Obesity has become quintessentially American and an equal-opportunity problem.  Name a group — children, seniors, poor people — excessive weight is a health threat. In Central Pennsylvania, researchers from Temple University's Center for Obesity Research and Education are working in group homes to help people with developmental disabilities find solutions.

 

A healthy, Friday-night dinner at the Lisburn Group Home in Camp Hill, Pa., is a mix of convenience, quick-cook foods and cajoling.

Resident adviser Ashley Still pops a packaged mix of veggies and pasta in the microwave, puts salmon fillets under the broiler to brown, then urges resident Kevin Grimes to eat.

"Hey Kevin, I put everything on your plate," says Still. "If you try it and don't like it, that's fine. Don't eat it."

Grimes, 46, and three other men with intellectual or developmental disabilities share the modest ranch-style home.

One man is non-verbal and autistic, others have trouble with impulse control. Still drives the men to work, helps with grocery shopping and food prep. She says, a year ago, frozen lasagna was a favorite on Friday nights.

"It's high in sodium and high in calories, definitely not a healthy option," Still said.

Dinner still needs to be simple, but these days it's slimmed down.

In addition to the salmon and pasta, there's also a big salad. This new menu is served up on new dishes that serve as a visual reminder to keep portion sizes small.

Smaller dishes, glasses help with portion control

An illustration of green vegetables covers half of each plate; another quarter depicts whole grains; and the remaining fourth is for meat or protein. The glasses look tiny, just eight ounces. The bowls hold only a cup and half.

"The bowls do help," Still said. "If they are pouring cereal, and we have a huge bowl, they are going to fill it the whole way."

The residents -- and staff -- also meet with a food educator.

"You can sit in any mall or town square and see that overweight is a problem we have, and it is in the group homes, and it is in my home. A lot of homes," said Fran Shade.

Shade, who's from Carlisle, is a nutrition trainer and a parent. Her 31-year-old daughter, who has cerebral palsy, moved into a Cumberland Valley community home two years ago.

"When my daughter was in my house, if she wanted chocolate milk, I could say, 'No Sara, you've had a cup of chocolate milk.' In the group home, if she wants chocolate milk, I don't know if they have to give it to her, but they give it to her," says Shade.

Temple University researchers are looking to curb weight gain without controlling the group home residents.

Shade serves up the usual advice: Eat better, exercise more. But knows the complications that make that advice hard to follow.

"If you want to take 'em for a walk, they all have to go. And it's unlikely that they all want to go and go the same distance," she said.

Some residents have trouble chewing, others have allergies or a restricted diet. Often movement limitations make exercise difficult, especially when there's just one person to supervise three or four group home residents.

"That ain't gonna happen, if you take away the exercise side of a healthy lifestyle, the only thing you can change is eating habits," Shade said.

Small changes add up to big differences

Shade is pushing for small changes over time, and urges staffers to be vigilant at the grocery store — when they can.

"Look at the labels that one time and find the healthiest cereal, compare the sugar grams, the fiber, and stick with it," Shade suggested. "The next time, maybe breads."

Manager Diane Hoy, who works for the group home operator United Cerebral Palsy of Central Pennsylvania, said the men are eating more healthily — on most days.

"That's what we aim for. It's not really a diet. It's not really a punishment, and there's nothing that's really outlawed," Hoy said.

The study's been an education for her residents — and employees, Hoy says. She and her workers are trained caretakers, not cooks.

"My great-grandmother cooked what we would call Pennsylvania Dutch style. Heavy on the butter, heavy on the gravy. That's just how I've always learned to eat, it's a big challenge," Hoy said.

"We switched from white bread," she said. "Before, we did a lot of junk juices, lemonades and stuff."

Several studies show higher rates of obesity among those with intellectual disabilities compared with other Americans. Researchers say weight is a problem, in particular, for people who live in group homes versus institutional settings, perhaps because greater independent living brings greater food temptations.

Research scientist Mary Segal is leading the study.

Making substitutions, making them stick

"We've given up soda, that was really difficult. We're still dealing with that," Hoy said.

Resident Daniel Clemson, 41, said he misses soda but doesn't mind flavored water as an alternative. Grimes likes Sierra Mist, but knows it is loaded with caffeine.

Hoy says Grimes weighed about 210 pounds a year ago. He's down to 189 now and he's talking about food differently.

Unprompted Grimes contributes, "I don't eat cholesterol," and listed the foods he avoids. "Eggs. Doughnuts. Red meat."

During the nutrition education, trainers brought in plastic toys shaped like items from the grocery store to quiz the residents on the healthiest choices -- chicken versus cookies, carrots versus cake.

"Fake food, it just showed me which is the best," Clemson said.

"They were very quick to understand, these foods are healthy for you," Shade said. "These foods give your body no nutrition, no vitamins, nothing to fight disease.

"They can make those good choices," she says.