There's a spectrum to downs, and this guy is on the higher end of it. People with downs at his level are very capable of living relatively independent lives and do really well with setting goals, with the right support they can do great things. Some I work with own homes, have jobs and pets and just really need someone to make sure no one is taking advantage of them and making sure their medical conditions are managed. That said, he must have a great circle of support and family. We get many clients with downs and other conditions spread across the spectrum whose families let them get insanely fat. It's a struggle to help them break those habits, but once a routine is in place and they see the rewards disabled adults more often than not enjoy taking part in living healthy lives. I love coming in to work and having a client tell me "I lost 3 pounds!" The conditions they have might make weight loss more difficult and sometimes they have impulse problems with food but like anyone else they can be a healthy weight.