EXPLORATION OF OBESITY AND PEOPLE WITH INTELLECTUAL DISABILITY

Overweight is not inevitable for persons with intellectual disability, writes Rachel Brosnan who, as part of her clinical training, is looking at obesity in persons with learning disability in Ireland says Rachel Brosnan, Psychologist in Clinical Training, UCD

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As a country, we will soon surpass the UK in the league of the most overweight nation in Europe. Obesity is fast becoming a serious concern as the most probable cause of ill health. Statistics show alarming rates of increased levels of obesity. This problem is particularly evident in persons with intellectual disability. Obesity can be defined as an excessive, health-impairing accumulation of body fat. ‘Excessive’ refers to body weight approximately twenty per cent above the desirable weight with reference to population norms adjusted for height, sex and age. The term ‘overweight’ refers to a more arbitrary classification based on societal standards; a body shape considered ‘slim’ in the 1960s would be perceived as more overweight today. Measurement of obesity can be determined in a number of ways. One internationally accepted method of measuring is the calculation of Body Mass Index (BMI) (Bray 1992). Body weight in kilograms is divided by the square of height in metres (kg/m2). The normal range is considered to be between 18.5 and 24.9. Overweight is usually defined as a BMI between 25 and30; a higher figure indicates obesity.

Exact prevalence rates of obesity are difficult to obtain owing to differing measurement techniques and cultural variations, but rates are increasing. Before the industrial revolution, obesity was a rare phenomenon in the United States. That country now reports around thirty per cent of the population to be overweight. In Ireland a recent study carried out by the Department of Health and Children (1999), from a population of over 6000 adults, identified 32% of the overall sample as overweight and 10% as obese. The study revealed that 12% of Irish people eat fried foods more than four times a week.

Studies in the UK reveal that obesity has been identified as one of the most probable causes of ill health. It has been identified as a risk factor for many conditions, such as coronary heart disease, stroke, hypertension, diabetes, many cancers, impaired hepatic function and decreased life expectancy.

Basically, fat storage is a result of the ingestion of more energy than the individual expends. However, research has shown that there are diverse reasons for obesity: high-fat diet, sedentary lifestyle, genetic risks and ill health and disability.

Studies to date indicate that overall prevalence rates of obesity are higher for people with an intellectual disability when compared with the general population; rates are significantly higher among females. In their UK study, Kelly, Rimmer and Ness (1986) found that 45% of males and 50% of females in an institutionalised setting were obese. Close examination of the findings reveals that individuals with a severe and profound disability tend to be underweight, while those with a mild or moderate disability are more likely to suffer from obesity. A small body of evidence appears to indicate that people living at home or in community group homes may be more susceptible to developing obesity, possibly because these less restrictive environments present more opportunities to engage in the consumption of high-fat, calorific snack foods (Prasher 1996). Another argument centres on how carers and relatives may come to use sweets and confectionery as elements in reward systems.

Golden and Hatcher (1997) state that ‘as individuals are placed in less restrictive environments they are often given more responsibility for food choices, but often possess inadequate nutrition knowledge’. Studies reveal that meals prepared in group homes were often high in fat and calories. Such a reality may explain why high rates of obesity are found in individuals with mild to moderate disability who have made the transition from institution to the community.

There is a serious paucity of research examining the psychological functioning and consequence of obesity in adults and children with intellectual disability. Perhaps the greatest grouping of psychological difficulties experienced by obese persons result as a consequence of the obesity and negative societal attitudes. Studies reveal that this prejudice transcends class and is even present among obese persons themselves. It must also be stated that, beyond the more serious health risks, obese persons with intellectual disability are more likely to be the object of increased social prejudice and non-acceptance owing to the social stigma associated with having a weight problem.

A healthy diet, combined with a moderate exercise programme, appears to be the long-term strategy for managing obesity. This ‘slow to show’ intervention is more successful than drastic methods of surgery or the use of medication. The difficulties of dealing with the condition have led doctors to approach the problem with prevention rather than cure. Awareness of the problem is very important. The statistics need to be acknowledged.

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