Strategies to Promote Weight Loss in Adolescents with Intellectual and Developmental Disabilities

Abstract

Introduction: Adolescents with intellectual and developmental disabilities (IDD) are at an increased risk of obesity with up to 55% considered overweight and 31% obese. However, there has been minimal research on weight management strategies for adolescents with IDD. This series of studies aimed to (1) compare the effectiveness of two weight loss diets, an enhanced stop light diet (eSLD) and a conventional diet (CD), for overweight and obese adolescents with IDD, (2) to determine the feasibility of using tablet computers as a weight loss tool in overweight and obese adolescents with IDD, (3) to determine if the use of photo-assisted 3-day food records significantly improved the estimation of energy and macronutrient intake reported in proxy assisted 3-day food records in adolescents with IDD, and (4) to evaluate the intervention components of the program by discovering parents' feelings and opinions on the intervention program for both diet groups. Methods: A 2-month pilot intervention was conducted. All participants were randomized to the eSLD or CD, and were given a tablet computer which they used to track daily dietary intake and physical activity. Participants and a parent met weekly with a health educator via video chat on the tablet computer to receive diet and physical activity feedback and education. Participants completed a proxy-assisted 3-day food record and took pictures of all meals at baseline and the end of month 2 to determine dietary intake, and parents of participants were interviewed using a semi-structured interview at the end of the study. Results: Twenty participants (45% female, 14.9 ± 2.2 yrs. old) were randomized and completed the intervention (10 eSLD, 10 CD). Participants in both diets were able to lose weight, the mean weight change in the eSLD group is 1.67kg more than that of the CD group, but the difference (eSLD: -3.89 ± 2.66 kg vs. CD: -2.22 ± 1.37 kg)was not statistically significant. Furthermore, participants in both groups increased their diet quality as measured by the HEI-2005. Participants were able to use the tablet computer to track their dietary intake 90.4% (range: 27.8%-100%) of possible days, to track their physical activity 64.3% (range: 0%-100%) of possible days, and to attend 80.0% of the video chat meetings. The use of photo-assisted food records significantly increased the estimates of energy intake by 16.7% (p=0.0006) at baseline and 10.6% (p=0.0305) at the end of month 2 compared to use of proxy-assisted food records. Interviews identified that parents had a positive attitude towards the program, liked the convenience of the program, appreciated the use of the tablet computer, and felt that the program taught beneficial strategies to continue to encourage healthy habits in the home. Conclusion: A weight loss program in adolescents with IDD was successfully conducted, with overall acceptability from both adolescents and parents. Both the eSLD and the CD were identified as weight management strategies that could potentially lead to clinically significant weight loss in adolescents with IDD, and tablet computers were found to be a feasible tool and delivery system for weight loss in adolescents with IDD. The results also suggest that photo-assisted 3-day food records may provide better estimates of energy intake in adolescents with IDD compared to proxy-assisted 3-day food records. Finally, parents reported changing their behaviors to help their child successfully follow a weight loss intervention, but may need more education about the benefits of physical activity and ideas on how to increase the physical activity of adolescents with IDD.