Weight Loss Treatment for People Weight Loss Treatment for People with Disabilities with Disabilities Parent Supported Weight Reduction in Adolescents and Parent Supported Weight Reduction in Adolescents and Young Adults with Down Syndrome Young Adults with Down Syndrome Richard K. Fleming Richard K. Fleming E. K. Shriver Center at E. K. Shriver Center at UMASS Medical School UMASS Medical School Psychiatry Research Day Psychiatry Research Day UMASS Medical School UMASS Medical School Oct. 21, 2009 Oct. 21, 2009
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Weight Loss Treatment for People with Disabilities Parent Supported Weight Reduction in Adolescents and Young Adults with Down Syndrome Richard K. Fleming.
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Weight Loss Treatment for People Weight Loss Treatment for People with Disabilitieswith Disabilities
Parent Supported Weight Reduction in Adolescents and Parent Supported Weight Reduction in Adolescents and Young Adults with Down SyndromeYoung Adults with Down Syndrome
Richard K. FlemingRichard K. FlemingE. K. Shriver Center at E. K. Shriver Center at UMASS Medical SchoolUMASS Medical School
Psychiatry Research DayPsychiatry Research DayUMASS Medical SchoolUMASS Medical School
Oct. 21, 2009Oct. 21, 2009
“An epidemic of childhood obesity and overweight, to which social, economic, and human behaviors have contributed, threatens long-term medical, psychosocial, and financial consequences beyond US society's current capacity to respond.
How the epidemic is controlled will be about the art and practice of social and behavioral change as well as the art and science of medicine.”
(Lavisso-Mourey, 2007, JAMA, 298, p. 920)
Overweight/Obesity in Down Syndrome Overweight/Obesity in Down Syndrome (DS) and Intellectual Disabilities (ID)(DS) and Intellectual Disabilities (ID)
Prevalence estimates of obesity Prevalence estimates of obesity (BMI ≥ (BMI ≥ 30kg/m30kg/m22) ) in adults with DS in five small in adults with DS in five small studiesstudies11
Healthy People 2010, Ch. 6: Promote Healthy People 2010, Ch. 6: Promote the health of people with disabilitiesthe health of people with disabilities
1. Bandini, L.G. Obesity In Nehring W.M. (Ed). Health Promotion for 1. Bandini, L.G. Obesity In Nehring W.M. (Ed). Health Promotion for persons with intellectual and developmental disabilities. The persons with intellectual and developmental disabilities. The state of scientific evidence. American Association on Mental state of scientific evidence. American Association on Mental Retardation, 2005, pp. 30-31,Washington D.C.Retardation, 2005, pp. 30-31,Washington D.C.
2. Luke, A., Roizen, N.J., Sutton, M., Schoeller, D.A. Energy 2. Luke, A., Roizen, N.J., Sutton, M., Schoeller, D.A. Energy expenditure in children with Down syndrome: Correcting expenditure in children with Down syndrome: Correcting metabolic rate for movement. metabolic rate for movement. Journal of Pediatrics,Journal of Pediatrics, Vol. 125, Vol. 125, 1994, 829.1994, 829.
Current RCT: Parent Supported Weight Reduction Current RCT: Parent Supported Weight Reduction in Down Syndromein Down Syndrome
NIDDK, R03DK070627-01A2, Fleming (PI)
Research TeamResearch Team(alphabetical)(alphabetical)
Linda Bandini, PhD, RDLinda Bandini, PhD, RD Carol Curtin, MSWCarol Curtin, MSW James Gleason, MS, PTJames Gleason, MS, PT Melissa Maslin, MS Melissa Maslin, MS Aviva Must, PhD, Sarah Anderson, PhD and Keith Aviva Must, PhD, Sarah Anderson, PhD and Keith
Conditions/groupsConditions/groups::– Treatment = 16 sessions over 6 mos.; follow-up at 12 monthsTreatment = 16 sessions over 6 mos.; follow-up at 12 months– Nutrition/Activity Education (NAE)Nutrition/Activity Education (NAE)– Parent-Supported Weight Reduction (PSWR)Parent-Supported Weight Reduction (PSWR) (= NAE + (= NAE +
Behavioral Intervention)Behavioral Intervention)– Random assignment, “waves” with up to 5 participants per Random assignment, “waves” with up to 5 participants per
Session features:Session features: Lecture (brief, simple), Lecture (brief, simple), instructions, demonstrations, games, practice instructions, demonstrations, games, practice with feedback, reinforcement, “incentives”with feedback, reinforcement, “incentives”
Sessions:Sessions:
1.1. Good Nutrition & Healthy EatingGood Nutrition & Healthy Eating2.2. Stay Fit, Stay Strong, Keep Moving All Day Stay Fit, Stay Strong, Keep Moving All Day
LongLong3.3. Fruits, Vegetables & Low-Fat DairyFruits, Vegetables & Low-Fat Dairy4.4. Physical Activity: Warm-Ups & StretchingPhysical Activity: Warm-Ups & Stretching5.5. Serving SizesServing Sizes6.6. Why is Physical Activity Good for Me?Why is Physical Activity Good for Me?7.7. Meal PlanningMeal Planning8.8. More Meals!More Meals!9.9. Activities at Home and in the CommunityActivities at Home and in the Community10.10. Snack Attack: Healthy Snacking, Mindful Snack Attack: Healthy Snacking, Mindful
NAE were PSWR interventions were well suited to the population and well received.
Both were replicated successfully at a new site and with a new (trained) treatment team
Small pilot, but with some very suggestive findings – The PSWR group lost marginally significantly more
weight than NAE alone
Small numbers precluded inclusion of a no-treatment group
ConclusionsConclusions
PSWR represents a promising approach to weight loss PSWR represents a promising approach to weight loss in adolescents with Down syndromein adolescents with Down syndrome
A full scale trial on a larger sample appears to be A full scale trial on a larger sample appears to be warrantedwarranted