LETTER TO THE EDITOR Obesity treatment and cardiovascular prevention in mentally retarded subjects

People with intellectual disabilities (IDP) experience significant health inequalities compared with the general population, including a shorter life expectancy and high levels of unmet health needs. Obesity, more prevalent in IDP, has been shown to contribute to their reduced life expectancy and increased health needs, with a greater incidence in females than in males. Relatively few studies have examined the effectiveness of weight loss interventions for IDP. In our study, a group of 50 consecutive IDP outpatients (42% men and 58% women, mean age 39±9 s.d.) of our lipid clinic (LC), living during the day in Institutions, were treated with a hypolipemic and hypocaloric diet. Twelve percent of our disabled patients were overweight, while 88% were obese (obesity grade: 8% I1, 18% II1 and 14% III1). Down’s syndrome accounted for 1/5 of cases and a small percentage of IDP showed other chromosomal abnormalities, autism or metabolic disease. According to the literature, 28% of the patients had thyroid problems. The whole study group involved in this explicative research program had significantly increased incidence of cardiovascular risk (CR) factors (dyslipidemia, diabetes, hypertension, hyperfibrinogen, steatohepatitis) when compared with our LC population (3.5±1.8 medical disorders per person, half of which were not detected previously). According to the Guidelines for Assessment and Management of CR WHO, 2–4 all subjects were treated with a hypolipemic-hypocaloric diet (60% carbohydrates, 25% lipids and 15% protein) during the day in the residential school and in the evening at home. Parents and teachers received information and instructions concerning weight and diet management. After 1 month, only 20 subjects had the collaboration of the family: 60% in the parent group refused or were absolutely unable to be minimally involved in the treatment program, while 40% of the parent participants were actively involved. At the end of the dietetic treatment, while IDP without parental involvement did not get any result (body mass index (BMI) was stable or increased), all subjects of the parent-involved group lost weight significantly (kg from 87±18 to 73±14 Po0.00001, BMI from 36± 7t o 31±6 Po0.00001), with a strong correlation between parent’s involvement degree and weight loss. We concluded that the provision of health care to IDP needs to be improved. Our preliminary data show consistent nutritional status impairment in IDP resulting in an overrepresentation of CR factors, with a good prognosis and better response to treatment if family is strongly involved in their treatment. In a world where CR factors are improving, there is a clear need to develop accessible, evidence-based, clinical weight-management services and cardiovascular prevention. To reduce the health inequalities experienced by IDP and to take forward the priorities for research and the development of effective, accessible services, there is a need for strong collaboration between families and professionals working (teachers and physicians) in the fields of IDP, internal medicine and obesity.