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.