Weight management interventions in adults with intellectual disabilities and obesity: a systematic review of the evidence

Abstract

To evaluate the clinical effectiveness of weight management interventions in adults with intellectual disabilities (ID) and obesity using recommendations from current clinical guidelines for the first line management of obesity in adults. Full papers on lifestyle modification interventions published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on 1) intervention components, 2) methodology, 3) attrition rate 4) reported weight loss and 5) duration of follow up. Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (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 behaviour change techniques. Three studies reported clinically significant weight loss (≥ 5%) at six months post intervention. Current data indicate weight management interventions in those with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified.

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

“…In line with previous systematic reviews in this area, [153][154][155] findings from this systematic review demonstrate a lack of quality evidence on the effectiveness of multicomponent behaviour change interventions in people with ID. In 2010, Jinks et al 153 focused a systematic review on qualitative studies of behavioural change approaches in people with ID to aid weight loss and health.…”

“…However, there is a paucity of literature on their long-term effects in this population. In keeping with existing recommendations, 154 we highlight the need for robust RCTs to evaluate the long-term effects of multicomponent behaviour change interventions, informed by current guideline recommendations, for people with ID.…”

“…The authors noted an overall lack of research on behavioural approaches and using qualitative methods. Similarly, in 2013, Spanos et al 154 reviewed 22 papers that assessed interventions for weight loss in people with ID. They noted that many of the interventions did not meet the recommended duration in clinical guidelines and were too specific.…”

“…However, there is a lack of quality evidence on the health and health care of people with ID, including the effectiveness of health interventions. 152 Previous systematic reviews of lifestyle behaviour change interventions in ID [153][154][155] have generally been unable to make specific recommendations because of inadequacies in study design and conduct, a lack of theory basis for intervention and/or unclear reporting.…”

Managing with Learning Disability and Diabetes: OK-Diabetes – a case-finding study and feasibility randomised controlled trial

“…121,202,203 The second characteristic of our intervention was its emphasis on diabetes self-management in a broadly defined sense rather than specifically on weight reduction through a calorie-deficit diet, given the centrality of obesity to type 2 diabetes and its very high prevalence in our population. There is a challenge here, too, in that effective weight management programmes require a specific focus, 204 whereas the most effective diabetes programmes are said to be multicomponent.…”