Obesity in people with intellectual disabilities: the impact of nurse‐led health screenings and health promotion activities

Marshall, David C.; McConkey, Roy; Moore, Gordon T.

doi:10.1046/j.1365-2648.2003.02522.x

Cited by 107 publications

(125 citation statements)

References 16 publications

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“…Primarily, the included studies were cross-sectional observational (n = 31 81,82,98,[100][101][102]104,106,[109][110][111]114,116,119,121,124,[126][127][128][129][130][131][132][133][134][135]137,139,142,143,145 ). The remaining studies involved retrospective database or medical records data (n = 22 [83][84][85][86][87][88][89]94,95,99,107,113,115,117,118,120,122,123,136,…”

Section: Study Characteristicsmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

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Section: Study Characteristicsmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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“…Based on actual measurements of body weight and height of 183 British men and women with ID living with other family members, Bell and Bhate [1992] found that 19.0% of men and 34.6% of women were obese (i.e., BMI Ն 30). In a sample of 321 adults with ID who resided in Northern Ireland, Marshall et al [2003] reported that 32% were obese (BMI Ն 30), and 4.2% were classified in the extremely obese category (BMI Ն 40). In a sample of adults with ID (n ϭ 202) residing in Sydney, Australia, 16.3% of men and 26.5% of women were obese (i.e., BMI Ͼ 30).…”

Section: Obesity Prevalence In Adults With Id Outside the United Statesmentioning

confidence: 99%

Obesity and intellectual disability

Rimmer

Yamaki

2006

Ment. Retard. Dev. Disabil. Res. Rev.

231

165

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While much of the industrialized world struggles for clues to the growing rise in obesity in their respective countries, researchers and service providers involved in understanding the health characteristics and health behaviors of persons with intellectual disability (ID) struggle with their own issues regarding the increased prevalence of obesity in this segment of the population. What is particularly alarming is that adults with ID residing in the United States in smaller, less supervised settings (e.g., group homes and family households) have a significantly higher rate of obesity compared to other countries and those living in larger and more supervised settings (e.g., institutions). These differences support the theory that the environment appears to exert a powerful influence on obesity in this population. Obesity presents a substantial threat to the livelihood of persons with ID and may have an effect on community participation, independent living, and healthy years of life. The lack of research on successful weight reduction strategies for obese persons with ID makes this an important and greatly needed area of research. Key Words: obesity; intellectual disability; developmental disability; health promotion; health status O besity is a serious health risk among many individuals and groups throughout the industrialized world and often leads to various health conditions including hypertension, diabetes, heart disease, arthritis, stroke, stress, depression, and respiratory diseases [Eckel, 1997; National Institutes of Health, 1998;Must et al., 1999;Pi-Sunyer, 1999; National Task Force on the Prevention and Treatment of Obesity, 2000]. In the United States, obesity has more than doubled from 13.4% in 196013.4% in to 30.9% in 200013.4% in [Flegal et al., 2002. As a result of this substantial increase, the U.S. Surgeon General declared that obesity has reached epidemic proportions in the nation and called for an immediate action to prevent and reduce its impact on both the individual and society at large [U.S. Department of Health and Human Services, 2001].Researchers have also recognized that obesity is a major health threat in persons with intellectual disability (ID) [Fox and Rotatori, 1982;Kelly et al., 1986;Rimmer et al., 1993;Rubin et al., 1998;Horwitz et al., 2000;Janicki et al., 2002;Traci et al., 2002]. Population-level prevalence data indicate that the obesity levels of adults with ID are either similar to or higher than their non-ID counterparts [Emerson, 2005;Yamaki, 2005]. Lack of healthy eating habits and regular physical activity, common factors associated with obesity in the general population [U.S. Department of Health and Human Service, 2001], are also growing problems among persons with ID [Draheim et al., 2002;Braunschweig et al., 2004;Emerson, 2005].Obesity results in significant societal and personal costs [Poston and Foreyt, 1999]. Among persons with ID, it has the potential to reduce or limit opportunities for various types of community participation, including employment and leisu...

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“…Obesity is a significant health problem within the intellectual disability population (Blair and Nichaman, 2002), as a higher proportion are overweight or obese compared with the general population (Marshall et al, 2003;Draheim, 2006). The Centres for Disease Control and Prevention (CDC) reports this rate is higher by 59% (CDC, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…Health promotion aims to enable people to gain control over their lives (World Health Organization (WHO), 1986) and refers to health in a broad sense including physical, mental and social health (Ewles and Simnett, 2010) focusing on primary, secondary and tertiary prevention (Hart, 2007). Within intellectual disability, the emphasis in health care has predominantly been directed at the primary disability rather than on prevention or reducing secondary health conditions (Marshall et al, 2003). This emphasis on prevention or management of disability may indicate a possible reason why health promotion issues have not been addressed for people with an intellectual disability (Rimmer, 2002), and terms such as 'wellness' and 'health promotion' are not often associated with this population (Rimmer, 1999;Marshall et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Health promotion for people with intellectual disability and obesity

Doody

2012

Br J Nurs

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Obesity is a significant health problem for people with intellectual disability, as they report a 59% higher rate of obesity as compared with those in the general population (Centres for Disease Control and Prevention, 2006). Causes are multifactorial and obesity leads to a higher risk of developing chronic conditions, such as diabetes and heart disease. While the risks of these conditions generally increase with age, people with an intellectual disability are at risk of developing them earlier owing to their higher levels of obesity. Client groups with mild intellectual disability residing in a group home or family home are at a higher risk of obesity than those in institutional care, mainly owing to increased independence and available choices. Healthcare services have predominantly focused on the primary disability rather than on prevention or reduction of secondary health conditions. As health promotion enables people to gain control over their lives, it is essential to address the health concern of obesity for people with intellectual disability. This article highlights the issues in health care faced by people with an intellectual disability and aspects that health professionals need to consider when engaging in health promotion for those who are obese.

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Obesity in people with intellectual disabilities: the impact of nurse‐led health screenings and health promotion activities

Cited by 107 publications

References 16 publications

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Obesity and intellectual disability

Health promotion for people with intellectual disability and obesity

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