Summary

The importance of childhood obesity in recent years has increased noticeably especially when Healthy People 2020 topic and objective stress the need of population-based database system to monitor health status among people with disabilities (DH-1) and reduction the proportion of children and adolescents who are considered obese (NWS-10). In this blog (http://obesityid.blogspot.com/), there are two major presentations. One is the four webpages provided on the top of the blog including the Facts of Obesity, Health Brochure, Lesson Plans, and Strategy Presentation and Reflection. The viewers could easily locate the both the fast fact and recommended prevention strategies in relation to obesity.

The second part of blog writing is mainly focus on the other empirical aspects of the role of health educators in preventing from obesity threats. For example, use of peer modeling in health promotion (posted on 2014/10/15) and following the example of peer modeling using pedometry in students with intellectual disabilities in Taiwan (posted on 2014/10/15). The results of the peer modeling showed the significant improvement of step counts within a period of time (30 mins) when compared to those without peer modeling. Also, the other posts also highlighted the importance of evidence-based practice (posted on 2014/9/14), indicating that the components of obesity intervention should consist of behavioral intervention, health promotion intervention, physical activity intervention and carer involvement to ensure the effectiveness of obesity prevention. In conclusion, I believe that the viewers could quickly gain the understanding of why obesity prevention is a critical health issue and how the health educators would carry out the proactive plans to keep the threat at bay.

Obesity is a disease or not?

Obesity is a disease, by definition, which is related to abnormal endocrine and metabolic malfunction (Bays et al., 2008; DeClercq, Taylor, & Zahradka, 2008). Some organizations, such as American Heart Association, American College of Cardiology, American Medical Association and The Obesity Society, have also proposed that obesity is labeled as a new disease, indicating that obesity involves some medical criteria of a disease related to impairing body functions. However, such descriptions of definition of obesity raise several arguments. For example, the measurement of body mass index (BMI) has its bias between races and body statures. A professional athletes may be overweight (higher BMI/low body fat) than the normal populations. Also, BMI involves only the measurement of height and weight rather than body fat levels.

Other discussion about obesity centers on the question that obesity is the consequence of health outcomes due to inactivity and poor diet habit. Psychologically, overweight/obese persons may not perceive being sick and uncomfortable instead of the thought of changing current lifestyles. Therefore, to reach a consensus of treating obesity as a disease may be hard. As we know, obesity is an epidemic and growing public health issue. According to Centers for Diseases Control and Prevention (2014, Aug 13), an increase of childhood obesity (aged 6-11 years) rate between 7% in 1980 and 18% in 2010 in the states has shown the weight problems. Recently, there is still controversial about the obesity is a disease or not, which may change the strategies of how researchers prevent from the threat to the public health.

For a health educator or healthcare providers, to increase the awareness of the obesity problems in public health issues is still an important characteristic of a healthy lifestyle and continuously needed to pay more attention and move forward to create feasible plans for everyone.  

References

Bays, H., González-Campoy, J., Henry, R., Bergman, D., Kitabchi, A., Schorr, A., & Rodbard, H. (2008). Is adiposopathy (sick fat) an endocrine disease?. International Journal Of Clinical Practice, 62(10), 1474-1483.

Centers for Diseases Control and Prevention (2014, Aug 13). Childhood obesity facts. Retrieved from http://www.cdc.gov/healthyyouth/obesity/facts.htm

DeClercq, V., Taylor, C., & Zahradka, P. (2008). Adipose tissue: The link between obesity and cardiovascular disease. Cardiovascular & Haematological Disorders - Drug Targets, 8(3), 228-237.

Need More Positive Stories Covered in the Mass Media.

The use of the mass media constructs a viewer’s perspective based on how a story presents to the public. A public service announcement (PSAs) is an approach which may impress the public regarding a specific topic that the media wants to deliver by using magazine, newspaper, radio station, television station, Web site, outdoor venue, etc.

For example, the images of people with intellectual disabilities (ID) in Taiwan newspapers included “dispirited” (44.5%), “needy” (32.7%), and “affirmative” (22.8%) images, as result of stigma impression in Taiwan (Chen, Hsu, Shu, & Fetzer, 2012). It implies that the media (i.e., newspapers) potentially create the negative atmosphere on individuals with ID. An investigation of how Special Olympics Games volunteers perceived the inclusion via the mass media showed that parents and mass media (particular television and movie) were the top two sources for them to learn about ID (Chunxiao & Lifang, 2012). However, the study did not address how the volunteers know about individuals with ID and what the mass media represented the information of the ID populations. Based on these two recent studies, I can assume the mass media plays an important role in delivering the more positive attitude on “inclusion” or “acceptance” among individuals with ID.

In order to facilitate the health promotion of individuals with ID, Special Olympics (SO), undoubtedly, is the largest organization in the world to provide community supports to engage them in sports events, health screening, and other health advocacy activities. In my opinion, the mass media may not only promote international/national SO games but also regional games and cover the more positive stories in local newspapers. It may help a local community to learn about what is happening regarding the ID population in the community.

                                              (2014 Special Olympics National Game)

                                          (Special Olympics Law Enforcement Torch Run)

References

Chen, C.-H., Hsu, K.-L., Shu, B.-C., & Fetzer, S. (2012). The image of people with intellectual disability in Taiwan newspapers. Journal of Intellectual and Developmental Disability, 37(1), 35-41.    

Chunxiao, L., & Lifang, W. (2012). A survey study on attitudes of Special Olympics games volunteers toward the inclusion of individuals with intellectual disabilities in China. European Journal of Adapted Physical Activity, 5(1), 28-38.         

An example of peer modeling using pedometry in high-school aged students with ID in Taiwan.

Walking is the most common physical activity in individuals with intellectual disability (ID; Stanish, Temple, & Frey, (2006). ; however, lack of motivation and lower cognitive level, it limits its exercise benefits while walking. Peer-modeling is considered as an effective strategy which may encourage exercise participation among adolescents with ID (Vashdi, Hutzler, & Roth, 2008).

In Taiwan, I evaluated the efficacy of the walking intervention program using peel-modeling approach for a total of 16 high-school aged students with ID. In 2012, the pedometry used in  a 30-min walking exercise for 11 weeks during an after-school program to see whether peer-modeling (n = 8 ) and walk alone group (n = 8) on 30-min step counts is more effective. 

The findings of this proposed walking sessions was shown below. In general, the peer modeling group averaged 3,430 ± 111 step counts compared to the control group, 2,831 ± 189 step counts over week1, week7 and week11. The 30-min step counts of peer-modeling group appeared increased over time from 3125, 3532, to 3614 steps while that of the walk-alone group gradually decreased from 2953, 2748, to 2684 steps, when controlling for BMI and stride length.  

Lately, I used Beet and Pitetti's (2011) findings to evaluate the moderate-to-vigorous physical activity (MVPA) for individuals with an ID in my study. The peer modeling group in W7 & W11 achieved MVPA, when referring to the height- and age-specific steps/min ranged from 135 steps/min to 112 steps/min recommend by Beet and Pitetti's (2011) study.  

To conclude, the efficacy of peer-modeling intervention of the walking program on 30-min step counts for high-school students with ID was effective. The findings suggest that the use of peer modeling as a strategy may be infused into a physical exercise program to facilitate exercise adherence. 

 

(An example using peer-modeling approach among students with autism spectrum disorders in health promotion.) 

References

Beets, M. W., & Pitetti, K. H. (2011). Using pedometers to measure moderate-to-vigorous physical activity for youth with an intellectual disability. Disability and Health Journal, 4(1), 46-51. 

Stanish, H. I., Temple, V. A., & Frey, G. C. (2006). Health-promoting physical activity of adults with mental retardation. Mental Retardation and Developmental Disabilities Research Reviews, 12(1), 13-21.  

Vashdi, E., Hutzler, Y., & Roth, D. (2008). Compliance of children with moderate to severe intellectual disability to treadmill walking: a pilot study. Journal of Intellectual Disability Research, 52(5), 371-379. doi: 10.1111/j.1365-2788.2007.01034.x

Use of a Peer Modeling in Health Promotion

Peer-modeling is considered as an effective strategy which may encourage exercise participation among individuals with ID (Stanish & Temple, 2012). In addition, the improved exercise engagement is associated with the degree of self-efficacy in sport-related activities (Hutzler & Korsensky, 2010). For parents and teachers, we cannot neglect the effect of peer-modeling which facilitates observational learning as proposed by Social Cognitive Theory. A recent study by Stanish and Temple (2012) supports this perspective that peer partner provided a reciprocal support and improved the exercise participation. 

Another example (see: Peer modeling in students with autism) is attached to present the effect of peer modeling in school.  

When we plan an exercise program, to build up a network of workout buddy may be needed, particularly for individuals with ID. In Texas Woman’s University, the Adapted Physical Activity Lab offers volunteer opportunities for college students to provide assistance for the motor & aquatic activities.

If you are interested in volunteering, you should email me at CPan@twu.edu   

  

References

Hutzler, Y., & Korsensky, O. (2010). Motivational correlates of physical activity in persons with an intellectual disability: A systematic literature review. Journal of Intellectual Disability Research, 54(9), 767-786.        

Stanish, H. I., & Temple, V. A. (2012). Efficacy of a peer-guided exercise programme for adolescents with intellectual disability. Journal of Applied Research in Intellectual Disabilities, 25(4), 319-328. doi: 10.1111/j.1468-3148.2011.00668.x

Evidence-Based Practice for Individuals with ID

Interveners of weight management are recommended to implement evidence-based practice (EBP) because EBP is more valid and reliable to see the significantly positive outcomes of intended purposes. Hamilton and other researchers (2007) have proposed clinical EBP for weight interventions of individuals with ID, including the following components:

Behavioral intervention

• Teaching self-control techniques such as self-monitoring of daily weigh and food intake.
• Promoting health behaviors such as eating habit and hygiene.

Health promotion intervention

• A group based learning for in-home preventative healthcare programmes such as diet and exercise.
• An individual support from a healthy living coordinator, who regularly visits at-risk overweight/obese persons with ID.

 Physical activity intervention

• Combined exercise including aerobic and resistance training.
• 30 minute moderate physical activity intensity per day to limit health risks. 
• 60-90 minute moderate exercise intensity to maintain weight loss per day. 

Carer involvement

• Family involvement integrated into weight control treatment.

                      (Walk Your Way to Fitness: Routines for people who have Intellectual Disabilities)

Reference

Hamilton, S., Hankey, C. R., Miller, S., Boyle, S., & Melville, C. A. (2007). A review of weight loss interventions for adults with intellectual disabilities. Obesity Reviews, 8(4), 339-345. doi: 10.1111/j.1467-789X.2006.00307.x

Instructional Strategies in Nutrition Curriculum

A healthy lifestyle encompasses multiple levels from the perception of nutrition, attitude of health, and to practice of health habits. Nutrition curriculum, such as diet selection, meal time planning and so forth, is an important issue for a basic preparation level of leading to health and wellness life. Use of proactive instructional strategies is considered as an important means of teaching health eating behavior delivery for students with cognitive or physical limitation. According to Simpson, Swicegood, and Gaus, (2006), guideline principles taken into consideration include the following:

* Modeling and increased guidance.

"Thinking aloud" may help students with intellectual disabilities (ID) to appropriately choose good food and to avoid excessive intake. A guided demonstration also facilitates more positive learning outcomes students with ID. 

*Scaffolded experiences. 

Explicit guidance regarding clear feedback, multiple prompts based on students' present level will foster learning step by step. To lead the discussion for students definitely makes students with ID to clarify their confusion. This may develop self-monitoring skills.

*Gradual move from the concrete and familiar to the abstract and symbolic.

In an early stage of nutrition classes, teachers focus more on concrete examples (e.g., health eating habits) to link to learning of life experiences. When achieved so, the abstract and symbolic learning such as "divergent and/or convergent learning styles" may be blended into group discussion for gaining more understanding of the reasons health eating habits are important for themselves.  

*Model choice-making techniques

To provide simple self-monitoring skill helps to make consequences of behaviors appropriate. For example, the "STOP AND THINK" strategy as a self-question approach is recommended in teaching NE.  

*Set clear, specific goals

The goal must be attainable, manageable and reachable for students with ID. For example, Roger will lose 20 pounds over an 8-week period, using aerobic and resistance training 3 times per day, 60 mins per session. 

*Design a program for generalization.

Use of a field trip (e.g., visit Wal-Mart) to practice the appropriate food choices may help students in their real situation when grocery shopping with their parents. Thus, a generalization of a nutrition program may be promoted to see how students with ID to make their decision through the practical food options.   

To conclude, we propose some effective strategies in terms of modeling, scaffolding, self-monitoring, and goal setting that are integrated into a nutrition curriculum to expect a better quality of instructions to prevent obesity on students with ID.  

(Program keeps adults with disabilities on healthy track)

References

Simpson, C. G., Swicegood, P. R., & Gaus, M. D. (2006). Nutrition and fitmess curriculum: Designing instructional interventions for children with developmental disabilities. Teaching Exceptional Children, 38(6), 50-53.

Obesity and Related Secondary Conditions

Obesity is a public health concern in both general and ID populations. The prevalence of obesity in adolescents with ID is approximately 36% higher than general populations in boys and girls (Stewart el a., 2009). Another study by Rimmer and his colleagues (2014) investigated the obesity and its related secondary conditions among adolescents with intellectual/developmental disabilities, as follows.

²  High blood pressure,

²  High blood cholesterol,

²  Diabetes,

²  Depression,

²  Fatigue,

²  Liver or gallbladder problems,

²  Low self-esteem,

²  Preoccupation with weight,

²  Early maturation

²  Pressure sores.

Regarding the obesity of health problems in children and adolescents in ID, Lin and his researchers (2005) reported that the top five health concerns in this sample were neurological disorders (including epilepsy; 11%), others (11%), Cardiovascular problems (7%), skin diseases (6%), gastrointestinal illness (5%), and respiratory illness (5%). In addition, there were 26% of study sample having regular medication history. With increase age, the weight status of obesity/overweight conditions has been apparent in ID population. It draws an attention to the fact that early interventions and strategies for the problem of obesity in children and adolescents with ID are needed to ensure the quality of life.  

External reading: Obesity Impacting More With Disabilities

            (By TastyCakes [CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons)

References

Lin, J.-D., Yen, C.-F., Li, C.-W., & Wu, J.-L. (2005). Patterns of obesity among children and adolescents with intellectual disabilities in Taiwan. Journal of Applied Research in Intellectual Disabilities, 18(2), 123-129. doi: 10.1111/j.1468-3148.2005.00241.x

 Rimmer, J. H., Yamaki, K., Lowry, B. M. D., Wang, E., & Vogel, L. C. (2010). Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities. Journal of Intellectual Disability Research, 54(Part 9), 787-794.

Stewart, L., Van De Ven, L., Katsarou, V., Rentziou, E., Doran, M., Jackson, P., . . . Wilson, D. (2009). High prevalence of obesity in ambulatory children and adolescents with intellectual disability. Journal of Intellectual Disability Research, 53(10), 882-886. doi: 10.1111/j.1365-2788.2009.01200.x

Why Obesity?

                                                 (See: External Reading )

Obesity is a disease, by definition, which is related to abnormal endocrine and metabolic malfunction (Bays et al., 2008; DeClercq, Taylor, & Zahradka, 2008). Some organizations, such as American Heart Association, American College of Cardiology, American Medical Association and The Obesity Society, have also proposed that obesity is labeled as a new disease, indicating that obesity involves some medical criteria of a disease related to impairing body functions. However, some discussion about obesity centers on the question that obesity is the consequence of health outcomes due to inactivity and poor diet habit. Psychologically, overweight/obese persons may not perceive being sick and uncomfortable instead of the thought of changing current lifestyles. Therefore, to reach a consensus of treating obesity as a disease may be hard.

In terms of obesity in the states, the United States has borne the brunt of obesity related diseases, and what concerns both authorities and researchers is the prevalence rate of obese or overweight being at approximately 50% among 2-19 year olds in the U.S. (Ogden, Carroll, & Flegal, 2008). Further, 66% of all adults are overweight or obese. Being overweight or obese is also affected by education as a mediator. For example, nearly 47% of students in families did not graduate high school were overweight, compared with 37.5% of those whose level of education went beyond high school (Adams et al., 2008).

Thus, for a health educator or healthcare provider, to increase the awareness of the obesity problems in public health is still an important characteristic of a healthy lifestyle. I believe that it is necessary to pay more than the usual attention to obesity prevention and health professionals move forward to create feasible plans for everyone.

External Reading: Deaths From Obesity Almost Quadruple What Was Thought

                                        (Visual analysis on causes and consequences of obesity )

Reference

Adams, M., Carter, T., Barnett-Lammon, C., Hicks-Judd, A., Leeper, J., & Wheat, J. (2008). Obesity and blood pressure trends in rural adolescents over a decade. Pediatric Nursing, 34(5), 381-394.

Bays, H., González-Campoy, J., Henry, R., Bergman, D., Kitabchi, A., Schorr, A., & Rodbard, H. (2008). Is adiposopathy (sick fat) an endocrine disease?. International Journal Of Clinical Practice, 62(10), 1474-1483.

DeClercq, V., Taylor, C., & Zahradka, P. (2008). Adipose tissue: The link between obesity and cardiovascular disease. Cardiovascular & Haematological Disorders - Drug Targets, 8(3), 228-237.

Odgen, C. L., Carroll, M. D., & Flegal, K. M. (2008). High body mass index for age among US children and adolescents, 2003-2006. Journal of the American Medical Association, 299(20), 2401-2405.