Feature Issue on Addiction and IDD

Clear-language summary

Eating too much sugar is a serious health problem. It can cause problems with a person’s behavior, emotions, and ability to think clearly. It can also affect their friendships with others and their physical health. People with IDD are at risk for serious consequences related to sugar. Although there has not been much research, eating too much sugar has been a serious concern for people with IDD. Some of the signs of eating too much sugar are eating sweet things when you are feeling bad, eating too much food that comes from cans or the freezer, and not knowing enough about nutrition.

There are many reasons why people with IDD eat so much sugar. They consume more sugars, fats, and fast food than people who do not have IDD. People who live in group homes are often taken to fast food restaurants by their staff, and sometimes given rewards of food when they reach their goals. Some people with IDD struggle to buy nutritious food because they do not have a lot of money.

If people want to cut down on how much sugar they eat, it’s a good idea to work with a doctor. They can also work on not eating junk food and start eating nutritious food instead. DSPs can support people by showing them which foods are nutritious, role-playing by saying “No” to junk food, and keeping a journal to track and celebrate progress. Researchers don’t agree on the best way to cut down on sugar, but they agree that it’s best to start with each person’s strengths and preferences.

An alarming number of people consume more sugar daily than is recommended by established guidelines. This is gravely concerning because several research studies have linked excessive sugar consumption to serious behavioral, emotional, cognitive, social, and physical health consequences. While it is different from addictions to alcohol and other drugs, excessive sugar consumption is a habit that should be considered a serious threat to human health and well-being.

One group that may be particularly susceptible to the overconsumption of sugar is those living with an intellectual and/or developmental disability (IDD), according to several published research studies. Few professionals consider how excessive sugar consumption can worsen the social, emotional, behavioral, and physical well-being of individuals with IDD.

Sugar is a reward that our brains seek out. Yet, consuming excessive amounts of sugar has been linked to emotional, behavioral, cognitive, and physical health consequences. Individuals can be affected in different ways and can be influenced by a number of other factors, but potential consequences noted in research literature include weight gain, inflammation, sleep problems, digestive health issues, hormone dysregulation, inattentiveness, learning difficulties, depression, mood instability, impulsivity, and increased risk-taking behaviors.

Potential Factors, Barriers, and Challenges Specific to Those with IDD

The reasons why someone would consume excessive amounts of sugar are nuanced and diverse. Although still understudied, excessive sugar consumption has been noted as a serious concern in individuals with IDD in a growing number of studies. This is consistent with research reporting that adults with IDD experience difficulties in living healthy lives. For instance, individuals with IDD consume more sugar, fats, and fast food compared to the general population. Complicating matters, individuals with IDD often confront social, emotional, environmental, financial, and cognitive barriers to making healthy lifestyle choices. This is particularly true when the individual has limited support services in place. Increasing awareness and understanding of excessive sugar consumption in individuals with IDD is a critical first step in the intervention process.

It’s important to note that not all people who consume large amounts of sugar would be considered addicted to it. Every case should be individualized, but it is important to consult a licensed nutritionist and a behavioral health provider who are trained in the complexities of these topics.

There are several red flags that professionals and family members can watch out for that lead to signs of a problem with, or even a potential addiction to, sugar. Dietary issues can include emotional eating, reliance on highly processed foods, or nutritional illiteracy. Being ill-informed about nutrition or living in a group-home setting where support professionals are ill-informed about nutrition can be significant contributors. Cognitive issues, including self-regulation and executive functioning challenges, can also be factors, as can anxiety, grief, trauma, and emotional dysregulation. Behavioral issues or being victimized by bullying are other factors.

Strategies, Solutions, and Interventions

Creating and maintaining a strong relationship between a person with IDD and healthcare providers is important as the support team works to develop and implement solutions. Support professionals, mental health providers, and families should stay in regular contact with healthcare providers and consult with a licensed nutritionist. Unfortunately, many behavioral health and medical health providers do not have advanced education and training in how excessive sugar consumption can impact clients with IDD. As such, there is a strong need to increase professional awareness and competencies in this area. This is critical because proper nutrition can improve quality of life by addressing existing secondary conditions, such as weight gain, digestive health problems, and fatigue. It can also prevent additional secondary conditions from developing.

Beyond general strategies for encouraging healthy lifestyles and improving emotional and behavioral health, there are specific techniques that can be considered in supporting people with IDD to reduce sugar consumption. Harm-reduction approaches have been used successfully with other areas of addiction, so in this context, it might mean working with the person being supported to start with reducing the number of sodas being consumed from 12 down to 11 per day and gradually cutting it down from there.

It is essential to first consult a nutritionist or medical doctor before introducing major dietary changes. Eliminating junk food is a positive step, but just because something seems healthy on paper doesn’t mean it will work every time. If someone has a food sensitivity or allergy, they are going to have an inflammatory response that, over time, may lead to serious consequences. It’s also important to recognize from the start the many socioeconomic barriers people with IDD often face to accessing good healthcare and nutrition, and to factor those into the intervention process.

Other strategies include journaling, and that doesn’t have to be writing it down in a book but could include talking into a recorder. The critical step is to have lots of repetition and to celebrate progress, which can best be done with family members or support workers who are in the person’s life every day. Journaling is a great way to self-reflect and it can strengthen cognition and slow the mind down to focus and create more patience. If you’re recording progress toward reducing sugar consumption, having a journal to look back on and reflect after a bad day can be very helpful.

Modeling and role-playing behavior are also techniques that work well. If a support person or family member is drinking lots of soda or eating fast-food often, this makes a deep impression on someone with IDD. Setting them up for success by creating a positive food environment around them and modeling health-promoting behaviors should be considered.

Unfortunately, many caregivers and direct support workers and group staff lack a true understanding of the impact excessive sugar consumption can have on overall health and well-being. Group home staff may in some cases reward people living in such settings with trips to fast-food restaurants or gas stations that sell junk food. They may buy unhealthy processed food, and the residents love it, but the support workers may not realize it can contribute to people’s irritability, gut issues, depression, and anxiety. As part of a holistic approach to intervention, being aware of this and also helping people get better sleep, improve their gut health, and manage blood sugar levels should be considered.

Another strategy that works across many types of habit-forming behavior is to work on ways to reduce loneliness in people’s lives. These are skills that can be taught in a clinician’s office, but also need to be applied and practiced in everyday situations. Reducing loneliness should be considered as part of a comprehensive and holistic intervention approach.

Another strategy to consider is to help the individual reduce sedentary behaviors. Starting a walking club, for example, can not only deliver the benefits of getting more physical exercise, but also can introduce a social component to combat loneliness. Even chair yoga or other mind-body interventions may be beneficial. Such approaches can also be delivered through telehealth. However, before implementing such interventions, consultation with the individual’s healthcare team is advised and working with a qualified exercise professional should be strongly considered.

Future Directions

While there is a lack of consensus within the research literature on which health-promoting interventions are most appropriate for people with IDD who also consume excessive amounts of sugar, we know that tailoring them to individual strengths and preferences will help the success rate. This of course needs to be done with the direction of the individual’s medical doctor and/or nutritional professional. While the field awaits further research and evidence-based best practices in interventions, awareness of these issues and repetitive efforts to improve nutritional habits are critical.