Obesity services for adults with learning disabilities

Abstract

Background: Adults with learning disabilities are at high risk of obesity and its subsequent health risks with prevalence as high as 64% (Marshall et al., 2003). The number of adults with learning disabilities and the numbers surviving into old age are increasing as healthcare improves (Cooper et al., 2004) although obesity contributes to reduced life expectancy for this population (Janicki et al., 2002) and life expectancy remains considerably lower than the general population. Adults with learning disabilities experience significant inequalities in health care but few studies have focused on weight loss services specifically. Little is known about how obesity services are organised for adults with learning disabilities by general practitioners (GPs) and dietitians and whether they have access to general or specialist services. This study aimed to determine obesity prevalence and map the existing obesity services available to adults with learning disabilities in Surrey, within the community and primary care. Methods: A mapping exercise was undertaken and three questionnaires were designed. As this was a service evaluation and all data was confidential, ethical approval was not required. One hundred and 58 GPs from primary care practices in Surrey were sent a questionnaire which examined clinician self reported obesity management for this population. A second questionnaire aimed to identify current themes in dietetic management and was sent to five dietetic teams working within NHS health providers in Surrey. A third questionnaire was designed to identify the community obesity services available for this population. This was placed online and sent to 73 Surrey community organisations. Differences in GP service provision between the general population and adults with learning disabilities were investigated using Chi squared tests. Results: Nine percent (n = 14) of GPs completed the questionnaire and five practices provided body mass index (BMI) data. Reported obesity prevalence was high, although comparable to other studies (Marshall et al., 2003) (21 and 42% of adults classified as overweight or obese respectively). Two dietitians and one learning disability team manager completed the dietetic questionnaire. Eleven percent (n = 8) of community organisations completed the online questionnaire. Obesity services were not well communicated or well organised for this population. Having a learning disability was significantly associated with reduced referrals to external dietetic services and exercise on prescription programmes in primary care (P = 0.018 and 0.013 respectively). GPs that did not refer to a specialist dietetic service were unaware of the service or commented on a lack of availability. The majority of GPs (71%) felt that service provision, in terms of nutrition and weight management, was currently inadequate for this population. The organisations providing nutrition and activity schemes for this population, including exercise on referral, were not well known to GPs. Discussion: Provision of dietetic services for this population appears to be insufficient to meet current demand, although areas of good practice and access to leisure opportunities were identified. Poor response rates limit the findings of this study. Surrey GPs would benefit from a resource highlighting the leisure services and other weight loss services available for this population as a knowledge gap was identified. Wider circulation of appropriate health promotion materials is required and primary care needs to assess what additional support and adjustments are required to allow adults with learning disabilities to benefit equally from obesity services. Conclusions: More extensive mapping research and improved communication networks are required to reduce the health inequalities experienced by this population and the high prevalence of obesity both within Surrey and other areas of the UK.