VOL: 97, ISSUE: 32, PAGE NO: 48
Susan Grassick, BSc, RNMH, is a community learning disability nurse, Southampton Community Health Services NHS TPeople with learning disabilities face the same nutrition-related health problems as the general population, including obesity, constipation, arteriosclerosis and diabetes. Large amounts of information on the benefits of healthy eating have become more widely available in recent years and offer a source of education and guidance. However, many people with learning disabilities cannot read the available literature or find the relevant concepts difficult to understand and are therefore unable to make a reasoned decision.
People with learning disabilities face the same nutrition-related health problems as the general population, including obesity, constipation, arteriosclerosis and diabetes. Large amounts of information on the benefits of healthy eating have become more widely available in recent years and offer a source of education and guidance. However, many people with learning disabilities cannot read the available literature or find the relevant concepts difficult to understand and are therefore unable to make a reasoned decision.
Underweight or obese?
Our Healthier Nation (Department of Health, 1988) and The Health of the Nation (Department of Health, 1992) have recommended that action be taken to reduce the incidence of obesity in order to prevent serious health problems, such as stroke and heart disease. Despite these publications, the rates of obesity in the UK continues to rise, which is a concern in itself. What is more alarming is that the incidence of people with learning disabilities who are obese has been described as higher than the general population (Department of Health, 1995). This statement can be supported by a variety of research data (Simila and Niskanen, 1991; Perry, 1996).
Gaps exist between the available knowledge and practice, and without public health statistics it is difficult to identify need and target practice effectively. The importance of targeting practice should not be underestimated owing to the vulnerability of people with learning disabilities (Jeffereys, 2000).
Having greater knowledge of the increased risk of obesity and underweight issues among people with learning disabilities will enable community practitioners to raise health issues with them. The evidence available to support practice in this area is limited to quantitative studies that appear to focus on the prevalence of obesity and underweight. Simila and Niskanen (1991) examined the prevalence of underweight and overweight in a learning disabled population in Finland. The quantative data presented indicated that obesity was more common in the learning disabled population and women with a learning disability are more likely to be overweight than their male counterparts. Those at the greatest risk of being seriously underweight are individuals with more profound disabilities. Although cultural bias is a possibility, these findings are supported by earlier work. Fox and Rotatori (1982) found differences in weight according to gender and the degree of learning disability. Wallen and Roszkowski (1980) identified a greater proportion of overweight women and comparatively more underweight men. This may be explained when examining the research population which, in this case, comprised of adults living in an institutional setting.
It was not uncommon to find a high proportion of overweight women and underweight men in hospitals for people with learning disabilities (Perry, 1996). One reason for this could be that often the same quantities of food were served to everyone, regardless of nutritional need (Bennett et al, 1995). As women in general need fewer calories than men, food presented often exceeded their energy needs and as a result many became overweight, whereas many male clients were not given enough food to meet their energy requirements (Perry, 1996).
Factors not considered by either of these studies that are clearly influential on weight and are evident in practice include low activity levels, immobility due to associated physical disabilities and increased appetite due to medication.
The relationship between food and health is not confined to just its nutritional importance - food also has a social and emotional significance. Food may be used as an emotional prop - for example, clients may eat if they feel depressed or bored. Nutritional status may also be affected by environmental factors, such as living alone, no regular cooked meals and inadequate finances.
Roger (1996) examined people's social and economic circumstances in relation to nutrition and found that the eating patterns of people with learning disabilities living in the community were very similar to those of the general population. However, differences did exist in relation to food choice. He identified that people with learning disabilities had a lack of control over what they ate and often had to fit in with the likes and dislikes of carers.
Studies relating to nutritional issues and weight status in people with learning disabilities are scarce and material brief. The information available is predominantly concerned with obesity and overweight prevalence, yet evidence from practice and work by Kennedy et al (1997) identify that adults with severe learning disabilities are at a greater risk of becoming underweight. The contributing factors affecting this client group include poor food intake due to feeding problems, pureed diets, prolonged inability to eat following epileptic seizures and a reluctance or inability to ask for larger helpings, seconds or snack foods between meals (Perry, 1996).
Experiences from practice identify the difficulties that clients and carers face in providing adequate food intake. These difficulties include seating and positioning, knowledge of appropriate foods and portion sizes and anxieties related to swallowing, coughing and the risk of food aspiration.
Following a review of the small amount of literature available and the exploration of experiences from practice, several themes have emerged:
- Overweight and obesity are more prevalent in the learning disabled population;
- Women with learning disabilities are more likely to be overweight than their male counterparts;
- The incidence of underweight is higher in men with learning disabilities;
- Individuals with profound disabilities are at the greatest risk of becoming underweight and seriously underweight;
- The more dependent the client, the higher the risk of becoming malnourished and dehydrated;
- Individuals with complex feeding problems are at a greater risk of receiving inadequate nutritional intake.
These findings appear to identify that the weight distribution of people with learning disabilities is polarised at opposite ends of the spectrum, with higher numbers of obesity and overweight at one end and higher numbers of underweight and severe underweight at the other. A need exists for greater research into the causation and monitoring of nutrition-related health issues for people with learning disabilities. Nurses need to be aware of the increased risks to this client group and develop a wider understanding of the social and environmental influences and their relationship to nutritional status and long-term health.