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Richard K. Fleming E. K. Shriver Center at UMASS Medical School Psychiatry Research Day

Weight Loss Treatment for People with Disabilities Parent Supported Weight Reduction in Adolescents and Young Adults with Down Syndrome. Richard K. Fleming E. K. Shriver Center at UMASS Medical School Psychiatry Research Day UMASS Medical School Oct. 21, 2009.

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Richard K. Fleming E. K. Shriver Center at UMASS Medical School Psychiatry Research Day

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  1. Weight Loss Treatment for People with DisabilitiesParent Supported Weight Reduction in Adolescents and Young Adults with Down Syndrome Richard K. Fleming E. K. Shriver Center at UMASS Medical School Psychiatry Research Day UMASS Medical School Oct. 21, 2009

  2. “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)

  3. Overweight/Obesity in Down Syndrome (DS) and Intellectual Disabilities (ID) • Prevalence estimates of obesity (BMI ≥ 30kg/m2) in adults with DS in five small studies1 • Males: 25%-71% • Females: 42%-56% • Lower Resting Metabolic Rate2 • Healthy People 2010, Ch. 6: Promote the health of people with disabilities 1. Bandini, L.G. Obesity In Nehring W.M. (Ed). Health Promotion for persons with intellectual and developmental disabilities. The state of scientific evidence. American Association on Mental Retardation, 2005, pp. 30-31,Washington D.C. 2. Luke, A., Roizen, N.J., Sutton, M., Schoeller, D.A. Energy expenditure in children with Down syndrome: Correcting metabolic rate for movement. Journal of Pediatrics, Vol. 125, 1994, 829.

  4. Current RCT: Parent Supported Weight Reduction in Down SyndromeNIDDK, R03DK070627-01A2, Fleming (PI)

  5. Research Team(alphabetical) • Linda Bandini, PhD, RD • Carol Curtin, MSW • James Gleason, MS, PT • Melissa Maslin, MS • Aviva Must, PhD, Sarah Anderson, PhD and Keith Lividini (Tufts) • Renee Scampini, MS, RD • Elise Stokes, MS, BCBA

  6. Parent-Supported Weight Reduction in Down Syndrome (PSWR) • Participants: Adolescents/young adults w/Down syndrome, 13-26 yrs. • Conditions/groups: • Treatment = 16 sessions over 6 mos.; follow-up at 12 months • Nutrition/Activity Education (NAE) • Parent-Supported Weight Reduction (PSWR)(= NAE + Behavioral Intervention) • Random assignment, “waves” with up to 5 participants per group. • Measurement: • BL → 10 wks. → 6 mos. → 12 mos. • Weight /height, BMI • Bioelectrical impedance: % body fat • Accelerometry (physical activity): 7-day durations • 3-day food record → categorical analysis • Knowledge pre-/post-test • Child and parent satisfaction

  7. Nutrition & Activity Education (NAE) • Prior to sessions: • Individualized Healthy Eating Plan • Individualized Physical Activity Plan • Session features:Lecture (brief, simple), instructions, demonstrations, games, practice with feedback, reinforcement, “incentives” • Sessions: • Good Nutrition & Healthy Eating • Stay Fit, Stay Strong, Keep Moving All Day Long • Fruits, Vegetables & Low-Fat Dairy • Physical Activity: Warm-Ups & Stretching • Serving Sizes • Why is Physical Activity Good for Me? • Meal Planning • More Meals! • Activities at Home and in the Community • Snack Attack: Healthy Snacking, Mindful Eating • Strength-Building Activities • Measure Food, Measure Success! • Physical Activity Review • Eating Around Town: Eating Out • Favorite Physical Activities • Potluck Dinner Celebration

  8. Parent Supported Weight Reduction (PSWR) • Monitoring • Daily self-recording of selected diet and physical activity behaviors • Goal setting • Weekly high priority goals • Report to group • Feedback & Reinforcement • Feedback from group • Individual reinforcement w/adolescent • Environmental arrangements (stimulus control) • Assessment • Altered arrangements • Behavioral contracting • Weekly, negotiated

  9. Trial Design 0 wks 10 wks 6 mos 12 mos Intensive Period Taper Period Follow-up

  10. Baseline Characteristics of Participants * Reported as mean (SD) ** Reported as number (%)

  11. Results of Paired and Independent Samples T-tests

  12. Regression Model* Results * adjusted for wave

  13. Discussion • 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

  14. Conclusions • PSWR represents a promising approach to weight loss in adolescents with Down syndrome • A full scale trial on a larger sample appears to be warranted

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