Risk Factors and Health Conditions Associated with Obesity for Individuals with IDD Melissa A. DiSipio, MSA, FAAIDD Philadelphia Coordinated Health Care (PCHC), Director Southeastern PA Health Care Quality Unit
Objectives Describe the risk factors and health conditions associated with obesity for individuals with IDD. Review various prevention strategies and resources to promote a healthy lifestyle in the community. Summarize ways to encourage individuals with IDD to participate in their own health promotion.
Statistics More than 1/3 (36.5%) of U.S. adults have obesity In PA: approx, 33.9% adults were overweight, 30.2% had obesity in 2016 (CDC, 2016) Prevalence estimates of obesity in the general population have dramatically increased from less than 15% to over 35% during the past 20 years (CDC) Prevalence of obesity among adults with ID ranges from 26.5% to 58.5% in the USA
Prevalence Due to a complex mix of behavioral, environmental and biological factors. Obesity-related conditions include: heart disease, stroke, type 2 diabetes and certain types of cancer Genetic Disorders (IE. Prader-Willi syndrome) Estimated that 24-48% of adults with Down s syndrome are classified as obese. Other key factors: gender, severity and type of ID, genetic pre-disposition
Personal Risk Factors Medications: antipsychotics, antidepressants, antihypertensives, diabetes-related meds Reduced or no physical activity Sedentary behaviors such as television watching Poor diet including consuming fast food Sugar sweetened beverages High energy/low nutrient or high fat food intake
Environmental Risk Factors Living in rural counties Residential type Living in less restrictive community settings vs. more restrictive institutional settings
How are Health Risks Identified? Individual assessment Assessment of the full range of current health conditions and management Assessment of staffing and community health care supports in place for the individual: systems implications Health promotional activities
Proactive Response to Indications of Health Risk Promote awareness of immediate needs Prioritize risk Assure pro-active supports Determine staff training needs Define documentation needs Define quality assurance measures
Health Conditions Associated with Obesity Heart disease and stroke High blood pressure Diabetes Cancer Gallbladder disease and gallstones Osteoarthritis Gout Asthma Sleep apnea
Prevention/Intervention
Intervention Behavior change Behavior change plus physical activity Dietary Physical activity Diet plus physical activity Multi-component (three or more components)
Behavior Change Self-monitoring Self-reinforcement Complete food diaries Reward themselves for achieving specific changes of their dietary habits
Physical Activity Simple changes (i.e. taking the stairs) Walking Aerobic activity Fitbit buddy reinforcement
Dietary
Weight Normal weight varies with age, height, body build, size of frame, muscle mass, and activity.
Factors Affecting Weight Age Activity level Medications Food intake Other conditions
Calculating Weight Use the same scale each time Scale on a hard floor Under same conditions Document weights
Regular Weights Should Be Kept When: Immobile or non-ambulatory Adults who are underweight or overweight Lost or gained >10% BW in past 12 months On weight gain or reduction diet Has recurrent weight problems
Overweight Individuals Use fruits or raw veggies for snacks Discourage second helpings Use skim milk Encourage non caloric drinks Increase veggies and decrease breads, pastas,and potatoes Keep food and weight diaries
Developing a Plan Prioritize chronic conditions When possible, prevent progress of the disease process Recognize risks Who does what Review with physician Review for - timeliness, workability, completion Make changes as needed
Healthy People 2020 Federal Initiative on Health Promotion and Disease Prevention Increase quality and years of healthy life Eliminate health disparities
Healthy People 2020 Leading Health Indicators Nutrition, Physical Activity, & Obesity Reproductive & Sexual Health Maternal, Infant, & Child Health Access to Health Services Clinical Preventative Services Mental Health
Physical Activity, Nutrition, & Obesity Strategies o Increase proportion of adults who engage in physical activity & muscle strengthening guidelines: 150 minutes of moderate intensity aerobic activity per week, muscle strengthening involving more than one muscle group at least 2 days per week Approaches o o o o o walking arm movement swimming membership to health & fitness facility individual activity program o Increase the daily intake of total vegetables
Nutrition, Physical Activity, and Obesity (con t) Strategies o reduce numbers of adults & children who are obese Approaches o o o train individuals and their supports in creative menu planning, food prep resource material post dietary guidelines in the home
Remember when
Menu Planning Why do we need to plan? Involve the person that you support Food Pyramid Doctors prescribed diets Substitutions Healthy Snacks
Grocery Shopping Tips Coupons are key Store brands Use menus See what's needed Universal foods o Vegetables ofruits
Meal Prep Make meals easier to prepare oslow cooker ocrock pot ostews & soups o Utilize leftovers
Teaching Authentic Cooking Skills to Adults With IDD: Active Engagement https://aaidd.org/publications/bookstorehome/training/teaching authentic cookingskills to adults with intellectual anddevelopmental disabilities activeengagement
The role of social support Emotional, instrumental, informational, and appraisal support Family members, friends, colleagues, DSPs, careers Encourage and appreciate minor changes Ensure that a participant takes an active role in making lifestyle changes Promote realistic changes in diet and activity Support participants to keep weight records, menu planners and exercise journals
Developing a Plan Prioritize chronic condition When possible, prevent progress of the disease process Recognize risks Who does what Review with physician Review plan Make changes
When you leave here... Check records Evaluate chronic conditions Evaluate existing resources Develop health promotional priorities Highlight staff training needs
Remember!!! Always present any proposed lifestyle changes incorporating health promotion and/or disease prevention activities to the individual s primary care physician for approval first
Remember!!! Research in this area is ever changing; always verify current practices before embarking on any program Always address health promotion and disease prevention when looking at an individual s health issues at the time of annual planning
Resources https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/trends.html https://www.healthypeople.gov/ https://www.healthypeople.gov/2020/topicsobjectives https://www.onhealth.com/content/1/health_risks_ associated_with_obesity
Melissa A. DiSipio Philadelphia Coordinated Health Care A Core Program of www.pchc.org mdisipio@pmhcc.org