Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the effectiveness of interventions intended to result in weight reduction among individuals with intellectual disabilities? Is effectiveness modified by individual characteristics, including gender?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Interventions are intended to result in weight reduction modified by individual characteristics, including gender.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Persons with intellectual disabilities (adults and children)

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

We are interested in improving weight loss interventions for persons with intellectual disabilities. Weight loss programs for individuals with intellectual disabilities promote weight loss in the short-term and promote long term maintenance of their weight with potential to reduce obesity and the potential to reduce secondary conditions arising from obesity.

Describe any health-related risks, side effects, or harms that you are concerned about.

Common risks of obesity such as cardiac disease, obesity among individuals with intellectual disabilities is associated with the development and/or deterioration of secondary problems arising from the underlying disability. These include fatigue, pain, loss of mobility, social isolation and loss of independence. Researchers have observed higher rates of obesity among individuals living in family settings than institutional settings; this variation is especially large for women.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Developmental delays, attention-deficit hyperactivity disorder, and autism
• Obesity

AHRQ Priority Populations

• Women
• Children
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)
• Other

Importance

Describe why this topic is important.

Obesity is more prevalent in individuals with intellectual disabilities than in the general population and contributes to disparities in morbidity and mortality. Reasons for the high prevalence of obesity among adults and children with intellectual disabilities are unclear but may include barriers to physical activity, lack of access to health promotion programs and disease-specific risk factors. Obesity in individuals with intellectual disabilities is a prevalent yet under-researched phenomenon. Research is needed to investigate weight loss interventions for this population.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was nominated by a panel of stakeholders to identify potential systematic research topics for health care and mental health for individuals with intellectual disabilities.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Existing research on weight loss programs in individuals with intellectual disabilities finds modest evidence of weight loss in the short-term but less evidence of long term maintenance. Much of the research on obesity lacks large samples and controlled comparisons, which will be challenging to systematic reviewers.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The high prevalence of obesity among adults and children with intellectual disabilities are unclear and research is needed to investigate weight loss interventions for this population and whether effectiveness of weight loss programs varies by gender, disability severity, care setting, or other characteristics.

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Obesity is more prevalent in individuals with intellectual disabilities than in the general population and contributes to disparities in morbidity and mortality. In addition to common risks of obesity such as cardiac disease, obesity among individuals with intellectual disabilities is associated with the development and/or deterioration of secondary problems arising from the underlying disability. These include fatigue, pain, loss of mobility, social isolation and loss of independence.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The high prevalence of obesity among adults and children with intellectual disabilities are unclear and research is needed to investigate weight loss interventions for this population and whether effectiveness of weight loss programs varies by gender, disability severity, care setting, or other characteristics.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program