Abstract
To evaluate the clinical effectiveness of weight management interventions in adults with intellectual disabilities (ID) and obesity using recommendations from current clinical guidelines for the first line management of obesity in adults. Full papers on lifestyle modification interventions published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on 1) intervention components, 2) methodology, 3) attrition rate 4) reported weight loss and 5) duration of follow up. Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (2510 kilojoule) daily energy deficit diet. Study durations were mostly below the duration recommended in clinical guidelines and varied widely. No study included an exercise program promoting 225–300 minutes or more of moderate intensity physical activity per week but the majority of the studies used the same behaviour change techniques. Three studies reported clinically significant weight loss (≥ 5%) at six months post intervention. Current data indicate weight management interventions in those with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified.
Highlights
Intellectual disability is defined as the “disability characterized by significant limitations both in intellectual functioning and in adaptive behaviour, which covers many everyday social and practical skills” [1]
Study outcomes Fox et al [19] showed that the combination of physical activity and behavioural approaches could lead to weight loss greater than 5% at 10 weeks post intervention
Several studies and ethics committees have looked at the ethical issues related to the types of interventions provided to people with Intellectual disabilities (ID), reporting the necessity of interventions tailored to the needs of the participants and reviewing the principles and procedures that need to be followed when individuals with ID have not the capacity to consent their participation in a study [41]
Summary
Intellectual disability is defined as the “disability characterized by significant limitations both in intellectual functioning and in adaptive behaviour, which covers many everyday social and practical skills” [1]. There appears to be only a limited evidence-base underpinning the management of obesity in this population group [3]. Previous reviews of weight loss interventions in adults with ID found that studies. 1. Adults who are overweight or obese should aim for a clinically significant 5-10% weight loss (approximately 5–10 kilograms (kg)) from initial body weight for three to six months. After six months of weight management adults should be encouraged to develop skills relevant to maintaining weight losses
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