S. Boyle

The prevalence and determinants of obesity in adults with intellectual disabilities.

People with intellectual disabilities experience significant health inequalities compared with the general population, including a shorter life expectancy and high levels of unmet health needs. Another accepted measure of health inequalities, the prevalence of obesity, has been shown to be higher in adults with intellectual disabilities than in the general population. While the factors contributing to the increased prevalence among adults with intellectual disabilities are not well understood, the high rates of obesity among younger adults highlight the need for further research involving children and adolescents with intellectual disabilities. To take forward the priorities for research and the development of effective, accessible services, there is a need for collaboration between professionals working in the fields of intellectual disabilities and obesity.

A review of weight loss interventions for adults with intellectual disabilities

Obesity is more prevalent in adults with intellectual disabilities than in the general population, and has been shown to contribute to their reduced life expectancy, and increased health needs. Relatively few studies have examined the effectiveness of weight loss interventions for adults with intellectual disabilities. However, there is evidence to support interventions that take account of the context of the lives of adults with intellectual disabilities, including carer involvement in interventions. To reduce the health inequalities experienced by adults with intellectual disabilities, there is a clear need to develop accessible, evidence‐based clinical weight management services.

Changes in body weight and food choice in those attempting smoking cessation: a cluster randomised controlled trial

BackgroundFear of weight gain is a barrier to smoking cessation and significant cause of relapse for many people. The provision of nutritional advice as part of a smoking cessation programme may assist some in smoking cessation and perhaps limit weight gain. The aim of this study was to determine the effect of a structured programme of dietary advice on weight change and food choice, in adults attempting smoking cessation.MethodsCluster randomised controlled design. Classes randomised to intervention commenced a 24-week intervention, focussed on improving food choice and minimising weight gain. Classes randomised to control received “usual care”.ResultsTwenty-seven classes in Greater Glasgow were randomised between January and August 2008. Analysis, including those who continued to smoke, showed that actual weight gain and percentage weight gain was similar in both groups. Examination of data for those successful at giving up smoking showed greater mean weight gain in intervention subjects (3.9 (SD 3.1) vs. 2.7 (SD 3.7) kg). Between group differences were not significant (p = 0.23, 95% CI −0.9 to 3.5). In comparison to baseline improved consumption of fruit and vegetables and breakfast cereal were reported in the intervention group. A higher percentage of control participants continued smoking (74% vs. 66%).ConclusionsThe intervention was not successful at minimising weight gain in comparison to control but was successful in facilitating some sustained improvements in the dietary habits of intervention participants. Improved quit rates in the intervention group suggest that continued contact with advisors may have reduced anxieties regarding weight gain and encouraged cessation despite weight gain. Research should continue in this area as evidence suggests that the negative effects of obesity could outweigh the health benefits achieved through reductions in smoking prevalence.Trial registrationCurrent Controlled Trials ISRCTN73824458

A cluster randomised control trial of a multi-component weight management programme for adults with intellectual disabilities and obesity

There have been few published controlled studies of multi-component weight management programmes that include an energy deficit diet (EDD), for adults with intellectual disabilities and obesity. The objective of this study was to conduct a single-blind, cluster randomised controlled trial comparing a multi-component weight management programme to a health education programme. Participants were randomised to either TAKE 5, which included an EDD or Waist Winners Too (WWToo), based on health education principles. Outcomes measured at baseline, 6 months (after a weight loss phase) and 12 months (after a 6-month weight maintenance phase), by a researcher blinded to treatment allocation, included: weight; BMI; waist circumference; physical activity; sedentary behaviour and health-related quality of life. The recruitment strategy was effective with fifty participants successfully recruited. Both programmes were acceptable to adults with intellectual disabilities, evidenced by high retention rates (90 %). Exploratory efficacy analysis revealed that at 12 months there was a trend for more participants in TAKE 5 (50·0 %) to achieve a clinically important weight loss of 5-10 %, in comparison to WWToo (20·8 %) (OR 3·76; 95 % CI 0·92, 15·30; 0·064). This study found that a multi-component weight management programme that included an EDD, is feasible and an acceptable approach to weight loss when tailored to meet the needs of adults with intellectual disabilities and obesity.

Carers' perspectives on a weight loss intervention for obese adults with intellectual disabilities: a qualitative study

The prevalence of obesity rates has been reported to be higher in adults with Intellectual Disabilities (ID) than in the general population (1) . It is likely that multi-component weight management interventions that involve carers could have considerable impact on process and potentially on actual weight loss for adults with ID (2) . To date no studies have explored the role of carers in supporting adults with ID and obesity during a weight loss programme. The aims of the present study were (i) to explore perceptions of carers supporting adults with ID as they participated in a 6-month multi-component weight loss intervention (TAKE 5), (ii) to identify strategies that carers and participants adopt to overcome barriers to changes in lifestyle, and (iii) to record carers’ perceptions of the acceptability and utility of the multicomponent weight loss intervention. TAKE 5 is a multi-component weight loss intervention that is consistent with recommendations included in current clinical guidelines (3) . TAKE 5 comprised nine individual sessions delivered to fifty-four adults (‡ 18 years) with ID and obesity (BMI ‡ 30 kg/m 2 ), involving carers (paid carers or family carers) to support the participants where appropriate. The TAKE 5 intervention aimed for a 5 % weight loss from initial body weight after 6 months. A purposive sampling method was used to incorporate the experiences of twenty-four carers who were paid (n 16) or family carers (n 8) and who supported participants who successfully achieved a 5 % weight loss (n 12) or did not (n 12). One to one semi-structured interviews were conducted and later transcribed verbatim at week 24. The transcripts were analysed using ATLAS ti 5.2 software, alongside a ‘thematic analysis’ (4) as a qualitative analytical method. The main themes that emerged on analysis were carers’ perceptions on participants’ health; barriers and facilitators in weight loss and carers’ perceptions of the multi-component weight loss intervention. Carers described the weight loss as being beneficial to participants’ health. Furthermore, they discussed their efforts to encourage and aid participants to improve their diet and physical activity. However, lack of sufficient support and poor communication among carer colleagues were identified as being inhibitory. The need for resources tailored to aid weight loss among adults with ID was also highlighted. This study identified specific facilitators and barriers experienced by carers during the process of supporting obese adults with ID to lose weight. Future research should utilise these findings to develop appropriate and effective weight management interventions for this group.

A pilot study of the TAKE 5 weight loss intervention for adults with obesity

Aim: To explore the health needs of young people with ID living in state care in Northern Ireland. Method: The general health and mental health needs of 37 adolescents with ID (aged 10–15 years) were compared with an age-matched sample of young people without ID (n = 128) living in state care. Data were collected from social worker reports and the Strengths and Difficulties Questionnaire (SDQ). Results: The young people with ID had a significantly greater prevalence of health difficulties than their non-ID peers and also showed significantly more emotional and behavioural problems. In particular, 77.1% of the young people with ID scored within the abnormal range of the SDQ thereby indicating potential mental health difficulties compared with 49.6% of young people without ID. Conclusion: Young people with ID have additional physical and mental health needs which may not currently be met, or even recognized. They may be subject to ‘diagnostic overshadowing’, may have less effective coping strategies than their non-disabled peers and may be less able to utilize available health services. A greater awareness of the health needs of this vulnerable population is needed so effective health promotion strategies and interventions can be developed.Aim: To ascertain knowledge of breast cancer among women with ID and explore their experiences of breast mammography. Method: A qualitative approach using four focus groups with women with ID was employed and a semi-structured interview schedule aided the process. Results: Knowledge of associated risks, preventative factors and signs and symptoms of breast cancer were extremely limited with their sources of knowledge primarily coming from carers. Positive attitudes towards mammography were reported. However, these women also described feelings of fear and anxiety, attributed to a lack of under- standing about the screening process. A lack of information and embarrassment were identified as the main barriers to screening. Ongoing support from carers and accessible information were considered to be the main solutions for encouraging attendance for breast mammography. Conclusion: This study highlights the need for health promotion and education for women with ID, their family and carers in order to enhance the knowledge and awareness of breast cancer and screening. This will aid not only in reducing the adverse affects of breast mammography but will ensure that informed decisions about breast screening are made. More accessible multi-format information for women with ID is essential in order to facilitate health promotion and education.Abstract aim: The aim was to identify if a health promotion intervention using action research promotes healthier lifestyles for intellectually disabled (ID) children related to diet and physical activity. Method: School pupils with an ID (N=34; 50% male/female) attending 10 participating schools took part, 27 were overweight/obese. The study followed an action research cyclic approach with pupil’s agreeing an individualised ‘healthy living plan’. Repeated measurements of the children’s body composition (BMI, body fat, waist circumference); adherence to 7 health improvement behaviours and one-to-one interviews at 3 time intervals were undertaken over 12-weeks (beginning, mid-point and end). Ethical agreement was obtained and sound ethical principles followed. Results: No significant difference was identified in body composition measurements in the pupils across study period. However, active engagement in the healthy living plans related to diet and activity levels occurred, with three quarters of the agreed behaviours being adhered at the end of the 12-weeks. Narratives from the children identified difficulties with engagement but also the value from healthier lifestyle changes. Conclusions: A 12-week period was not sufficient to see statistical change in growing children’s body composition measurements. However, this study demonstrates that ID children can meaningfully partake in an action research study. A health promotion intervention involving education within an empowering framework with children reaching joint participatory agreement as co-planners has a place in the repertoire of health improvement for such children and long-term health gains can result from adopting healthy life-styles early in life.