Adults with intellectual disabilities experience high rates of obesity. Despite this higher risk, there is little evidence on the effectiveness of weight-loss interventions for adults with intellectual disabilities and obesity. The present study examined the effectiveness of the TAKE 5 multi-component weight-loss intervention. Adults with obesity were invited using specialist intellectual disability services to participate in the study. Obesity was defined as a BMI of 30 kg/m 2 or greater. TAKE 5 included a daily energy-deficit diet of 2510 kJ (600 kcal), achieved via a personalised dietary prescription. Participants' body weight, BMI, waist circumference and levels of physical activity and sedentary behaviour were measured before and after the intervention. A total of fifty-four individuals consented to participate, of which forty-seven (87 %) completed the intervention in the study period. There was a significant decrease in body weight (mean difference 24·47 (95 % CI 25·91, 2 3·03) kg; P,0·0001), BMI (21·82 (95 % CI 2 2·36, 2 1·29) kg/m 2 ; P,0·0001), waist circumference (26·29 (95 % CI 2 7·85, 24·73) cm; P,0·0001) and daily sedentary behaviour of participants (2 41·40 (95 % CI 2 62·45, 220·35) min; P¼ 0·00 034). Of the participants who completed the intervention, seventeen (36·2 %) lost 5 % or more of their initial body weight. Findings from the study suggest that TAKE 5 is an effective weight-loss intervention for adults with intellectual disabilities and obesity. The effectiveness of TAKE 5 should be examined further in a controlled study.

Background Carers can have a significant impact supporting people with intellectual disabilities to make healthy lifestyle choices. This study examines carers' training needs on diet and physical activity. Methods A cross-sectional survey was undertaken of the knowledge and perceptions of carers supporting adults with intellectual disabilities. An interviewer administered questionnaire was used to examine carer knowledge of public health recommendations on diet and physical activity; perceptions of the benefits of healthy diets and physical activity levels; and the carer views on the barriers to change experienced by individuals with intellectual disabilities. Results Sixty-three carers took part in the study. They generally had a low level of knowledge around public health recommendations on diet and physical activity. Greater importance was attributed to the health benefits of diet than physical activity. Carers rated intrapersonal barriers to change within the person with intellectual disabilities as more important, than interpersonal or external barriers to change, with significant differences in perceived barriers relevant to diet and physical activity. Conclusions Carers supporting adults with intellectual disabilities have significant training needs relevant to promoting healthy lifestyles. This highlights the opportunity to promote health improvement via the development, and provision, of effective training initiatives.

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.

Homeless youths (N = 684) in eight cities participated in this study to understand the rates and correlates of substance use. Rates of lifetime and recent substance use ranged from 66% to 90%. Variability in lifetime and recent substance use was partially explained by being white (ages 14-17); ever attempting suicide (ages 14-17); not being African American (lifetime substance use) or Hispanic (ages 18-24); being male (ages 18-24); identifying as lesbian, gay, or bisexual (ages 18-24); using substances with a parent; beginning substance use at a young age; and having a family history of a substance problem.

Objective: To evaluate the first phase of a specialist weight management programme provided entirely within the UK National Health Service. Design: Prospective cohort study using multiple logistic regression analysis to report odds of $5 kg weight loss in all referrals and completers, and odds of completion, with 95 % confidence intervals. Anxiety and depression 'caseness' were measured by the Hospital Anxiety and Depression Scale. Conclusions: Further improvements in overall effectiveness might be achieved through targeting improvements in appropriateness of referrals, retention and effective interventions at specific populations of patients. KeywordsObesity Overweight Secondary preventionThe prevalence of excess weight and obesity is increasing in the UK and is a major cause of morbidity and mortality from cardiovascular and respiratory diseases, non-insulin dependent diabetes, musculoskeletal disorders and many cancers (1,2) . It has been estimated that 60 % of men and 50 % of women could be clinically obese (BMI $30 kg/ m 2 ) by 2050, costing the National Health Service £49?9 billion per year (3) . In Scotland, the prevalence of obesity has increased consistently since 1995 (4)(5)(6) such that, by 2008, about 26 % of men and 27?5 % of women were obese (7) . Overweight in men is about 6 % less prevalent in the largest regional Health Board of Scotland, Greater Glasgow and Clyde, but the prevalences of obesity in men and both overweight and obesity in women are similar to the national figures (5) . Despite the broad public health concerns about the impacts of obesity, evidence for the effectiveness of interventions based on diet and physical activity alone has been sparse and inconsistent (8) . Obesity is a complex problem that requires multi-modal approaches. Interventions incorporating an energy-deficit diet plus exercise, underpinned by behavioural interventions, are most clinically effective (9,10) and recent treatment guidelines developed in the UK recommend multicomponent approaches as an integral part of weight management (11,12)