Looking At Metabolism

Joan E. Medlen, R.D.
Disability Solutions, September/October 1996 Volume 1, Issue 3, p. 10-11
© Copyright 1996-1998
ISSN: 1087-0520
  Printed with the permission of Joan E. Medlen, R.D., Editor
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     In the first weeks after our son with Down syndrome was born, my thoughts strayed to his health throughout his life. My impression was that all adults with Down syndrome were very obese. As a dietitian, most of my work had been in the weight management area. I had seen first-hand the effects long-term obesity had on a person's life. I remember emphatically explaining to my husband that we needed to be an aerobically active family. I asked him to consider cross-country skiing instead of downhill skiing, and to plan for activities like family biking trips.
     Now, seven years later, Andy is a slender, tall boy, like his brother. He eats well, but not perfectly. He appears "active," but it's not very aerobic. And, when I look at other children with Down syndrome at conferences and in my community, there seems to be a mix of body types: some are slight and petite, some are thick and stocky, and some are overweight. Where did that early image of obese adults come from? Had I fallen for a myth? Could it be that this younger generation of persons with Down syndrome will not have as many obese adults? Has the increase in community inclusion changed the incidence of obesity?
     Probably not. Research suggests children with Down syndrome are as active as their peers, yet use fewer calories overall. They appear to have a lowered Basal Metabolic Rate, which is the rate a person burns calories for fuel when completely at rest—or sleeping. This means that children with Down syndrome use less energy when they are resting or sleeping.
     Taking that information one step further, it means that they use fewer calories throughout the day to accomplish the same activities as their normal peers. When Andy hangs out with his friend, and eats the same amount and kind of foods, does the same activities with the same intensity for the same amount of time, he will burn up to 15% fewer calories than his buddy. Since he ate the same amount of food as his buddy, but needs less to do the job, he has calories left over. These extra calories—even as few as 50 calories a day—can lead to an increase in weight. For example, 50 calories is equal to a half of a large Red Delicious Apple. The calories from half an apple left over at the end of the day for one year will lead to about 5 pounds of increased weight. If that continues for 5 years, it becomes a troublesome 25 pounds. With this in mind, it is easy to see how slender children and adolescents with Down syndrome can change into overweight young adults.
     There are three ways to adapt for this difference in metabolism: Focusing on Calories alone is one option. However, unless there are other medical reasons, it is risky to limit calories for children under 18 without direct medical supervision. Children have great vitamin, mineral, protein, carbohydrate and energy needs while they are growing. Limiting calories may cause children to get too few of what they need to grow and develop well. For Adults, a sole focus on calories becomes a battle of will-power, and feels like a punishment.
     As with everything else, focusing on positives and abilities has a far greater effect. Beginning with a focus on physical activity has many more positives. A person can choose from a variety of aerobic activities that are enjoyable. Additionally, regular aerobic activity has many health benefits: increased muscle tone, decreased resting heart rate, decreased blood pressure, a sense of well-being, better sleep, and an increase in metabolism.

Here is a brief list of exercise ideas and resources:

NADS Aerobics. National Association for Down Syndrome (Oak Brook, IL: NADS). PO Box 4542, Oak Brook, IL 60522-4542. $25.00 This 30 minute video tape is meant to be a fun way to get people with Down syndrome of all ages up and moving. It provides a great work out for friends and family members, too! It includes a six page booklet that offers some helpful guidelines to eating right. This video stars adults and young adults who have Down syndrome. Price includes shipping and handling.

Starting Point 1996: The Year-Round Walking Event Book. The American Volkssport Association (Universal City, TX: The American Volkssport Association, 1996). (210) 659-2112 $5.00 + $3.00 s/h. A guide to more than 1100 self-guided walking and biking trails throughout the USA. Once you get to the start point, sign the log and take a map and directions to enjoy a walk as invigorating or as relaxing as you choose. Most of the walks are free. You may choose to make a small donation to the host club. The American Volkssport Association will also have information about walking clubs in your area. Many walks have commemorative pins that you may purchase at the end of the walk as a reward for the accomplishment. Volksmarching can be a fun way to enjoy walking with others in your community.

Blair, Steven. Living With Exercise (Dallas, TX: American Health Publishing Company). (800) 736-7323. This book is a part of the LEARN Education Center materials. It presents ideas and processes to include activity to lives easily. Concepts about exercise and changing habits are presented simply and clearly. Though this information would require adaptation for ability, it is a great tool for working as a team to become more active. Forms and lists are provided to help with practical goal setting and habit changes. It was written before the Food Pyramid was introduced, so it may be confusing.

Here are some ideas for adding aerobic activity.
For parents, adults, and children:

For teenagers and adults: Coming up with ideas to increase activity is the easy part. The hard part is choosing activities that are motivating. It is important that the person with Down syndrome make the choice of activity and be involved in setting the goals.
     Working together as a team in the plans for activity will help. Sit down and make plans together. Write them down in a special place. Create a list of 3 small, but specific activities to add in a week. Begin with things that are 99% achievable. Talk about when these activities will be done and who they will be done with, if appropriate. Write them on the calendar. Then, create a way to keep track visually as those goals are met with a chart or check list. Remember to leave room for doing more than the goals you write down—a chance to over achieve!
     For Andy, we hope to build habits that will last a lifetime, and be fun. Habits that will increase his activity overall, and hopefully, reduce the risk that he will have to fight the battles that extra weight can bring. And ours too.

Luke, A., Roizen, N.J., Sutton, M., Schoeller, D.A. "Energy Expenditure in Children with Down Syndrome: Correcting Metabolic Rate for Movement." Journal of Pediatrics, Vol. 125, 1994, 829.

Joan E. Medlen, R.D., is the mother of two boys, one of whom has Down syndrome. Joan is a NetPro Trainer with the Oregon Department of Education Child Nutrition Program and Editor. She resides with her family in Portland, Oregon.

  Revised: September 21, 1999.