Students
Health U. - Weight Loss and Down Syndrome
By: Renee Scampini, M.S., R.D.
Overweight and obesity are common among children with Down syndrome (DS). Recent studies suggest that the prevalence of overweight and obesity in this group is higher than that of other individuals with intellectual disabilities (Bhaumik, 2008; Melville, 2005) as well as the general population (Bell, 1992; Rubin, 1998). Despite the pressing need for preventive and treatment programs, little research has been done to determine how to help persons with DS lose weight or even learn about healthy lifestyle choices.
Dr. Richard Fleming and an interdisciplinary research team at the University of Massachusetts Medical School/Eunice Kennedy Shriver Center have developed an educational program called Health U. The Health U. curriculum consists of 16 sessions that focus on nutrition and physical activity, with materials and activities modified to meet the cognitive needs of the participants. Health U. is currently being conducted as a randomized controlled trial to determine the best approach for promoting weight loss in adolescents and young adults (ages 13-26) with DS.
Participants are assigned to one of two conditions: a nutrition and physical activity education alone (NAE) group; or a behaviorally-based parent-supported weight reduction (PSWR) group. In both groups, participants and their parents attend the 16 Health U. nutrition and physical activity classes led by a dietitian and an adaptive physical education specialist. In addition, parents in the PSWR group also receive a detailed behavior modification curriculum, taught weekly by a behavioral psychologist. The PSWR group will be compared to the NAE group to determine if the addition of parent-directed behavior modification increases weight loss and/or healthy lifestyle choices.
Through Health U., participants and their parents learn how to initiate and maintain a healthy lifestyle by making healthful nutrition choices and increasing daily physical activity. The lessons are designed to be interactive, social, fun, and engaging with an emphasis on hands-on, interactive activities. Nutrition topics include the importance of fruits, vegetables and low-fat dairy, portion sizes, healthy choices, eating at restaurants and mindful snacking. We also provide simple, healthy recipes with few steps and ingredients. All lessons include “taste-tests” for making and sampling healthy foods and drinks such as: novel vegetables and fruits; healthy ‘cracker stackers;’ and smoothies. The goal of the “taste tests” is to encourage participants to try new foods and to potentially expand their food repertoires. Thus far participants have been willing to try new foods, even though some have had trepidation in doing so. As a result, participants have found new foods to enjoy. Participants also attempt and practice modified physical activities, focusing on stretching, strengthening and cardiovascular exercises. Formal exercise plans, yoga mats, gym bags, and exercise balls and bands are some of the incentives that participants take home to increase their opportunities to exercise.
At the onset of the program, an individualized healthy eating plan is developed for each participant based on body size, age and activity level. The eating plans are designed to promote gradual weight loss (approximately 1/2 lb per week). The plans are based on a dairy, fruit, vegetable, grain, and protein needs assessment from the mypyramid.gov recommendations combined with portion sizes similar to the carbohydrate exchange list. In this way, a calorie-based healthy eating plan is developed for each individual. Participants are given a specific number of servings of fruits, vegetables, grain, protein, and dairy represented in picture form on their healthy eating plans.
During multiple nutrition lessons, participants are taught about portion sizes and healthy food choices within each food group. While calorie-based, the nutrition lessons are not calorie driven; in fact, calories are rarely mentioned. We wanted to ensure that the program remain focused on healthy, balanced and fun eating; thus we elected not to make calorie-counting a focus of the Health U. experience. We also believed that it would be difficult and tedious for this population to “count” calories. Therefore, we chose an approach based on food group and portion size to prescribe the participants’ diets. Discretionary calories were allotted daily for each participant and were converted into treats and extras; both incorporated into the participants healthy eating plans.
The study measurement protocol is comprehensive. At the start of the program, baseline weight, height, 7 day physical activity (using accelerometers), and a 3 day food diary are recorded. These measurements are repeated at sessions 10 (11 weeks) and 16 (6 months), as well as 6 months after the final session (1 year). As we continue to track the data on weight loss and physical activity levels, the feedback we are getting from parents has been incredibly encouraging. Attendance has been very high, even during inclement weather, and the participants report truly enjoying the lessons. Parents state that their children have learned to make many healthier choices in their daily lives. Because weight loss and maintenance is a life-long struggle, Health U. is geared toward helping participants and parents make independent, realistic and lasting healthful food and physical activity choices. We hope to have the data of the program analyzed and interpreted by summer 2009.
About Renee
At the time of publication, Renee Scampini, M.S., R.D. was the research dietitian for the Health U. team and led the weekly sessions of the Health U. curriculum.
Additional Resources
For more information about Health U. and other on-going projects at UMass Med School/EK Shriver Center go to:
- http://www.umassmed.edu/shriver/recruit/health.aspx
- http://www.umassmed.edu/shriver/service/community
References
- Bell AJ & Bhate MS. Prevalence of overweight and obesity in Down’s syndrome and other mentally handicapped adults living in the community. Journal of Intellectual Disability Research. 1992; 36:359-364.
- Bhaumik S, Watson JM, Thorp CF, Tyrer F & McGrother CW. Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study. Journal of Intellectual Disability Research. 2008; 52: 287-298.
- Melville CA, Cooper SA, McGrother CW, Thorp CF & Collacott R. Obesity in adults with Down syndrome: a case-control study. Journal of Intellectual Disability Research. 2005; 49: 125-133.
- Rubin SS, Rimmer JH, Chiccoine B, Braddock D & McGuire DE. Overweight prevalence in persons with Down syndrome. Mental Retardation. 1998; 36(3): 175-181.