Individually Tailored, Remotely-Delivered Interventions May Offer Promise for Weight Reduction in People with Intellectual Disabilities
A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Obesity is a national health concern in the US, where rates of obesity have increased by about 12% over the last 2 decades. Prior research has shown that obesity is closely related to the onset of chronic diseases such as type 2 diabetes, high blood pressure, and heart disease, as well as premature death. Increased rates of obesity and its associated health challenges are especially concerning for people with intellectual disability (ID), who tend to have higher rates of obesity compared to people without ID. Past research suggested that these higher obesity rates might be related to unique challenges for this population, such as financial constraints, limited transportation, and higher reliance on caregivers for assistance. In addition, people with ID may be more predisposed to obesity due to lower rates of access to preventative health services (e.g., cancer screenings, blood pressure monitoring, cholesterol checks) and lack continuity of care.
Despite the increased risk for obesity for people with ID, there is little research on weight loss and/or weight management programs for this population. Prior research using a hybrid approach of in-person and remotely-delivered weight loss interventions via information and communication technology (ICT) have shown some promise in the general population.
In a recent NIDILRR-funded study, researchers tested a tailored health intervention program for people with ID delivered using ICT. The researchers wanted to know whether a tailored program delivered remotely could improve participants’ body weight and other health risk factors (e.g., blood sugar, cholesterol).
Researchers at the Rehabilitation Research and Training Center on Developmental Disabilities and Health enrolled 35 adults with ID in a study to test the Personalized Online Weight and Exercise Response System for Individuals with Intellectual Disability (POWERSforID), a weight management intervention specifically developed for people with ID that combines remote coaching with an online platform. POWERSforID used a person-centered approach to help participants identify areas of change and set realistic goals for improvement. It included information and resources geared toward people with ID, such as easy to understand categorization for foods, simple activity and food logs, and guidance from coaches to help participants make decisions for themselves.
The participants were between the ages of 18-50 with a diagnosis of either mild or moderate intellectual disability, and were receiving care in a clinic that specialized in caring for people with ID. In addition to these criteria, participants also had to have a body mass index of at least 30 (which indicated obesity), be cleared by a medical provider for participation in a weight loss program, and have access to a computer and the internet during the week.
The 35 participants were randomly assigned to two groups: An intervention group and a comparison group. The study time frame was 24 weeks. At the start of the study, all participants completed clinic visits and in-person assessments with a health coach. A clinician took body measurements (height, weight, body mass index or BMI, waist circumference, and body fat), vital signs (blood pressure, heart rate), and biomarkers (cholesterol profile and blood sugar levels). Finally, all participants also completed questionnaires regarding what they liked to eat, what physical activity they enjoyed, and how they felt about their health and wellness. During the study period, participants in both groups were asked to visit the clinic every six weeks for a total of four visits. Body measurements and vital signs were measured again at weeks 12 and 24, and biomarkers were measured at week 24.
The participants in the intervention group received a portable scale to track their weight and a pedometer to track their steps each week. They also received a unique username and password for the POWERSforID website. The POWERSforID program was split into 2 phases. In the first phase (weeks 1-12), participants received a weekly coaching call with a health coach. During these calls, the coach helped the participant set diet and exercise goals, such as reducing highly processed foods or finding ways to add physical activity. Participants and coaches also discussed barriers to these goals and strategies to get around them. The POWERSforID website provided each participant with a personal space to monitor and track their health behaviors like food intake and exercise, a discussion space to interact with their coach, and a journal section to record daily behaviors. The website used the information from the questionnaires to create customized health strategies for the participants and their coaches. For example, if a participant said they did not like eating whole fruits and vegetables, the website would suggest a smoothie as an alternative. The participants were also asked to track their physical activity and target food consumption using the POWERSforID online journal. The intervention program continued through the second phase (weeks 13-24), when the coaching calls were reduced to once every other week. During each clinic visit, the researchers also gathered information about how often intervention participants met with their coaches via telephone and monitored how often they logged into the website and completed their weekly journals.
Participants in the comparison group did not receive coaching calls or access to the POWERSforID website. Instead, they received a consultation with a medical professional and met in person with a health coach to discuss overall health management strategies when they went in for each clinic visit. At the end of 24 weeks, they were given educational materials from the National Center on Health, Physical Activity, and Disability (NCHPAD) and could contact NCHPAD Information Specialists for advice on nutrition and physical activity.
At the end of 24 weeks, the researchers found that:
- The intervention group had a greater reduction in body weight, BMI, and waist circumference compared to the comparison group.
- The intervention group had a reduction in low density lipids (LDL or “bad cholesterol”), triglycerides, and total cholesterol while the comparison group had an increase in those three markers.
- There was no notable change in blood sugar in either the intervention or the comparison groups.
- For the intervention group, participants completed an average of 61% of the scheduled calls with their coaches. About 24% of participants regularly completed weekly journals of their physical activity and nutrition.
The authors noted that the participants in the intervention group who had access to coaches and a tailored program showed improvements in important areas of health: body weight, BMI, and LDL. The interactive coaching calls may have been key to these improvements rather than the automated guidance from POWERSforID website, since only about a quarter of the participants successfully logged in and interacted with the website to journal their activity. They noted that, generally, weight loss interventions for adults with ID are usually not as successful as those developed for the general population. They suggested that this may be due to unique barriers people with ID face, and a tailored, adaptable program with a coach such as this program may help in finding strategies to overcome these barriers.
According to the authors, this study shows promise for a remote weight management intervention tailor-made for people with ID to assist with weight loss in this population. This intervention could potentially alleviate challenges people with ID may face in finding a health program that meets their unique needs or accessing transportation for regular visits if they do find a program. A telehealth program with coaches and computer guidance targeted to their needs may fill this gap. Future research focusing on larger number of participants or on incorporating other mobile health technologies such as text messaging and social networks may be helpful. They noted that this pilot study may serve as a promising starting point for future remotely-delivered and technology-based weight loss interventions for people with ID.
To Learn More
Partnerships in Wellness is a universally-designed health promotion curriculum that addresses the unique learning needs of adults with ID who require ongoing daily support and have limited to no reading skills. The curriculum takes a unique approach to teaching persons with ID about healthy living: Individuals with ID learn alongside a partner who does not have ID. Partnerships in Wellness is structured in a way that both partners can learn new information, skills, and habits as it relates to their own health and well-being.
The National Center for Health, Physical Activity, and Disability offers resources for people with disabilities, families, and health and fitness providers on integrating physical activity and good nutrition into one’s life.
To Learn More About this Study
Neumeier, W.H., Guerra, N., Hsieh, K., Ervin, D., Thirumalai, M., and Rimmer, J.H. (2021) POWERSforID: A personlized online weight and exercise response system for individuals with intellectual disability: A randomized controlled trial. Disability and Health Journal, 14(4). The article is available from the NARIC collection under Accession Number J87379.