Prevalence of Obesity in Mentally Disabled Children

Attending Special Education Institutes in Khartoum

State

Dr. Rogia El sayed El Tayeb

Dr. Rasha Khalid El Khider

Introduction

The importance of overweight and obesity related to people with disabilities is a particular problem of public health importance. Obesity is more prevalent among people with disabilities than for people without disabilities and is an important risk factor for other health conditions.

Goal

The goal of this research is to incorporate nutritional care in the multidimensional care provided to mentally disabled children.

Objectives

1. Determine the prevalence of obesity in the mentally disabled children attending the special education institutes in Khartoum state.

2. Detect different risk factors of obesity in the study subjects.

3. Assess the nutritional status of the study subjects.

Methods

This is a descriptive cross sectional study for determining the prevalence and risk factors of obesity in mentally disabled children in the special education centers in Khartoum state.

This study was conducted at the forty special education institutes in Khartoum state including its seven governorates (Khartoum, Jabal Olia, Omdurman, Karary, Ambdh, Bahry, and East Nile (Sharg El Neel).

Methods

All mentally retarded children between 10-18 years attending all special education centers in Khartoum state during period from 1\12\2011 to 31\1\2012 were included in the study the number is 290 children 190 males and 100 females.

Study tools

Interview questionnaire with personnel working at the institutes including data about different aspects of care provided for the attended children. Clinical data and causes of mental retardation were collected by reviewing the records.

Demographic data, socioeconomic data and 24 hours recall sheet were collected by interview questionnaire with the mother. Nutritional assessment like anthropometric measurements was done.

Results

Socio-demographic characteristics

Variable Number=290 Percent (%)

Age (years)

10 - 181 62.4%

15 - 18 109 37.6%

Sex

Male 190 65.5%

Female 100 34.5%

Socioeconomic status

low 20 6.9%

middle 177 61.0%

high 93 32.1%

Body Mass Index

underweight5%

normal41%

over-weight26%

obese28%

Intelligence Quotient (IQ)

profoundsevermoderatemildborder line

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

Scoring of the institutes

Variable Number=40 Percent (%)

Scoring of the institutes

low 8 20.0%

middle 15 37.5%

high 17 42.5%

Type of services in the institution

Percent ≠ 100%

Educational 40 100%

Entertainment 39 97.5%

Vocational 34 85.0%

Sports 3 7.5%

Medical 1 2.5%

Scoring of the mothers’ nutritional knowledge

Nutritional knowledge of the

mother Number=290 Percent (%)

Low 0-5 15 5.2%

Middle 6-9 181 62.4%

High 10-13 94 32.4%

Macronutrients consumption as percentage of total caloric intake

Protein Energy ratio

Carbohydrate Energy ratio

Fat Energy ratio

Mean 14.5681 60.4835 24.9484

Std. Deviation 1.62539 6.10247 5.44328

Median 14.4982 61.1201 24.4641

Minimum 7.16 35.02 12.36

Maximum 19.91 73.48 46.84

Protein and calorie intake compared to RDA

Variable Number=290 Percent (%)

Protein

<50% (unsafe) 1 0.3%

50-<75%( needs improvement)

23 7.9%

75-<100% (accepted) 45 15.5%

100-<120% (normal) 62 21.4%

120%( unaccepted) ≤ 159 54.8%

Calorie

<50% (unsafe) 82 28.3%

50-<75%( needs improvement)

135 46.6%

75-<100% (accepted) 61 21.0%

100-<120% (normal) 10 3.4%

120%( unaccepted) ≤ 2 0.7%

continue

Protein Energy ratio

<10 % 4 1.4%

10- <15% 176 60.7%

≤15% 110 37.9%

Carbohydrate Energy ratio

<55 % 42 14.5%

55- <70 % 238 82.1%

≤ 70% 10 3.4%

Fat Energy ratio

< 20 % 43 14.8%

20- < 30 % 208 71.7%

≤ 30% 39 13.4%

BMI according to some socio-demographic and medical factors.

Variables

Total sampleUnder wt/normal wt Over wt/obese

Number Percent (%) Number Percent (%)

sexmale 86 45.3% 104 54.7%

female 46 46.0% 54 54.0%Family size

<5 41 51.2% 39 48.8%5-<10 84 42.6% 113 57.4%

≤10 7 53.8% 6 46.2%

Years in institution

≥5 118 45.2% 143 54.8%>5 14 48.3% 15 51.7%

Socioeconomic status

low 12 60.0% 8 40.0%middle 78 44.1% 99 55.9%high 42 45.2% 51 54.8%

continue

Variables

Total sample

Under wt/normal wt Over wt/obese

Number Percent (%) Number Percent (%)

Other disability

Yes 24 49.0% 25 51.0%

No 108 44.8% 133 55.2%

Age

10-14 y 79 43.6% 102 56.4%

15-18y 53 48.6% 56 51.4%

IQ

Sever 30 46.2% 35 53.8%

Moderate 42 47.7% 46 52.3%

Mild 60 43.8% 77 56.2%

BMI according to nutritional knowledge score of the mother

Under wt/normal wt

Over wt/obese

Number Percent (%)

Number Percent (%)

Low 0-5 7 46.7% 8 53.3%

Middle 6-9

80 44.2% 101 55.8%

High 10-13

45 47.9% 49 52.1%

Total 132 45.5% 158 54.5%

Conclusion

More than half of the sample were males (65.5%) and (34.5%) were females and less than one third (30.3%) of the sample has moderate mental retardation, more than one third (37.6%) was mildly mentally disabled and almost tenth was border line.

A small proportion (4.5%) of mentally disabled children were underweight, less than half (41.0%) of them were normal, about quarter (26.2%) were at risk of obesity and (28.3%) of the sample are obese. The prevalence of obesity in females is (30.0%) and (27.4%) in males.

Conclusion

Analysis of 24 hours dietary recall sheets revealed major deficiencies in their calcium and iron intake. Caloric intake needs improvement in (46.6%) of the sample, while (28.3%) has unsafe low intake.

Mentally retarded children are lacking physical activity.

IQ and socioeconomic and demographic factors don’t appear to affect body mass index.

Recommendations

Integration of eating behavioral modification program, nutrition education, physical activity and familial support.

Parent involvement for ensuring home support for the development of new behaviors. They exert a powerful influence on the eating activity, and attitude patterns of their children.

Recognize the barriers to exercise and healthy diet and explain these to the patients and their families

Recommendations

Encouragement of physical exercise in institutes, and in the child's home under the supervision of their teachers and their parents.

Be aware of suitable exercise programs (for example, wheelchair sports groups) and nutrition/diet programs within the region and make these available to affected families.

Recommendations

Monitor the weight development of the disabled children or adolescents, and in case of rapid weight increase inform patients and their families, about the overweight and its individual effects on the underlying disease

National studies were recommended to precisely detect the magnitude of obesity among mentally disabled at all age groups and to probe all possible risk factors. This will be the base for nation-wide prevention and control program.

Thank You