Incidence and Implications of Overweight and Obesity Among Individuals with Mental Retardation

Prepared by Chahira Kozma, MD

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During the past decade, the rate of obesity has risen significantly in the United States, reaching epidemic proportions. The latest data from the National Center for Health Statistics show that 30 percent of U.S. adults are obese. Individuals with mental retardation are at higher risk for obesity than the population as a whole. The incidence of obesity among them is close to 50%, with many more overweight women than men. Numerous studies have documented this trend.

Nutrition screening conducted by the American Dietetic Association during the 1999 Special Olympics World Summer Games revealed that 53 percent of the American athletes participating in these games had a body mass index (BMI) that indicated that they were overweight and 33 percent had a BMI that indicated obesity and were at risk for significant health problems. BMI is a screening tool used to determine nutrition status and overall health and correlates with measures of subcutaneous and total body fat. Data reported from the New Jersey 2000 Special Olympics indicated that 33.5 percent of the adults participating in these games had a BMI that indicated overweight and 32.6 percent had a BMI that indicated obesity.

Inappropriate eating practices, limited mobility, intake of certain drugs and specifically psychotropic medications, characteristics of certain genetic syndromes (Down syndrome, Prader-Willi syndrome, fragile X syndrome), and alteration in body composition are contributors to obesity in individuals with mental retardation. Other factors include reduced opportunities for dietary counseling and exercises, decreased motivation, and sedentary life style.

The high levels of obesity found in people with mental retardation expose them to a higher risk for many different types of diseases that are associated with high levels of body fat. This raises concerns because of their implications for health and wellness. Being overweight or obese increases the risk of many diseases and health conditions, including the following:

• Hypertension
• High cholesterol or triglycerides levels
• Type 2 diabetes
• Coronary heart disease
• Stroke • Gallbladder disease
• Osteoarthritis
• Sleep apnea and respiratory problems
• Surgical risk
• Some cancers (endometrial or the lining of uterus, breast, and colon)
• Poor circulation
• Skin problems
• Decreased fitness
• Stigma and negative social consequences of obesity
• Barriers to successful employment
• Barriers to participation in leisure activities and performance of daily living activities
• Negative effect on other quality of life areas

Overweight and obesity result from an imbalance involving excessive calorie consumption and/or inadequate physical activity. Body weight is complex and is the result of a combination of genetic, metabolic, behavioral, environmental, cultural, and socioeconomic influences. While some people are genetically determined to be obese, behavior and environment play a significant role in causing people to be overweight and remain the greatest areas for prevention and treatment actions.

Eating better diets and being more physically active are important in achieving and maintaining a normal weight and helping reduce chronic diseases. In his call to action to prevent and decrease overweight and obesity in 2001, the U. S. Surgeon General recommended that all Americans should take action in balancing healthful eating with regular physical activity. His recommendations included:

• reducing time spent watching television and sedentary behaviors,
• building physical activity into regular routines,
• ensuring that adults get at least 30 minutes of moderate physical activity on most days of the week including walking,
• creating more opportunities for physical activity at work,
• promoting healthier food choices,
• decreasing the intake of refined sugar and high fat foods, and
• reducing portion sizes.

References

Glossary of Terms:

Down syndrome: A chromosomal condition associated with mental retardation, a characteristic facial appearance, slow physical growth, and poor muscle tone (hypotonia) in infancy. It is caused by a genetic imbalance resulting from an extra copy of chromosome 21.

Fragile X syndrome: an X linked genetic disorder resulting from a fragile or broken site on the X chromosome, often characterized by mental retardation, hypotonia and hyperactivity. Males are often more affected than females.

Obesity is being overweight by 20-30 percent of the ideal body weight.
Overweight is being too heavy for one’s height.

Prader-Willi syndrome: A genetic disorder characterized by impulsive eating, compact body build, underdeveloped sexual characteristics, behavioral problems, poor muscle tone, obesity, and a variable mental retardation. It results from abnormalities of chromosome # 15. 2