This chapter presents findings from the articles that matched the inclusion criteria. It will introduce evidence found via literature search described on ‘Chapter 2: Methodology’. Therefore, this chapter presents the evidence on the health promotion interventions for obesity in adults with ID; and its effectiveness. It also includes some of the key limitations found by the researcher/s that carried out each of the discussed reviews. The documents reviewed had directly and indirectly the same point: to be designed aiming to reduce and tackle obesity in people with ID. Nine studies met the inclusion criteria. Furthermore a systematic and an integrative literature review were focused on obesity and people with ID.
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One systematic review was focused on weight loss interventions for people with ID and was written by Hamilton et al. (2007). It includes programmes that focus on nutrition, physical activity or health promotion (education). From the research five studies will be presented in this chapter. The other documents reviewed could not be included in this piece of work as Hamilton et al. included the review of five outdated studies, in which three were undertaken in the 1980s. The approaches to the management of obesity for people with ID discussed in the systematic review included behavioural approaches, and surgical interventions including gastric bypass surgery and pharmacological treatment. However, relatively few researchers have examined the effectiveness of weight loss interventions for adults with ID.
One paper was an integrative literature review of interventions designed to reduce obesity in people who have ID was written by Jinks et al. (2010). The paper is a review of the effectiveness of non-surgical, non-pharmaceutical interventions designed to promote weight loss in people with ID. It also discusses how qualitative evidence on people’s experiences and motivations can help understanding of the quantitative research outcomes. An integrative review method was used and synthesis of the findings related to study design, participants, and types of interventions, outcome measures and participant perspectives. Twelve studies met the inclusion criteria, seven of these studies will be presented in this chapter as it met the inclusion criteria of this research. Interventions presented by Jinks et al. (2010) that included as participants people without ID and focused only in adolescents were excluded. The majority of the interventions discussed were focused on energy intake, energy expenditure or health promotion. Just a small number of studies incorporated behaviour modification approaches.
The nine studies to be discussed in this chapter were undertaken in different settings (supported and non-supported living, day centres, group and residential homes). The majority of the researches were undertaken with population from the United Kingdom (three studies) and United States (five studies) with the exception of one study from Taiwan. Sample sizes of the intervention studies varied in numbers of group of 6 to 201 participants. The preponderance of the studies used samples of people who are considerate to have mild to moderate ID. One study (Rimmer et al., 2004) focused only on people with Down syndrome. Most of the groups were of mixed gender, only Bradley (2003) that included only women in the study. The age of the participants that undertook the researches varied a lot. All participants were aged 16 years or older. None of the studies were focused only with elderly participants, although one study had participants of ‘ageing group’, meaning individuals older than 32 years of age. A summary of these findings are presented on the next page on Table 4.
Table 4. Study description, sample and findings.
Study
Description
Country and Settings
Sample
Findings
Aronow and Hahn (2005)
One year multi component intervention
US.
Non-institutional settings.
201 adults (mild to moderate ID – 59% overweight/obese)
Health risks = decreased
Health strength=
increased
Bradley (2005)
One year nutritional and physical program.
UK.
Supported living settings.
09 women (mild ID – 8 obese)
Weight loss
8 of 9 having breakfast regularly
Healthy diet=increased
Chapman et al. (2005)
One year multi-component intervention
UK.
Day centre.
Input group 38 adults (97% overweight/obese)
Nor input group 50 adults
(64% overweight/obese)
Input group=significant weight loss
Non input group=
Non significant weight loss
Mann et al. (2006)
9 week health promotion program.
US.
Independent and supported living settings.
192 adults (mild to moderate ID) all overweight/obese
Highly significant decrease in BMI
Marshall et al. (2003)
6 to 8 week health promotion intervention promoting weight loss. Modifies Active’ materials including information on exercise and healthy eating.
UK
Day centres.
25 adults with ID
(17 overweight/obese)
Weight reduced significant
Podgorski et al. (2004)
12 week physical activity intervention promoting weight loss. Follow-up of one year.
US.
Day Centre.
15 older adults (40 – 80+) (mild to severe ID) 10 overweight/obese
Physical fitness scores improved
Rimmer et al. (2004)
12 week physical activity intervention promoting weight loss. Fitness program of 3 sessions a week lasting 45 minutes.
US.
Supported living settings and Group homes.
52 adults with Down Syndrome (69% overweight/obese)
Small but not statistically significant weight reduction
Sailer et al. (2006)
10 week weight loss program
US.
Human services centre.
6 adults (mild to moderate ID – all obese).
Moderate weight reduction
Wu et al. (2010)
6 months physical activity intervention promoting weight loss. Fitness program of daily 45 minutes sessions.
Taiwan.
Disability Institution.
146 adults with ID
(47.9% overweight/obese).
Decreases in individual’s weight
The types of intervention of the studies varied from a range of categories. Some studies focused on nutrition (Sailer et al., 2006), physical activity (Rimmer et al., 2004; Chapman et al., 2005; Wu et al., 2010) and mainly health promotion intervention (Aronow and Hahn, 2005; Marshall et al., 2006). A study included the use of behavioural relapse prevention strategies (Mann et al. 2006). Another used mainly behavioural approaches and concentrated on teaching self-control techniques and self-monitoring of food intake (Sailer et al. 2006). The majority included educational programmes planned to increase understanding of the significance of having and keeping a healthy lifestyle. To obtain improved understanding, some of the studies involved activities that were intended to improve participants’ life skills. These studies included, for example, visits to supermarkets, food preparation and food-tasting sessions (Bradley, 2005), and health fairs and a ‘Shop, Cook and Eat’ initiative (Chapman et al., 2005).*
The types of interventions were a large combination and examples of different interventions tackling obesity. A variety of professionals apart from the researchers were involved in the process and delivery of the interventions.
The BMI was the most common outcome used in the studies to diagnose obesity and outcomes. Even though two researches (Podgorski et al.,2004; Sailer et al., 2006) used as measurement the total body weight. Waist measurement (Bradley,2005), cardiovascular
Results of studies with weight reducement:
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Health promotion is a new public health initiative which has been integrated into governmental strategies to improve health either within a family, a community, health institutions and work places. It refers to effort to prevent ill health and promote positive health with the aim of enabling people to take control over their own health.
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