Obesity among adolescents with physical disabilities

Obesity among adolescents with physical disabilities
Lawrence C. Vogel, M.D.1, 3, Pamela L. Patt, RDN1, Susan Lescher, MT1, Kiyoshi Yamaki,Ph.D2, Brienne Davis Lowry, MPH2, James H. Rimmer, Ph.D4
1Shriners Hospitals for Children, Chicago, IL; 2University of Illinois, Chicago, IL; 3 Rush University, Chicago, IL , University of Alabama, Birmingham, AL4
BACKGROUND
Obesity is a critical health problem among American children, leading to an increased risk of
adverse health consequences . Obesity is also a significant health concern among children with
disabilities. The current and future health consequences of obesity could be more intense for
these children, who already have impairments and related functional limitations, than those
without a disability. Research has shown a higher rate of overweight among youth with mobility
limitations than those without mobility limitations.
The majority of obesity reporting is through population-based data sets, which frequently use
self-reported height and weight data. While this data is more readily available, it has also been
shown to under-report obesity prevalence vs. data using actual measurement . This
discrepancy may be even more pronounced among those with disabilities. The majority of
surveillance data is also limited by the defining of disability based on functional limitations,
potentially obscuring differences in weight status by specific disability types.
RESULTS
RESULTS, CONT.
Weight distribution categories of adolescents as a function of diagnostic categories are
shown in Table 1. Obesity was most common in those with orthopaedic conditions (54.4%),
followed by OI and SB (26.5% and 25.9%, respectively). In contrast, underweight was most
common in those with SCI (26.1%) and CP (18.5%). Combining all diagnostic categories,
older adolescents (19-20 years) were more likely to be underweight (24.5%) compared to
younger adolescents (12.0% and 14.9% in 15-16 years and 17-18 years, respectively) and
this difference remained when analyzed separately for males and females.
Table 1. Weight Distribution as a function of diagnosis (percentage with 95% confidence
intervals)
The present study attempted to better understand the prevalence of overweight and obesity in
adolescents with physical disabilities, utilizing clinical data from five Shriners Hospitals for
Children across the US. Specifically, the following questions are addressed in the present study:
(1) What is the prevalence of obesity and overweight among adolescents with physical disability
and 2) how does this prevalence vary among specific disability diagnoses.
METHODS
Data: The study utilizes existing demographic and anthropometric data from the physical exam
records of approximately 1210 adolescents (15-20 years) with physical disabilities. Data was
collected from 5 pediatric specialty hospitals (Tampa, Portland, Honolulu, Chicago and
Sacramento).
Obese
Overweight
Healthy
Underweight
CP (n=654)
10.1%
(7.8-12.4)
12.8%
(10.2-15.3)
58.6%a, b, c
(54.8-62.4)
18.5%
(15.5-21.5)
SCI (n=142)
16.2
(10.0-22.2)
13.4%
(7.8-19.0)
44.4%
(36.2-52.6)
26.1%
(18.9-33.3)
SB (n=162)
25.9%d
(19.2-32.7)
27.85%a, d
(21.0-34.8)
38.3%
(30.8-45.8)
8%
(3.8-12.2)
OI (n= 49)
26.5%d
(14.1-38.9)
16.35
(6.0-26.8)
51%
(37.0-65.0)
6.1%
(-.6-12.8
ORTHO (n=79)
54.4%a,b,d,e,f
(43.4-65.4)
16.3%
(9.8-22.8)
15.25%
(7.3-23.2)
21.1%
(13.9-28.3)
29.1%
(19.1-39.1)
57.7% b, c
(49.0-66.4)
0%
(0)
4.9%
(1.1-8.7)
CLP (n=123)
a significantly
Status Variables:
Disability: Patients’ disability status was identified using ICD-9 codes. Records were screened
to include only patients with cerebral palsy (CP), spinal cord injury (SCI), spina bifida (SB),
osteogenesis imperfecta (OI), orthopaedic conditions (ORTHO) (Blount’s disease or slipped
capital femoral epiphysis ), and cleft lip and palate (CLP). Those who had one or more of these
diagnoses were considered to have physical disabilities.
higher than SCI b significantly higher than SB c significantly higher than ORTHO
d significantly higher than CP e significantly higher than OI f significantly higher than CLP
Table 2. Weight Distribution as a function of age (percentage with 95% confidence intervals)
Body Weight Status: BMI percentile score was calculated using the body weight and height,
age-in-months and sex included in the medical record. Following a commonly used procedure,
age-in-months was approximated by adding six months to the age in years reported by patients.
Utilizing these variables, respondents were classified into the following categories: obese (BMI
≥ 95th percentile) , overweight (BMI 85th - 94th percentile) , healthy BMI 5th - 84th percentile) or
underweight (BMI < 5th percentile).
Analysis:
Pooled cross sectional analysis was conducted by aggregating disabilities into 6 groups to
produce stable estimates. A statistical weight was used to produce population-level estimates
and associated 95% confidence intervals. The difference in obese/overweight prevalence
across x groups was tested using a 95% confidence interval. SPSS 18 Complex Sample Addon was used for analyses to accommodate the complex sampling design employed by these
programs.
a
Obese
Overweight
Healthy
Underweight
Ages 15-16
(n=601)
19.1%
(16.2-22.4)
13.6%
(11.1-16.6)
55.2%
(51.1-59.1)
12.0%
(9.6-14.8)
Ages 17-18
(n=424)
15.1%
(12.0-18.8)
19.3%
(15.8-23.4)
50.7%
(45.9-55.5)
14.9%
(11.8-18.6)
Ages 19-20
(n=184)
15.2%
(10.7-21.2)
16.3%
(11.6-22.4)
44%
(37.0-51.3)
24.5%a
(18.3-31.2)
Ages 15-16
(n=280)
21.7%
(17.6-26.6)
11.8%
(8.7-15.8)
51.2%
(45.8-56.7)
14.9%
(11.4-19.2)
Ages 17-18
(n=174)
16.0%
(11.9-21.1)
15.6%
(11.6-20.7)
45.8%
(43.0-55.4)
19.2%
(14.8-24.6)
Ages 19-20
(n=86)
17.3%
(11.0-26.2)
12.2%
(7.1-20.4)
35.3%
(35.3-54.9)
25.5%
(17.8-35.1)
CONCLUSIONS
Limitations:
• Neither the method of measurement nor the accuracy of these methods is known for the
adolescents included in this data set, and are likely to have varied by hospital, person
performing the measurement, and the type of disability.
•Due to the limitations of BMI to detect differences in lean tissue and fat mass in the body,
both of which may vary significantly across populations and disability type, it may be an
inaccurate indicator of body weight status among those with physical disabilities.
Conclusion:
Obesity among youth with physical disabilities can have a significant impact on their mental
and physical health, and cause problems that can further aggravate their current condition
while setting them up for health risks that will follow them into adulthood. Because BMI may
underestimate the degree of obesity in adolescents with lower extremity paralysis, the
incidence of obesity may be an even greater problem for those with SB and SCI than is
illustrated using this measure of body weight status. The higher percentage of underweight
adolescents with CP and SCI merits further investigation and appropriate investigations.
Increased focus on monitoring the weight status of youth with physical disabilities, perhaps
exploring methods of body fat composition more specific than BMI, may aid in the
improvement of quality of life, prevention of secondary conditions and the reduction of
obesity related health risks in these individuals.
significantly higher than ages 15-16
Table 3. Weight Distribution as a function of age for Males (percentage with 95% confidence
intervals)
Obese
Overweight
Healthy
Underweight
a
Table 4. Weight Distribution as a function of age for Females (percentage with 95%
confidence intervals)
Obese
Overweight
Healthy
Underweight
Ages 15-16
(n=321)
16.1%
(12.2-20.9)
15.7%
(11.9-20.5)
59.6%a
(53.8-65.3)
8.6%
(5.8-12.5)
Ages 17-18
(n=250)
13.8%
(9.4-19.8)
24.7%
(18.8-31.7)
52.9%
(45.4-60.2)
8.6%
(5.3-13.8)
Ages 19-20
(n=98)
12.8%
(7.2-21.7)
20.9%
(13.6-30.9)
43.0%
(32.9-53.7)
23.3%b, c
(15.5-33.4)
significantly higher than ages 19-20 b significantly higher than ages 15-16 c significantly higher than ages 17-18
Support:
This project is supported by Grant H133A100011 from the National Institute on
Disability and Rehabilitation Research, U.S. Department of Education
Contact Information:
Lawrence C. Vogel, MD
[email protected]