Student Well-Being

Disabilities Seen Complicating Anti-Obesity Efforts

By Christina A. Samuels — October 16, 2007 6 min read
Cindy Combs, named Adapted Physical Education Teacher of the Year by a group that promotes activity for people with disabilities, leads students in games using snowshoes at South Breeze Elementary School in Newton, Kan.
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A sedentary lifestyle and too much tasty but high-calorie food are fattening America’s children to an alarming degree, doctors and researchers agree. Now, some researchers are trying to determine how that trend affects children with disabilities.

More children than ever are overweight or obese, putting them at risk, as they reach adulthood, for such serious health problems as heart disease, bone and joint disorders, diabetes, and certain types of cancer.

Children with disabilities are just as tempted by food and the lure of television as those without such conditions. But unlike their typically developing peers, such children may face additional challenges, from a possible genetic propensity to be overweight, to a lack of outlets designed to help children with disabilities engage in physical activity.

In a 2007 commentary that has been accepted for publication in the Journal of Adolescent Health, researcher James H. Rimmer and his co-authors compiled some of the existing research on children with disabilities and obesity.

According to their report, children with spina bifida, cerebral palsy, Down syndrome, attention deficit hyperactivity disorder, learning disabilities, muscular dystrophy, brain injury, visual impairments, and autism-spectrum disorders have all been shown in studies to have a higher reported prevalence of being overweight than their peers without disabilities.

For children and adolescents, “overweight” is defined by the U.S. Centers for Disease Control and Prevention as a body-mass index that ranks above the 95th percentile for children of the same age.

“The substantial physical, social, and attitudinal barriers experienced by many youth with disabilities presents a challenge to health professionals and researchers to find innovative ways to reduce, or prevent, obesity in this underserved and marginalized population,” the commentary says.

Mr. Rimmer, a professor at the University of Illinois at Chicago and the director of the National Center on Physical Ability and Disability, based there, says school personnel need to look at a mosaic of issues when it comes to addressing obesity in this group.

Children with disabilities need to have the same opportunities for play and recreation as their typically developing peers, he says, and nutrition information needs to be taught in an accessible way for students who may have problems understanding standard texts. Even work-study opportunities should be examined, Mr. Rimmer believes; too often, he says, young people with mental retardation are given food-industry jobs where they’re working with fast food.

“We need to create strategies for learning that go beyond a school day,” Mr. Rimmer said.

Linda G. Bandini, a nutritionist and professor based at the University of Massachusetts Medical School in Boston, was the lead author of another 2005 report that examined the data contained in the National Health and Nutrition Examination Survey, one of the largest and longest-running national sources of health and nutrition data on American adults and children.

Her research found that children who were noted as having physical limitations were more likely to be overweight or at risk for being overweight. Being at risk is defined as having a body-mass index greater than the 85th percentile for children the same age.

Girls with learning disabilities seemed to have a higher prevalence of obesity compared with girls without such a disability.

Research Base Limited

The researchers offer one caution, however: More investigation of weight problems in children with disabilities is needed.

“The limited research that does exist suggests that it is a problem, but we know very little about who is at risk, and why,” Eric Emerson, a professor of disability and health research at Lancaster University in the United Kingdom, said in an e-mail message.

Ken Pitetti, a researcher and professor in the department of physical therapy at Wichita State University in Kansas who has focused on the health of adults and children with developmental disabilities, says that children with disabilities have just as much of a risk of being overweight as their peers without disabilities—and that’s bad enough.

“The issue of obesity in our society goes through all levels of culture, class, religion, [and] socioeconomic strata,” he said. “This access to cheap, high-calorie food is something that has never occurred before in the history of man.”

And in some cases, the resulting health problems are more likely to be severe for people with disabilities.

The stark findings of a 2002 report by the U.S. surgeon general on health disparities and mental retardation found that people with retardation were likely to receive fewer health examinations, fewer immunizations, less mental health care, and fewer opportunities for physical exercise than people without retardation. People with mental retardation and communication disorders had an even greater likelihood for poor nutrition, overmedication, injury and abuse, the report said.

Such people “deserve our full attention and support in their efforts to get the health care they need,” the report said.

Joan Guthrie Medlen, the mother of a child with Down syndrome and autism and the author of the Down Syndrome Nutrition Handbook, says she has treated some children whose parents say their youngsters won’t eat anything but soft, easy-to-chew, and high-calorie foods. In some cases, she hypothesizes, the low muscle tone that is a feature of Down syndrome may make it easier for children to chew soft food, so that’s what they learn to prefer.

Sometimes children with disabilities dislike certain sensory inputs, and that’s why they may avoid crunchy fruits and vegetables, suggests Ms. Medlen, who is a registered nurse and a licensed dietitian.

Children with disabilities may also be less likely to get the physical exercise that their typically developing peers do.

Adapted Activities

But skilled teachers can effectively meet the physical fitness needs of children with disabilities, practitioners say.

Cindy Combs, an adapted-physical-education teacher in Newton, Kan., for the past 25 years, has her students use snowshoes on grass as a way to move and increase their heart rates. A new experiment has her students with balance problems start out rollerblading in the swimming pool. The water helps stabilize and balance children who have motor difficulties, she says.

“You have to be a little creative, and have the desire to do it,” said Ms. Combs, the 2006 Adapted Physical Education Teacher of the Year, an honor given by the Adapted Physical Activity Council, a subgroup of the American Association for Physical Activity and Recreation, based in Reston, Va.

Heidi Stanish, an assistant professor of exercise and health sciences the University of Massachusetts in Boston and a specialist in adapted physical activity, said parents are often concerned about the safety of their children with disabilities, as are teachers who may have limited experience and training.

“And a lot of children with disabilities have negative experiences with [physical education]. They become their own worst enemy. They don’t want to do it,” Ms. Stanish said.

One approach is to promote activities that don’t require a lot of physical skill, she says. Children and adults can get a good workout just by walking or riding a bicycle. Students also can offer good suggestions for how to adapt games so that all the children in a classroom can participate.

“I tell people, don’t be afraid. Be open to this as a challenge, as opposed to an impossibility,” Ms. Stanish said.

Research librarian Rachael Holovach contributed to this story.

Coverage of education research is supported in part by a grant from the Spencer Foundation.
A version of this article appeared in the October 17, 2007 edition of Education Week as Disabilities Seen Complicating Anti-Obesity Efforts

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