1. Daniel Marsden - Community Learning Disability Nurse Fat Chance? Opportunities to change for people with learning disabilities. Daniel Marsden – Community Learning Disability Nurse

2. Daniel Marsden - Community Learning Disability Nurse Evidence Base Gaps in the evidence / research Not a homogeneous group Obesity  Medway - 36% BMI 25> (Young, 1996)  64% adults and 26% 10-19year olds (Marshall et al, 2003)  26% Overweight 35% BMI 30> (Martin, 2005) Hypertension  32% of those aged 40-49 years old (Marshall et al, 2003) Coronary Heart Disease  Second most common cause of death (14-20%, Hollins et al, 1998)

3. Daniel Marsden - Community Learning Disability Nurse Possible Causes Non- specific Syndrome specific Predisposing factors Likely to Interact

4. Daniel Marsden - Community Learning Disability Nurse Suggested Causes Non-specific Many non- specific to people with learning disabilities The impact of these may be greater if dependent on others Syndromes Prader Willi Down’s Bardet Bidel Carpenter Cohen Borjeson Forssman Lehmann (Jeffreys, 2000)

5. Daniel Marsden - Community Learning Disability Nurse Predisposing Factors (Jeffreys, 2000, p.32) Medication mental health problems limited access to exercise lack of knowledge boredom communication difficulties provision of poor diet by services low self-esteem Hypothyroidism sedentary lifestyle inappropriate use of food as reward lack of literacy skills lack of power and control over life low income attitudes of carers/ staff

6. Daniel Marsden - Community Learning Disability Nurse Personal View Low exposure to health promotion messages Motivation Support available Place of residence  Prasher & Roy (2000) found weight higher in people living family homes and lowest in those living in institutions. Unclear policy guidance and service priorities  social care settings may not view health improvement as their business.

7. Daniel Marsden - Community Learning Disability Nurse Activity Levels Messent et al (1998) compared fitness levels with general population: The men were 24-28% less active The women were 42% less active 93% did <1hour moderate exercise/ week

8. Daniel Marsden - Community Learning Disability Nurse New Opportunities Valuing People (dh 2001) Health Facilitators  Strategically developing links between LD and other health services Annual health checks  Platform for health promotion advice

9. Daniel Marsden - Community Learning Disability Nurse Bridging Role LD social care issues  Access  Staffing/support  Transport  Individual problems Public Health Agenda  Partnerships statutory and private industry  Leadership within statutory services  Partnership between health social care and industry

10. Daniel Marsden - Community Learning Disability Nurse Interventions Health education  1-1 work – weight management  Organised groups, peer education, videos, games. Skills teaching  meal planning Include and engage  Professionals  Peers  Private industry

11. Daniel Marsden - Community Learning Disability Nurse Strategic Opportunities Social Care Staff = Public Health Staff. Evaluation and sharing results/ resources. Creating leadership

12. Daniel Marsden - Community Learning Disability Nurse Questions How can public health professionals engage individuals in healthy lifestyles? How do public health professionals support services to provide healthy options? Should health services provide more support to people with learning disabilities?

13. Daniel Marsden - Community Learning Disability Nurse References and thanks Thanks to Greatfield Lodge Staff and Users, Alison Williamson – Teeside University and all at Janet Cobb’s Primary Care Network Hollins, S., Attard, M.T., von Fraunhofer, N. and Sedgwick, P. (1998) Mortality in people with learning disabilities: risks, causes and death certification findings in London. Developmental Medicine & Child Nuerology, 40, 50-56. Illingworth, K., Moore, K.A. and McGillivray, J. (2003) The development of athe nutrition and activity knowledge scale for use with people with an intellectual disability. Journal of Applied Research in Intellectual Disabilities, 16, 159-166. Jeffereys, K. (2000) Managing and treating obesity in people with learning disabilities. Learning Disability Practice, 2, 4, 30-34. MarshallD., McConkey, R. and Moore, G. (2003) Obesity in people with intellectual disabilities: the impact of nurse-led health screenings and health promotion activities. Journal of Advanced Nursing, 41, 2, 147-153. Messent, P. et al (1998) Physical activity, exercise and health of adults with mild and moderate learning disability. British Journal of Learning Disabilities, 26, 1, 17-22. Prasher, V. and Roy, A. (2000) Physical Health in The L.D. Book on www.ldbook.co.uk www.ldbook.co.uk