Intellectual disability is
defined by substantial disability or limitations in the intellectual capacity
and functioning that interferes with the normal social behavior and practical
skills. Intellectual disabilities in adults may be congenital due to genetic
syndromes such as Down's syndrome
or Cerebral Palsy
acquired due to sudden accident or a shocking tragic event in life.
Obesity in Adults with
as a medical condition wherein there is an excess accumulation of body fat
overweight. Obesity is a significant health problem for adults with ID. The
estimated prevalence of Obesity in adults with ID is about 27% in UK and 33.6%
Several clinical guidelines
advocate that obesity management programs should apply multi-component strategy
that include guidance on dietary activities along with physical activity model
and also ought to comprise behavior change practice to help individuals achieve
sustainable transformation in their lifestyle.
Research Studies conducted on
adults with Intellectual disabilities were based on:
1) Intervention components 2)
methodology 3) attrition rate 4) reported weight loss
duration of follow up.
The interventions were classified
according to inclusion of the following components:
1) Behavior change alone 2)
behavior change plus physical activity 3) dietary advice / changes alone 4) physical activity
alone 5) dietary changes plus physical activity advice and 6) multi-component
(Behavior, Diet and Physical Activity Advices).
There were eight research studies
with multi-component interventions, of which, one study used a 600kilocalorie
(2510 kilojoule) daily energy deficit diet. Study durations were mostly below
the duration recommended in clinical guidelines and varied widely.
No study included an exercise
promoting 225-300 minutes or more of moderate intensity physical activity
per week but the majority of the studies used the same behavioral techniques.
Three studies reported clinically significant weight loss (≥ 5%) at six months
The international clinical
guideline for the management of obesity in people with ID includes:
Adults who are overweight
should aim for a clinically significant 5-10% weight loss (approximately 5-10
kilograms (kg)) from initial body weight for three to six months.
interventions that include:
An advice to encourage a daily
dietary restriction of 600 kcal to 1000 kcal energy deficit diet per day by
lowering the carbohydrate
and fat intake.
Treatment of obesity is
recommended for an increase in the physical activity to more than 225-300
minutes of moderate intensity physical activity/ exercise per week. However,
the benefits of physical activity in the management of obesity depend upon the amount
and the intensity of the exercise intervention.
Behavior change strategies are
used to facilitate the dietary and activity changes advocated. Behavior
techniques in weight management aim to sustain changes in cognitive behavior
pertaining to the eating habits or eating activity patterns of individuals with
Most common behavioral techniques
used in management of obesity in adults with ID are the same with those
recommended in adults without ID, and includes self-monitoring, goal setting,
reward strategies and relapse prevention.
management interventions in adults with intellectual disabilities and obesity:
a systematic review of the evidence; Dimitrios Spanos, BMC Nutrition