Fat Chance? Opportunities to change for people with learning disabilities.

1. Fat Chance?Opportunities to change for people with learning disabilities. Daniel Marsden – Community Learning Disability Nurse Daniel Marsden - Community Learning Disability Nurse

2. Evidence Base • Gaps in the evidence / research • Not a homogeneous group • Obesity • Medway - 36% BMI 25> (Young, 1996) • 64% adults and 26% 10-19year olds (Marshall et al, 2003) • 26% Overweight 35% BMI 30> (Martin, 2005) • Hypertension • 32% of those aged 40-49 years old (Marshall et al, 2003) • Coronary Heart Disease • Second most common cause of death (14-20%, Hollins et al, 1998) Daniel Marsden - Community Learning Disability Nurse

3. Possible Causes Likely to Interact Non- specific Syndrome specific Predisposing factors Daniel Marsden - Community Learning Disability Nurse

4. Non-specific Many non- specific to people with learning disabilities The impact of these may be greater if dependent on others Syndromes Prader Willi Down’s Bardet Bidel Carpenter Cohen Borjeson Forssman Lehmann (Jeffreys, 2000) Suggested Causes Daniel Marsden - Community Learning Disability Nurse

5. Medication mental health problems limited access to exercise lack of knowledge boredom communication difficulties provision of poor diet by services low self-esteem Hypothyroidism sedentary lifestyle inappropriate use of food as reward lack of literacy skills lack of power and control over life low income attitudes of carers/ staff Predisposing Factors(Jeffreys, 2000, p.32) Daniel Marsden - Community Learning Disability Nurse

6. Personal View • Low exposure to health promotion messages • Motivation • Support available • Place of residence • Prasher & Roy (2000) found weight higher in people living family homes and lowest in those living in institutions. • Unclear policy guidance and service priorities • social care settings may not view health improvement as their business. Daniel Marsden - Community Learning Disability Nurse

7. Activity Levels Messent et al (1998) compared fitness levels with general population: • The men were 24-28% less active • The women were 42% less active • 93% did <1hour moderate exercise/ week Daniel Marsden - Community Learning Disability Nurse

8. New Opportunities Valuing People (dh 2001) • Health Facilitators • Strategically developing links between LD and other health services • Annual health checks • Platform for health promotion advice Daniel Marsden - Community Learning Disability Nurse

9. LD social care issues Access Staffing/support Transport Individual problems Public Health Agenda Partnerships statutory and private industry Leadership within statutory services Partnership between health social care and industry Bridging Role Daniel Marsden - Community Learning Disability Nurse

10. Interventions • Health education • 1-1 work – weight management • Organised groups, peer education, videos, games. • Skills teaching • meal planning • Include and engage • Professionals • Peers • Private industry Daniel Marsden - Community Learning Disability Nurse

11. Strategic Opportunities • Social Care Staff = Public Health Staff. • Evaluation and sharing results/ resources. • Creating leadership Daniel Marsden - Community Learning Disability Nurse

12. Questions • How can public health professionals engage individuals in healthy lifestyles? • How do public health professionals support services to provide healthy options? • Should health services provide more support to people with learning disabilities? Daniel Marsden - Community Learning Disability Nurse

13. References and thanks Thanks to Greatfield Lodge Staff and Users, Alison Williamson – Teeside University and all at Janet Cobb’s Primary Care Network Hollins, S., Attard, M.T., von Fraunhofer, N. and Sedgwick, P. (1998) Mortality in people with learning disabilities: risks, causes and death certification findings in London. Developmental Medicine & Child Nuerology, 40, 50-56. Illingworth, K., Moore, K.A. and McGillivray, J. (2003) The development of athe nutrition and activity knowledge scale for use with people with an intellectual disability. Journal of Applied Research in Intellectual Disabilities, 16, 159-166. Jeffereys, K. (2000) Managing and treating obesity in people with learning disabilities. Learning Disability Practice, 2, 4, 30-34. MarshallD., McConkey, R. and Moore, G. (2003) Obesity in people with intellectual disabilities: the impact of nurse-led health screenings and health promotion activities. Journal of Advanced Nursing, 41, 2, 147-153. Messent, P. et al (1998) Physical activity, exercise and health of adults with mild and moderate learning disability. British Journal of Learning Disabilities, 26, 1, 17-22. Prasher, V. and Roy, A. (2000) Physical Health in The L.D. Book on www.ldbook.co.uk Daniel Marsden - Community Learning Disability Nurse