Determinants of Childhood Obesity May Take a Different Path for Children with Disabilities
By: Dr. Jim Rimmer
Childhood obesity rates are increasing across Canada and the United States. However, not all children are affected equally by the burden of obesity and poor health. Children with disabilities are more likely to be obese and are disproportionately affected by its associated health problems than children who are not disabled or grow up in families that are better off socioeconomically. While the U.S. and Canada continue to explore ways to reduce obesity among children and adolescents, it’s important to not lose sight that certain groups of children with disabilities have some of the highest rates of obesity compared to their peers.
If we really want to tackle childhood obesity, we must address the underlying social determinants of health. A recent Canadian expert panel on childhood obesity addressed some important themes that have relevance to children with disabilities.
Early Intervention is the Key to Preventing Childhood Obesity
To reduce childhood obesity, the Canadian expert panel recommended focusing on early childhood development to ensure that all children have the best opportunities for good health, and creating a strong network of prenatal supports and early childhood supports. Families who have a newborn child with a disability are often in a high state of alert about their medical and psychological needs and may not be exposed to the same level of health/wellness advice as other family members. Healthcare providers need to make a conscious effort to not ‘overplay’ the medical effects of the disability while downplaying the importance of good nutrition and physical activity to prevent secondary health conditions in children with such disabilities as spina bifida, autism, cerebral palsy and Down syndrome. Early intervention has a key effect on reducing the risk of obesity, and family members who have a newborn infant with a disability need to be provided with specific advice on diet, physical activity and behavior.
Changing the Food Environment
Neighborhoods or households that do not have access to high quality and affordable foods are predisposing children to higher risk for obesity. One of the recommendations from the Canadian expert panel is to examine more closely how neighborhoods are designed to ensure that there is greater infrastructure and opportunities for children and their families to purchase affordable fresh foods and use active transportation. These are excellent recommendations and communities should know how to make their health promotion programs inclusive of children with disabilities.
Promoting healthy eating habits and nutritious food choices in the home setting for all children is a challenge but may be even more so for children with disabilities. Some families, motivated by guilt, stress, or the fear of appearing to not be a caring parent, regularly offer food as a reinforce for good behavior. The use of food to reduce a child’s sadness or isolation from his peers can confuse some children with disabilities into assuming that food is a treatment for uncomfortable feelings (this can also occur in obese children who are shunned or bullied by their peers). Parents who have a child with a disability need to have a higher level of professional advice from school personnel and healthcare providers to ensure that they establish the right framework regarding eating behavior and diet early in the child’s life.
Next month I’ll discuss some ideas for creating healthy inclusive communities.