Friday, April 11, 2014

When it’s harder to lose weight

from Times of
World Down Syndrome Day, celebrated last month, promoted a healthier and active lifestyle. Rosette Gatt takes a look at how the physiological and behavioural aspects of this condition place these individuals at an increased risk of obesity.
Down syndrome, a genetic condition that causes delays in physical and intellectual development, occurs in one in every 800 live births and is not related to race, nationality, religion or social status.
The condition carries various health complications, but with appropriate medical care and an active lifestyle, most individuals can lead healthy lives. Nowadays the average life expectancy of individuals with Down syndrome is 55 years, with many living into their 60s and 70s.
Early childhood intervention, screening for medical problems, a sound and caring family environment, proper individualised education programmes and a supportive community can all improve the quality of life.
Unfortunately, recent research shows that between 30 and 50 per cent of children with Down syndrome are obese. Specific associated health and behavioural concerns in the individual with Down syndrome foster the development of obesity. A prevention and management plan thus needs to be mapped out for each individual to avoid negative consequences.
Weight gain in people with Down syndrome is a consequence of:
• physical characteristics, mainly short stature and hypotonic musculature also affecting ligaments, joints, hips, knees, pelvis and the spine;
• health concerns such as cardiac defects, thyroid function disorders, a decreased basal metabolic rate, gastro-intestinal tract anomalies, sleep apnea and sight defects;
• an inadequate diet because of dental problems, poor oral musculature and oral sensitivity;
• behavioural difficulties such as oppositional behaviour, impulsivity, negativity and non-compliance.
All of these factors affect:
• Exercise – Individuals with Down syndrome are less vigorous and take part in less intensive exercise routines because of lack of coordination and efficiency that causes low motivation and a tendency to stop when uncomfortable. They also tend to lead an inactive lifestyle – not going out, not having friends, not having hobbies and, last but not least, not having a job and not having a scope in life.
• Diet – Because of gastro-intestinal tract anomalies and poor oral musculature, difficulty with chewing raw fruit and vegetables, and difficulty with swallowing, children tend to eat softer foods which are usually higher in carbohydrates, cholesterol, sugars and fats.
• Behaviour – Opposition to eating a more nutritious diet, attempting an exercise routine and adopting a healthy lifestyle is reported in many children with Down syndrome.
Everyone benefits from exercise. An individual with Down syndrome can participate in most forms of physical activity, but before starting a healthier lifestyle, certain aspects have to be looked into.
The trainer must first seek the recommendations of a medical doctor. This needs to include the effect and restrictions that the health implications mentioned have on the individual, as well as any medication that is being administered and any effects this has on the person.
A psychological report must also offer recommendations as to any communication or behavioural techniques that the individual will need during training. One must also consider the need for more personalised support. Initially, activities need to be easy, enjoyable and pain-free.
Recommended exercise reg­imes and nutrition-based interventions are crucial to prevent and reduce excessive weight-gain. Exercise recommendations should include aerobic training and muscle-strengthening programmes that start at the individual’s level and gradually increase in intensity.
Nutritional recommendations include oral health follow-ups, decreasing caloric intake and attending behaviour management programmes to also address parental control over feeding practices.
When an individual with Down syndrome is working out as part of a group, the instructor needs to try to adapt to their needs by looking at the environment, the exercise itself, the equipment to be used and at adapting the rules of the game and the scope of the competition (reaching a target for oneself as opposed to winning).
Individuals with Down syndrome can be supported when parents/carers:
• make healthy habits a priority and talk about the benefits;
• encourage regular physical activities;
• control how much time family members spend in front of TV, computers or video games;
• enrol their children at a sport the child likes best or chooses and attend with them;
• advocate for more sports activities in schools and communities;
• work together with their local council in campaigning for the setting up of inclusive recreational areas, health and fitness facilities, sports clubs.
Parents do not have to become athletes to be role models for their children. Benefits of leading a healthy lifestyle include gains in mental and physical well-being as well as improved self-esteem and better social skills. Exercise can also reduce the risk of chronic and secondary conditions.
Having fun while being active is the key to success!
• Ms Gatt is manager for the Programme for Individuals with Intellectual Disabilities and Specific Learning Difficulties at The Inspire Foundation.

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