A Call To Action: Obesity In Children With Physical Disabilities
This is even more true for children with physical disabilities, who face even greater challenges when it comes to preventing or managing excessive weight gain. Unfortunately, not much is known about the extent of this problem or possible solutions.
Now a group of Canadian experts in paediatrics and rehabilitation have put out a Call to Action, published in Childhood Obesity, for a research agenda that focuses on this important sub-group of kids.
The call is the result of a Canadian multistakeholder workshop on the topic of obesity and health in children with physical disabilities that was held in October 2014.
The participants in the workshop included researchers, clinicians, parents, former clients with disabilities, community partners, and decision makers.
Given the paucity of research in this area, it is not surprising that the participants identified over 70 specific knowledge gaps that fell into 6 themes: (1) early, sustained engagement of families; (2) rethinking determinants of obesity and health; (3) maximizing impact of research; (4) inclusive integrated interventions; (5) evidence-informed measurement and outcomes; and (6) reducing weight biases.
Within each theme area, participants identified potential challenges and opportunities related to (1) clinical practice and education; (2) research (subareas: funding and methodological issues; client and family engagement issues; and targeted areas to conduct research); and (3) policy-related issues and topic positioning.
Recommendations emerging from the workshop’s multistakeholder consensus activities included:
Children’s and families’ needs must be integrated into prevention and treatment programs, taking into account the additional caring commitments and environmental challenges often experienced by families of children with physical disabilities. Guidelines need to be developed regarding how best to engage children/families meaningfully in designing both clinical interventions and health promotion research initiatives.
Research in obesity and health in children with physical disabilities should be guided by a conceptual model, determining both common and unique determinants of health and obesity compared with their typically developing peers. A conceptual model enables existing knowledge about obesity prevention and management from other populations to be integrated into approaches for children with physical disabilities where appropriate, as well as the identification of areas where disability-specific knowledge is still needed. It is critical that any such model incorporates social and environmental factors that can affect both weight and health, rather than locating responsibility within the individual by default.45 The alignment of our model with the ICF ensures that our approach remains truly biopsychosocial.
Valid, reliable, clinically appropriate, and acceptable outcome measures are urgently needed in order to monitor children’s weight and health, and identify overweight and obesity, where conventional outcomes (e.g., BMI) alone have been shown as suboptimal.
As the authors note,
“Canadian researchers are now well positioned to work toward a greater understanding of weight-related topics in children with physical disabilities, with the aim of developing evidence-based and salient obesity prevention and treatment approaches.”
Hopefully, they will now find the funding required to do the work.