Obesity in Adolescents with Autism Spectrum Disorders BRANDY

Obesity in Adolescents with Autism Spectrum Disorders BRANDY STRAHAN, PHD, RN Assistant Professor

Introduction • Adolescent obesity has tripled in the past three decades. • Contributes to serious health problems • Centers for Disease Control and Prevention (CDC) defines obesity as: • 70% remain obese through adulthood • Vulnerability of children with developmental disabilities such as ASD

Purpose • Provide a general background related to obesity in adolescence with specific emphasis on obesity in the ASD population • Illustrate in a case study the special challenges related to treating an obese adolescent with ASD • Describe current interventions to address obesity in typically developing (TD) adolescents and discuss how these interventions could be used with adolescents with ASD • Discuss suggestions for future research regarding the prevention and reduction of obesity in this vulnerable population

Obesity in TD Adolescents • Predominant health crisis in America’s youth • Life expectancy rates • National Health and Nutrition Examination Survey (NHANES) • Development of comorbidities • Complications magnified in adolescents with ASD

Obesity in Adolescents with ASD • Autism – developmental disorder under broad category of ASD • Hallmark characteristics include impairments in the following areas: • Social interaction • Communication • Behavior control • Typically appear prior to age 3

Obesity in Adolescents with ASD • No cure • Treatment options may help with day-to -day functioning • Caregivers focus on problematic features • Less concern for adverse health behaviors and weight, physical activity and eating patterns, and over consumption of junk food

Obesity in Adolescents with ASD • May not encourage exercise due to motor impairments such as: • Poor motor skills • Uneven developmental milestone acquisition • Low muscle tone • Postural instability • Obesity in ASD population is 30. 4% compared to 23. 6% in TD adolescents. • Important to understand unique challenges of adolescents

Case Study • Henry (pseudonym) is a 14 year-old Caucasian adolescent diagnosed with ASD and is obese. • Height – 69 inches • Weight – 247 lbs. • Tanner Stage IV • BMI – 36. 5 (above 99 th percentile for sex and age)

Case Study • Attends public school with a daily physical education class (PE, 30 minutes) • No other active recreational activities • Trouble performing skills necessary to successfully participate in class activities • Watches television at home • No other playmates except parents and younger brother (10 year old with ASD and is obese)

Case Study • Diet: • Variety of fruits and vegetables • Relies on favorites – chicken nuggets and hot dogs • Parents offer lean proteins and complex carbohydrates • New foods are refused • Exposure to new foods incites a tantrum causing Henry to leave the table • Parents must choose-unhealthy, uneventful dinner or healthy dinner accompanied by an argument and tantrum.

Case Study • Inactivity not the only contributor to weight • Prescribed medication of Risperdal • Antipsychotic • Treats common features such as aggression and mood swings • Side effect of weight gain • Continual unhealthy weight gain • Parents encourage healthier food choices and physical activity • No empirically based dietary/lifestyle intervention for obese adolescents with ASD • Potential to become obese adult with increased morbidity and mortality

Interventions for Obese Adolescents • Extensive body of literature on the prevention and treatment of obesity in TD adolescents • Increased activity levels, reduced television hours, and improved nutrition decrease obesity and improve health outcomes • Mentoring adolescents in community and school based programs • Nutrition and aerobic/strength training • Active video gaming

Interventions for Obese Adolescents • All studies employed experimental design with physical activity intervention aimed at: • Reducing weight or BMI • Decreasing the amount of weight gained during the study • Decreasing body fat percentages

Interventions for Obese Adolescents • Randomized controlled trials (RTCs, home or community based) used a variety of physical activity interventions: • • • Individual aerobic activity Nutrition and strength training Active video gaming Group exercises Activity combined with reduced caloric intake and healthier choices

Limitations of Reviewed Studies • Standardized measures • Multiple points of comparison • Longitudinal studies since maintaining weight loss is much more challenging

Implications of Future Research • Direct and adequate comparisons are limited due to: • • • Wide range of methodologies Various physical activities Numerous physiological measurements Sample variety Variation in study length Confounding effects

Unique Challenges of ASD • • Food selectivity Schedule rigidity Social impairments Problematic features versus health behaviors and weight gain • Motor impairment

Discussion • Findings represent a powerful way to induce weight loss in obese adolescents with ASD. • Active video gaming may be a solution since male adolescents with ASD spend 41% of free time playing video games. • Combining community and home based interventions may prove to be the most promising avenue for research and long term effects. • There exists a need for more research that accounts for unique challenges of adolescents with ASD and ensures success with this population.

Conclusion • Adolescent obesity is an epidemic. • Obesity present in adolescents with developmental disabilities such as ASD. • Parents, such as Henry’s, need to understand how to better manage the disorder as well as prevent further health related complications • Research is needed that addressed the needs of this vulnerable population.