The tailoring and implementation of evidence-based multi-component weight management interventions for adults with intellectual disabilities who are obese: a whole systems approach

Abstract

Adults with intellectual disabilities in the UK are more likely to be obese than their non-disabled peers and are at risk of experiencing serious medical conditions such as heart disease, stroke and Type 2 diabetes. UK weight management guidance recommends multi-component weight management interventions, tailored for different population groups. The aim of this thesis was to explore how evidence-based multi-component weight management interventions can be tailored for adults with intellectual disabilities who are obese. The thesis comprised three phases.
Phase One included an integrative review of evidence-based multi-component weight management interventions for adults with intellectual disabilities; an exploration of theories used to underpin weight management interventions for this population; and a mapping exercise to investigate the extent of weight management service provision for adults with, and without, intellectual disabilities. The review found emerging evidence to suggest that multi-component weight management interventions can be tailored and are effective for adults with intellectual disabilities. However, the review identified few studies (n=5) and none of the identified studies explored this population’s views and experiences of such interventions. Phase One also found gaps in underpinning theories and insufficient service provision for this population.
Phase Two comprised three studies to explore participants’ views and experiences of the barriers and facilitators to weight management for adults with intellectual disabilities. These studies included a qualitative study involving interviews with 14 health care practitioners; a co-produced focus group qualitative study involving 19 adults with intellectual disabilities and 8 of their carers; and a survey involving 19 carers and support workers. Thematic analysis of participants’ responses highlighted their frustrations with several barriers including a lack of accessible healthy lifestyle information, a lack of resources, a lack of reasonable adjustments, inconsistencies in caring support, unmet training needs for carers and support workers, and socio-economic and environmental barriers. Facilitators included the provision of clear and accessible healthy lifestyle information, provision of resources, consistent caring support, reasonable adjustments, and training for carers, support workers and health care practitioners.
Phase Three involved a synthesis of findings from Phases One and Two. The overall findings imply that it is inequitable support and barriers associated with complex systems-related issues, rather than poor lifestyle choices or a lack of motivation, which inhibits this population from managing their weight if they want to. A whole systems approach is needed to address the systems-related issues and barriers experienced by this population, rather than a sole reliance on non-evidence-based weight management interventions (such as diet-only or exercise-only interventions) focused primarily on individual behaviour change to achieve short-term weight loss.
The thesis has implications for research, policy and practice. It presents a whole systems approach and a logic model outlining the types of systems-related activities needed at several levels to overcome identified barriers and to contribute to reductions in the inequities and inequalities experienced by adults with intellectual disabilities who want to manage their weight.