Weight management services for an underserved population: a rapid review of the literature

Blindspot in the evidence base: A systematic review of psychological interventions for children and adolescents with intellectual disabilities and co-occurring obesity

BACKGROUND

Children and adolescents with intellectual disabilities (C&A-ID) face many disadvantages in healthcare research and service delivery. Intellectual disabilities have been found to precipitate weight-related problems, and together, they may be indicators of rare genetic diseases (RGDs). C&A-ID may require support for health problems exacerbated by primary diagnoses. While it is generally agreed that C&A-ID have more complex needs than typically developing individuals, psychological services to address these needs are under-explored.

AIMS

This systematic review aimed to identify psychological interventions for weight management in C&A-ID.

METHOD

MEDLINE, PsycINFO, CINAHL, The Cochrane Library and SCOPUS were systematically searched. Data extraction and quality appraisal were performed for all eligible studies RESULTS: The search strategy yielded seven studies published in English between 2010 and 2022. All interventions addressed obesity through multi-disciplinary programmes and resulted in weight reductions, with most interventions theoretically influenced by principles of behaviourism. Quality appraisal revealed methodological weaknesses in six of seven studies, such as heterogeneity in samples, interventions, and outcome measures, disallowing meta-analyses and weakening the generalisability of interventions to diverse contexts and groups CONCLUSIONS AND IMPLICATIONS: A genuine disconnect between empirical evidence and services for C&A with complex needs was observed. This emphasises an urgency for increased inclusion in clinical and behavioural research and for robust enquiries to test/adapt psychological interventions for weight management for C&A-ID. The findings of this review hold clinical utility for clinicians working with C&A-ID, and with RGDs such as Bardet-Biedl, Prader-Willi and Down syndromes. Recommendations and a conceptual framework are provided herein for enhanced efficacy of interventions.

Weight management interventions that include dietary components for young people with chronic health care needs: A systematic review

AIMS

To identify and describe weight management interventions that include a dietary component for young people with chronic healthcare needs and overweight or obesity and their effect on body mass index (BMI) or weight.

METHODS

Six databases were searched in 2017 and 2020 for experimental studies in English: Ovid MEDLINE, Ovid Embase, Ovid AMED, EBSCO CINAHL, Scopus and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Two independent reviewers conducted data extraction and quality assessment using the Cochrane Risk of Bias tool. Eligible studies included young people with chronic healthcare needs ≤18 years with overweight or obesity with an intervention that included a dietary component. Eligible outcomes were BMI or weight. Data were synthesised narratively.

RESULTS

The search identified 15 293 references, 12 studies were included (randomised controlled trials n = 5, before-after comparisons n = 7). Participant diagnoses were neurodevelopmental disabilities (n = 5) and mental illness (n = 1); survivors of cancers or tumours (n = 4); congenital heart disease (n = 1) and; migraine (n = 1). No studies addressed weight management in physical disabilities. Eight studies demonstrated a significant reduction in BMI or weight. Of these, most interventions used dietary counselling or an energy deficit, were family-focused, multicomponent and delivered by a multidisciplinary team including dietitians. A high risk of bias was detected across studies.

CONCLUSIONS

There is limited high-quality evidence about effective dietary solutions for the management of overweight and obesity for young people with chronic healthcare needs. While more research is required, dietary management appears to be important to manage weight in these populations.

Using photo-elicitation to explore health promotion concepts with children and adolescents with disabilities: a rapid scoping review

PURPOSE

It is important to directly engage children and adolescents with disabilities (CAWD) in health promotion research to ensure their health needs are met. Arts-based research methods may help CAWD better express their ideas; photo-elicitation is one such technique, using self-captured photographs to enhance verbal descriptions of complex concepts. This review 1) summarizes findings from health promotion studies using photo-elicitation with CAWD; 2) explores benefits and challenges of using photo-elicitation; 3) identifies recommended photo-elicitation practices.

MATERIALS AND METHODS

A scoping review was conducted using rapid review principles. Four health and social science databases were searched (2009-2019) using terms related to children, adolescents, disability, and photo-elicitation. Articles meeting inclusion criteria were summarized and analyzed thematically.

RESULTS

Eight studies met inclusion criteria and explored a range of health promotion topics. Benefits of photo-elicitation included the ability to mediate communication and direct participants' focus. Challenges included difficulty operating a camera and understanding instructions about photograph subject matter. Four recommended practices were identified: 1) brainstorming photograph ideas; 2) photograph-taking training; 3) having CAWD select photographs for discussion; 4) limiting the number of photographs CAWD could capture.

CONCLUSIONS

Integrating practices to support CAWD in using photo-elicitation can help researchers more fully understand their health experiences.Implications for RehabilitationThere is a need to directly engage children and adolescents with disabilities to express themselves in health promotion research.The arts-based method of photo-elicitation may help children and adolescents with disabilities convey how they view and experience health.Children and adolescents with disabilities may need supports, including camera training, to participate in photo-elicitation.

The delivery of obesity interventions to children and adolescents with physical disabilities: a systematic review

BACKGROUND

To examine the process and mechanisms of delivering obesity interventions to physically disabled children/adolescents.

METHODS

PubMed, Medline, CINAHL Plus, Embase, Cochrane Library, Google Scholar, ClinicalTrials.gov, Science Direct were systematically and manually searched for studies conducted in physically disabled children/adolescents (0-18 years). Included interventions were physical activity, diet and obesity prevention education. Included outcomes were body mass index (BMI)/weight and obesity prevention knowledge. The Mixed Methods Appraisal Tool aided methodological quality assessments. Data were extracted and delivery models were synthesized and narratively summarized using the social ecological model.

RESULTS

Seven studies of low (n = 4) and moderate (n = 3) scoring on methodological quality were eligible for inclusion. Study duration was 5 months or less (n = 5), 8 months (n = 1) and 2 years (n = 1). Interventions were delivered at home, school, hospital and rehabilitation centre through the internet, face-to-face and parents. No intervention was delivered at three or more levels of individual, interpersonal, institutional or community levels. No study reported significant outcomes on reduction in BMI/weight, or increase in obesity prevention knowledge.

CONCLUSIONS

Evidence reviewed in this study shows that obesity interventions for physically disabled children/adolescents lack both in delivery and design. Gaps revealed should be considered when developing interventions for this special population.