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Longitudinal Follow-Up of Weight Change in the Context of a Community-Based Health Promotion Programme for Adults with an Intellectual Disability

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Title: Longitudinal Follow-Up of Weight Change in the Context of a Community-Based Health Promotion Programme for Adults with an Intellectual Disability
Language: English
Authors: Thomas, G. R., Kerr, M. P.
Source: Journal of Applied Research in Intellectual Disabilities. Jul 2011 24(4):381-387.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 7
Publication Date: 2011
Document Type: Journal Articles
Reports - Research
Descriptors: Obesity, Body Composition, Health Promotion, Mental Retardation, Clinics, Followup Studies, Body Weight, Community Programs, Adults, Program Effectiveness, Foreign Countries, Physical Fitness, Physical Health, At Risk Persons
Geographic Terms: United Kingdom
DOI: 10.1111/j.1468-3148.2010.00611.x
ISSN: 1360-2322
Abstract: Background: Obesity has been identified as a major health concern in adults with intellectual disabilities. This study evaluates a health promotion programme delivered by a NHS department for adults with intellectual disabilities. Method: Routine NHS data were collated and analysed descriptively. One hundred and ninety one adults with intellectual disabilities were screened and monitored over a 2-year period, with a sequence of health and fitness tests. Attendance rates and body mass index (BMI) were the principal outcome measures for this evaluation. Results: 69% of the samples were overweight/obese/morbidly obese at the beginning of the programme. Despite attendance at intermediate follow-up clinics, 21% of the sample failed to attend at year 1 and 34% failed to attend at year 2 clinics. In terms of BMI changes at year one, 52% of the "at risk" BMI category remained static, 26.7% showed a worsening weight status and 20.7% showed an improving weight status. At year 2, 52.1% of the "at risk" BMI category remained static, while 22% got worse and 25% showed an improvement in weight status. Conclusions: This study illustrates the possibilities and difficulties of devising an effective health promotion model within the NHS framework. For long-term obesity-specific interventions to be successful, further research is needed into multi-disciplinary programmes which incorporate the primary carers and are responsive to NICE guidelines.
Abstractor: As Provided
Entry Date: 2011
Accession Number: EJ927705
Database: ERIC
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  Value: <anid>AN0061038029;e0301jul.11;2019Jun04.08:07;v2.2.500</anid> <title id="AN0061038029-1">Longitudinal Follow-up of Weight Change in the Context of a Community-Based Health Promotion Programme for Adults with an Intellectual Disability. </title> <p>Background  Obesity has been identified as a major health concern in adults with intellectual disabilities. This study evaluates a health promotion programme delivered by a NHS department for adults with intellectual disabilities. Method  Routine NHS data were collated and analysed descriptively. One hundred and ninety one adults with intellectual disabilities were screened and monitored over a 2‐year period, with a sequence of health and fitness tests. Attendance rates and body mass index (BMI) were the principal outcome measures for this evaluation. Results  69% of the samples were overweight/obese/morbidly obese at the beginning of the programme. Despite attendance at intermediate follow‐up clinics, 21% of the sample failed to attend at year 1 and 34% failed to attend at year 2 clinics. In terms of BMI changes at year one, 52% of the at risk BMI category remained static, 26.7% showed a worsening weight status and 20.7% showed an improving weight status. At year 2, 52.1% of the at risk BMI category remained static, while 22% got worse and 25% showed an improvement in weight status. Conclusions  This study illustrates the possibilities and difficulties of devising an effective health promotion model within the NHS framework. For long‐term obesity‐specific interventions to be successful, further research is needed into multi‐disciplinary programmes which incorporate the primary carers and are responsive to NICE guidelines.</p> <p>Keywords: interventions; learning disability; obesity; health promotion</p> <p>Obesity is a major global cause of reduced life expectancy ([<reflink idref="bib21" id="ref1">21</reflink>]). Consensus exists on the potential long‐term effects of obesity: increased risk of cardio‐vascular disease, osteoarthritis, type II diabetes, some cancers and osteoporosis ([<reflink idref="bib4" id="ref2">4</reflink>], [<reflink idref="bib19" id="ref3">19</reflink>]; [<reflink idref="bib10" id="ref4">10</reflink>]). For people with an intellectual disability, obesity has been widely described as a key determinant of negative health status ([<reflink idref="bib22" id="ref5">22</reflink>]), and the measurement of obesity has been identified as an important public health indicator in the European context ([<reflink idref="bib24" id="ref6">24</reflink>]; [<reflink idref="bib25" id="ref7">25</reflink>]).</p> <p>There is a high prevalence of obesity in people with an intellectual disability ([<reflink idref="bib15" id="ref8">15</reflink>]; [<reflink idref="bib6" id="ref9">6</reflink>]; [<reflink idref="bib30" id="ref10">30</reflink>]; [<reflink idref="bib13" id="ref11">13</reflink>]). Reasons for this high prevalence are less clear: a positive correlation with inactivity is recognised, as are barriers to participation in exercise ([<reflink idref="bib16" id="ref12">16</reflink>], [<reflink idref="bib17" id="ref13">17</reflink>], [<reflink idref="bib18" id="ref14">18</reflink>]; [<reflink idref="bib1" id="ref15">1</reflink>]; [<reflink idref="bib13" id="ref16">13</reflink>]). It is also recognised that people with an intellectual disability have reduced access to a range of health promotion programmes ([<reflink idref="bib5" id="ref17">5</reflink>]).</p> <p>Access to health promotion and exercise programmes has come under scrutiny ([<reflink idref="bib23" id="ref18">23</reflink>]; [<reflink idref="bib16" id="ref19">16</reflink>], [<reflink idref="bib17" id="ref20">17</reflink>]; [<reflink idref="bib1" id="ref21">1</reflink>]). An international panel recommends <emph>accessible health promotion programmes</emph> for people with an intellectual disability, as well as <emph>research into fitness</emph>, <emph>nutrition and common health problems</emph> associated with intellectual disability, to redress the long‐standing disparities ([<reflink idref="bib22" id="ref22">22</reflink>], p. 252).</p> <p>The research base suggests a range of approaches to obesity reduction. [<reflink idref="bib15" id="ref23">15</reflink>], showed that uptake of existing exercise opportunities available in the community could be appropriate for individuals with intellectual disabilities, providing they found them 'fun and fulfilling'.</p> <p>[<reflink idref="bib12" id="ref24">12</reflink>] evaluated a health promotion programme for 192 overweight adults with intellectual disabilities. The results showed positive change, with body mass index (BMI) reducing modestly in all participants bar those with Down syndrome. [<reflink idref="bib3" id="ref25">3</reflink>], assessed the effects of physiotherapist input to 'improve healthy living', finding modest but significant reductions in BMI over a 12‐month period.</p> <p>There continues to be a strong mandate to explore access to health promotion and measures to reduce obesity. This study reflects recommendations made by the International Association for the Scientific Study of Intellectual Disabilities ([<reflink idref="bib22" id="ref26">22</reflink>]), and the [<reflink idref="bib5" id="ref27">5</reflink>], for services to deliver and investigate accessible health promotion programmes. 'Fit4Wales' is an ongoing service which screens, documents and monitors the weight status of individuals with an intellectual disability.</p> <p>The aims of this study were to evaluate the following outcomes of participation in the Fit4Wales programme:</p> <p></p> <p>• 1</p> <p></p> <ulist> <item> Accessibility of the programme;</item> <p></p> </ulist> <p>• 2</p> <p></p> <ulist> <item> Outcome in terms of weight alteration as measured by BMI.</item> </ulist> <hd id="AN0061038029-2">Method</hd> <p></p> <hd id="AN0061038029-3">Process</hd> <p>The study used an analysis of data collected prospectively from the attendees of the Fit4Wales programme. Over 2 years of data were available. The data is presented as a service evaluation; the South East Wales Local Research Ethics Committee confirmed the nature of the study as a service evaluation.</p> <hd id="AN0061038029-4">Participants</hd> <p>Clients were invited to join the programme if they were: (i) known to the physiotherapy team and assessed as having an intellectual disability, (ii) at least 18 years of age, (iii) free of any medical conditions for which exercise is contraindicated, (iv) exhibiting no significant challenging behaviour that led to intolerance of the process and (v) had informed consent form signed by participant or assent from carer/family.</p> <hd id="AN0061038029-5">The Fit4Wales programme</hd> <p>The programme was designed in 2005 to address the fitness and activity levels of an adult population with intellectual disability known to a NHS physiotherapy team in SE Wales, as a response to a national health promotion initiative, Health Challenge Wales ([<reflink idref="bib27" id="ref28">27</reflink>]). It aimed to be a motivational tool to increase members' participation in sport and exercise, supported by routine measurement of health parameters.</p> <p>Potential members and their next of kin/carers/service providers were invited to an open meeting on the project which described its purpose and methods. Clients were then offered appointments at an enrolment clinic which offered the following tests:</p> <p></p> <ulist> <item> <bold> Station 1: </bold>  Height and weight;</item> <p></p> <item> <bold> Station 2: </bold>  Heart rate and blood pressure;</item> <p></p> <item> <bold> Station 3: </bold>  Hydration level, body fat percentage and BMI as measured by <emph>Bodystat™</emph> bioelectrical impedance monitor (BMI cross‐checked with the Quetelet formula);</item> <p></p> <item> <bold> Station 4: </bold>  Grip Strength Dynamometry, a measure of general muscular strength; Peak Expiratory Flow for general lung function, and Sit & Reach Hamstring test for measure of flexibility.</item> </ulist> <p>Each test was explained and demonstrated to the participant on an individual basis. The client would do as many of the tests as they were comfortable with, and were offered a copy of their collated results.</p> <p>In addition to the measurements, the programme involved the following motivational intervention. At baseline, members were issued with Fit4Wales log‐books and kit‐bags. The log‐books explained the importance of exercise, asked the clients to set personal goals and issued the project's main advice i.e. to aim for five bouts of moderate exercise/week (moderate exercise being that which would make you slightly breathless). It was emphasized to members and their support staff/families, that re‐testing would occur every 6 months to monitor their progress, and at each 12‐month stage a medal and trophy ceremony would take place to reward those who had made significant improvements to their health. All improvements would be noted, but only positive changes in the BMI/body weight would be celebrated explicitly. All Fit4Wales members were invited to the medal ceremonies.</p> <p>Clients had no further structured intervention from the physiotherapy team between testing sessions unless they expressly asked for support. Table 1 describes the 2‐year structure of the programme.</p> <p>1  Structure of the project over 2 years</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><italic>Months</italic></th><th><italic>Project milestones</italic></th></tr></thead><tbody valign="top"><tr><td>0</td><td>Enrolment</td></tr><tr><td>6</td><td>Re‐testing</td></tr><tr><td>12</td><td>Re‐testing and Award Ceremony 1</td></tr><tr><td>18</td><td>Re‐testing</td></tr><tr><td>24</td><td>Re‐testing and Award Ceremony 2</td></tr></tbody></table> </ephtml> </p> <hd id="AN0061038029-6">Measurement and analysis</hd> <p>Data was collated from the Fit4Wales records. Individuals were included for whom there were 2‐year follow‐up data. Drop‐outs and missing data were recorded and reported appropriately. Data is presented in a descriptive manner to reflect that this was a retrospective reporting of anonymised routine data, evaluating a health service programme.</p> <p>The accessibility was measured by participation and continuation, with information on barriers provided by carers/family members. The outcome in terms of alteration in weight, as measured by BMI, is presented by describing the population in terms of BMI groupings ([<reflink idref="bib29" id="ref29">29</reflink>]) at baseline and at years one and two. Describing the population in this way has particular relevance in a health service context, as BMI groupings can indicate specific risk to individuals as well as recommended interventions ([<reflink idref="bib20" id="ref30">20</reflink>]).</p> <hd id="AN0061038029-7">Results</hd> <p></p> <hd id="AN0061038029-8">Sample characteristics</hd> <p>One hundred and fifty nine clients were initially recruited, and a further 56 participants joined subsequently. At the 2‐year point, 191 people were still registered on the programme. One hundred and eighteen (61.7%) of these were male, and 73 (38.2%) were female. The mean age of participants was 42 years (with a range of 19–72 years of age). Of the 24 people who exited the programme, 16 never returned after enrolment, 4 were discharged by the team on the basis of ill‐health, and 4 died.</p> <p>Table 2 shows attendance of those with long‐term data at baseline, year one, and year 2 by BMI grouping. At the beginning of the programme, 11 (6%) participants were Underweight (BMI <18.5), 47 (25%) participants were Normal (desirable) (BMI 18.5–25), 59 (31%) participants were Overweight (BMI >25), 60 (31%) participants were Obese (BMI>30) and 14 (7%) were morbidly obese (BMI >40).</p> <p>2  Distribution of the membership across BMI categories at enrolment, and the attendance rate for testing thereafter</p> <p> <ephtml> <table><thead valign="bottom"><tr><th valign="bottom"><italic>BMI category</italic></th><th valign="bottom"><italic>n at enrolment (%)</italic></th><th><italic>Year 1</italic></th><th><italic>Year 2</italic></th></tr><tr><th><italic>n tested</italic></th><th><italic>n not tested</italic></th><th><italic>n tested</italic></th><th><italic>n not tested</italic></th></tr></thead><tbody valign="top"><tr><td>Underweight</td><td>11 (6)</td><td>10</td><td>1</td><td>8</td><td>3</td></tr><tr><td>Normal (desirable range)</td><td>47 (25)</td><td>35</td><td>12</td><td>31</td><td>16</td></tr><tr><td>Overweight</td><td>59 (31)</td><td>51</td><td>8</td><td>37</td><td>22</td></tr><tr><td>Obese</td><td>60 (31)</td><td>44</td><td>16</td><td>39</td><td>21</td></tr><tr><td>Morbidly Obese</td><td>14 (7)</td><td>11</td><td>3</td><td>10</td><td>4</td></tr><tr><td>Total</td><td>191</td><td>151</td><td>40</td><td>125</td><td>66</td></tr></tbody></table> </ephtml> </p> <p>An increasing proportion of clients did not return for monitoring appointments, with 40 of 191 (21%) failing to attend at year 1 and 66 of 191 (34%) non‐attending at year 2. Carers in this project cited as barriers the difficulty of fitting the appointments around the clients' day service provision – not wanting to disrupt the client's timetable, despite the possible health implications of their F4W appointment.</p> <hd id="AN0061038029-9">Changes in body mass index groupings</hd> <p>Table 3 presents the shifts in BMI within the grouping categories over the time of the programme. Thus, it is possible to catalogue how BMI was maintained in an individual as well as indicating those who may have gained or reduced weight.</p> <p>3  BMI changes of all Fit 4 Wales members over the 2‐year period by weight category</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><italic>BMI categories</italic></th><th><italic>Changes to BMI score</italic></th><th><italic>No. and % of sample at 1 year</italic></th><th><italic>No. and % of sample at 2 years</italic></th></tr></thead><tbody valign="top"><tr><td valign="top">Underweight</td><td>>2 BMI gain</td><td>1 (10)</td><td>0</td></tr><tr><td>>1 BMI gain</td><td>1 (10)</td><td>1 (12)</td></tr><tr><td>Maintained (−1 to +1 range)</td><td>6 (60)</td><td>7 (88)</td></tr><tr><td>>1 BMI loss</td><td>2 (20)</td><td>0</td></tr><tr><td>>2 BMI loss</td><td>0</td><td>0</td></tr><tr><td valign="top">Normal</td><td>>2 BMI gain</td><td>3 (9)</td><td>1 (3)</td></tr><tr><td>>1 BMI gain</td><td>6 (17)</td><td>2 (6)</td></tr><tr><td>Maintained (−1 to +1 range)</td><td>23 (66)</td><td>22 (71)</td></tr><tr><td>>1 BMI loss</td><td>2 (6)</td><td>3 (10)</td></tr><tr><td>>2 BMI loss</td><td>1 (2)</td><td>3 (10)</td></tr><tr><td valign="top">Overweight</td><td>>2 BMI gain</td><td>8 (16)</td><td>6 (16)</td></tr><tr><td>>1 BMI gain</td><td>8 (16)</td><td>6 (16)</td></tr><tr><td>Maintained (−1 to +1 range)</td><td>26 (51)</td><td>21 (58)</td></tr><tr><td>>1 BMI loss</td><td>4 (8)</td><td>2 (5)</td></tr><tr><td>>2 BMI loss</td><td>5 (9)</td><td>2 (5)</td></tr><tr><td valign="top">Obese</td><td>>2 BMI gain</td><td>4 (9)</td><td>3 (8)</td></tr><tr><td>>1 BMI gain</td><td>6 (14)</td><td>4 (10)</td></tr><tr><td>Maintained (−1 to +1 range)</td><td>23 (52)</td><td>15 (38)</td></tr><tr><td>>1 BMI loss</td><td>5 (11)</td><td>7 (18)</td></tr><tr><td>>2 BMI loss</td><td>6 (14)</td><td>10 (26)</td></tr><tr><td valign="top">Morbidly Obese</td><td>>2 BMI gain</td><td>3 (27)</td><td>0</td></tr><tr><td>>1 BMI gain</td><td>0</td><td>2 (20)</td></tr><tr><td>Maintained (−1 to +1 range)</td><td>6 (55)</td><td>6 (60)</td></tr><tr><td>>1 BMI loss</td><td>2 (18)</td><td>1 (10)</td></tr><tr><td>>2 BMI loss</td><td>0</td><td>1 (10)</td></tr></tbody></table> </ephtml> </p> <p>Table 4 describes the change in BMI of clients in the clinically <emph>at risk</emph> BMI groupings at year 1 and year 2 of the project, (with <emph>at risk</emph> quantified as a BMI under 18.5 and over 25, and these individuals grouped together). At year one, 24(20.7%) of these <emph>at risk</emph> individuals had demonstrated an improvement in their BMI, 31 (26.7%) had worsening BMI, while 61 (52.6%) had remained static i.e. neither raising nor lowering their BMI by a factor of one.</p> <p>4  BMI change in at risk groupings</p> <p> <ephtml> <table><thead valign="bottom"><tr><th valign="bottom"><italic>Time of testing</italic></th><th valign="bottom"><italic> </italic></th><th><italic>Change in at risk</italic><sup><italic>1</italic></sup><italic>groupings</italic></th></tr><tr><th><italic>Improved</italic></th><th><italic>Static</italic></th><th><italic>Decline</italic></th></tr></thead><tbody valign="top"><tr><td valign="top">1st year (116 at risk individuals, from 151 tested)</td><td>No.</td><td>24</td><td>61</td><td>31</td></tr><tr><td>As %</td><td>20.7</td><td>52.6</td><td>26.7</td></tr><tr><td valign="top">2nd year (94 at risk individuals, from 125 tested)</td><td>No.</td><td>24</td><td>49</td><td>21</td></tr><tr><td>As %</td><td>25.5</td><td>52.1</td><td>22.3</td></tr></tbody></table> </ephtml> </p> <p>1 <sups>1</sups>At risk is those with BMI <18.5 and BMI >25.</p> <p>By the end of the second year, there was a smaller sample size recorded due to non‐attendance, but again just over half (52.1%) kept a static BMI, while 24 (25.5%) showed an improvement and 21 (22.3%) showed a deterioration.</p> <hd id="AN0061038029-10">Discussion</hd> <p>This study evaluated an NHS‐based health promotion programme for adults with an intellectual disability. The key findings are: (i) a large proportion of the population were at risk from being overweight or obese, (ii) the programme was accessible to a large number of individuals though there was considerable non‐attendance for appointments and (iii) the majority of the at risk population remained stable in terms of their BMI grouping, a further proportion deteriorated and a similar proportion improved.</p> <p>The study was an evaluation of routinely collected data and as such the methodological issues should be noted. Firstly, the representativeness of the sample cannot be measured, and the impact of the missing data cannot be accurately predicted. Secondly, attribution of effect to the project is not possible as there is no control group, blinding or randomisation. Notwithstanding this, the evaluation has raised important questions for the delivery of health promotion programmes to adults with an intellectual disability; the present authors will discuss these here.</p> <p>The high proportion of overweight and obese clients (69%), exceeds comparative data for the general population ([<reflink idref="bib20" id="ref31">20</reflink>]). Other intellectual disability literature quote a prevalence of combined overweight and obesity ranging from 48.7% ([<reflink idref="bib2" id="ref32">2</reflink>]) to 55% ([<reflink idref="bib6" id="ref33">6</reflink>]).</p> <p>Our underweight finding (6% at enrolment) is much lower than [<reflink idref="bib2" id="ref34">2</reflink>] prevalence estimate of 18.6% in the intellectual disability population, or [<reflink idref="bib6" id="ref35">6</reflink>] 14%. The small number of underweight clients may be indicative of a referring bias in the physiotherapy department towards individuals who need more exercise, and therefore likely to have higher body mass. The threats to individual health from such extremes of BMI are a source for clinical, ethical and financial concern within the NHS, and illustrate the need for targeted health intervention by appropriate health professionals.</p> <p>Initial enthusiasm for the programme by adults and their carers (family or support workers), was followed by patchy attendances at follow‐up clinics. This could reflect flaws in the project design, such as a lack of motivational incentive, or call‐back clinics that were too widely spaced. It could also relate to the barriers faced by people with an intellectual disability in accessing appointments and services because of staffing problems within supported accommodation, or transport difficulties ([<reflink idref="bib18" id="ref36">18</reflink>]; [<reflink idref="bib1" id="ref37">1</reflink>]).</p> <p>The role of the carer in terms of health promotion is being explored in the literature, in terms of carer involvement ([<reflink idref="bib8" id="ref38">8</reflink>]), active support ([<reflink idref="bib7" id="ref39">7</reflink>]), and carer knowledge and perceptions ([<reflink idref="bib14" id="ref40">14</reflink>]) and this evaluation emphasizes the carer role. The majority of adults were supported to Fit4Wales clinics by their carers, and future programmes ought to consider carer training needs, particularly their awareness of public health recommendations and the health benefits of physical activity ([<reflink idref="bib14" id="ref41">14</reflink>]). Multi‐disciplinary teams could also consider the inclusion of health promotional projects into care plans/person‐centred plans.</p> <p>The study showed changes in at risk weight groupings over time. At year one, 52.6% had remained static with their BMI; whilst over a quarter (26.7%) had demonstrated a worsening weight status. 20.7% (24 out of 116 under or overweight clients) showed positive changes in their lifestyle as evidenced by improving BMI score. For the quarter that showed positive change at year 2 (be it weight gain for the low BMI clients, or weight loss in the high BMI's), the associated reduction in chronic disease/disability risk and the potential improvement in quality of life should not be underestimated. As the study had no control, and no comparative data studies are available to show weight trends in individuals with intellectual disability over time, these changes cannot be seen as directly related to the programme. However given that longitudinal studies of the general population demonstrate that most people gain weight in young adulthood (0.5 to 1 kg lifestyle‐related annual weight gain ([<reflink idref="bib11" id="ref42">11</reflink>])), and continue to put on weight gradually into their 70's ([<reflink idref="bib9" id="ref43">9</reflink>], [<reflink idref="bib11" id="ref44">11</reflink>], [<reflink idref="bib28" id="ref45">28</reflink>]; [<reflink idref="bib26" id="ref46">26</reflink>]), the BMI reduction observed in this project seems unlikely to occur by chance.</p> <hd id="AN0061038029-11">Conclusions</hd> <p>This evaluation shows that long‐term health promotion services like Fit4Wales are challenging to deliver. Accessibility problems have to be addressed thoughtfully, and a more intensive and dynamic approach is needed to support those individuals at greatest risk from their obesity status.</p> <p>Changes are needed in service delivery and research. Adults with intellectual disabilities and obesity should be offered a multi‐disciplinary service mindful of the NICE guidelines, i.e. inclusive of exercise, dietary and primary care professionals, so that support for the client is comprehensive. The primary carer and the social worker (where applicable) should be recruited in the process to ensure the feasibility and importance of the health promotion programme in the individuals' daily life. This area is critically in need of high quality research in the form of randomised controlled trials to assess meaningful changes in weight risk.</p> <hd id="AN0061038029-12">Acknowledgments</hd> <p>The authors would like to thank Neil Edwards, David Felce and Juliana Po for their support.</p> <hd id="AN0061038029-13">Correspondence</hd> <p>Any correspondence should be directed to Gwenno R Thomas, Highly Specialist Physiotherapist, Abertawe Bro Morgannwg University Health Board, Cardiff Community Support Team, Social Care & Health, PO Box 97, Cardiff CF11 1BP (e‐mail: gwthomas@cardiff.gov.uk).</p> <ref id="AN0061038029-14"> <title> References </title> <blist> <bibl id="bib1" idref="ref15" type="bt">1</bibl> <bibtext> Beart S., Hawkins D., Kroese B. S., Smithson P. & Tolosa I. (2001) Barriers to accessing leisure opportunities for people with intellectual disabilities. 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  Label: Title
  Group: Ti
  Data: Longitudinal Follow-Up of Weight Change in the Context of a Community-Based Health Promotion Programme for Adults with an Intellectual Disability
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  Data: English
– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Thomas%2C+G%2E+R%2E%22">Thomas, G. R.</searchLink><br /><searchLink fieldCode="AR" term="%22Kerr%2C+M%2E+P%2E%22">Kerr, M. P.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. Jul 2011 24(4):381-387.
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  Label: Availability
  Group: Avail
  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
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  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 7
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2011
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Obesity%22">Obesity</searchLink><br /><searchLink fieldCode="DE" term="%22Body+Composition%22">Body Composition</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Promotion%22">Health Promotion</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Clinics%22">Clinics</searchLink><br /><searchLink fieldCode="DE" term="%22Followup+Studies%22">Followup Studies</searchLink><br /><searchLink fieldCode="DE" term="%22Body+Weight%22">Body Weight</searchLink><br /><searchLink fieldCode="DE" term="%22Community+Programs%22">Community Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Fitness%22">Physical Fitness</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Health%22">Physical Health</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22United+Kingdom%22">United Kingdom</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/j.1468-3148.2010.00611.x
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1360-2322
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Obesity has been identified as a major health concern in adults with intellectual disabilities. This study evaluates a health promotion programme delivered by a NHS department for adults with intellectual disabilities. Method: Routine NHS data were collated and analysed descriptively. One hundred and ninety one adults with intellectual disabilities were screened and monitored over a 2-year period, with a sequence of health and fitness tests. Attendance rates and body mass index (BMI) were the principal outcome measures for this evaluation. Results: 69% of the samples were overweight/obese/morbidly obese at the beginning of the programme. Despite attendance at intermediate follow-up clinics, 21% of the sample failed to attend at year 1 and 34% failed to attend at year 2 clinics. In terms of BMI changes at year one, 52% of the "at risk" BMI category remained static, 26.7% showed a worsening weight status and 20.7% showed an improving weight status. At year 2, 52.1% of the "at risk" BMI category remained static, while 22% got worse and 25% showed an improvement in weight status. Conclusions: This study illustrates the possibilities and difficulties of devising an effective health promotion model within the NHS framework. For long-term obesity-specific interventions to be successful, further research is needed into multi-disciplinary programmes which incorporate the primary carers and are responsive to NICE guidelines.
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  Data: 2011
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  Data: EJ927705
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        Value: 10.1111/j.1468-3148.2010.00611.x
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      – Text: English
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      Pagination:
        PageCount: 7
        StartPage: 381
    Subjects:
      – SubjectFull: Obesity
        Type: general
      – SubjectFull: Body Composition
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      – SubjectFull: Health Promotion
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      – SubjectFull: United Kingdom
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      – TitleFull: Longitudinal Follow-Up of Weight Change in the Context of a Community-Based Health Promotion Programme for Adults with an Intellectual Disability
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