THE ‘HEALTHY LIVES STUDY’
The ‘Healthy Lives’ study was a qualitative research study which assessed how far a group of 30 adults with learning disabilities were able to live healthy lives in the community. The study addressed people’s social and economic circumstances, their health-related behaviour and their experience of medical and dental services. Participants in the study (13 men and 17 women) represented a wide age spectrum (19-79 years) and lived in various types of accommodation, including staffed houses, family homes and independent living. A range of impairments were represented, from people defined as having mild learning disabilities to those with complex support needs. Wherever possible, participants answered for themselves in interviews.
Healthy eating is a particular issue for people with learning disabilities. The Health of the Nation strategy for people with learning disabilities (UK Department of Health, 1995) identifies obesity as a condition that occurs more frequently than in the general population, although people with profound impairments may sometimes become seriously underweight.
PARTICIPANTS’ EATING PATTERNS
Current nutritional advice recommends eating more fibre, fresh fruit and vegetables, and reducing sugar, salt and fat consumption. The eating patterns of participants in this study were similar to those of people in the general population, as assessed for Blaxter’s (1990) ‘Health and lifestyles’ study. Ten participants were found to have ‘good’ eating habits; seventeen had ‘average’ patterns, and only three were classified as ‘poor’.
Participants had some experiences that were particular to them as people with learning disabilities. Notably, many people had a lack of control over what they ate. Twenty-two people did not plan what they were going to eat themselves. They often had to fit in with the likes and dislikes of carers, or with the dietary requirements of other residents in staffed houses. Carers intervened in what people ate to try and make their diet healthier; nevertheless, this represents a degree of control exercised by carers, rather than the person concerned choosing to eat a healthy diet.
Eight people planned their meals for themselves, and those participants generally had an ‘average’ or ‘good’ number of good food habits. However, a couple who lived together independently scored very badly, illustrating that people moving to independent living may need practice to plan their own diet and to make healthy choices for themselves.
SHOPPING AND COOKING
Of the 30 participants, eighteen had their food shopping done by staff or carers; eight more had some involvement; only four people shopped for themselves. Only three people cooked all their own food; five others cooked with the support of staff/carer, and the remaining 22 had their food cooked for them by others (although seven of those people had learned cooking skills at their day/training centre).
KNOWLEDGE OF HEALTHY EATING
Given people’s lack of involvement in shopping and cooking, it is perhaps not surprising that only seven were able to give a good or reasonable idea of what constitutes a healthy diet. Sixteen of the 30 respondents were unable to think of any source of information about healthy eating options. Others mentioned carers, cooks at the day-centre, TV or magazines, college, the nurse at the doctor’s surgery, a neighbour and a shop assistant as sources of information.
There are clearly health implications in what people eat, and for the way eating as a social activity is organised, particularly for the lack of control people with learning disabilities may have in their lives. If we are to develop an adequate understanding of how people with learning disabilities can adopt healthier eating patterns, it is important to view food choices as a consequence of people’s economic and social circumstances, rather than simply a matter of individual preference. It is unhelpful to analyse the situation in terms of apportioning blame to individual carers, since carers share many of the economic and social circumstances of the people they support. We also need to recognise the potential for pleasure from eating, and the social and emotional significance of food.
There are a number of strategies which can support people to follow healthier eating patterns which would have a positive effect on their quality of life as a whole:
- Provide people with learning disabilities with clear accessible information about the key elements of a healthy diet.
- Encourage people to practise informed choice about eating, and accept that people will sometimes choose less than healthy options.
- Offer choice and encourage involvement at every stage of the eating process, including meal planning, shopping and cooking.
- Recognise the economic constraints on healthy eating, and help people to learn about cheap and healthy options, rather than concentrating on apparently easier to cook convenience foods.
- Ensure that people can have meals that are geared to their individual preferences and nutritional needs, rather than those of a larger group. People can eat together regularly, without necessarily eating the same food.
- Ensure that people have adequate dental care.