Obesity in People with Learning and Intellectual Disabilities

Obesity becomes a major health concern in recent years with its increasing prevalence in people with learning and intellectual disability. According to PHE (2019), obesity is the clinical condition in which a high amount of body fat is stored into body cells thereby increasing the overall BMI of the person from the normal range. Generally, a person is called obese if his or her BMI is more than 30 kg/m. Evidence suggests that people with learning and intellectual disability are more vulnerable to obesity as compared to their normal peers. A report from Sainsbury’s Centre for Mental Health (2006) has shown that 28% of intellectually disabled people suffer from obesity as compared to 20% of people without any disability. Different factors act as the facilitators for enhancing the risk of obesity and mortality in intellectually disabled people such as high caloric food intake, use of anti-depressant and psychotropic medicines, lack of exercise, unhealthy mental and physical condition and irregular lifestyles. In case of intellectually disabled people, the risk the obesity is higher than the normal people because of their inability to express and communicate their basic needs and lack of support from family as well as from the society that poses adverse impact on their lifestyle, mentality and physical health (De Lorenzo et al. 2020.). In this context, the selection of this topic is highly relevant which will provide new insight into the importance of taking effective approaches to reduce preventable deaths in intellectually disabled people due to obesity. The topic is highly appropriate that will highlight the important obesity-prevention initiatives such as balanced diet, healthy food intake, regular and systematic lifestyle, energy enhancement through exercise, provide strong mental and emotional support, deliver holistic care, conduct health promotion and provide health education to disabled people. This essay will encounter the social, political, legal and economic factors that are associated with increased vulnerability of disabled people to preventable health due to obesity. The topic will demonstrate the roles and responsibilities of social workers and nurses in terms of developing healthy habits in intellectually disabled people to reduce their prevalence of the chronic disease. The topic will also discuss how health and social care professionals will work under principles of Mental Capacity Act, 2005 to assure that disabled people who are highly vulnerable to obesity will be provided with safe and positive care framework that will not only improve their health and wellbeing but also protect them from abuse and harm.

People suffering from learning and intellectual disability are more likely to be affected by obesity than normal people. As mentioned by Patel et al. (2016), obesity in intellectually disabled people poses adverse impact not only on their physical health but also on their emotional, spiritual and psychological wellbeing. The evidence-based report has shown that rate of obese people who are intellectually disabled increase at a faster rate in the UK from 13% during 1993 to 26% during 2013 in men and from 16.4% to 24% in women. The increasing prevalence of obesity among intellectually disabled people enhances their risk for different chronic diseases such as cancer, cardiovascular disease, pulmonary disease, respiratory issues and health attack. Nice guidance (2014) has recommended providing proper health educational and clinical guidance to the people with special communication in order to improve their food habits, lifestyle, living standard and physical mental and emotional wellbeing. As mentioned by Pieńkowska et al. (2019) obesity is associated with developing risk of type 2 diabetes in young adults and children with learning and intellectual disability in the UK. Recent clinical research has shown that the accumulation of excessive fats into the wall of vein and arteries block the flow of normal blood supply that enhances the risk of cardiac arrest and coronary arterial disease. PHE (2019) report has mentioned intellectually disabled people suffering from obesity have a higher risk of diabetes as the additional fat accumulation in the body interferes with the normal functions of hormones and enzymes which regulate the level of carbohydrates into the body (insulin and glucagon). As mentioned by Benalcazar and Cascella (2020), obesity in the group of intellectually disabled people causes manifold chronic diseases such as high blood pressure, gall bladders and liver disease, osteoarthritis, gynaecological problems and lipid disorders. The evidence-based report has suggested that many factors make the intellectually disabled people more vulnerable to obesity such as lack of healthy eating, lack of guidelines regarding choosing foods and living a regular life, poor ability to communicate the needs, lack of energy, poor thinking and reasoning ability and lack of resources. In this context (0mmentioned that, intellectually disabled people are generally devoid of support and guidance that they need to take the right decision reading food selection, healthy practices development and have a systematic lifestyle. In the UK, majority the obese people which are intellectually disabled suffers from chronic diseases such as cardiovascular disease and coronary arterial disease that which are considered as the result of their late eating, skipping of meals, improper diet, a heavy dose of psychotropic medicines and lack of health literacy (Tartof et al. 2020). A cross-sectional study has shown that while comparing vulnerability of intellectually disabled people to obesity with their normal peers, it is seen that 39% women and 27% men are obese in the disabled group as compared to only 25% women and 22% men in normal people globally. PHE (2019) has mentioned in a report that, intellectually disabled people suffering from obesity are highly vulnerable to morbidity and mortality due to the act that, both clinical prevention and management of obesity in intellectually disabled people is a matter of challenge. The reason behind this is that people with learning and intellectual disability face severe health and social inequality, abuse, unsupportiveness, bias and discrimination that pose potential barriers on getting fair and highly effective primary care setting that is important for reducing the risk of morbidity and mortality in these disabled people due to obesity (Czernichow et al. 2020). Evidence suggests that people with intellectual duality in the UK accounts for only 2.5% of the entire UK population. Therefore, disabled people belong t a minority community in the UK which makes them devoid of proper health and social care facilities that are important for minimising their prevalence to chronic diseases. The aetiological study has suggested that the are some important factors as well as causes that are associated with increasing the risk of obesity and morbidity in the disabled group of people. These factors are mix behaviour of proper of learning and intellectual disability, lack of supervision to these disabled people, poor ability of disabled people to express their health condition and needs and negligence, abuse and negative environment supporting these disabled people. As argued by Gao et al. (2018), although there are many socio-cultural factors are associated with a high risk of obesity and mortality in disabled people as compared to their normal peers, there are also biological and genetical factors that can act as a facilitator to carry the symptoms of obesity from one generation to the next generation. On supporting this statement many medical researchers have mentioned that there is a strong connection between genetics and obesity in which of ancestors intellectually disabled people had obesity than it is possible that the next generation can carry this health issues.

as mentioned by Tartof et al. (2020), people with intellectual and learning disabilities generally devoid of proper guidance ad support about what foods needed to be selected for good health or what would be good as well as systematic lifestyle. NICE guidelines (2014) have emphasized on improving health literacy in intellectually disabled people by providing them proper guidance and advice about the diet, food selection, regularity in lifestyle, developing right sleeping pattern and development of healthy habits [NICE, 2014]. A report from the World Health Organisation [WHO] has shown that more than 24-48% of down syndrome people are obese and have a high risk of developing cardiovascular disease and coronary arterial disease [WHO, 2019]. Nurses and social care staff face great changes while providing primary care to intellectually disabled people who suffer from obesity due to many reasons such as poor communication, lack of social ad family support and poor cooperation from the dibbled patients due to poor mental and physical health. On the contrary Hussain et al. (2020) argued that other factors pose potential barriers in providing primary care to intellectual dibbles people in terms of managing and preventing obesity, the factors are limitation of health and social care staffs, lack of good care delivery infrastructure, poor be the accessibility of health and social care by disabled people and poor transportation facility. Due to these factors, in many rural and suburban areas, intellectually disabled people suffering from obesity are unable to access proper primary care that they need to have to combat the adverse impact on obesity of the mental and physical health.

Health and social care practitioners need to develop an effective primary care setting that will assist intellectually disabled people to reduce their fat accumulation in the body and develop healthy habits (Wang et al. 2020). PHE (2019) mentioned in its report that while working individually with patients with intellectual disabilities, practitioners are recommended to conduct the weight management program and health education. NICE guidelines (2014) also recommended that health and special care practitioners need to develop highly effective patients-management in which people with intellectual disability will be advised and trained about how to live a healthy and well-organised lifestyle that can reduce the vulnerability to obesity and associated chronic disease [NICE, 2014]. Through conducting a useful weight management program, health and social care practitioners can determine the individual weight, physical problems and current health status of intellectually disabled people at the individual level. As mentioned by Gameiro et al. (2018), weight management is widely used process by practitioners to reduce the risk of preventable deaths due to obesity in people with learning and intellectual disability, PHE(2019) mentioned that weight management program will benefit intellectually disabled people who suffer from obesity in manifold ways such as they would get advice on food selection, proper diet, essential nutrients, sleeping pattern and the right quantity of meals. On the other hand, a weight management program would assist social and healthcare practitioners to guide intellectually disabled people about how to work out, time to rake any meal and proper medication management. On the other hand, health education and health literacy program are the important initiatives used by the health and social care practitioners to minimising the risk of morbidity and mortality in obese people with learning and intellectual disability (Siegel et al. 2020). Through conducting a health literacy program, nurses and social care staffs can enhance the knowledge of intellectually disabled people about how to manage their health and wellbeing independently. Through providing proper health education and weight management training to intellectually disabled people, practitioners can develop positive behaviour, thoughts and knowledge in them which assist them to have a strong as well as a healthy mindset. PHE (2019) mentioned that obesity is strongly associated with increased risk of deadly health issues such as cancer, cardiovascular disease and pulmonary disease. Evidence suggests that through effective weight management and follow a healthy diet, it is possible to reduce more than 70000 premature death across the UK due to obesity in the disabled community (Gazzaruso et al. 2020). The British Dietetic Association (BDA) has recommended that nutritional guidelines vary from one individual to the other based on their BMI and nutritional need of the body. Therefore, practitioners while dealing with intellectual and learning disabled people will determine the current BMI of the person and then recommend such diet that will relevant to the nutritional needs of that person (Kwon et al. 2017). BDA recommends that effective weight management through healthy eating, regular exercise and systematic lifestyle would assist people with learning and intellectual disability to reduce not only their risk of obesity but also reduce their risk to chronic diseases such as CVD and cancer.

While it comes to minimise the risk of preventable death due to obesity in intellectually disabled people, general practitioners (GP) in the UK also consider other factors that enhance the risk of preventable deaths due to non-communicable diseases that result from obesity (Whelton et al. 2020). The factors are social, legal, economic and healthcare aspects that impact on how effectively GPs can provide primary care to people with intellectual diabesity to reduce their risk to premature death due to obesity. General practitioners need to ensure that evidence-based care is provided to disabled people who suffer from obesity to develop their positive health and wellbeing. Additionally, general practitioners ensure that hospital and communicate care services are properly articulated in relation to the current health needs of disabled people suffering from obesity (Montano‐Loza et al. 2016). The world health organisation has reported that obesity prevention intervention is associated with determining the current socio-economic condition, current health status, preference and health behaviour of intellectually disabled people suffering from obesity. PHE (2019) recommend that an effective obesity prevention program is not only associated with providing effective hospital and community care to people with learning and intellectual disability but also elevating their social, economic, cultural and behavioural status. Social care practitioners can develop positive cognitive skill and good decision making in intellectually disabled people by involving them in intellectual works that will assist them to manage their weight through the workout and improve their thinking and reasoning ability. As mentioned by Tartof et al. (2020), skill development and employment to disabled people who suffer from obesity are the highly effective process to improve the mental, physical and emotional wellbeing of these people that can reduce their vulnerability to non-communicable disease. General practitioners need to work under the guidelines of mental capacity act 2005 in terms of assuring that equal and baseless care facilities would be provided to intellectually dibbles people who suffer from obesity. Under this act nurses and social care, practitioners ensure that additional protection and safety will be provided to these dabbled people while minimising the risk to premature death due to obesity thereby providing them such an environment in which they are free from any of harm, abuse and discrimination. While working on individual health needs of disabled people GPs always follow the professional codes of conducts in order to provide safe and quality care to people with obesity. As mentioned by Czernichow et al. (2020), in case of management and prevention of obesity in intellectually disabled people, practitioners need to ensure that they have determines all the risk factors that enhance the risk of premature death in disabled people. General practitioners in the UK also conduct psychotherapies that assist people with learning and intellectual disability to improve their cognitive skill that is important for them to take the right decision for their health and wellbeing. The evidence-based report also suggests that cognitive behavioural therapy (CBT) is also an effective process of improving the thinking and reasoning skill in intellectually disabled people that assist them to understand and follow the instruction of GPs regarding the weight management food intake, food selection and nutrients consumption.

While it comes to be involved in partnership working in terms of reducing the risk of premature deaths in intellectually disabled people due to obesity, general practitioners work in a multidisciplinary team (MDT). Working in MDT assist GPs to address the social health and communication needs of people with learning and intellectual disability (Gao et al. 2018). In partnership working, practitioners work in partnership with patient’s family members, neighbours and relatives to have effective communication with them to determine the preference, behaviour, pre-medical history, past experiences, regular habits and socio-economic condition of patients (Hussain et al. 2020). Working in partnership with the nurse and social care staffs in an MDT assist general practitioners to get a regular update on eight management, dietary intake, current mental and physical health condition, health behaviour and preference of disabled people. Partnership working assist practitioners to involve the disabled patients in the care process, in which GPs interact with the patients with help of psychiatrist and psychotherapist, which assist the practitioners to address the mental, emotional and spiritual distress through which the disabled patients is going (Wang et al. 2020). On the other hand, partnership working with nurse, social care staffs and psychotherapist assist general practitioners to identify the risk factors that are associated with enhancing the vulnerability of these disabled people towards obesity and non-communicable disease.

While implementing social and health care intervention, practitioners can face several ethical issues. One of the common ethical issues face is the lack of consent from the family members ad guardian of the intellectually disabled individual suffering from obesity (Siegel et al. 2020). Evidence suggests that in most of the cases family members of disabled patients do not provide their consent to the practitioners in terms of implementing innovative and effective care process. Another ethical issue arises when the professional integrity of practitioner interferes with patients’ autonomy. Although health and social practitioners need to respect patients’ autonomy, in case of people with learning and intellectual disability practitioners cannot go with patient's preference and decision as it enhances the health risk to them (Gazzaruso et al. 2020). Practitioners also face ethical issues that are created due to their professional obligations and boundary, which resist them to work beyond their professional power and confinements. In many cases, practitioners can understand that the ongoing eight management process and dietary guidelines are not relevant to the current health condition of intellectually disabled people they cannot decide on changes the treatment process instantly, rather they need to inform the entire health care authority about the changes in the treatment process which can make delay to the treatment (Kwon et al. 2017). Lack of skills and knowledge of members of MDT can create ethical issues for practitioners that not only interfere with the success and usefulness in treatment process but also raise the question on the professional integrity and accountability of practitioners toward the responsibility.

In terms of dealing with ethical issues, practitioners can take several initiatives such as developing transparent information delivery system in healthcare, conduct effective training and skill development program for nurses and social care staffs, improve the level of communication with the guardian of disabled people and adhere to health and social care policies to ensure effective care setting to each obese people who suffer from learning disability (Whelton et al. 2020). In addition to this, national and local mental heat care authority need to work synergistically to conduct health awareness program against obesity and health literacy program that will assist raise public concern over the harmful impact of obesity on people with learning and intellectual distality. Implementation an articulation mental health act (Mental Capacity Act 2005) and disability discrimination regulation in society will also assist practitioners to provide a healthy and positive environment to people with intellectual disability that will be helpful to develop healthy eating habits, systematic lifestyle and healthy living standard.

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