Treatment of Obesity in Mentally Retarded Persons: The Rehabilitator\u27s Role

Obesity is a common problem for the mentally retarded and nonretarded populations. Prevalence estimates ranging from 40 to 80 million obese Americans have been reported. The relationship between obesity and cardiovascular disease, diabetes mellitus, and other health related problems is strong. Also, the greater the degree of obesity, the higher the risk of medical problems. In addition to the health problems associated with obesity, the obese mentally retarded person is likely to be the object of increased social prejudice and nonacceptance as a result of being mentally retarded and obese. Fortunately, this solution does not need to be an intractable one. Van Itallie cited studies reporting a positive influence for weight reduction on health. Another treatment goal has been enhanced self-esteem. Given these promising outcomes for weight reduction, the field of obesity has witnessed an explosion of diet programs and exercise regimes to promote weight loss. These programs have varied in their initial success but nearly all have failed to produce long-term maintenance of weight loss. The application of behavioral procedures to the problem of obesity has produced more promising results. This approach has also been successfully extended to the mentally retarded population. This article describes the treatment rationale and procedures for a behavioral self-control package that has been developed for the obese retarded population. Implications of this approach for professionals concerned with rehabilitation efforts for mentally retarded persons will be delineated

Weight management interventions in adults with intellectual disabilities and obesity: a systematic review of the evidence

o 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

Cardiac stem cells possess growth factor-receptor systems that after activation regenerate the infarcted myocardium, improving ventricular function and long-term survival.

Cardiac stem cells and early committed cells (CSCs-ECCs) express c-Met and insulin-like growth factor-1 (IGF-1) receptors and synthesize and secrete the corresponding ligands, hepatocyte growth factor (HGF) and IGF-1. HGF mobilizes CSCs-ECCs and IGF-1 promotes their survival and proliferation. Therefore, HGF and IGF-1 were injected in the hearts of infarcted mice to favor, respectively, the translocation of CSCs-ECCs from the surrounding myocardium to the dead tissue and the viability and growth of these cells within the damaged area. To facilitate migration and homing of CSCs-ECCs to the infarct, a growth factor gradient was introduced between the site of storage of primitive cells in the atria and the region bordering the infarct. The newly-formed myocardium contained arterioles, capillaries, and functionally competent myocytes that with time increased in size, improving ventricular performance at healing and long thereafter. The volume of regenerated myocytes was 2200 m3 at 16 days after treatment and reached 5100 m3 at 4 months. In this interval, nearly 20% of myocytes reached the adult phenotype, varying in size from 10 000 to 20 000 m3. Moreover, there were 4313 arterioles and 15548 capillaries/mm2 myocardium at 16 days, and 316 arterioles and 39056 capillaries at 4 months. Myocardial regeneration induced increased survival and rescued animals with infarcts that were up to 86% of the ventricle, which are commonly fatal. In conclusion, the heart has an endogenous reserve of CSCs-ECCs that can be activated to reconstitute dead myocardium and recover cardiac function