This study will pilot the use of portion control plates and other visual cues for healthy nutrition and decreased caloric intake to reduce obesity and overweight in persons with developmental disabilities (DD) who live in community group homes with care provider staff. People with DD are at particular risk for obesity, because they often (but not always) have intellectual disabilities including attention, cognitive and memory deficits, making skills like pre-planning and self-monitoring difficult. In addition, tasty energy-dense foods are often seen as highly rewarding "treats" for special occasions or desired behaviors and are consumed in large quantities. Finally, they have limited financial and informational resources with which to cope with health and nutrition needs. This proposal results from the collaboration of a community agency, United Cerebral Palsy of Central Pennsylvania, and an academic center, Temple University, funded through NIH's "Partners in Research" program to develop feasible projects to improve health promotion in persons with DD. Community members identified as a priority the need for effective, simple-to-implement incremental steps to improve weight control that could be sustained over the long term through positive changes in residents'everyday routines. The study arms are: one set of homes will receive materials including standardized plates and bowls with illustrations of portion servings for different food groups and other visual cues along with an orientation session on using the plates;another set of homes will receive the visual cues and orientation plus a series of onsite educational and problem-solving sessions on the importance of healthy weight, portion control and good nutrition;a third set of homes will serve as an assessment-only control.
Specific aims are to: 1) calculate effect sizes for change in residents'BMI to enable a full-scale RCT;2) determine quantitative changes in mediating variables, including 7 care providers'and residents'knowledge about good nutrition and portion control;7 care providers'and residents'perceptions of acceptability and feasibility;and 7 food purchases based on food shopping receipts;and 3) analyze qualitative data from separate focus groups of care providers and residents to enrich understanding of their perceptions of the acceptability of the interventions, their feasibility, the fidelity with which the visual cues were displayed and used, usefulness of the educational sessions, and barriers and facilitators regarding future implementation. Group homes present a "best case" scenario because more control is possible in this setting, in which agency staff can be provided guidelines as part of their continuing education, than in family or independent living situations of persons with disabilities. If the intervention is successful in this setting, it can be modified and piloted for persons with disabilities in other living situations.
This pilot project breaks new ground in the search for ways to decrease risk of obesity-related disease in community-living persons with developmental disabilities, an under-served group with higher obesity prevalence than the general population. We will explore the effectiveness of two interventions to decrease meal portion size and increase choice of low energy-dense foods, based on salient cues for behavior change and hands-on presentation of principles of basic good nutrition and their application. If successful, this pilot will lead to a full-scale RCT to improve the health of persons with developmental disabilities.