The Challenge of Obesity In Children With Physical Disabilities
Thursday, December 12, 2013
Preventing and managing excess weight is hard enough in able-bodied adults.
Imagine the challenges of addressing this issue in kids, especially those with physical disabilities.
Just how difficult this problem is and how largely ineffective current behavioural approaches to dealing with this issue are is nicely outlined in a paper by McPherson and colleagues from the Holland Bloorview Kids Rehabilitation Hospital, Toronto, published in Disability and Rehabilitation.
This scoping review examined the current evidence on interventions designed to facilitate weight management and/or weight-related behaviors (i.e. physical activity and/or healthy eating habits) in children with physical disabilities.
None of the 34 articles included in the synthesis addressed the issue of long-term obesity prevention.
The majority of research focused upon children with cerebral palsy, and had case study, quasi- or non-experimental designs.
Of the 18 studies that reported positive outcomes, all included physical activity interventions using motivational strategies for the child and child self-direction.
However, none of the studies targeting body weight/composition reported long-term successes.
The authors conclude that we currently lack a robust evidence base for long-lasting obesity interventions for children with physical disabilities.
Given the clear limitations of behavioural interventions in this population, one can only wonder about the efficacy of pharmacological or even surgical obesity treatments, at least for severely obese kids with such disabilities.
I wonder if amy of my readers has any experience with this special population.
@DrSharma
Berlin, Germany
McPherson AC, Keith R, & Swift JA (2013). Obesity prevention for children with physical disabilities: a scoping review of physical activity and nutrition interventions. Disability and rehabilitation PMID: 24308905
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Thursday, December 12, 2013
I’ve used in 10 obese Down Sindrome adolescents Orlistat 80 mg BID, with good compliance and moderate weight loss (from 4 to 7 kg unpublished data). Therapy was dropped out for cost after 6 monts. Very little physical activity was possible for psyco-social reasons.
Thursday, December 12, 2013
My wife and I are volunteers for Special Olympics Montana. We have a 22-year-old Down syndrome son who participates in basketball, swimming, and track events. We keep him slim by feeding him plenty of butter, cheese, full-fat yogurt, and mostly home cooked food. We limit his juice intake (mixture of carrot juice and apple cider we make ourselves) to 8 ounces a day. He gets to drink sodas at parties and punch at weddings but that’s it. He has no cavities despite the fact that we’ve always brushed his teeth sporadically with nothing but water. He’s very sedentary – spends considerable time watching videos. He can’t run very well due to hip dysplasia. Never-the-less, he is lean and surprisingly strong.
We have chaperoned a number of Special Olympics events. The food provided is generally of poor quality compared to what our family eats at home – high sugar/refined carbohydrate/ omega-6 oils content. Until the quality of the food supply is improved, people with disabilities, our most vulnerable population, will continue to struggle with the same obesity and chronic disease issues that “normal” people face.
Friday, December 13, 2013
Thank you David for these insightful comments. The nutritin problems associated with participation in organised sports are indeed appalling. I wish there was a simple way to fix this. It is most interesting to observe how parents, who are fanatic about their kids’ participation in organised sports can be so ignorant and indifferent to the negative health impacts of junk foods served at these facilities.
Thursday, December 12, 2013
Dr. Sharma, as usual, I continue to be impressed with the breath of your advocacy for the obese patient. Although I do not have experience working with children with physical disabilities, I work with children with learning disabilities and ADHD on a daily basis. My experience has provided ample first hand evidence of increased obesity in this population. These personal observations surprised me, as they seem to be anti-intuitive when ADHD is considered. ADHD is most often diagnosed in young boys who seem to be more active and physical than the population at large; furthermore, the Rx for ADHD consists of medications that decrease appetite. Therefore, it would seem unlikely that obesity would be seen in increased numbers in this population. Yet my personal observations are consistent with the prevailing research. I work with my students from mid-childhood to early adulthood and it has always puzzled me why many of my ADHD, formally thin clients, begin to put on significant amounts of weight. Scott Kollins, PhD from Duke University published his findings in International Journal of Obesity. In this study, symptoms of hyperactivity and poor impulse control were highly correlated with obesity later in life. The more symptoms of ADHD that were present, the higher the correlation with obesity. This is not the only study that has found such a link; the literature is full of similar findings. It is now accepted that there is a strong link between childhood ADHD and obesity. In retrospect, I wonder why I was puzzled by my observations. Lack of impulse control, poor planning, and a diet that is quite often high in sugar and high fat is quite common in children with ADHD. This seems like a recipe for obesity in adulthood and many studies now point to the doubling of obesity prevalence in this population. Being aware of this link can help parents concentrate on the eating habits of their children. Many parents of ADHD children are more focused on increasing caloric consumption to meet basic needs using any means necessary. This is why sugar and fat are quite often provided in large doses to these children. The parents are completely unaware of any future obesity issues when they observe their super thin and in some cases underweight children. Changing the focus in childhood from increased caloric consumption to increased healthy caloric consumption might be helpful.
Friday, December 13, 2013
Thank you Elina for sharing your observations. Screening for ADD is a regular part of our assessment for obesity and we find that treating ADD isoften the ket step for patients with ADD to better manage their weight.