Strategies to Promote Weight Loss in Adolescents with Intellectual and Developmental Disabilities

Introduction: Adolescents with intellectual and developmental disabilities (IDD) are at an increased risk of obesity with up to 55% considered overweight and 31% obese. However, there has been minimal research on weight management strategies for adolescents with IDD. This series of studies aimed to (1) compare the effectiveness of two weight loss diets, an enhanced stop light diet (eSLD) and a conventional diet (CD), for overweight and obese adolescents with IDD, (2) to determine the feasibility of using tablet computers as a weight loss tool in overweight and obese adolescents with IDD, (3) to determine if the use of photo-assisted 3-day food records significantly improved the estimation of energy and macronutrient intake reported in proxy assisted 3-day food records in adolescents with IDD, and (4) to evaluate the intervention components of the program by discovering parents' feelings and opinions on the intervention program for both diet groups. Methods: A 2-month pilot intervention was conducted. All participants were randomized to the eSLD or CD, and were given a tablet computer which they used to track daily dietary intake and physical activity. Participants and a parent met weekly with a health educator via video chat on the tablet computer to receive diet and physical activity feedback and education. Participants completed a proxy-assisted 3-day food record and took pictures of all meals at baseline and the end of month 2 to determine dietary intake, and parents of participants were interviewed using a semi-structured interview at the end of the study. Results: Twenty participants (45% female, 14.9 ± 2.2 yrs. old) were randomized and completed the intervention (10 eSLD, 10 CD). Participants in both diets were able to lose weight, the mean weight change in the eSLD group is 1.67kg more than that of the CD group, but the difference (eSLD: -3.89 ± 2.66 kg vs. CD: -2.22 ± 1.37 kg)was not statistically significant. Furthermore, participants in both groups increased their diet quality as measured by the HEI-2005. Participants were able to use the tablet computer to track their dietary intake 90.4% (range: 27.8%-100%) of possible days, to track their physical activity 64.3% (range: 0%-100%) of possible days, and to attend 80.0% of the video chat meetings. The use of photo-assisted food records significantly increased the estimates of energy intake by 16.7% (p=0.0006) at baseline and 10.6% (p=0.0305) at the end of month 2 compared to use of proxy-assisted food records. Interviews identified that parents had a positive attitude towards the program, liked the convenience of the program, appreciated the use of the tablet computer, and felt that the program taught beneficial strategies to continue to encourage healthy habits in the home. Conclusion: A weight loss program in adolescents with IDD was successfully conducted, with overall acceptability from both adolescents and parents. Both the eSLD and the CD were identified as weight management strategies that could potentially lead to clinically significant weight loss in adolescents with IDD, and tablet computers were found to be a feasible tool and delivery system for weight loss in adolescents with IDD. The results also suggest that photo-assisted 3-day food records may provide better estimates of energy intake in adolescents with IDD compared to proxy-assisted 3-day food records. Finally, parents reported changing their behaviors to help their child successfully follow a weight loss intervention, but may need more education about the benefits of physical activity and ideas on how to increase the physical activity of adolescents with IDD

Diet Quality of Overweight and Obese Adults with Intellectual and Developmental Disbilities as Measured by the Healthy Eating Index-2005

BACKGROUND: Little research has been conducted to examine diet quality of overweight and obese adults with intellectual and developmental disabilities (IDD) in the United States. The purpose of this study was to determine diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of overweight and obese adults with IDD. METHODS: Data were obtained from community-dwelling overweight individuals. 3-day food records were administered and completed with assistance by staff or family members and then reviewed by a dietitian. All records were analyzed and HEI-2005 was calculated using NDSR output. RESULTS: 178 records were analyzed from 70 subjects (28 male, 42 female; mean age 33.9 ±11.5 years). The mean energy intake was 1928 ± 891 kcals and the mean total HEI-2005 score was 46.7± 11.5. Participants scored the lowest in total fruits, whole grains, dark green and orange vegetables, non-hydrogenated vegetable oils, and sodium. Both male and females had diets deficient in fiber, vitamin A, vitamin D, vitamin E, folate, and potassium. Additionally men were deficient in vitamin K, and women were deficient in calcium. CONCLUSIONS: Overweight and Obese adults with IDD had a lower HEI-2005 score compared to the general population and are at an increased risk of poor diet quality and nutritional deficiencies that could contribute to the development of diabetes, cardiovascular disease, cancer and other health complication

Photo-assisted recall increases estimates of energy and macronutrient intake in adults with intellectual and developmental disabilities

Diet assessment of adults with intellectual and developmental disabilities (IDD) is challenging due to their limited cognitive abilities. The objective of this study was to examine the feasibility and outcomes of combining photos with 24-hour dietary recalls for the assessment of energy and macronutrient intake in adults with IDD. Participants used an iPad 2 tablet computer to take photos of all food and beverages consumed before a standard, multiple-pass, 24-hour dietary recall. Following the standard 24-hour diet recall, the photos were reviewed with the participant for clarification details (e.g., portion size, etc.) and differences were recorded. The standard 24-hour recall and the photo-assisted recall were entered separately into Nutrition Data System for Research for computerized dietary analysis. Sixty-four eating occasions were entered from 23 participants (48% female; mean age 26.4 ±9.7 years). Participants captured photos for 66.5% ± 30.4% of all recorded eating occasions. Greater energy intake per eating occasion was reported with the photo-assisted recalls than the standard recalls (625.6 ± 85.7 kcals vs. 497.2 ± 86.6 kcals, p=0.002) and a greater intake of grams of fat (p=0.006) protein (p=0.029) and carbohydrates (p=0.003). Photo-assisted 24-hour recalls provided a significant increase in total calories and macronutrient content compared to a standard 24-hour recall and may be a feasible method to enhance dietary assessment in adults with IDD

Weight management for individuals with intellectual and developmental disabilities: Rationale and design for an 18 month randomized trial

Weight management for individuals with intellectual and developmental disabilities (IDD) has received limited attention. Studies on weight management in this population have been conducted over short time frames, in small samples with inadequate statistical power, infrequently used a randomized design, and have not evaluated the use of emerging effective dietary strategies such as pre-packaged meals (PMs). Low energy/fat PMs may be useful in individuals with IDD as they simplify meal planning, limit undesirable food choices, teach appropriate portion sizes, are convenient and easy to prepare, and when combined with fruits and vegetables provide a high volume, low energy dense meal. A randomized effectiveness trial will be conducted in 150 overweight/obese adults with mild to moderate IDD, and their study partners to compare weight loss (6 months) and weight maintenance (12 months) between 2 weight management approaches: 1. A Stop Light Diet enhanced with reduced energy/fat PMs (eSLD); and 2. A recommended care reduced energy/fat meal plan diet (RC). The primary aim is to compare weight loss (0–6 months) and weight maintenance (7–18 months) between the eSLD and RC diets. Secondarily, changes in chronic disease risk factors between the eSLD and RC diets including blood pressure, glucose, insulin, LDL-cholesterol, and HDL-cholesterol will be compared during both weight loss and weight maintenance. Finally, potential mediators of weight loss including energy intake, physical activity, data recording, adherence to the diet, study partner self-efficacy and daily stress related to dietary change will be explored

Experiences and Perspectives of Polycystic Kidney Disease Patients following a Diet of Reduced Osmoles, Protein, and Acid Precursors Supplemented with Water:A Qualitative Study

Background Salt, protein, acid precursors, and fluid intake have been identified as factors that influence cyst growth in ADPKD. Unfortunately, the feasibility of following these dietary restrictions/enhancements from a patient's point-of-view has yet to be studied. The purpose of this study is to understand better the experiences of patients following a relatively complex dietary prescription targeting these factors. Methods Twelve adults with ADPKD and kidney function >30ml/min/1.73m(2) were recruited from the University of Kansas Medical Center Polycystic Kidney Disease clinic. In a qualitative design, semi-structured interviews of participants were conducted following a four week dietary intervention (experimental diet lower in sodium, protein, and acid precursors, and supplemented with water) either face-to-face or by telephone. All interviews were recorded, transcribed verbatim, and checked for accuracy. Transcripts were analyzed thematically for emerging themes. Results Participants reported that eating less meat and more fruits and vegetables were the easiest components of the diet, whereas reaching the daily goal amount of fruits and vegetables and tracking the diet constantly were the most difficult components. Participants had little difficulty with fluid intake and reported the prescribed fluid goal as achievable. The tracking system for fruits and vegetables and protein was reported to be both helpful and intuitive, but tracking their intake on paper was tedious. Eating out was the most significant barrier to following the diet with some individuals avoiding restaurants in order to comply with the dietary prescription. Conclusion Participants on the experimental diet heightened their awareness of the consumption of dietary salt, protein, acid precursors, and fluid intake. Additionally, most participants believed adherence to the prescribed diet was feasible. However, participants wanted less cumbersome ways to track and monitor the diet, especially given that the prescribed diet is designed for lifelong adherence. Future studies should focus on targeting these specific dietary factors in larger groups of more ethnically and culturally diverse populations to help inform clinicians and how best to help diverse populations adhere to the dietary intervention

Demographic characteristics of 12 individuals with ADPKD who completed interviews after following a dietary intervention trial.

<p>Demographic characteristics of 12 individuals with ADPKD who completed interviews after following a dietary intervention trial.</p