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Overweight and Obesity in Individuals with Intellectual and Developmental Disabilities. A community based participatory Action Research Study. Research Team. Nursing: K . Fisher, PhD; T . Hardie , EdD & C . Polek PhD Physical Therapy: M. O’Neil, PhD Nutrition: A. Ventura, PhD
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A community based participatory Action Research Study
Nursing: K. Fisher, PhD; T. Hardie, EdD & C. Polek PhD
Physical Therapy: M. O’Neil, PhD
Nutrition: A. Ventura, PhD
Special Education: M. Miller, PhD
Health Sciences: Informaticist: P. Sockolow, DrPH
Service agency: KenCrest Services
E. Shulkusky (Director of Healthcare Services)
D. Gregoire(Director of Development)
F. Loomis(Board Member)
Higher health risks
Lower rates of health promoting behaviors
Lower socio-economic status
Issues with accessing services
Unique environmental considerations
Lack targeted programs to address their unique needs
Health Care Team lacks knowledge of their unique needs
Like other Americans, persons with mental retardation (MR) grow up, grow old, and need good health and health care services in their communities. But people with MR, their families and their advocates report exceptional challenges in staying healthy and getting appropriate health services when they are sick. They feel excluded from public campaigns to promote wellness. They describe shortages of health care professionals who are willing to accept them as patients and who know how to meet their specialized needs.
US Surgeon General’s Office. (2002): Closing the Gap: Report of the surgeon General’s Conference on Health Disparities and Mental Retardation; p. xi
Consistently report higher rates of obesity in adults with I/DD worldwide when compared to general population (Stedman & Leland, 2010).
Associated with: hypertension, diabetes, dyslipidemia, CAD, stroke, osteoarthritis, sleep disturbances, some cancers.
Nutrition – considered vulnerable or at risk for malnutrition according to American Dietetic Association (2004)
Environmental influences = lack of nutrition knowledge, limited control over food purchasing, food planning or food preparation; finances.
Living arrangements = less restrictive (own home; family home) = have higher prevalence of obesity
Nutritionists have not validated a dietary intake assessment for adults with I/DD because of significant barriers to collecting valid data.
Challenges = problems with memory, comprehension, dexterity, literacy, communication, recording, estimating quantities
Physical Activity guidelines are also lacking in adults with I/DD
Annual cross-sectional household interview survey
Measures = general health status, acute/chronic conditions, impairment/functional limitations and use of medical services.
Proxy info provided for those not able to respond due to physical/cognitive limitations.
Sample = adults with I/DD in community (own home, family home)
Findings higher % of obese adults with I/DD compared to general population = also reflects an increase in obese I/DD over 16 yr period % overweight is similar in both populations
“In summary, a large proportion of adults with intellectual disability was likely to be either obese or overweight.” (Yamaki, 2005. p. 7)
Compared National Core Indicators program of 20 states in 2008-2009 with Natl Health & Nutrition Examination Survey: NHANES (2010)
Findings: those with ID not different than general population i.e. Obesity in NCI sample = 33.6% (represents ~2/3 or 62.2% of sample)
Obesity in US sample = 33.8%
Found: higher prevalence of obesity among women with ID; those with DS and milder ID.
Found living arrangements: highest prevalence among individuals living in own home (42.8%) and lowest among institutional residents (18.6%).
Dec, 2011 = defined for this effort as overweight or obese to be a priority for a first project.
Plan: Meetings with Administrators (4) & Nursing Staff (2);
Health Record Review
Development of healthy weight screening instrument.
N=20 = 65% male (13)
Mean age = 47.5 Years (16-73)
All = dual diagnosis
Average no of psych meds = 3.45
Average no of other meds = 5
Health care visits/18 month period = 41.8
Many in the IDS-TILDA sample, particularly those in the younger age cohorts, reported experiencing good health but there were significant concerns in terms of cardiac issues (including risk factors), epilepsy, constipation, arthritis, osteoporosis, urinary incontinence, falls, cancer, and thyroid disease.
American Dietetic Association (2004). Position of the ADA: Providing nutrition services for infants, children and adults with DD and special health care needs. Journal of the ADA 104: 97-107.
CDC (NCBDDD) Developmental Disabilities Homepage http://www.cdc.gov/ncbddd/dd/
CDC FASTSTATS: Obesity and Overweight http://www.cdc.gov/nchs/fastats/overwt.htm
Harris, J (2006) Intellectual disability: Understanding its development, causes, classification, evaluation, and treatment. Oxford University Press, Inc New York.
Humphries, K. Traci, M. & Seekins, T. (2009) Nutrition and Adults with Intellectual or Developmental Disabilities: Systematic Literature Review Results. Intellectual and Developmental Disabilities. 47(3): 163-185.
Melville, C. Hamilton, S., Hankey, C., Miller, S. & Boyle, S. (2007). The prevalence and determinants of obesity in adults with intellectual disabilities. Obesity Reviews. 8: 223-230
Moran, M. (12/16/11) AMA Says Intellectual Disability Warrants ‘Underserved’ Designation. Psychiatric News (46)24: 8a American Psychiatric Association
Morstad, D. (2012) How prevalent are intellectual and developmental disabilities in the United States? http://bethesdainstitute.org/document.doc?id=413
Stancliffe, R., Lakin, K., Larson, S., Engler, J., Bershadsky, J., Taub, S., Fortune, J. & Ticha, R. (2011) Overweight and Obesity Among Adults With Intellectual Disabilities Who Use Intellectual Disability/Developmental Disability Services in 20 U.S. States. American Journal on Intellectual and Developmental Disabilities. 116(6): 401-418.
Stedman, K. & Leland, L. (2010) Obesity and intellectual disability in New Zealand. Journal of Intellectual & Developmental Disability. 35(2);112-115
US census state and county quick facts (2011) at http://quickfacts.census.gov/qfd/states/00000.html
US DHHS (2012) The President’s Committee for People with Intellectual Disabilities. http://www.acf.hhs.gov/programs/pcpid/
US Surgeon General’s Office. (2002): Closing the Gap: Report of the surgeon General’s Conference on Health Disparities and Mental Retardation.
Yamaki, K. (2005) Body Weight Status Among Adults With Intellectual Disability in the Community. Mental Retardation 43(1): 1-10