social barriers. We argue that applying an autism-specific, neurodiversity-informed lens can improve engagement, mitigate risk, and enhance the effectiveness of obesity management for autistic adults.