Effective weight management programmes for adults with learning disabilities Dr Craig Melville Senior Lecturer in Learning Disabilities Psychiatry

Dr Catherine Hankey Professor Nanette Mutrie Professor Kirsten Stalker Ms Nicola Robinson Dr Dimitrios Spanos Ms Leanne Harris Dr Lynsay Matthews Dr Alex McConnachie Dr Andrew Walker Mrs Chris Melling Dr Fiona Mitchell Mrs Victoria Penpraze Mrs Heather Murray

Five evidence-based principles: 1. Interventions based on social model of disability 2. Aim for clinically significant weight loss of at least 5% 3. Physical activity programmes are not associated with clinically significant weight loss 4. Health education programmes are not associated with clinically significant weight loss 5. The key aim is weight loss maintenance

Obesity in adults with learning disabilities Odds Ratio Melville, 2008

The prevalence of obesity against age for women with intellectual disabilities, and female participants in the Scottish Health Survey 2003

The prevalence of obesity against age for men with intellectual disabilities, and male participants in the Scottish Health Survey 2003

A weight management programme for adults with intellectual disabilities and obesity.

Health education programmes are not effective for weight loss

Best-practice evidence Health benefits of 5-10% weight loss Multicomponent interventions comprise: –Energy deficit of 600kcal (2512kJ) per day –Increase physical activity (45-60min, 5 days/ week) –Behavioural methods to encourage change

In a multicomponent weight loss intervention, do participants achieve clinically important: »Change in body weight »Increase in levels of physical activity »Reduction in time spent in sedentary behaviour.

Dietary change- personalised dietary prescription based on a daily caloric deficit of 600 kcal Increased physical activity- walking based Behavioural methods- self- monitoring, goal setting, problem solving, making healthy choices

Energy deficit diet- personalised prescription

Anthropometric outcome measures at 24 weeks from baseline *p < 0.001

Sedentary behaviour 24 weeks from baseline *p< 0.05

Comparison with GCWMS (parent service)

12 month weight maintenance phase (n=28)

Quantitative Dietary Advice Physical activity Behaviour change techniques Non- quantitative Dietary Advice Physical activity Behaviour change techniques WWToo Pilot RCT: WELLDO

Priorities for the future: 1.Funding for first ever trial of energy deficit diet, multi- component intervention 2.Prevention studies- Moving on, feeling good 3.Accessible, effective weight management programmes for adults with learning disabilities

Key references Melville, C.A., Boyle, S., Miller, S., Macmillan, S., Penpraze, V., Pert, C., Spanos, D., Matthews, L., Robinson, N., Murray, H. and Hankey, C.R An open study of the effectiveness of a multi- component weight loss intervention for adults with intellectual disabilities and obesity. (2011) British Journal of Nutrition 105, Spanos, D., Hankey, Boyle, S. & Melville, C.A. (2014) Comparing the effectiveness of a multi- component weight loss intervention in adults with and without intellectual disabilities Journal of Human Nutrition and Dietetics 27, Spanos, D., Melville, C.A., and Hankey, C. (2013) Weight management interventions in adults with intellectual disabilities and obesity: a systematic review of the evidence. Nutrition Journal 12, 132 Spanos, D., Hankey, C. and Melville, C.A. (online early 1/04/2015) The effectiveness of a weight maintenance intervention for adults with intellectual disabilities and obesity: a single stranded study Journal of Applied Research in Intellectual Disabilities Harris, L., Melville, C.A., Jones, N., Pert, C., Boyle, S., Murray, H., Tobin, J., Gray, F. and Hankey, C.R. (2015) A single-blind, pilot randomised trial of a weight management intervention for adults with intellectual disabilities and obesity: study protocol. Pilot and Feasibility Studies 1, 5 Jones, N., Melville, C.A., Tobin, J. and Gray F. (2015) A retrospective evaluation of an adapted group weight management intervention for adults with intellectual disabilities: Waist Winners Too. British Journal of Obesity 1, 132– 40 Jones N., Melville C.A., Harris L., Bleazard L. and Hankey C. (2015) A qualitative study exploring why adults with intellectual disabilities and obesity want to lose weight and views of their carers BMC Obesity 2, 49.