Background to the Research

• Obesity is increasing at an alarming rate throughout the world with the World Health Organisation referring to it as a global epidemic. Predictions are that overweight/obesity shall increase dramatically in adults and children, with over half the population in many developed countries being obese by the year 2050.
• Obesity is not only an issue for adults as, increasingly, children are also becoming more overweight. This creates potential future health problems that include heart disease, diabetes, respiratory problems and a number of cancers. Problems are not restricted to physical illness with reports highlighting how obese children can face emotional issues such as low self esteem and feelings of isolation because they are marginalised and stigmatised.
• Adults with a learning disability have been found to be more susceptible to overweight/obesity, but no research to date has identified if children with a learning disability (LD) are more overweight/obese than non-learning disabled (NLD) children.
• To address this knowledge deficit the study reported here investigated the following research questions:
  • What is the prevalence of overweight and obesity in representative samples of LD and NLD school pupils?
  • Are there significant differences in overweight and obesity between the LD and NLD pupils?
  • What are the main determinants of overweight and obesity with a specific focus on the LD children?
    

Research Approach

• 460 pupils who attended schools in the SELB/SHSSB areas participated in the study. Of these 108 (24%) pupils were from the special schools and 351 (76%) were from mainstream schools. Among the 351 pupils in the mainstream schools 120 (34%) attended learning support units and had a moderate LD. All those who attended the special schools (n=109) had a severe LD. Therefore, in this total sample of children 232 (50%) pupils were NLD and 228 (50%) had a LD.
• Sample selection involved all pupils attending five special schools in the area and the mainstream pupils were a representative sample selected by random means from the mainstream schools.
• A survey of the school pupils with and without a LD was undertaken. This involved administration of a 'Food intake and physical activity questionnaire' to pupils in schools. The questionnaire was self-report and included three main sections: (i) food intake (ii) eating patterns and (iii) physical activity. It was specifically designed to ascertain the number of times specific foods are consumed by school children, their eating patterns and the length of time that is spent on various activities over a one week period.
• The questionnaire was user friendly to facilitate understanding by LD children and younger children. Pictures were included to aid understanding. For the most severe LD or very young pupils, assistance from parents or staff to complete the questionnaire was permitted. Various anthropometry measurements of each pupil were undertaken i.e. weight, height, waist circumference, body fat and calculating their BMI. After the pupils had completed the questionnaire, two members of the research team went to their school and undertook the anthropometry measurements.
• Ethical approval was obtained and the study was guided by the research principles beneficence, non-malificence, informed consent and parental agreement.
  

Main Findings

• The body measurements undertaken with the pupils found:
  • In accordance with BMI 28% of the pupils overall are overweight or obese.
  • LD children were significantly more likely to be overweight/obese than NLD children, with 33% of them being in the overweight/obese category compared to 24% of the other pupils.
  • LD children had significantly higher waist circumferences.
  • Significantly more of the pupils had higher body fat percentages than expected for age.
• With respect to the reported lifestyles of the pupils it was found that:
  • In accordance with BMI 28% of the pupils overall are overweight or obese.
  • LD children were significantly more likely to be overweight/obese than NLD children, with 33% of them being in the overweight/obese category compared to 24% of the other pupils.
  • LD children had significantly higher waist circumferences.
  • Significantly more of the pupils had higher body fat percentages than expected for age.
• With respect to the reported lifestyles of the pupils it was found that:
  • Over a quarter of all foods eaten by the pupils during a one week period are fatty and sugary foods and for LD children close to 30%, or moving towards one third of the foods eaten are fatty and sugary foods.
  • The majority of the pupils spend most of their time on low level physical activities.
  • LD pupils spend fewer hours on moderate level activities and significantly less time on high level activities.
    

Conclusions/Recommendations

• There are higher levels of overweight and obesity in this sample than in comparable national and international published findings. It seems reasonable to assert that the unhealthy eating habits and low levels of activities found in the pupils are determinants of the high levels of overweight and obesity found.
• The LD pupils spend fewer hours on moderate level activities and significantly less time on high level activities. All children had a high consumption of fatty and sugary food and there was a pattern of 'snack eating' by the pupils every day and throughout the day. There needs to be a concerted effort by the school and family to promote more healthy behaviours in children. However, schools and families need support if they are to be successful in preventing the increasing epidemic of obesity that is predicted.
• All recommendations apply equally to learning disabled children but it is suggested that this group require special considerations.
• Some LD children have different eating patterns that may be difficult to alter.
• There is a need to understand the personal choices of these children, their special needs and social influences to achieve long-term success in the prevention of overweight and obesity.
• The best strategies for health promotion programmes with children who have a learning disability are: behavioural interventions; education and training of caregivers in behaviour programmes; promoting a positive environment; individual tailored programmes specific to the current lifestyle of an individual.
• Finally, a moral stance must be maintained with overweight children. Children should have their body image affirmed and be educated on the fact that no matter what their shape, size or body features, all human beings differ and should be respected for their 'person-hood'.