Guidelines and legislation
Most people with intellectual disabilities have a reduced capacity to make rational choices and to grasp the long-term consequences of an unfortunate lifestyle. This can result in significant weight increase and substantially greater health risks.
The quality regulations for the Norwegian Act relating to Municipal Health and Care Services, stipulate that ʻ[… ]the municipality (must) draw up written procedures to ensure that the users of nursing and care services have their basic needs met (…) such as sufficient nutrition (food and drink), a varied and health-promoting diet and reasonable dietary choice' (5).
The intellectual functioning of people in this group is globally impaired, and in adults with a moderate to mild intellectual disability, their capacity level, measured by neuropsychological testing, equals that which is expected in children aged 6–12. Their cognitive difficulties make it important that they receive appropriate guidance to ensure they have a good diet. How long are we meant to sit back and watch this group of vulnerable people ruin their own health within a publicly-run health and care system before we intervene?
The right to a health-promoting diet should be defined as a basic need that must be met if we are to provide a safe standard of services. Consequently, it is important to establish guidelines and procedural requirements that support proactive and health-promoting dietary initiatives in the primary care sector (box 1). This means day-to-day assistance with the buying and cooking of food, help to make sure that portion sizes are appropriate, limiting the intake of sweets and treats – and increasing the level of physical activity.
Proactive initiatives will reduce the need for more radical dietary/nutritional interventions.
Box 1 Proposed focus areas for nutritional work among people with intellectual disabilities
Better national overview of the situation
Clearer distribution of municipal responsibilities and better organisation of dietary initiatives
Increased nutritional expertise among service providers and people with intellectual disabilities
Increased knowledge of regulations and statutory provisions
Further research on dietary interventions
The increased incidence of obesity and unhealthy diets in this group may suggest that our health and care services have insufficient knowledge and inadequate procedures in this area. For instance, there is no tool that specifically facilitates dietary screening of this group. If a person with an intellectual disability is at risk of doing serious damage to his/her own health as a consequence of malnutrition, the highest-ranking municipal officer-in-charge can, under Chapter 9 of the Act relating to Municipal Health and Care Services, liaise with the specialist health service and the County Governor to decide that coercive measures should be taken. This may involve interventions such as restricting the purchase of sweets, sugary drinks and ready meals, and the locking of fridges.
Over time an unhealthy diet can cause considerable harm to a person's health, but the legislation is rarely interpreted with this in mind. Instead, the immediate risk of injury has been given prominence rather than the proactive initiatives that may prevent such harm in the longer term, for example due to a significant weight increase. This means that structured dietary initiatives are often introduced at an unnecessarily late stage.