Obesity and nutrition: supporting positive dietary behaviour change in people with learning disabilities
Intended for healthcare professionals

Obesity and nutrition: supporting positive dietary behaviour change in people with learning disabilities

Mhari Henderson Lecturer, Division of Nursing and Paramedic Science, School of Health Sciences, Queen Margaret University, Edinburgh, Scotland

Why you should read this article:
  • To enhance your knowledge of the causes of, and risk factors for, obesity in people with learning disabilities

  • To acknowledge the importance of nutrition as a key controllable factor in preventing long-term conditions

  • To contribute towards revalidation as part of your 35 hours of CPD (UK readers)

  • To contribute towards your professional development and local registration renewal requirements (non-UK readers)

Obesity is a major global concern and is more common among people with learning disabilities than in the general population. If unmanaged, obesity can lead or contribute to various long-term health conditions, such as type 2 diabetes, cardiovascular disease and cancer. People with learning disabilities often rely on support staff, families and carers to meet their individual nutritional needs, but care teams and families may lack adequate knowledge of public health recommendations about healthy diet and optimal nutrition. More needs to be done to enhance the diet, and subsequently improve the health outcomes, of people with learning disabilities. This article provides an overview of obesity in people with learning disabilities, including contributing factors, associated health conditions and nutritional considerations. It also details recommendations for nurses to promote a healthy diet and support positive dietary behaviour change in this population.

Learning Disability Practice. doi: 10.7748/ldp.2024.e2223

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software



Conflict of interest

None declared

Henderson M (2024) Obesity and nutrition: supporting positive dietary behaviour change in people with learning disabilities. Learning Disability Practice. doi: 10.7748/ldp.2024.e2223

Published online: 14 March 2024

Aims and intended learning outcomes

The aim of this article is to support learning disability nurses in their health promotion roles by increasing awareness about obesity in people with learning disabilities, explaining the role of nutrition in supporting health and outlining how to promote behaviour change in relation to diet and nutrition. After reading this article and completing the time out activities you should be able to:

  • Identify the factors associated with obesity in people with learning disabilities.

  • Explain the long-term consequences of suboptimal nutrition.

  • Outline nutritional recommendations based on the Mediterranean diet and the Eatwell Guide.

  • Describe strategies that nurses can use to support behaviour change in relation to diet and nutrition for people with learning disabilities.


Obesity is defined as having a body mass index greater than 30 (World Health Organization 2024). Obesity, which is associated with physical health conditions such as type 2 diabetes, stroke, hypertension and some cancers, is a growing concern, with the numbers of people with obesity increasing each year (Tremmel et al 2017, Blüher 2019). Between 2014 and 2015, the NHS spent an estimated £6.1 billion on overweight and obesity-related ill-health. As obesity rates continue to increase, this cost is projected to rise to £9.7 billion by 2050 (Public Health England (PHE) 2017).

People with learning disabilities experience health inequalities, with their average life expectancy being up to 20 years shorter than that of the general population (Heslop et al 2014). Long-term conditions such as cancer, cardiovascular disease (CVD) and diabetes mellitus are prevalent among people with learning disabilities (Liao et al 2021). Obesity is more common in people with learning disabilities than in the general population (PHE 2020). Research has identified that limited physical activity, a sedentary lifestyle and inadequate nutritional intake are significant factors for the development of these conditions in people with learning disabilities (Melville et al 2017).

To reduce the prevalence of obesity, long-term conditions and health inequalities in people with learning disabilities, healthcare professionals, support staff and carers need to understand their role in raising awareness of the importance of optimising diet and nutrition and in supporting behaviour change in relation to diet and nutrition.

Time Out 1

Write down everything you ate and drank yesterday, including volumes, times of meals and any snacks. Now make notes on how you feel today. What are your energy levels like? Do you have any health issues or symptoms, for example weight gain, constipation, headaches, allergies or hormonal imbalances? Have you considered how your eating habits may affect your health in the long term?

Obesity in people with learning disabilities

Obesity in people with learning disabilities can be due to genetic factors, such as Prader-Willi syndrome or Down’s syndrome, and/or environmental factors, such as reduced physical exercise and suboptimal nutritional intake – for example a diet high in fat, calories, salt and sugar (Hamzaid et al 2020). Individuals with obesity are more likely to develop conditions such as type 2 diabetes, osteoarthritis, CVD, respiratory issues and cancer (Astrup and Bügel 2019). Since obesity is more common in people with learning disabilities, it may be contributing to the shorter average life expectancy seen in that population (Heslop et al 2014, Public Health England 2020).

People with learning disabilities often experience limited access to services and barriers to accessing healthcare due to factors such as physical or cognitive impairment and communication issues (Smith et al 2020). They also age earlier than the general population, with some groups such as those with Down’s syndrome being considered older adults by the age of 45-50 years (Emerson et al 2012). Sensory impairments, Alzheimer’s disease, declining musculoskeletal function and the menopause may occur up to two to three decades earlier than in the general population (Schoufour et al 2013, Hermans and Evenhuis 2014, Covelli et al 2015). Nutrition has an important role in preventing and reducing the detrimental effects of health conditions, and timely interventions are needed to address the causes of suboptimal diet (Slawson et al 2013).

Time Out 2

Think about someone you support who has obesity. How is this affecting their daily life? Are they experiencing symptoms as a result of obesity? Consider areas such as mobility, respiratory function and cardiovascular function. How is their weight affecting them psychologically? What feelings or views do they have about their body?

Key points

  • Obesity is associated with conditions such as type 2 diabetes, osteoarthritis, cardiovascular disease, respiratory issues and cancer

  • Obesity in people with learning disabilities can be due to genetic factors and/or environmental factors including suboptimal diet

  • People with learning disabilities often rely on others to meet their individual nutritional needs

  • A diet centred on whole, unprocessed foods including fruits, vegetables, whole grains, lean protein and healthy fats is protective for health

  • Educating people with learning disabilities about nutrition can empower them and reinforce healthy dietary habits

  • Setting small, achievable goals and working collaboratively with all involved is crucial to support people with learning disabilities to make positive dietary changes

Nutrition in people with learning disabilities

The 2017 Health Needs Assessment Update Report on the health of people with learning disabilities in Scotland (Truesdale and Brown 2017) highlighted that there is limited research examining nutrition in people with learning disabilities. This report cited work by Draheim (2006), who had reviewed the literature on the prevalence of CVD, related mortality and behavioural and psychological risk factors for CVD in adults with learning disabilities. Draheim (2006) had found that the consumption of high-fat foods and limited fruit and vegetable intake had a role in obesity and long-term health conditions such as CVD and diabetes. Recommendations included educational programmes for people with learning disabilities and support staff on diet, physical activity and the importance of regular health screenings (Draheim 2006).

Despite the consumption of high-fat foods and limited intake of fruit and vegetables being known risk factors for CVD, Koritsas and Iacono (2016) found that more than half of the participants in their study of 68 Australian adults with learning disabilities had limited input into food choices and the timing of meals. McGuire et al (2007) asked 157 carers of adults with learning disabilities in the west of Ireland to complete questionnaires on lifestyle and health behaviours. The authors identified that few of the adults with learning disabilities consumed the recommended intake of fruit and vegetables, carbohydrates, dairy products and protein, although most did not consume sugar and fats beyond the recommended levels (McGuire et al 2007).

With the move away from institutional care, where catering staff provide all meals for service users, to community-based care, people with learning disabilities now often rely on support staff, families and carers to meet their individual nutritional needs. Therefore, educating staff and families on the importance of optimal diet and on how to meet people’s nutritional needs is essential.

Time Out 3

Think about a person with a learning disability who you support. Do they have choices about what they eat and when they eat? What influences these choices? How could improvements be made on dietary choices?

Nutrient deficiencies

Over-consumption of food leads to a positive energy balance, and a failure to compensate for increased energy levels with an increase in expenditure causes weight gain, potentially compounding or resulting in obesity. However, paradoxically, individuals with obesity often present with nutrient deficiencies (Karampela et al 2021). Vitamins and minerals are essential to human life and are crucial for growth, repair and healthy development (Capone and Sentongo 2019). Nutrients that may be lacking include iron, calcium, zinc, vitamins A and B12, folate and magnesium, all of which contribute to the healthy functioning of the body (Astrup and Bügel 2019).

The long-term use of some medicines is known to result in nutrient deficiencies. For example, the use of proton-pump inhibitors can lead to decreased levels of vitamin B12, vitamin C, iron, calcium, magnesium, zinc and beta-carotene, while the use of bronchodilators, corticosteroids, antidepressants and hypoglycaemics can lead to decreased levels of vitamin D and calcium (Mohn et al 2018). These nutrient deficiencies can develop gradually over time, and may go undiagnosed or be misattributed to disease or the ageing process by healthcare professionals who are not sufficiently knowledgeable in this area (Mohn et al 2018).

Vitamin D deficiency

Deficiency in vitamin D – an essential nutrient that has a vital role in calcium homeostasis and bone metabolism – is common (Soskić et al 2014). The risk of vitamin D deficiency is significantly increased by obesity and by other factors, including age (children and older adults are at higher risk), darker skin, some medicines, living in areas with high levels of pollution, limited access to sunlight, suboptimal diet, insulin resistance, a sedentary lifestyle and inadequate vitamin D supplementation (Mansoor et al 2010, Heaney et al 2013). People who spend a lot of time indoors, such as those living in residential care settings, those with frailty or those with physical disabilities, are at higher risk of vitamin D deficiency (Flood 2013).

While obesity is a risk factor for vitamin D deficiency, the reasons for that are not entirely understood (Lewis 2013). Vitamin D is fat soluble, so it has been suggested that its storage in adipose tissue may reduce bioavailability in people with obesity (Soskić et al 2014, Karampela et al 2021).

Dietary sources of vitamin D include fish and fortified dairy products, but the main source of vitamin D is endogenous synthesis in the epidermis triggered by ultraviolet B radiation from sunlight (van Schoor et al 2024). In the northern hemisphere, sunlight is reduced between October and March, which reduces vitamin D synthesis, so during those months maintaining adequate serum 25-hydroxyvitamin D (25(OH)D) concentrations relies on dietary sources of vitamin D and on vitamin D stores in the body. People who live in Scotland are more likely to experience vitamin D deficiency than people living in other areas of the UK due to predominantly cloudy weather conditions (Rush et al 2013).

In 2016 the Scientific Advisory Committee on Nutrition (SACN) published a report establishing that the threshold serum 25(OH)D concentration should be 25nmol/L, based on which it recommended a nutritional intake of 10 micrograms of vitamin D per day throughout the year for everyone in the UK aged 4 years or over (SACN 2016). Recommendations on sunlight exposure are not provided in the SACN report because of the complexity of factors that affect endogenous vitamin D production.

The extent to which people with learning disabilities have access to sunlight is largely unknown due to little research in this area as well as a failure to measure this accurately (Wong et al 2006). Frighi et al (2014), who compared serum 25(OH)D levels in 155 people with learning disabilities living in the community and receiving psychiatric care with those of 192 controls from the general population, found that almost twice as many people in the learning disability group had vitamin D deficiency. Frighi et al (2014) noted that insufficient exposure to sunlight was a likely cause of the difference in the vitamin D levels, but noted that they had been unable to obtain quantifiable data on exposure to sunlight. Böhmer et al (2021) studied the personal light exposure of 82 older people with learning disabilities living in 16 residential homes in the Netherlands. They found that participants spent most of their waking day in low light levels and concluded that the lit environment of this population should be given more attention (Böhmer et al 2021).

Time Out 4

Think about a person with a learning disability who you support. How would you identify whether they are at risk of nutrient deficiencies? Do they have risk factors for nutrient deficiencies – for example, are they taking medicines that affect vitamin absorption? Are they at increased risk of health issues such as bone fractures? You may wish to consider monitoring their dietary intake of nutrients for a typical day

Promoting a healthy diet

The rise in non-communicable diseases globally has been linked to the increase in ‘Westernised’ dietary patterns, characterised by a lack of whole foods, fruits and vegetables and by the consumption of foods that are highly processed and high in saturated fats, sugar and salt (Cena and Calder 2020). Nutrition is one of the most controllable factors in preventing long-term conditions. However, a lack of knowledge about food and nutrition is often a barrier to people making positive food choices or being in a position to provide appropriate advice to others. This lack of knowledge arises partly from concerns about the reliability of information sources (Zorbas et al 2018). Furthermore, there is a link between low socioeconomic status and high rates of obesity, which could affect people with learning disabilities and support staff from lower socioeconomic backgrounds (Leung and Stanner 2011). Some staff may lack awareness of public health advice on diet, which can be a barrier to improving the health of people with learning disabilities (Özdemir et al 2023).

Consuming whole, unprocessed foods including fruits, vegetables, whole grains, lean protein and healthy fats supports the optimal functioning of the body. Foods that are nutrient-dense and provide a wide range of vitamins and minerals have protective factors against many long-term conditions. A diet rich in fruit, vegetables, legumes, fish and extra virgin olive oil can support the prevention of non-communicable diseases (Noce et al 2021). Diets centred on plant-based foods, with moderate consumption of dairy products, fish and poultry and low consumption of sugar, saturated fat and processed foods, have anti-inflammatory and antioxidant properties that are beneficial for healthy aging (Yeung et al 2021).

The Mediterranean diet is one of the most well researched diets and is based on the eating patterns of people living in countries bordering the Mediterranean Sea. It is known for its anti-inflammatory benefits and protective properties, with evidence of benefits in terms of CVD – including a reduction in risk factors for CVD such as obesity, hypertension, metabolic syndrome and dyslipidaemia – and other conditions including type 2 diabetes, cancer and cognitive decline (Guasch-Ferré and Willett 2021). Figure 1 shows the Mediterranean diet pyramid.

Figure 1.

Mediterranean diet pyramid


In the author’s clinical experience, some people misguidedly believe that the Mediterranean diet leads to weight increases due to its high percentage of fat and that it should therefore be avoided by those who are overweight. Research has shown that the Mediterranean diet is not associated with weight increases. Studies have reported that people following that diet achieved greater reductions in waist circumference and visceral fat than people following low-fat diets (Tobias et al 2015).

The Eatwell Guide (Figure 2) (PHE 2016) provides a visual representation of official dietary recommendations and can be used as a guide to support positive changes in eating habits over time. It provides detailed information on each food group and on portion sizes as well as advice on making healthier food choices.

Figure 2.

Eatwell Guide


Time Out 5

How does your diet compare with the Mediterranean diet pyramid (Figure 1) and with the recommendations of the Eatwell Guide (Figure 2)? What changes could you make to improve your diet? How could you use this information to educate people with learning disabilities and their families and carers?

Supporting positive dietary behaviour change

Food choices and habits are influenced by various social, environmental and economic factors as well as by information and knowledge, attitudes and skills (Zorbas et al 2018). Learning disability nurses have a crucial role in educating and promoting healthy food choices among the people they support. By educating people with learning disabilities about healthy eating, nurses can empower them to make informed decisions about their diet and therefore improve their health. By educating support staff, families and carers about healthy eating, nurses can increase the likelihood of people with learning disabilities having their nutritional needs met and making and sustaining changes to their diet.

A small study by Gill and Fazil (2013) highlighted the challenges that carers may experience in meeting the nutritional needs of people with learning disabilities. Issues raised by the six carers interviewed included (Gill and Fazil 2013):

  • Giving in to the person’s demand for unhealthy foods.

  • Having weekly takeaways because this is what they would do themselves.

  • Balancing unhealthier food choices with their duty of care to provide healthy options.

  • Inconsistencies between staff’s interpretations of ‘choice’ and ‘informed choice’.

  • Staff only willing to make small changes – such as changing from white bread to brown bread or using less sugar and salt – and being resistant to further changes without advice from a GP.

Experiencing resistance to change from carers and staff teams can be challenging for nurses, but they can address this issue by providing education that increases people’s knowledge about food and nutrition, thereby empowering them.

Assessing an individual’s nutritional needs is the first step in promoting healthy food choices. Finding out what they like eating, what they do not like eating and what their dietary habits are can assist in identifying possible areas of concern, such as nutrient deficiencies, and an appropriate plan of nutritional care can then be developed.

Activities such as testing different tastes can encourage individuals to try healthy foods and enable them to link learning about these foods with a new sensory experience (Curtin et al 2021). Smelling, touching and tasting different foods can make learning fun and interesting and can promote behaviour change.

Mealtimes can be viewed as a social activity, but many people with learning disabilities have limited social networks (Wilson et al 2017). Preparing and sharing meals with others can promote social interaction and assist in developing relationships while contributing to a sense of belonging and reducing feelings of isolation.

Time Out 6

What do you enjoy about food? Think about the links between food, social interaction and emotional well-being. How can mealtimes enhance quality of life?

It is not necessary to have a qualification in nutrition to educate others on healthy eating. Nurses who feel they lack adequate knowledge to provide nutritional advice can draw on information sources such as the Eatwell Guide (PHE 2016) (Figure 2).

There are many resources available online – some suggestions are listed under ‘Further resources’. There are also mobile phone applications that can help people track their nutritional intake, for example My Fitness Pal, MyNetDiary or Noom.

Box 1 outlines recommendations for supporting behaviour change in relation to diet and nutrition among people with learning disabilities, based on the author’s clinical experience.

Box 1.

Recommendations for supporting behaviour change in relation to diet and nutrition among people with learning disabilities

  • Developing trust and establishing a therapeutic relationship with the individual and their carers. This will help them feel comfortable discussing what they like and do not like eating as well as any barriers to dietary behaviour change

  • Establishing what healthy eating means for the individual and what is important to them

  • Assessing the individual’s food and fluid intake, considering mealtime patterns (including missed meals) and any cultural or religious dietary preferences and restrictions

  • Setting small, achievable goals that are clear, realistic and specific, ensuring the individual and their carers understand them. There may be many aspects of an individual’s diet that could be improved, but it is unrealistic to address them all at once and can set the individual up to fail

  • Making information – such as diet plans or recipes – accessible and tailoring information to individual’s communication needs

  • Encouraging involvement from support staff, family members and carers to increase the support the individual receives, ensure consistency of support and increase the individual’s motivation to make the behaviour change

  • Recording the individual’s progress at regular intervals and celebrating even the smallest wins. This will motivate the individual to continue with the behaviour change

  • Celebrating achievements with activities rather than with food-based rewards to avoid the individual falling back into unhealthy habits


Obesity in people with learning disabilities is more common than in the general population and can be due to genetic factors and/or environmental factors, including suboptimal nutritional intake. Individuals with obesity are more likely to develop conditions such as type 2 diabetes, osteoarthritis, CVD, respiratory issues and cancer. Since obesity is more common in people with learning disabilities, it may be contributing to their shorter average life expectancy compared with the general population.

Nurses have a duty of care to provide education on healthy diet and nutrition and support people with learning disabilities to make positive dietary changes by setting small, achievable goals. Working collaboratively with individuals and their carers, support teams and families can help develop trust, encourage discussion about any barriers to making dietary changes and therefore reinforce healthy long-term dietary habits.

Time Out 7

Identify how understanding obesity and nutrition and supporting positive dietary behaviour change in people with learning disabilities applies to your practice and the requirements of your regulatory body

Time Out 8

Now that you have completed the article, reflect on your practice in this area and consider writing a reflective account: www.rcni.com/reflective-account


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