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Learning disability and obesity: a case report of challenges and reasonable adjustments


Background When anxious, patients with learning disabilities may display challenging behaviour. The prevalence of obesity in patients with learning disabilities is rising and can increase the complexity of management. Reasonable adjustments are often necessary in order for treatment to be successful.

Case report A 41-year-old male patient with a severe learning disability, autism and obesity was referred to the dental hospital for dental treatment. The patient frequently demonstrated physically challenging behaviour, particularly when in unfamiliar environments. In order for the patient to access care, a multidisciplinary team (MDT) approach with a number of reasonable adjustments was required. The patient was then able to receive treatment under general anaesthesia (GA) from not only the special care dentistry team, but also additional medical specialties.

Discussion A holistic approach to care is important in this patient group in order to reduce health inequalities. Clinicians should be aware of their role in the screening and referral of patients with obesity.

Conclusion Reasonable adjustments and a team approach are essential to the dental management of patients with learning disabilities. Management is becoming increasingly complex as obesity continues to be a growing problem among this group.

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  1. 1.

    Mencap. What is a learning disability? Available at (accessed June 2019).

  2. 2.

    Emerson E, Bromley J. The form and function of challenging behaviours. J Intellect Disabil Res 1995; 39: 388-398.

  3. 3.

    NHS Digital. Health and Care of People with Learning Disabilities: 2016-17. 2017. Available at (accessed June 2019).

  4. 4.

    National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: preventions and interventions for people with learning disabilities whose behaviour challenges. 2015. Available at (accessed June 2019).

  5. 5.

    University of Bristol. The Learning Disabilities Mortality Review (LeDeR) Programme: Annual Report December 2017. 2018. Available at (accessed June 2019).

  6. 6.

    Cumella S, Ransford N, Lyons J, Burnham H. Need for oral care among people with intellectual disability not in contact with Community Dental Services. J Intellect Disabil Res 2000; 44: 45-52.

  7. 7.

    Public Health England. Reasonable adjustments: a legal duty. 2016. Available at (accessed June 2019).

  8. 8.

    World Health Organisation. Obesity and overweight. 2018. Available at (accessed June 2019).

  9. 9.

    NHS Digital. Statistics on obesity, physical activity and diet, England: 2018. 2018. Available at (accessed June 2019).

  10. 10.

    NHS Digital. Health and Care of People with Learning Disabilities: 2014 to 2015. 2016. Available at (accessed June 2019).

  11. 11.

    Cassidy S B, Schwartz S, Miller J L, Driscoll D J. Prader-Willi syndrome. Genet Med 2012; 14: 10-26.

  12. 12.

    Prasher V P. Overweight and obesity among Down's syndrome adults. J Intellect Disabil Res 1995; 39: 437-441.

  13. 13.

    Dayabandara M, Hanwella R, Ratnatunga S, Suraweera C, de Silva V A. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat 2017; 13: 2231-2241.

  14. 14.

    Guh D P, Zhang W, Bansback N, Amarsi Z, Birmingham C L, Anis A H. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009; 9: 88.

  15. 15.

    Baker S, Yagiela J A. Obesity: a complicating factor for sedation in children. Paediatr Dent 2006; 28: 487-493.

  16. 16.

    Kaufman F R. Type 2 diabetes mellitus in children and youth: a new epidemic. J Paediatr Endocrinol Metab 2002; 15 (Spec Iss): 737-744.

  17. 17.

    De Pergola G, Pannacciulli N. Coagulation and fibrinolysis abnormalities in obesity. J Endocrinol Invest 2002; 25: 899-904.

  18. 18.

    Lumeng C N, Saltiel A R. Inflammatory links between obesity and metabolic disease. J Clin Invest 2011; 121: 2111-2117.

  19. 19.

    Liu Y, Pleasants R A, Croft J B et al. Body mass index, respiratory conditions, asthma, and chronic obstructive pulmonary disease. Respir Med 2015; 109: 851-859.

  20. 20.

    Jou J, Choi S S, Diehl A M. Mechanisms of disease progression in nonalcoholic fatty liver disease. Semin Liver Dis 2008; 28: 370-379.

  21. 21.

    Powell A, Teichtahl A J, Wluka A E, Cicuttini F M. Obesity: a preventable risk factor for large joint osteoarthritis which may act through biomechanical factors. Br J Sports Med 2005; 39: 4-5.

  22. 22.

    Cheah M H, Kam P C. Obesity: basic science and medical aspects relevant to anaesthetists. Anaesthesia 2005; 60: 1009-1021.

  23. 23.

    Manchikanti L, Roush J R, Colliver J A. Effect of preanethetic ranitidine and metoclopramide on gastric contents in morbidly obese patients. Anesth Analg 1986; 65: 195-199.

  24. 24.

    Mayor S. Excess weight causes nearly 4% of new cancers a year worldwide. BMJ 2014; 349: g7240.

  25. 25.

    Luppino F S, de Wit L M, Bouvy P F et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67: 220-229.

  26. 26.

    Costantino T G, Parikh A K, Satz W A, Fojtik J P. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005; 46: 456-461.

  27. 27.

    Reilly D, Boyle C A, Craig D C. Obesity and dentistry: a growing problem. Br Dent J 2009; 207: 171-175.

  28. 28.

    Head S. We need a drug formulary for obese people. BMJ 2015; 350: h1356.

  29. 29.

    Lotia S, Bellamy M C. Anaesthesia and morbid obesity. Continuing Education in Anaesthesia Critical Care & Pain 2008; 8: 151-156.

  30. 30.

    Dalla Vecchia C F, Susin C, Rosing C K, Oppermann R V, Albandar J M. Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol 2005; 76: 1721-1728.

  31. 31.

    Levine R. Obesity and oral disease - a challenge for dentistry. Br Dent J 2012; 213: 453-456.

  32. 32. Mental Capacity Act 2005. Available at (accessed June 2019).

  33. 33.

    Mencap. Our health guides. Available at (accessed June 2019).

  34. 34.

    British Society of Disability and Oral Health. Unlocking Barriers to Care: Guidelines for 'Clinical Holding' Skills for Dental Services for people unable to comply with routine oral health care. 2009. Available at (accessed June 2019).

  35. 35.

    National Institute for Health and Care Excellence. Managing medicines for adults receiving social care in the community. 2017. Available at givingmedicinestopeoplewithouttheir knowledgecovertadministration (accessed June 2019).

  36. 36.

    Care Quality Commission. Brief guide: Covert medication in mental health services. 2018. Available at (accessed June 2019).

  37. 37.

    Royal College of General Practitioners. A step to step guide for GP practices: Annual health checks for people with a learning disability. 2010. Available at (accessed June 2019).

  38. 38.

    Carvill S. Sensory Impairments, Intellectual disability and psychiatry. J Intellect Disabil Res 2001; 45: 467-483.

  39. 39.

    Clough S, Shehabi Z, Morgan C. Reducing health inequalities in people with learning disabilities: a multi-disciplinary team approach to care under general anaesthesia. Br Dent J 2016; 220: 533-537.

  40. 40.

    Clough S, Shehabi Z, Morgan C, Sheppey C. Blood tests for people with severe learning disabilities receiving dental treatment under general anaesthesia. Dent Update 2016; 43: 849-850, 853-856, 858.

  41. 41.

    Mencap. Treat me well: simple adjustments to make a big difference. 2017. Available at (accessed June 2019).

  42. 42.

    Emerson E, Baines S. Health Inequalities & People with Learning Disabilities in the UK: 2010. Available at (accessed June 2019).

  43. 43.

    Public Health England. Making reasonable adjustments to obesity and weight management services for people with learning disabilities. London: Public Health England, 2016. Available at (accessed June 2019).

  44. 44.

    Public Health England. Making Every Contact Count (MECC): practical resources. 2016. Available at: (accessed June 2019).

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The authors would like to thank staff at the Royal London Hospital for their help with this case and the other patients we see with learning disabilities; namely Dr Barry Clifton (consultant anaesthetist) and his team, Patricia Handley (lead nurse for learning disabilities), our ENT and ophthalmology/orthoptic colleagues and all the staff in the day stay unit.

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Correspondence to Joanna Dick.

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Dick, J., Clough, S. Learning disability and obesity: a case report of challenges and reasonable adjustments. Br Dent J 227, 19–24 (2019).

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