Caroline Helwick

November 20, 2014

NEW ORLEANS — Teenagers with physical or mental disabilities, including learning disabilities, are more likely to be obese than their typically developing peers, and they are more likely to partake in unhealthy weight-loss behavior, new research shows.

"Adolescents with disabilities were more likely to be obese, more likely to recognize it, and more likely to be trying to do something to lose weight," said Mia Papas, PhD, from the University of Delaware College of Health Sciences in Newark.

Her team conducted one of the largest studies, presented here at the American Public Health Association (APHA) 142nd Annual Meeting, to examine weight, physical activity, and weight-loss behavior in an adolescent population.

The researchers used results from the 2011 Youth Risk Behavior Survey, which provided data on 9775 adolescents in grades 9 to 12 in four states: Delaware, North Carolina, North Dakota and Rhode Island.

The survey asked whether the teens had any physical disabilities, emotional problems, or learning disabilities that persisted for 6 months or longer.

It also asked teenagers to report their weight and height. They estimated sex- and age-specific body mass index (BMI) percentiles using reference data from published growth tables; they defined obesity as a BMI in the 95% percentile and above.

With this information, the researchers assessed the effects of dietary habits and physical activity on obesity, modified by disability status.

Of the 22% of respondents who reported having a disability, 51% were female, 55% were in grades 9 or 10, 75% were 15 to 17 years of age, and 63% were white.

A 70% Increase in Obesity

Adolescents with disabilities were 70% more likely to be obese than their peers without disabilities, and 40% more likely to be trying to lose weight, Dr. Papas reported.

Obesity was more common in adolescents with disabilities than in those without (16% vs 10%). Almost half of all respondents stated that they were actively trying to lose weight, but adolescents with disabilities were 40% more likely to be doing so than those without disabilities.

Although adolescents with disabilities reported being less physically active, unhealthy weight-loss behaviors were far more common in this group.

Reports of physical activity for at least 60 minutes for at least 5 days a week were less common in teenagers with disabilities than without (38% vs 52%), whereas reports of absolutely no sustained physical activity were more common in adolescents with disabilities (20% vs 13%).

They found a striking difference in unhealthy weight-loss behavior. "This was surprising," Dr. Papas said. "We didn't think we would see a difference this large."

Table. Unhealthy Weight-Loss Behavior

Behavior Disability, % No Disability, %
Vomiting or laxative use 12 3
Use of diet pills, powders, or liquids 11 4
Fasting in the previous 24 hours 20 9


"One possibility is that these children have less access to physical activity opportunities or healthy dietary choices, and are left with extreme measures for losing weight," she said. "We need to understand their motivations. Are other avenues of weight loss not open to them?"

Differences in the weekly dietary intake of fruits, vegetables, and green salads were numerically small but statistically significant, she added.

The groups shared the common risk factors for obesity, such as watching 2 or more hours of television per day or playing 2 or more hours of video games. The strength of these associations was similar between the two groups.

"There are a number of changes that occur in the transition from childhood to adulthood that may place transition-age youth at particular risk for obesity," said Nancy Miller, from the University of Maryland in Baltimore, who has conducted research on the topic of obesity and disability.

Social roles change in adolescents because of their greater expectations for autonomy, and transition-age youth enter situations where they have more control over what they eat and how they spend their money, she explained.

"The role that schools and the home play in shaping nutritional and physical activity may lessen during this time, and while these factors are experienced by adolescents with disabilities and those without, they may disparately place youth with disabilities at greater risk for obesity," she told Medscape Medical News. "For example, higher rates of poverty among youth with disabilities may limit their food choices and access to healthy food at the same time they gain more autonomy with regard to food choices."

"This study highlights a major gap in our attempts to identify and intervene with children and adolescents at high risk of obesity," Shiriki Kumanyika, PhD, from the University of Pennsylvania Perelman School of Medicine in Philadelphia, who is president of the APHA, told Medscape Medical News.

According to Dr. Papas, such interventions could include targeting dietary choices, physical activity, and weight-control strategies in adolescents with disabilities. "We need to increase the participation of children with disabilities in health promotion programs," she said.

Dr. Papas and Dr. Kumanyika have disclosed no relevant financial relationships.

American Public Health Association (APHA) 142nd Annual Meeting: Abstract 11456. Presented November 17, 2014.


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