Obesity in Adolescents with Autism Spectrum Disorders - PowerPoint Presentation

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Obesity in Adolescents with Autism Spectrum Disorders

BRANDY STRAHAN, PHD, RN

Assistant Professor

Introduction

Adolescent obesity

has tripled in the past three decades.

Contributes to serious health problems

Centers for Disease Control and Prevention (CDC) defines obesity as:

70% remain obese through adulthood

Vulnerability of children with developmental disabilities such as ASD

Purpose

Provide a general background related to obesity in adolescence with specific emphasis on obesity in the ASD population

Illustrate in a case study the special challenges related to treating an obese adolescent with ASD

Describe current interventions to address obesity in typically developing (TD) adolescents and discuss how these interventions could be used with adolescents with ASD

Discuss suggestions for future research regarding the prevention and reduction of obesity in this vulnerable population

Obesity in TD Adolescents

Predominant health crisis

in America’s youth

Life expectancy rates

National Health and Nutrition Examination Survey (NHANES)

Development of comorbidities

Complications magnified in adolescents with ASD

Obesity in Adolescents with ASD

Autism – developmental disorder under broad category of ASD

Hallmark characteristics include impairments in the following areas:

Social interaction

Communication

Behavior control

Typically appear prior to age 3

Obesity in Adolescents with ASD

No cure

Treatment options may help with day-to-day functioning

Caregivers focus on problematic features

Less concern for adverse health behaviors and weight, physical activity and eating patterns, and over consumption of junk food

Obesity in Adolescents with ASD

May not encourage exercise due to motor impairments such as:

Poor motor skills

Uneven developmental milestone acquisition

Low muscle tone

Postural instability

Obesity in ASD population is 30.4% compared to 23.6%

in

TD adolescents.

Important to understand unique challenges of adolescents

Case Study

Henry (pseudonym) is a 14 year-old Caucasian adolescent diagnosed with ASD and is obese.

Height – 69 inches

Weight – 247 lbs.

Tanner Stage IV

BMI – 36.5 (above 99

th

percentile for sex and age)

Case Study

Attends public school with a daily physical education class (PE, 30 minutes)

No other active recreational activities

Trouble performing skills necessary to successfully participate in class activities

Watches television at home

No other playmates except parents and younger brother (10 year old with ASD and is obese)

Case Study

Diet:

Variety of fruits and vegetables

Relies on favorites – chicken nuggets and hot dogs

Parents offer lean proteins and complex carbohydrates

New foods are refused

Exposure to new foods incites a tantrum causing Henry to leave the table

Parents must choose-unhealthy, uneventful dinner or healthy dinner accompanied by an argument and tantrum.

Case Study

Inactivity not the only contributor to weight

Prescribed medication of Risperdal

Antipsychotic

Treats common features such as aggression and mood swings

Side effect of weight gain

Continual unhealthy weight gain

Parents encourage healthier food choices and physical activity

No empirically based dietary/lifestyle intervention for obese adolescents with ASD

Potential to become obese adult with increased morbidity and mortality

Interventions for Obese Adolescents

Extensive body of literature on the prevention and treatment of obesity in TD adolescents

Increased activity levels, reduced television hours, and improved nutrition decrease obesity and improve health outcomes

Mentoring adolescents in community and school based programs

Nutrition and aerobic/strength training

Active video gaming

Interventions for Obese Adolescents

All studies employed experimental design with physical activity intervention aimed at:

Reducing weight or BMI

Decreasing th

e amount of weight gained during the study

Decreasing body fat percentages

Interventions for Obese Adolescents

Randomized controlled trials (RTCs, home or community based) used a variety of physical activity interventions:

Individual aerobic activity

Nutrition and strength training

Active video gaming

Group exercises

Activity combined with reduced caloric intake and healthier choices

Limitations of Reviewed Studies

Standardized measures

Multiple points of comparison

Longitudinal studies since maintaining weight loss is much more challenging

Implications of Future Research

Direct and adequate comparisons are limited due to:

Wide range of methodologies

Various physical activities

Numerous physiological measurements

Sample variety

Variation in study length

Confounding effects

Unique Challenges of ASD

Food selectivity

Schedule rigidity

Social impairments

Problematic features versus health behaviors and weight gain

Motor impairment

Discussion

Findings represent a powerful way to induce weight loss in obese adolescents with ASD.

Active video gaming may be a solution since male adolescents with ASD spend 41% of free time playing video games.

Combining community and home based interventions may prove to be the most promising avenue for research and long term effects.

There exists a need for more research that accounts for unique challenges of adolescents with ASD

and ensures success with this population.

Conclusion

Adolescent obesity is an epidemic.

Obesity present in adolescents with developmental disabilities such as ASD.

Parents, such as Henry’s, need to understand how to better manage the disorder as well as prevent further health related complications

Research is needed that addressed the needs of this vulnerable population.