Introduction
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Dietary advice to incorporate a diet with 600 kilocalorie (kcal) (2510 kilojoule (kJ)) per day to 1000 kcal (4186 kJ) per day deficit or low energy content by lowering fat intake
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Physical activity should be increased to 225-300 min or more of moderate intensity physical activity per week
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Behaviour change strategies to facilitate the dietary and activity changes advocated
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What components are included in weight loss interventions for adults with ID?
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Are weight loss interventions for adults with ID associated with a clinically significant weight loss (5-10% or 5-10 kg weight loss from initial body weight)?
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Do interventions include a weight loss maintenance component?
Method
Systematic electronic database searching
Selection criteria
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Valid diagnosis of ID at study enrollment
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Adults (≥ 18 years of age)
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Record of weight status (e.g. obese, overweight) based on the diagnostic criteria valid at the time of study
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Non-surgical or pharmacological interventions
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Impact of intervention on total body weight and/or BMI
Exclusion criteria
Data extraction
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author, title, year of publication
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research question, study design, duration, method of randomization, blinding, length of follow up
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sample characteristics, power calculation, sample size, diagnostic criteria for level of ID and weight status, attrition
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outcome measures: weight and BMI change
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intervention components
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results
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conclusion.
Evaluation of studies
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The presence of sampling bias e.g. power calculation, heterogeneity
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Detailed description of the methodology of randomization
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Replicability based on detailed description of intervention
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The level and explanation for attrition
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Follow up measurements
Results
Literature search
Behaviour change interventions
Study/ Location/ Type | Participants | Intervention | Follow up | Results |
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Fox 1985 [15] USA Community Quasi-experimental with a comparison group |
(a) Parent involvement group n = 8 Weight status: all obese Gender: 4 females, 4 males Age (years)a: 27(2.7) ID: moderate |
Duration: 10 week of 2 group sessions per week (60 min each).(a) Behaviour change methods based on Rotatori [18]. Parents involved with intervention strategies e.g. homework and reward systems. | 10 week |
(a) Mean weight change, kg: - 3.4 (range: -1.81 to -4.9) (b) Mean weight change, kg: -1.09 (range: +2.27 to -3.63). Significant between group difference (p < 0.05) |
(b) Subject involvement n = 7 Weight status: all obese Gender: all malesAge (years)a: 29 (2.2) ID: moderateAttrition/drop out: none |
(b) Same as (a) but parents were not involved. Maintenance: 3 monthly meetings reviewing eating and activity behaviours, reward system continued. | 3 month |
(a) Mean weight change, kg: + 0.7 (range: +3.6 to -2.7) (b) Mean weight change, kg: +0.1 (range: +3.2 to -5.4)No significant between group difference | |
6 month |
(a) Mean weight gain, kg: +1.8 (range: -3.2 to +5.4) (b) Mean weight gain, kg: +2.8 (range: 0 to +6.8) No significant between group difference | |||
McCarran 1990 [16] USA Community Quasi-experimental with a comparison group | Total n = 12, 8 completers Weight status: 22-109% overweight Gender: 7 females, 1 male Age (years): 19-42 ID: cerebral palsy, IQ: 50-80 Attrition/drop out: 4 drop outs |
Duration: 14 weeks of 3 group sessions per week (60 min each) led by a graduate student and undergraduate.(a) Home Help group: Behaviour change methods based on Rotatori [18]. Frequent contacts with the parents/caretakers by the group leader. | 14 weeks |
(a) Mean weight change, kg:-2.5b (b) Mean weight change, kg: -1.2 Significant weight loss for both groups (p < 0.01) No significant between group difference Significant reduction in BMI, weight reduction quotient, % overweight for both groups (p < 0.05) |
(b) No Help group: Behaviour change methods same as (a) but with no communication with the parents/caretakers. Maintenance: 5 weeks of practicing techniques identified as problematic. | 12 months |
(a) Mean weight change, kg: -1.5 (b) Mean weight change, kg: +0.5 | ||
Sailer 2006 [17] USA Community Uncontrolled Quasi-experimental study | Total n = 6 Weight status: all obese Gender: 4 females, 2 males Age (years): 34-54 ID: mild Attrition/drop out: none |
Duration: 10 weekly group sessions (60 min each) and phone call contacts. Behaviour change methods based on Rotatori [18]. Maintenance: none reported | 10 week | Mean weight change, kg: -2.5 (range: +0.5 to -8.2) |
1 month | Mean weight change, kg: -1.5 (range: +2.26 to -5.9) |
Intervention components
Behaviour change
Study outcomes
Study limitations
Behaviour change plus physical activity interventions
Study/ Location/ Type | Participants | Intervention | Follow up | Results |
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Fox 1984 [19] USA Community Quasi-experimental study with a control group |
(a) Behaviour Therapy group (BT) n = 8 Weight status, % overweighta: 44.4 (35.4) Gender: 5 females, 3 males Age (years)a: 29.5 (7.2) ID, IQ a: 42.1 (8.4) |
Duration: 10 weeks of 2 group sessions per week (60 min each) led by a researcher and a recreational therapist. (a) Behaviour change methods based on Rotatori [18]. Parents involved with intervention strategies e.g. homework, reward systems. Phone contacts were also included. Activity: calisthenics and aerobic exercises (2 times a day) plus walking and using stairs. | 10 week |
a) Mean weight change, kg:- 3.3 ( range: +0.4 to + 7.26) % weight loss: 5.7 (b) Mean weight change, kg:-3.72 (range: +1.36 to +7.7) % weight loss:6.6 |
(b) BT + Buddy reinforcement n = 8 Weight status, % overweight a: 34.7 (18.3) Age, (years)a: 27.5 ( 5.4) ID, IQ a: 46.3 (12.1) Attrition/drop out: none |
(b) Same as (a) plus participants were paired into 4 buddy teams.Maintenance: 5 weekly meetings reviewing behaviour change strategies, applying reinforcement and reducing homework. Weight loss was still promoted. | 15 week |
(a) Mean weight change, kg:-0.9 (range: +0.4 to -2.72) (b) Mean weight change, kg:-1.04 (range:+0.98 to -3.2) | |
52 weeks |
(a) Mean weight change, kg: -0.27 (range: +2.25 to -3.6) from baseline | |||
(b) Mean weight change, kg: -1.8 (range: +2.7 to -14.8) Total 37.5 % maintained weight.No significant between–group difference at 10 week, 15 week and 52 weeks follow up | ||||
Fisher 1986 [20] USA Community Quasi-experimental study with a control group | Total n = 17 Weight status: All obese Gender: All femalesAge (years) ≈ 20 ID: mild to moderate Attrition/drop out: none |
Duration: 8 week group sessions(a) Behaviour self control group: Behaviour change methods based on Rotatori [18]. | 8 week |
(a) Mean weight change, kg: -1b
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(b) Mean weight change, kg: -0.6 No significant difference between (a) and (b) | ||||
(b) Behaviour self control group plus physical activity: Behaviour change methods same as (a). Activity: walking (10 min/day increased to 30 min by week 8) Maintenance: none reported | 4 week |
(a) Mean weight change, kg: +0.6b
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(b) Mean weight change, kg: +0.6 No significant difference between (a) and (b) |
Intervention components
Behaviour change
Physical activity
Study outcomes
Study limitations
Dietary interventions
Study / Location/ Type | Participants | Intervention | Follow up | Results |
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Antal 1988 [21] Hungary Institution Uncontrolled quasi-experimental study | Total n = 92 inpatients, recruited: 15 Weight status: All obese Gender: 10 females, 5 males Age (years)a: females: 38 (13), males: 44 (15) ID: mainly imbeciles and one Down syndromeAttrition/drop out: none |
Duration: 9 months Diet: 30 day rotating menu of 1000 to 1100 kcal energy content, containing 125 g carbohydrate. Quantity of food was measured once a week. Maintenance: none reported | 9 months |
Females: Mean weight change, kg (SD): -16 (2.7) bMean BMI change, Kg/m2: -12.2 Males: Mean weight change, kg (SD): -13 (4.5)Mean BMI change, Kg/m2: -6.7 |
Bertoli 2008 [22] Italy Community Uncontrolled quasi-experimental study | Total n = 37 Gender: 12 females, 25 males Age (years) a: 33.5 (9.2) Weight status: 6 obese/overweight ID: 13 with ID (9 Down syndrome, 4 cerebral palsy), the rest were only physically disabled Drop out: 65%, 24 participants (9 of which with ID) |
Duration: 12 months of individual nutritional counseling led by doctor and dietician (60 min per session). Phone call consultations (15 min) every 3 months.Diet: Personalised dietary protocols based on healthy low fat eating and on LARN recommendations. Parents/ legal tutors of ID participants were asked to support participants e.g. dietary changes and completion of food diaries.Maintenance: none reported | 12 months | For the 6 obese/ overweight participants at baseline: Mean weight change, kg (SD): -6.8 (4) (p = 0.01) bMean BMI change, kg/m2 (SD): -2.4 (1.4) (p = 0.008) Significant reduction in fat mass (p = 0.008) No clarification if the 6 participants had ID. |
Intervention components
Diet
Study outcomes
Study limitations
Physical activity interventions
Study/ Location/ Type | Participants | Intervention | Follow up | Results |
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Rimmer 2004 [23] USA Community Quasi-experimental study with a control group |
(a) Exercise group n = 30 Weight status: 13% normal, 23%overweight, 64% obese Gender: 53% females, 47% males Age (years)a: 38.6 (6.2) ID: all Down syndrome |
Duration: 12 weeks of 3 exercise group sessions per week (45 min each) led by physiologists and assistants. (a) Activity: 30 to 45 min of cardiovascular exercise and 15 to 20 min of muscular strength and endurance.Maintenance: none reported | 12 weeks |
(a) Mean weight change, kg: -1b
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(b) Control group n = 22 Weight status: 14% normal weight, 9% overweight, 77% obese Gender: 59% females, 41% malesAge (years)a: 40.6 (6.5) ID: all Down syndromeAttrition/drop out: none |
(b) Mean weight change, kg: + 1.7 Significant between group difference (p < 0.01) | |||
Moss 2009 [24] South Africa Community Uncontrolled quasi-experimental study | Total n = 100Weight status, BMIa: 29.3 (6.8) for females, 29 (8.5) for males Gender: 53 females, 47 males Age (years)a: 37.1 (10.1) for females, 39.2 (8.9) for males ID: Intellectually aged between 4-12 yr oldAttrition/drop out: none reported |
Duration: 12 weeks of 3 days per week exercise group sessions.Activity: 20 min walking the first 4 weeks and completing 30 min of walking the final 4 weeks.Maintenance: none reported | 3 months | Females: Mean BMI change, kg/m2: -2.74b Males: Mean BMI change, kg/m2: -3.1 |
Wu 2010 [25] Taiwan Institution Uncontrolled quasi-experimental study | Total n = 146 weight status: 31% obese, 16.9% overweight, 45.8% normal weight, 6.3% underweight Gender: Age (years): 19-67 ID: 3.4% mild, 30.8%, moderate, 33.6% severe, 32.2% profound Attrition/drop out: none |
Duration: 6 months of 4 times per week exercise group sessions (40 min each) led by institutional caregivers.Activity: Exercise sessions included sports acrobatics, jogging, dancing, and walking.Maintenance: none reported | 6 months | Mean weight change, kg: -1.86 (p < 0.001)b Mean BMI change, kg/m2: - 0.84 (p < 0.001) |
Mendonca 2011 [26] Portugal Community Quasi-experimental study with a comparison group |
(a) Down Syndrome n = 13 Weight status, BMIa: 29.3 (3.7)Gender: 3 females, 10 malesAge (years): 27-50 ID: Down syndrome, mild -moderate ID |
Duration: 12 weeks of 3 days per week exercise group sessions led by physiologist and assistants. Activity: 2 days combined training separated by one day of endurance training (30 min): treadmill walking or running, dynamic exercises: leg press, chest press, vertical traction, shoulder press, lower back, leg extension, biceps curl, and triceps pushdown, abdominal curls Maintenance: none reported | 12 weeks |
(a) Mean BMI change, kg/m2:-0.4b
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(b) No Down syndrome n = 12 Weight status, BMIa: 26.6 (4.5)Gender: 3 females, 9 malesAge (years): 27-50 ID: No IDAttrition/drop out: none |
(b) Mean BMI change, kg/m2: 0No significant difference between (a) and (b) |
Intervention components
Physical activity
Study outcomes
Study limitations
Dietary plus physical activity interventions
Study/ Location/ Type | Participants | Intervention | Follow up | Results |
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Marshall 2003 [27] UK Community Uncontrolled quasi-experimental study | Total n = 25 Weight status: 12% obese, 32% very obese, 36% overweight, 20% normal weight and underweight Gender: 68% males, 32% females Age (years): 30-39 (60%), 12% in their 40s, 12% in their 50s, 12% >60 ID: Down’s syndrome (32%)Attrition/drop out: one |
Duration: 6 weekly group sessions (2 hr each) led by nurses. Diet: healthy eating. Activity: advice to be active Maintenance: none reported | 6 weeks | (n = 20 Overweight and obese participants) Mean weight change, kg: -3.4 (p < 0.001) bMean BMI change, kg/m2:-1.6 |
Bradley 2005 [28]UKCommunityUncontrolled quasi-experimental study | Total n = 9 Weight status: 8 out of 9 obese Gender: all females Age (years): over 18 ID: not reported Attrition/drop out: none |
Duration: 12 months of 34 group sessions (90 min to 2 hr each) led by a dietitian. Diet: information on healthy balanced diet. Food preparation and supermarket visits included. Activity: insufficient information.Maintenance: none reported | 12 months | (n = 7) Mean weight change, kg: -6.2 (range: 2.2 to -15.5)Mean BMI change, kg/m2: -3 |
Gender: 43% women, 57% men(a) Intervention group:n = 38 Weight status: 97% obese and overweight|Age (years)a: 37.13 (8.75) ID: not reportedAttrition rate (1-6 years): 13% (b) No intervention group: n = 50 Weight status: 64% obese and overweight Age (years)a: 43.32 (10.97) Attrition rate (1-6 years): 13% for (a), 20% for (b). |
(a) Individual sessions led by physiotherapist. Diet: advice (no details reported). Activity: designed activity programme. Carers were involved in the improvement of lifestyle.Maintenance: none reported(b) No input | 6 months |
(a) Mean BMI change, kg/m2: -0.32b
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(b) Mean BMI change, kg/m2: +0.35, (p < 0.05) | ||||
12 months |
(a) Mean weight change, kg: -1.52b Mean BMI change, kg/m2: -0.61 (p < 0.05) 42% reached > 1.6 kg weight loss | |||
(b) Mean BMI change, kg/m2:+0.41 (p < 0.05) | ||||
6 years |
(a) (n = 40), Mean BMI change, kg/m2:-1.02, Mean weight change, kg: -2.42 (range: -28.13 to 14.49, SD 9.15). | |||
(b) (n = 33), Mean BMI change, kg/m2: +0.16Mean weight change, kg: +0.61 (range: -18.62 to 16.37, SD 8.81) |
Intervention components
Diet
Physical activity
Study outcomes
Study limitations
Multi-component interventions
Study/ Location/ Type | Participants | Intervention | Follow up | Results |
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Jackson 1982 [31] Australia Community Quasi-experimental study with a control group | Gender: all females (a)Treatment group n = 6 Weight status: 10% overweight Age (years), mean: 21.8ID, mean IQ: 38.17 (b) Control group n = 6 Age (years), mean: 23.5 ID, mean IQ :40.33 Attrition/drop out: none |
Duration: 14 weeks of every 2 weeks group sessions (60 min each) led by a teacher. (a) 7 sessions with the parents, 6 sessions with group members and the teacher. Diet: Advice on healthy eating diet, avoid fad diets. Activity: General advice on physical activity e.g. using stairs instead of elevator. Behaviour: self-monitoring, reward, punishment, change of rate of eating, reinforcement. Maintenance: none reported (b) No intervention | 17 weeks |
(a) Mean weight change, kg: -5.75b
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(b) Mean weight change, kg:-0.59 | ||||
3 month |
(a) Mean weight change, kg :-6.25 | |||
(b) Mean weight change, kg: -0.59 | ||||
6 month |
(a) Mean weight change, kg: -6.08 | |||
(b) Mean weight change, kg: +0.33 | ||||
12 month |
(a) Mean weight change, kg: -7.33 | |||
(b) Mean weight change, kg: 0.00 Significant weight reduction of (a) across all the follow up | ||||
Harris 1984 [32] USA Community Quasi-experimental study with a comparison group | Total n = 21 Weight status: not reported (a) Completers n = 10 Gender: 8 females, 2 males Age (years)a: 22.7 (6.37) ID, IQa: 52.5 (12.80) (b) Non completers: 11 Attrition/drop out: 11 |
Duration: 7 weekly group sessions and 1 hour booster session 26 weeks after the first session. (a) Diet: education on healthy balanced diet, distinguishing high and low calorie foods, diabetic exchange diet (ADA, 1977). Activity: 5-10 min aerobic exercise at the end of session. Behaviour: stimulus control, self monitoring, self-reinforcement, goal setting, self-contacting. Carers attended the sessions. Maintenance: none reported | 7 week |
(a) Mean weight change, kg: -3.0 (p < 0.05)b
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12 months |
(a) Mean weight change, kg: -0.76 | |||
(b) Mean weight change, kg: +2.39 (p < 0.05) (p < 0.05) | ||||
Ewing 2004 [33] USA Community Quasi-experimental study with a comparison group |
(a) participants with ID Total n = 154, final n = 92 Weight status, BMIa: 35.4 (7.0) Gender: 54.4% females Age (years)a: 39.7 (11.5) ID, IQa: 50.2 (14.3) Attrition/drop out: 18.8% (b) no ID Total n = 270, final n = 97 Weight status, BMIa: 38.4 (8.6) Gender: 84.5% females Age (years)a: 49.9 (11.48) Attrition/drop out: 30% |
Duration: 8 week intervention. The “HELP” intervention (Health Education Learning Program) led by health educators. 8 group sessions and 2 to 4 home visits. Diet: a home visit to develop dietary plan and do a grocery visit. Activity: a home visit to develop an exercise programme e.g. walking routes, optional brisk walk after the sessions. Behaviour: motivation to change, relapse prevention, avoidance of “automatic thinking”. Maintenance: none reported | 2 months |
(a) Mean BMI change, kg/m2: 0b
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(b) Mean BMI change, kg/m2: -0.89 No significant difference between (a) and (b) |