Triceps skinfold thickness and body weight measures were obtained for 44 female and 40 male mentally retarded adults participating in a sheltered workshop setting. Subiects\u27 relative weights and skinfold thicknesses were found to correlate reasonably well for females and males, rs = .88 and .59, respectively. Use of only height and weight tables for determining the presence of obesity, however, resulted in 22.5 percent of the males and 13 .7 percent of the females being misclassified as nonobese. The distinction between overweight and obesity was discussed. Clinical/research implications of the findings were delineated

Burkhart, Jennifer E.

Fox, Robert

Fox, Robert A.

Rotatori, Anthony F.

English

epublications@Marquette

Marquette Universitye-Publications@MarquetteCollege of Education Faculty Research andPublications Education, College of7-1-1983Appropriate Classification of Obesity in MentallyRetarded AdultsRobert A. FoxMarquette University, robert.fox@marquette.eduRobert FoxMarquette University, robert.fox@marquette.eduJennifer E. BurkhartOhio State University - Main CampusAnthony F. RotatoriNorthern Illinois UniversityPublished version. American Journal of Mental Deficiency (American Journal on Intellectual andDevelopmental Disabilities), Vol. 88, No. 1 ( July 1983): 112-114. Publisher Link. © 1983 AmericanAssociation on Intellectual and Developmental Disabilities. Used with permission.112 OBESITY CLASSIFICATION Personality and Social Psychology, 1975,31, 674-685 . Guarnaccia, V. J ., & Slis, V. Effects of instructional set and self-awareness on task performance of re-tarded female adults. American Journal of Mental Deficiency, 1977,8/, 504-507. Hoffman, J ., & Weiner, B. Effects of attribution for success and failure on the performance of retarded adults. American Journal of Mental Deficiency , 1978, 82, 449-452. Horai, J. , & Guarnaccia;- V. J. Performance and attri-butions to ability, effort, task, and luck of retarded adults after success or failure feedback . American Journal of Mental Deficiency, 1975, 79, 690-694. Raber, S. M., & Weisz, J. R. Teacher feedback to mentally retarded and nonretarded children. Ameri-American Journal of MenIal Deficiency 1983 . Vol. 88. No. I. 112-114 © 1983 American Association on Mental Deficiency can Journal of Mental Deficiency, 1981 , 86, 148.-156. Siegel , P. Incentive motivation and the mentally re-tarded person. In N. R. Ellis (Ed.), Handbook of mental deficiency: Psychological theory and re-search. Hillsdale, NJ: Lawrence Erlbaum Assoc 1979. . , Weiner, B. Achievement motivation as conceptualized by an attribution theorist. In B. Weiner (Ed.), Achievement motivation and attribution theory. Morristown, NJ: General Learning Press, 1974. Weiner, B. A theory of motivation for some educa_ tional experiences. Journa l of Personality and So-cial Psychology, 1979, 71, 3-25 . Weiner, B. Human motivation . New York: HOlt, Rinehart, & Winston , 1980. Appropriate Classification of Obesity of Mentally Retarded Adults ROBERT Fox Marquette University JENNIFER E . BURKHART Ohio State University ANTHONY F . ROTATORI University of New Orleans Triceps skinfold thickness and body weight measures were obtained for 44 female and 40 male mentally retarded adults participating in a sheltered workshop setting. Su~iects' relative weights and skinfold thicknesses were found to correlate reasonably well for females and males , rs = .88 and .59, respectively. Use of only height and weight tables for determining the presence of obesity , however, resulted in 22.5 percent of the males and 13 .7 percent of the females being misclassified as nonobese . The distinction between overweight and obesity was discussed. ClinicaUresearch implications of the findings were delineated. Research has shown that obesity is a prev-alent condition among mentally retarded individuals (Fox & Rotatori, 1982). Mea-surement is a crucial aspect of obesity re-search in terms of appropriate classification and subsequent treatment of this condition. Yet some confusion remains concerning how obesity is to be defined and measured. For example, the terms overweight and obesity have been used interchangeably in most clinical settings, although they are not identical (Bray, 1979). Obesity refers to -The second author is now affiliated with the Western Psychiatric Institute and Clinic , University of Pittsburgh School of Medicine. Send reprint requests to R. F., School of Education, Schroeder Complex, Marquette University , Milwaukee , WI 53233 . surplus body fat whereas overweight indi-cates an excess in body weight relative to established height standards. Also, sepa-rate measures of excess body weight (such as the Metropolitan Life Insurance , 1977, desirable weight for height tables) and surplus body fat (e .g., skinfold thickness at various body sites) have been developed. Further complicating the situation, a review of the literature reveals a marked tendency for investigators and clinicians to use mea-sures of overweight to describe a condition of obesity . Implicit in this practice is the assumption that measures of overweight correlate strongly with obesity measures. The purpose of the present study was ~o test this assumption with a sample of re-Fox, BURKHART, AND ROTATORI 113 tarded adults. Failure to find a strong re-lationship between obesity and measures of overweight would suggest that some indi-viduals may be misclassifiec! and thus not receive treatment for obesity. In a related study with non retarded subjects, Johnson and Stalonas (1977) found that body weight correlated minimally with triceps skinfold measures, r = .34. In the present study we were interested in determining the relation-ship between relative body weight (or per-centage of desirable weight) with an esti-mate of body fat (as measured by triceps skinfold thickness). Subjects were 40 males and 44 females drawn from two sheltered workshops for mentally retarded adults. The mean age of both males and females was 31 years (standard deviation [5 D] = 10). Half of the subjects (n = 42) were cho-sen by the staff of one workshop to partici-pate in a separate study. These subjects represented two extremes of the weight continuum (obese and thin). The remaining 42 subjects were randomly selected from a second workshop. Each subject was weighed (accurate to Vz pound) and measured (accurate to v,. inch) on a standard medical scale. Desirable weights for subject heights were deter-mined from the Fogarty Center Table (Bray , 1979) , which was adapted from the Metropolitan Life Insurance Table. The advantage of the Fogarty Table is that it does not require estimates of body frame size to determine desirable weights for heights . For female s between the .ages of 18 and 25 , one pound was subtracted from the table's desirable weight value for each year under 25. Regression equations were used to establisH desirable weights for subjects' heights not included on the Fogarty Table. The relative weight for each subject was calculated as follows: Relative Weight = Present Weight -Desirable Weight Desirable Weight x 100 In addition to height and weight data, triceps skinfold thickness was obtained for each subject. In order to facilitate reliable measurement, we used a tape measure to locate and mark the midpoint between the top of each subject's acromion process (at the shoulder) and olecranon process (at the elbow) on the left arm. Using this midpoint, two experimenters independently measured and recorded each subject's triceps skinfold thickness in mm with a Lange skinfold caliper. The caliper was checked for accu-racy , using a standard sized metal block, before each measurement session. Analysis of the skinfold data revealed a significant correlation between the measurements by the two experimen~ers , r (82) = .99, p < .001; the experimenters never deviated from each other's measure by more than 4 mm, mean deviation = 1.4 mm, mode = 1.5 mm . . Relative weight and skinfold data for the subjects by sex is shown in Table I. The relative weight values and triceps skinfold thicknesses for males correlated r (38) = .59, p < .001 ; for females ,. the correlation between these measures was r (42) = .88, p < .001. A correlation ofr (82) = .76,p < .01, was found for the entire sample. Based on established cutoff values for defining obesity (i .e ., relative weight value of 20 or more [Robinson , 1972] ; skinfold thickness.of 18 mm for males and 25 mm for females [Frisancho, 1974]) , 16 males and 18 females in the present study would be classified as obese by their relative weight; 22 males and 23 females would be diag-nosed as obese based on skinfold measures. Discrepancies found between the relative TABLE I RELATI VE W EIGHT (IN PERCENTAGES) AND TRI CEPS SKINFOLD THI CKNESS ( I N MM) BY SEX Relative weight Tricep skinfold thickness Subjects' Mean \ SD Mode Range Mean SD Mode Range Males 17.3 29.5 10.0 - 22.1 to 91.9 20.5 10.4 19.0 5 to 50 Females 25.2 34.9 11. 7 -10.8 to 142.9 26.1 11 .6 25.5 9 to 54 No/e. Relative weight = present weight minus desirable weight divi.ded by desirable weight times 100. a 40 males , 44 females. 114 OBESITY CLASSIFICATION weight and skinfold measure resulted from I female and 3 males being classified as obese by relative weight and not by skinfold scores; 6 females and 9 males were classified as obese by skinfold and not by relative weight scores. Percentages of sub-jects classified as obese by each measure alone and the combined measures (i.e., classified as obese by relative weight or skinfold thickness) is shown in Table 2. Based on the percentages of subjects classified as obese using the combined measures, the data in Table 2 indicates that 22.5 percent of the males and 13 .7 percent of the females in the sample would be mis-classified as nonobese using the relative weight formula alone; 7.5 percent of the males and 2.3 percent of the females would be misclassified as nonobese by the triceps skinfold measure used alone. TABLE 2 SUBJECTS CLASSIFIED AS OBESE BY VARIOUS MEASURES (IN P ERCENTAGES) Relative Relative Skinfold weight or weight . thickness skinfold Subjects' alone alone thickness Males 40.0 55.0 62.5 Females 40.9 52.3 54.6 Total sample 40.5 53.6 58.3 • 40 males, 44 females. Although relative weight and skinfold thickness data were found to correlate rea-sonably well for our sample, greater errors in classification for a given individual were likely to occur when only the height-weight tables were used for measurement. Errors of misclassification of an obese condition were reduced through the combined use of skinfold thickness and relative weight mea'-sures. It is important to remember that heavi-ness and corpulence are different concepts; therefore , it is possible for a person to be overweight and underfat or overfat and not at all heavy (Seltzer & Mayer, 1965) . Suc-cessfully defining overfat (obese) individu-als requires using both heaviness and fat-ness estimates .(Le Bow, 1981). In fact, Durnin and Rahaman (1967) recommended several measures be used including mUltiple skinfold measures at various body sites (e .g. , biceps , subscapular) and an-thropometric measures (e.g., waist, thigh circumference). Using at least triceps skinfold thickness and relative weight mea-sures in obesity related work should help to ensure that a given individual desiring or in need of treatment for obesity is served. This is potentially important in light of the increased health implications associated with obesity, including cardiovascular dis-ease, respiratory problems, and diabetes (Van Itallie, 1979). Future investigators should address the reasons for discrepant classification out-comes based on height-weight and skinfold thickness data. For the-present, particular syndromes commonly associated with mental retardation (e.g., Down syndrome) did not account for the discrepant findings in the present sample. It is likely that sev-eral factors, such as site of skinfold thick-ness measurement, subject age and sex, and measurement method and errors, con-tribute to diagnostic discrepancies. These factors require identification in order for professionals to arrive at a valid and reli-able classification system for obesity. Manuscript submitted 3/25/82. References Bray, G. A. (Ed.). Obesity in America. Washington, DC: U.S. Department of Health , Education, and Welfare, NIH Publication No. 79-359, 1979. Durnin, J. V. G. A., & Rahaman, M. M. The assess-ment of the amount of fat in the human body from measurements of skinfold thickness. British j ournal of Nutrition, 1967,2 1, 28 1-289. Fox, R., & Rotatori , A. F. Prevalence of obesity among mentally retarded adults. American j ournal of Mental Deficiency, 1982, 87. 228-230. Frisancho, A. R. Triceps skinfold and upper arm mus-cle size norms for assessment of nutritional status . American jOllrnal of C1inicul Nutrition. 1974,27. 1052- 1058. Johnson, W. G., & Stalonas, P. Measuring skinfold thickness-A cautionary note. Addictive Behaviors, 1977,2. 105-107. Le Bow. M. D. Weight control: The behavioral strate-gies. New York: John Wiley & Sons, 1981. Metropolitan Life Insurance Co. Heigh f-l veight tables . New York: Metropolitan Life Insurance Co., 1977. Robinson , C. H. Normal and therapeutic nllfrition . New York: MacMillan, 1972. Seltzer, C. C., & Mayer, J . A simple criterion of obe-sity. Pqstgraduate Medicine, 1965, 38, AIOI-AI07. Van Hallie , T . B. Obesity: Adverse effects on health · and longevity. American joul'Ilal of Clinical Nutri-tion. 1979,32 . 2723-2733. 

Appropriate Classification of Obesity in Mentally Retarded Adults

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Appropriate Classification of Obesity in Mentally Retarded Adults

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