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HEALTHY EATING AND EXERCISE

by Mary Sawtell

Information for older children and adults with Down's syndrome, and their carers

This article is particularly for older children and adults with Down's syndrome, their families, and their professional carers. Parents and others caring for a young child with Down's syndrome may want to read it for guidance on making healthy eating and exercise a natural part of their child's life as they grow up.

Healthy eating and exercise

It is food that provides the energy to live and enjoy life. Eating a healthy diet and exercising regularly cannot guarantee perfect health, but both help to reduce the risk of developing a number of medical conditions. They also help to control weight gain. People who are overweight have an increased chance of experiencing certain health and social problems.

The principles of healthy eating and exercise are no different for the person with Down's syndrome than for anyone else. Healthy eating and exercise help a person to look good and feel good.

Food provides the energy needed for growth and activity. The energy in food is measured in calories (also called kilocalories and kilojoules). If the food eaten provides more calories than are used up in exercise, then the extra calories are converted into fat and weight is put on.

Excessive weight

Unfortunately, it is more common for a person with Down's syndrome to be overweight. The reasons for this are not straightforward. As with the population in general, there are some people with Down's syndrome who seem to put on weight more easily than others, even when they are being careful with their diet and exercise.

Some researchers studying weight gain in people with Down's syndrome found that the average basal metabolic rate (the rate at which the body burns food for energy when we are at rest) was slower in a group of people with Down's syndrome than in a matched group without Down's syndrome. The people with the slower basal metabolic rate eating the same amount of calories and doing the same amount of exercise would use up fewer calories as energy and hence gain more weight (1). Others doing similar studies have concluded that there is no difference in average basal metabolic rate, so this does not explain why excessive weight gain is more common in people with Down's syndrome (2)).

Obviously more research in this area is needed, but with the information available at present it is true to say that being overweight is generally not inevitable for people with Down's syndrome and can usually be avoided.

Ideally, healthy eating and regular exercising should start in early childhood, but it is never too late and a person is never too old to start. It is very important to teach people with Down's syndrome about healthy eating habits. If carefully taught and supervised in the early stages, they can become very responsible in controlling their own lives in this respect. They can help choose their own balanced diet and plan menus. The sense of control and achievement can then increase feelings of self-esteem.

Weight gain

There are some factors which are known to explain fully or partially why some people with Down's syndrome have difficulty controlling weight gain, as described below.

Social and psychological factors

Boredom and feeling fed-up can lead to over-eating and under activity. Friends and relatives may get into the habit of giving fattening treats which (like any gift) are hard to refuse, but if given regularly are not helpful to a person who is trying to lose weight.

Excessive weight gain can occur because of a lack of awareness as to what a healthy diet is, and why it and exercise are important. Teaching about these is therefore important.

Physical factors

People with Down's syndrome are on average shorter at all ages than people without Down's syndrome. A short person who eats the same amount as a tall person generally puts on more weight.

In the past, children with Down's syndrome may not have been encouraged to be very active or develop sporting hobbies. This might be because many such children have a certain lack of co-ordination, or because of medical concerns such as a heart condition. Therefore, taking regular exercise may not be something they are used to, but it is essential.

Medical factors

Someone who starts gaining weight may have an under active thyroid gland, a condition called hypothyroidism. The thyroid gland produces a hormone called thyroxine which circulates in the body and determines the rate at which the body creates energy from food. A person with an under active thyroid may become generally sluggish, gain weight, have increasingly dry and brittle hair, and be very sensitive to cold. As many as 15% of young people and adults with Down's syndrome have the condition. It can be diagnosed by a blood test and can be treated with tablets. As the possibility of developing this disorder is so high in people with Down's syndrome, regular blood tests should be carried out, and the condition should always be considered if someone is overweight (for more information, see the DSA leaflet "Thyroid Disorder Among People with Down's Syndrome".)

Avoiding weight gain

Weight gain should be avoided, if possible, for a variety of reasons.

Social reasons

Going out and making friends are activities which may not be easy for someone with Down's syndrome, particularly in adolescence and adulthood. Being overweight can make anyone clumsy and slow. If that person also has Down's syndrome, then the fact that they are overweight may make it even more difficult to make friends and pursue a range of social activities. This in turn may lead to feelings of rejection and boredom. More food may then be eaten in an attempt to feel better, and a pattern starts which can be difficult to change.

Health reasons

Some medical conditions and problems are more likely to occur or can be made worse if a person is overweight. People with Down's syndrome are already prone to some of these conditions. If they are overweight, they may increase their chances of experiencing problems. For example, congenital heart disease (i.e. a heart condition present from birth) is fairly common in people with Down's syndrome. As such people become adults, being overweight puts additional strain on the heart. Also, in people with Down's syndrome the ligaments which hold the joints together may be very slack, which can put additional strain on the joints. Carrying extra body weight increases this strain.

Exercise

Regular exercise is extremely important for general well-being and controlling weight. For people not used to exercising it may not be easy to start, particularly if they are very overweight or unsteady on their feet. Once a person starts to become more active, staying fit does not seem difficult.

The way to get fitter is to be more vigorous than usual. Choosing the active way of doing daily tasks, instead of the lazy way, makes a difference to fitness.

Choose a form of exercise which is enjoyed enough to be done regularly (for at least 20 or 30 minutes three times a week, every week). Always start exercising gently and build up gradually. Lots of different activities can be tried (e.g. walking, swimming, and dancing). This gives a good balance of suppleness, strength, and stamina. Because fitness cannot be stored, activity needs to be regular.

Diet

Careful control of the calories consumed in food and drink is important. Starchy foods (e.g. rice and potatoes) which were once thought to be fattening are now one of the main parts of a weight-loss diet. Fibre is also good, because it makes the stomach feel full and helps to prevent constipation, which can be a problem for people with Down's syndrome.

Fats have twice as many calories as the same weight of starch. Fats and sugar are the main foods to be avoided on a weight-loss diet.

However, being underweight can be a problem, and also needs attention. If insufficient food, or the wrong type of food, is eaten, then the body may not be getting all the nutrients it needs.

Some medical and psychiatric conditions can result in a person becoming underweight (e.g. depression, an overactive thyroid gland, poor absorption of food, any sort of chronic infection). Anyone who starts and continues to lose weight for no apparent reason, and whose weight goes considerably below that expected for their height, should go to a doctor and have a full medical check.

A healthy diet

A healthy diet is low in fat and sugar, and high in starch and fibre. A healthy daily diet includes foods from each of the four main food groups, outlined below.

Starchy foods

Examples are bread, rice, potatoes, chapatis, yams, plantains, and pasta. These provide energy, vitamins, some protein, fibre and minerals, but with little fat. They are not high in calories, provided fat and sugar are not added during preparation or cooking.

Dairy products

Examples are milk, cheese, and yoghurt. These foods are rich in calcium and protein. They are naturally high in fat, but low-fat versions are just as nutritious.

Meat, fish, beans, pulses, nuts and seeds

These foods provide protein, vitamins and minerals. They can be relatively high in fat but large amounts are not needed.

Vegetables and fruit

All provide vitamins, minerals, and fibre, with little fat. They can be eaten freely and at least two portions of either fruit or vegetables should be eaten every day.

Fat, sugar and starch

Although some fat is essential, most people eat more than is needed. The fats to avoid are called saturates, e.g. lard, butter, ghee, and some margarines. To reduce saturates try to eat lean meat, fish, low-fat dairy products, steamed, or grilled foods. Avoid foods such as puddings and cakes, roast and fried foods. Margarines and oils which are high in polyunsaturated fats, e.g. sunflower margarines and oil, rapeseed and olive oil, can all be used.

Eating sugar and sugary foods is the main cause of tooth decay. It also leads to weight gain. Sugar contains only calories, with no other nutrients. Extra sugar is not necessary for energy, as the starchy foods in a healthy diet are changed into all the sugar the body needs. Sugar is a large part of many foods (e.g. cakes, biscuits, sweets, tomato sauce, and fizzy drinks). Food labels list the ingredients in order, starting with the main ingredient, so look out for "hidden" sugars. These may be listed as glucose, dextrose, fructose, invert syrup - they are all sugars.

Having said all that, small quantities of food containing sugars does no harm. Moderation is the answer.

There is some evidence to suggest that the amount of salt eaten can encourage high blood pressure. It is worth cutting down on salt added to food. Herbs, spices, and lemon juice, can be used to flavour food.

Vitamin and mineral supplements

At the moment there is no evidence to prove that nutritional supplements such as mineral and vitamin pills are helpful for the person with Down's syndrome who is eating a healthy diet. Anyone thinking about using them should seek advice from someone who is medically qualified.

Diet Suggestions

Healthy food need not be expensive and time-consuming to prepare. Some suggestions for cheap and fast healthy food ideas are:

jacket potato with a low fat filling (e.g. low-sugar baked beans, cottage cheese, tuna in brine, all with side salad)
shish kebabs in pitta bread with salad
boiled rice or noodles with vegetables stir-fried in sunflower oil
soup and wholemeal bread
bean burger (grilled) in a wholemeal bun and side salad
tandoori chicken or chicken tikka with rice or naan bread and steamed vegetables
grilled fillet of cod with boiled potatoes and steamed fresh or frozen vegetables

Useful tips

Start by keeping a food diary. Record everything eaten or drunk for a week. Identify problem areas, and try to think of ways to deal with them and set realistic targets.

Make gradual changes. It is hard to suddenly lose a taste for sweet or fatty foods. It is perfectly possible to organise a diet which is just as large in volume and just as filling as the diet one has been used to, but which contains far fewer calories.

Plan food ahead and be prepared. Always make a shopping list and stick to it. Do not worry if targets are not kept. One slip is not the end, so do not give up.

Involve the whole family. Join healthy eating or fitness classes. Being part of a group can be fun, and helps an individual to keep changes going in the long term.

Question whether you are really hungry, or just bored or unhappy, when you eat. Find something else that you enjoy doing instead of eating between meals.

Practical help

Professional advice should always be sought before major changes in diet or exercise are made. This is particularly important if the person is unwell and/or has a medical condition.

Ask for help from a GP, health visitor, school nurse, dietician, clinical psychologist, dentist, physiotherapist, or sports coach.

More information on healthy eating and exercise can be obtained from the publications listed at the end of this article, and from leaflets in health centres and supermarkets.

Further help is obtainable from either:
Down's Syndrome Association
155 Mitcham Road
London
SW17 9PG
020-8682 4001
020-8682 4012

or:
Down's Syndrome Association - Scotland
158-160 Balgreen Road
Edinburgh
EH11 3AU
0131-313 4225

References

1. C E Cronk, W C Chumlea & A F Roche (1985). Overweight amongst children with trisomy 21. Americal Journal of Mental Deficiency, 89, 433-436.
2. M B Schapiro, S I Rapoport (1989). Basal metabolic rate in healthy Down's Syndrome adults. Journal of Mental Deficiency Research, 33, 211-219.

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