The Learning Disability Nurse Role In Managing Obesity With Young Adult With Learning Disability

Introduction

Young adults (or middle aged adults) are those aged 18-25 years, and are just transitioning from adolescence to adulthood. From time immemorial, it has been believed that middle aged adults are the most affected with obesity. However, research has identified an increasing trend of obesity among young adults especially those in university and collages (Anderson et al, 2003). According to Butler et al (2004), most young adults undergo various life changes such as becoming more independent, going to college or university, developing new relationships, starting to work, cohabitating and possibly marrying, and child rearing. These changes are characterised by a feeling of displacement, whereby the young adult feels like they have lost or disunited with their identity especially when they leave the family context to venture into new life experiences (Scanclon et al, 2007). But, Aucott et al (2014) observe that these key changes expose the young adults to the vulnerabilities of energy imbalance, leading to significant weight gain which may not be of specific concern to them at that time but may later accumulate. Besides, the psychological, biological and social interaction of various factors within this age may expose them to the vulnerability of risky behaviour. Hamilton et al (2007) also argue that it is at this age that individuals face the problem of unequal opportunities, exposing those already vulnerable to more risks. Young adults with intellectual disability (ID) are more prone to obesity that the general population. A previous report by Sainsbury’s Centre for Mental Health found a higher rate of obesity prevalence among people with LD (28.3%) compared to people without such disabilities (20.4%) (Biswas et al, 2019). Yamaki (2005) also conducted a cross-sectional study among 3499 non-institutionalised Americans with learning disability and found a 34.6% of obesity prevalence among them. Similarly, a study by Bhaumik et al (2008) found more prevalence of obesity among people with mild to moderate LD compared to those with severe LD. The results also found more prevalence of obesity among women (22.7%) than among men (15%) with LD. Against this background, the main aim of this essay is to explore the role of disability nurses in caring for obese young adults with learning disabilities. The main body of the essay will cover a range of issues. First, there will be coverage of the condition and the needs associated with obesity among young adults with learning disabilities. Next, the essay will explore the sociological, biological, psychological, moral and ethical considerations that influence the identified needs of obese youths with LD and their families. Lastly, the essay will explore evidence-based approaches that could be implemented by the learning disability nurse to meet the needs.

There are a stark of evidence highlighting the needs and conditions experienced by obese young adults with learning disabilities. Whereas some of these needs have been identified by various pieces of academic research, there are policy documents highlighting these needs and the factors that influence them. A typical example of policy documents is the UK’s Michael Inquiry, which highlighted how this group of population experience health inequalities (Healthcare for All, 2008). Nonetheless, the following section dives into the conditions and needs faced by this group of the population, and the factors influencing these needs.

According to findings by Adolfsson et al (2008), obese young adults are faced by poor nutrition in the character of high caloric intake because they tend to snack in between meals, consume a lot of meat, sugary food, and milk, and have low fruit consumption. Other researches have attributed the poor nutrition among this group of population to several factors. For instance, According to Abu-Saad & Fraser (2010), poor nutrition among young adults with learning disabilities can be attributed to poor environmental and socio-economic factors, whereby inability to afford a balanced diet may force them to eat unhealthy or a nutritionally unbalanced food.

This group of the population also live a life of low physical activity and are therefore in need of regular assistance of physical exercise. According to Messent et al (1998), young adults with learning disabilities tend to have low physical activity levels that emanate from inadequate community leisure activities, unclear residential home guidelines and unclear day services, poor staffing, and transport limitations, all which affect their ability to move around and engage in physical exercise. Messent et al (1999) also acknowledged that participant income or expenditure factors can influence the physical activity levels of this population.

Obese young adults with learning disabilities have been associated with the conditions of behavioural phenotype such as Prader-Willi syndrome (Cassidy, 1997) and Down’s syndrome (Henderson et al 2007). These insights corroborate with the findings of a research by Aschcroft et al (2001) where 205 of patients in the community and 45% of hospitalised patients with learning disabilities were under antipsychotic medication. Apparently, individuals under antipsychotic medication experience clinical exposure to significant weight gain, and this leads to the need for regular health monitoring.

Obese young adults with learning disabilities may also require effective nursing care services and close clinical monitoring due to the fact that obesity increases the risk of cardiovascular disease in the future (Biswas et al, 2019). But there is limited research evidence on the risk of cardiovascular disease in obese people. For instance, Wallace et al (2008) audited the medical records of 155 young adults with learning disabilities in Australia and found that people with learning disabilities had more favourable cardiovascular disease risk profile compared to the general population. In fact, the findings by Wallace et al (2008) also included other risk factors such as diabetes, hypertension, smoking and the presence of an already diagnosed cardiovascular disease. However, Wallace et al (2008) observed a low physical activity and obesity among the sample with a learning disability, 35% of them being obese. Similar findings were made by Van den Akker et al (2006) who examined 436 residential learning disability patients who had lower cardiovascular disease prevalence in comparison to the general Dutch population. These pieces of research evidence indicate that whereas the risk of future cardiovascular disease may influence the need for close clinical monitoring of obese young adults with high learning disabilities, this risk emanates more from the fact that they are obese and less from the fact that they have learning disabilities.

Generally, the need and conditions experienced by obese youths with intellectual disability are complex and wide in scope. This group of patients requires constant psychological and psychosocial support due to the issues of victimization, discrimination, and social exclusion. Several studies have examined the relationship between obesity and social discrimination, most of them finding that obesity among middle-aged and older adults causes loneliness. For instance, Schumaker et al (1985) found that obese individuals had higher loneliness scores compared to non-obese. Similarly, Oliveira et al (2013) examined the relationship between obesity and social relationships and found that lack of social relations and emotional support was associated with an increased incidence of obesity among men. This finding provides a piece of justifying evidence for the need for emotional support among obese youth with intellectual disability.

The need for psychosocial support among obese young youths is also justified by the fact that their learning disability status exposes them to further discrimination and social exclusion. A survey report by Mencap (2019) indicates that at least 1 in 3 young adults with learning disabilities stay outside their homes for at most 1 hour, as a result of being worried of bullying, stares and the fear that emanates from public attitudes. Exclusion and social inactivity is a key aspect that indicates the need for emotional and social support among this group of population because this exposes them to the risk of other mental disorders such as stress, depression, and anxiety. The need for emotional support for this group of population is also justified by the statistics that at least 1.4 million young adults with learning disabilities are in fear of making new friends, and this problem is compounded by a general public who tend to ignore this group of population (Mencap, 2019).

Whereas there is a lack of empirical evidence showing how and what degree of stigmatization affects the well-being of young adults affected with LDs, several pieces of evidence indicate that this group of population experience stigma, a phenomenon which creates a need for emotional support of this group of patients by nurses. For instance, there are constant personal accounts of discrimination from several qualitative studies. Particularly, young adults speak of being perceived as intellectually inferior and this indicates evidence of stigma (Denhart, 2008, Roear-Strier 2002, and McNulty 2003), regardless of the fact that they may be obese, this group of the population has a need for support against stigmatization from disability nurses.

Health anxiety is another reason why obese young adults with learning disabilities need nursing support and care. Oliveira et al (2013) note that this group of the population develop physical symptoms out of weight gain and therefore when a new health diagnosis of problem occurs, they tend to be worried about their health and this worry could escalate to chronic anxiety, depression, and stress. In fact, Roberts & Ashley (2010) found health anxiety to be one of the reasons why the study participants, obese adults with a learning disability, wanted to lose weight. Health anxiety could be more profound among young adults due to the impact that their body appearance has on their self-esteem.

More prominently, young adults with learning disabilities require close monitoring by disability nurses to assist them in addressing their weight problems (Henderson et al 2007). Based on existing research evidence, weight issues may sometimes be too complex for this group of population to handle because they emanate from certain biological factors that are out of their control. For example, both Adair et al (2007) and Tequeanes et al (2009) found an association between waist circumference/ BMI in young adults and foetal nutritional insufficiency, poor maternal nutrition, birth order, birth weight, and early child development. These risks factors and clinical in entire and therefore might require a response from a learning disability nurse with adequate competency.

Apparently, Hamilton et al (2007) observe that there is a paucity of research focusing on interventions for weight loss generally among people with learning disabilities, while the few ones tend to be methodologically weak – some of them involving a small number of subjects while others lacking controls. Furthermore, despite the existing evidence on the role of disability nurses, there is also a paucity of data on long-term sustainability approaches that can be taken by learning disability nurses to address obesity among this group of population. Nonetheless, recently, the British Association of Psychopharmacology (BAP) developed some guidelines to be used by both learning disability nurses and other practitioners in managing the cardiovascular disease risks (associated with antipsychotic and psychosis drugs) and weight gain among people with learning disabilities, and the guidelines recommended that weight management among this group of population should be managed with a group specialist expertise (Biswas et al 2019).

In two studies conducted by Chapman et al (i.e. fighting fit 2005 and following up fighting fit, 2008), a ‘healthy living coordinator’ (HLC) was recommended for designing dietary strategies, activity programs and identifying barriers to living a healthier lifestyle; as part of the team that could work with learning disability nurse and other professionals to ensure the positive treatment outcome for obesity among this group of population. In the study, the HLC was required to liaise with the care manager, the patient’s GP, relatives and support staff. Later on, the researchers compared the BMI of the input group with that of the non-input group and found a significant decrease in BMI among the input group and an increase in BMI among the non-input group – during 6 years of follow-up. However, it is important to note that the small difference in sample size between the two groups (i.e. n=37 for input and n=40 for non-input) could be attributable to the general lack of significance between the two groups. However, this study reveals the important role played by the multidisciplinary approach towards weight management in young adults with learning disabilities.

In another study by Hamilton et al (2007), a review of interventions for weight loss was conducted among obese adults with learning disabilities. The study covered four key interventional approaches namely: physical approaches focused on increasing energy expenditure, dietary intake approaches, health education, and promotion approaches, and multifaceted approaches involving one or more of the above approaches. The study found that each of the above-mentioned nursing role approaches was found to be effective in reducing weight among obese adults with a learning disability.

Marshal et al (2003) conducted a study to investigate the effectiveness of nursing-led health promotion activities and screening for adults with learning disabilities. The study setting was a clinic run by nurses for all people aged 10 years or above who needed special services within a local area in Northern Ireland. After screening, participants who were found to be overweight were enrolled in a 6-week weight reduction program characterised by health promotion classes. Follow-ups at the end of the program revealed that the participants experienced a significant reduction in BMI scores, revealing that pro-active nursing-led interventions can be effective in addressing the weight issues faced by obese young adults with learning disabilities.

Learning disability nurses can also play a role in closely monitoring the dietary behaviour of this group of the population so as to prevent the chronic conditions associated with weight gain and obesity. In a small study conducted by Gill et al (2013), the role of paid carers in promoting healthy eating was examined under the condition that they had to face the dilemma of choosing between the patient’s right to making unhealthy food choices and their own duty of care. Ultimately, the study concluded that disability nurses, especially those in residential care, should be motivated by ‘best interest’ to place restrictions and boundaries on food choice and access when handling obese adults with learning disabilities.

But, Jinks (2011), through an integrative literature review, also explored the role of disability nurses in implementing non-pharmaceutical and non-surgical interventions meant to address excessive weight among young adults with learning disabilities. The study recommended that whereas learning disability nurses have a role to play in weight reduction among this group of the population, the perceptions of their clients and families, and the cost of care were two major factors affecting their ability to deliver effective care. The results of this study reveal the important nature of financial and familial support to learning disability nurses when handling obese young adults with learning disabilities.

Based on the above-mentioned research pieces of evidence, it emerges that the role of learning disability nurses in delivering care to obese young adults with learning disability revolve around a multidisciplinary approach, best interest decisions, and availability of care at the point of need. In regards to the multi-disciplinary approach, it emerges that learning disability nurses need to liaise with both primary and secondary care practitioners to develop titrated care for the needs of their patients with a careful involvement of dieticians, the patient’s GP, speech and language therapists, practice nurse, and local social care service providers. According to Hamilton et al (2007), this lesion is especially important in developing a well-organized care program that focuses on delivering a personalized physical fitness program (i.e. that includes the assessment of risks such as atlantoaxial instability for those with down-syndrome), an effective dietary program that focuses on the patient’s food preferences, a health promotion and education campaign that considers the patient’s cultural preferences as well as issues relating to day-care, residential placement and respite care. This multidisciplinary approach will also provide a predictable structure for the subject patient especially those with autism (Henderson et al 2007). Ultimately, Hamilton et al (2007) argue that the multidisciplinary approach should incorporate various aspects such the British Sign Language or other aids such as the Picture Exchange Communication System that can assist the individuals in making healthy life choices that can enhance the health outcome of the individual.

Another important role of the learning disability nurse is to offer effective care to the patient while respecting the rights of the individuals with a learning disability by allowing them to make their choices and respecting those choices including lifestyle choices (Valuing People Now, 2007). However, it is worth noting that disability nurses face several dilemmas while addressing issues of obesity, where they have to balance their responsibilities of taking care of the patient and the potentiality of the patient to make harmful lifestyle choices (Henderson et al 2007). For instance, the nurse may be faced with the challenge of the patient being over-reactive, consistently choosing unhealthy eating behaviour or generally making decisions that affect their health. When faced with such circumstances, according to Oliveira et al (2013), nurses are expected to assess the patient’s mental capacity in regards to each identified risky behaviour or specific decisions made by the patient. If the patient lacks the mental capacity to make favourable lifestyle choices, the learning disability nurse should ensure that the best interest decision is made by other relevant stakeholders involved in the care process within the guidelines of Mental Capacity Act 2005.

Learning disability nurses may also encounter non-compliant or non-cooperating obese young adults with learning disabilities. In this regard, Oliveira et al (2013) acknowledge that patients might express a dislike or fear of GP surgeries of attending hospitals, a phobia for needles used in blood test screening, or a lack of compliance with procedural equipment such as electrocardiograph. This may result in non-detection of other health problems associated with learning disabilities and a furthering of health inequality among this population (Henderson et al 2007). In such situations, learning disability nurses have the responsibility of early detection of these risks with close lesion with both primary and secondary care practitioners using effective skills of calming their patients when they try to be resistant. More importantly, learning disability nurses could address the problem of non-cooperation by delivering care from home where the patient may be more comfortable to cooperate rather than from the hospital. These insights corroborate with the submissions of Disability Rights Commission (2006), which upon describing the barriers screening and care experienced by people with learning disabilities, suggested that learning disability nurses should conduct regular health checks to address the health needs of this group of patients especially those related to cardiovascular disease risks.

In conclusion, this study exudes the importance of inter-professional cooperation between learning disability nurses and other professional stakeholders in the early identification of potential problems facing obese young adults with learning disabilities. The essay has also established the effective nature of person-centred care in delivering effective care programs titrated to the needs and preferences of this group of population and delivered in cooperation with primary and secondary care practitioners, dieticians, psychiatrists, social care service deliverers and health and physical fitness trainers. Ultimately, the paper advocates for early prevention and intervention programs implemented by learning disability nurses to avoid the risk of cardiovascular morbidity among this group of population.

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