A systematic review of the effectiveness of weight management interventions in adults with learning disabilities

Abstract

Background: The increased prevalence of overweight and obesity in adults with a learning disability (LD) was highlighted by the Disability Rights Commission report (DRC 2006) as causing significant health risk and major health problems. The report called urgently for the development of evidence-based guidelines of effective weight loss methods for this target group, NICE (2006) guidelines similarly require clinicians working in weight management to promote interventions that are effective and evidence-based. Despite one review no systematic reviews in this area existed, thus the aim of this research was to systematically review current literature on weight management interventions for adults with LD to identify effective interventions. Method: A comprehensive, systematic search of the literature was conducted (via Academic Search Complete, AMED, CINAHL, Cochrane, Medline, PsycINFO and SCOPUS's electronic bibliographic databases) using key terms, and supplemented with hand searching of key journals, references and citations. Inclusion and exclusion criteria were applied to studies identified. Studies were included if they examined one or more weight management interventions recommended by NICE (2006): diet, physical activity, behavioural interventions, anti-obesity medication or bariatric surgery, in adults with a LD. Exclusion criteria were a mixed population, weight loss not reported and diagnosis of Prader-Willi Syndrome. The literature was assessed for quality using the validated Critical Appraisal Skills Programme tools (Public Health Resource Unit 2006) and the data synthesised for evaluation. Results: A total of 11 studies were identified: six quasi-experimental trials and five pre-experimental studies, no studies of anti-obesity medication or bariatric surgery were found. Weight loss was modest across all types of interventions; only one study showed clinically significant weight loss of 5–10% but had poor external validity and thus was not able to be generalised to the wider LD population; one study provided low level evidence for weight maintenance however did not demonstrate clinically significant weight loss. The overall quality of evidence reviewed was judged to be poor. Discussion: With the exception of one study, findings indicated modest, clinically insignificant weight loss which falls short of weight loss achieved by the general population using the same interventions, suggesting further adaptation to the programmes may be needed. However, the research reviewed has major methodological flaws relating to the research design, absence of randomisation, limited use of control groups, studies which are underpowered and insufficient long-term follow-up. Future research should take account of these flaws and also give greater consideration to the heterogeneity of this population with regards to inclusion criteria and analysis in order to draw out more useful conclusions for practice. Conclusion: There was insufficient evidence to support the effectiveness of currently recommended interventions for weight loss and weight maintenance in adults with LD and a need for further high quality research to inform clinical practice and decision-making in this area, thereby improving the long term health and well-being of this population.