Profiles: Obesity Profiles For Particular Special Needs Groups

An examination of how obesity factors into particular disabilities

“We find that many of the children who are overweight are still malnourished. They have sufficient caloric intake but not sufficient nutrients.”

Verna M. Baker, M.S., R.D., L.D.
Clinical Services Director of Nutrition,
KIDS FIRST/UAMS Department of Pediatrics

DOWN SYNDROME
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Children with Down syndrome tend to be shorter than other children, and studies indicate that their basal metabolic rate – the amount of calories the body burns at rest – is lower. At the same time, several aspects of the condition contribute to obesity:

  • Hypothyroidism, which affects 30-50% of children with Down syndrome
  • Increased leptin, a hormone that regulates food intake and correlates with obesity
  • Poor mastication, or chewing, which makes it difficult to eat raw fruits and vegetables

In addition, children with Down syndromeoften have sensory deficits that make balance and coordination more difficult, leading to decreased physical activity. They may also have poor impulse control and a tendency to be oppositional or noncompliant when a parent attempts to push exercise or healthy foods.

While estimates vary, one study found that between 30 and 50 % of children withDown syndromewere obese. Children with Down syndromeare also at increased risk for developing Type 2 diabetes both due to their propensity for obesity and their large abdominal fat stores.

AUTISM
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Children with autism often have sensory issues that affect their acceptance of healthy foods, sometimes exhibiting aversions to specific textures, smells, colors, temperatures, or brand names. “Often parents and caregivers give in to their preferences, which a lot of the time may be the high calorie items,” explains Baker. “We’ve had children who will only eat McDonald’s french fries and it had to be in the McDonald’s package.”

Even children who do not have specific aversions may find certain foods, particularly starches, so pleasurable that they have difficulty controlling their intake. “He loves fruits and vegetables but the pizza and the white bread and the fries, he cannot stop eating that stuff,” says the mother of a 12-year- old with autism. “He will eat a whole large pizza if it’s accessible to him.”
Studies have found that:

  • Children with autism are 40% more likely to be obese than children without autism.
  • Children with autism refused foods more than twice as frequently as their typically developing counterparts.
  • Children with autism consumed more sugar sweetened beverages and snack foods than their neuro-typical counterparts.

There are other factors as well. Children on the autism spectrum may be taking medications that lead to weight gain. They may also have motor impairments that may make it difficult to playsports, in addition to social skill impairments that make participation in structured activities with peers challenging. Additionally, behavior modification using candy or other treats is a common strategy for therapists working with children with autismas they usually don’t respond to social motivation. “A lot of kids are trained not to do anything unless you have M&Ms and jelly beans in your pocket,” observes the mother of a child with autism.

CEREBRAL PALSY
Children with cerebral palsy (CP) are obese at about the same proportion as other children, but the percentage of children with CP who are obese has more than doubled since 1994, an alarming trend.

Because children with cerebral palsy may have started out with feeding problems, their families may have gotten in the habit of relying on high calorie, nutrient dense foods that are no longer appropriate as their child’s health stabilizes. Some research also indicates that children who were ill or undernourished in utero may have metabolisms that cling assiduously to any available calories, making it easy for them to put on weight.At the same time, children with cerebral palsy may find it difficult to chew and swallow fruits and vegetables, leading them to rely on soft, less nutritious foods that are also high in calories.

article-6_profiles_-pic-3PRADER- WILLI
Children with Prader-Willi syndrome (PWS) are typically plagued by a chronic feeling of hunger and an inability to feel satiated that can lead to chronic food seeking and binge eating. In addition, children with PWS have lower caloric needs because of their slower metabolisms and short stature. They also frequently have intellectual and behavioral disabilities that make fitness activities more challenging and sleep disturbances that leave them sleepy and low-energy during the day. The combination of these factors makes PWS the most common genetic cause of life threatening childhood obesity.

SPINA BIFIDA
Children with spina bifida, especially those who also have hydrocephalus, are at high risk for obesity. The Spina Bifida Association reports that at least half of the children over age six with spina bifidaare overweight, and in adolescence and adulthood, more than half are obese.
Contributing factors for obesity in children with spina bifidainclude:

  • Neurological impairments that lead to mobility problems
  • Short stature, which leads to lower caloric needs
  • Slower metabolic rate resulting from a higher proportion of fat cells
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