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 or
acquired due to sudden accident or a shocking tragic event in life.
Obesity in Adults with Intellectual Disability
Obesity is defined as a medical condition wherein there is an excess accumulation of body fat, causing 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% in USA.
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 and 5) 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 program 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 post intervention.
The international clinical guideline for the management of obesity in people with ID includes:
Adults who are overweight or obese should aim for a clinically significant 5-10% weight loss (approximately 5-10 kilograms (kg)) from initial body weight for three to six months.
Multi-component lifestyle 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 obesity.
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.
Reference: Weight management interventions in adults with intellectual disabilities and obesity: a systematic review of the evidence; Dimitrios Spanos, BMC Nutrition Journal 2013.