Melissa O'Neil, the talented Canadian actress and singer-songwriter, has captivated audiences with her performances on stage and screen. Beyond her professional achievements, O'Neil's commitment to maintaining a healthy lifestyle through diet, fitness, and self-care routines has garnered attention. This article explores O'Neil's approach to well-being, drawing upon her experiences and insights, while also delving into the broader context of weight management, particularly for individuals with Down syndrome (DS).
Melissa O'Neil: A Glimpse into Her Wellness Practices
In a recent social media post, Melissa O'Neil showcased her fit figure in exercise attire while filming the final episode of her hit show, The Rookie. The post offered a glimpse into her dedication to fitness and overall well-being.
Self-Care Rituals
One of Melissa's cherished self-care routines is taking a bath. During a visit to Find Sanctuary, she enjoyed an outdoor bath. Baths have been linked to improved sleep and reduced anxiety and depression.
Embracing the Outdoors
Melissa is an avid hiker, frequently sharing photos of her climbs on social media. Despite occasional challenges, such as needing to break in new boots, she appreciates the beauty of nature and the invigorating experience of hiking. She finds joy in the fragrance of flowers and the feeling of being surrounded by nature.
The Power of Reading
Melissa finds solace and relaxation in reading, often seen enjoying a book in a hammock.
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Physical Activity and Body Awareness
Melissa's background in martial arts and sports has contributed to her body awareness. She is also a longtime yoga practitioner. Yoga has been shown to help people maintain or lose weight, potentially due to its emphasis on mindfulness.
Weight Management Recommendations for Youth with Down Syndrome
Given that weight management recommendations developed for the general population may not be suitable for youth with DS due to physiological and cognitive differences, recent recommendations for weight management in youth with DS are needed.
Prevalence of Overweight and Obesity in Youth with DS
Youth with Down syndrome (DS) have a higher prevalence of overweight and obesity compared to the general youth population. A 2021 report in 122 youth with DS living in the United States, estimated the prevalence of overweight and obesity in youth with DS was 49% compared to 39% in the general youth population. The onset of obesity in children with DS occurs around 2 years of age. BMI rankings remain stable until puberty (∼12 years of age) when there appears to be an increase.
Health Risks Associated with Overweight and Obesity in Youth
Obesity is one of the most prevalent chronic conditions, nearly one out of every five (19.3%) youth in the US are obese according to recent national statistics. Being obese during youth increases the risk of being obese during adulthood and has both short-and long-term health consequences. Children with obesity are at increased risk for cardiovascular conditions including high blood pressure and high cholesterol, metabolic dysregulation including impaired glucose tolerance and Type 2 diabetes, breathing complications including asthma and sleep apnea, gastroesophageal reflux, gallstones, joint pains, fatty liver disease, low self-reported quality of life, low self-esteem, mental health problems including depression and anxiety, difficulties with academic performance, and social problems including stigma and being bullied. Obesity can also increase the risk of complications for infections like influenza and COVID-19. Beyond the individual, obesity has substantial societal effects by increasing healthcare costs - the combined annual direct and indirect costs of obesity in the United States totaled over $147 billion in 2008.
Overweight and obesity in individuals with DS may contribute to health risks commonly observed in DS. Controlling and monitoring weight status in youth with DS may reduce health risks during the growing years and possibly in adulthood.
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Unique Needs and Challenges of Youth with DS
Youth with DS have unique needs and challenges that make them vulnerable to risk factors in the obesogenic environment not shared by those in the general population by virtue of their limited cognitive abilities. Youth with DS have limitations with reasoning, money management, memory, and decision making, and require assistance from parents/guardians to complete activities of daily life. Additionally, parents/guardians of youth with DS report high levels of stress, and often neglect their own health as they prioritize the needs of their children. Additionally, individuals with DS have physiological profiles that may contribute to obesity and could impact weight loss (e.g., hypotonia, decreased REE, increased leptin, cardiac chronotropic incompetence). Thus, the daily life experience of adolescents with DS and their families is vastly different from their typically developing peers.
Development of Weight Management Recommendations
A workgroup of clinicians and researchers with extensive experience working with youth and adults with DS came together in 2021 to develop recommendations that offer guidance to clinicians and families for behavioral weight management in youth with Down syndrome. This workgroup consisted of 1 Doctor of Medicine, 2 Registered Dietitians, one who is an expert in weight management, 1 non-profit foundation scientist, and 1 physical activity specialist, all with at least 10 years of experience working with individuals with DS. The following recommendations were developed via a methodical, deliberative process. Workgroup members participated in monthly conference calls between May 2021 and April 2022. They reviewed relevant extant research that focused on obesity in youth with DS, weight management interventions for youth with DS, co-occurring conditions in DS that could impact dietary intake and physical activity, and weight management guidelines for typically developing youth. Clinical consensus was achieved iteratively; the workgroup held extensive discussions focused on developing guidance for clinicians and families considering the lack of evidence-based weight management or weight loss approaches developed specifically for youth with DS. The workgroup consulted with other clinicians who provided either general medical care or weight management for individuals with DS to review standard of care, best practices, and clarify practices that deviated from published literature. Using peer-reviewed literature, data collected from external clinicians, and their own experiences working with youth with DS, the group initially developed 9 recommendations. These recommendations were then shared with an expert review panel, who are members of the Down Syndrome Medical Interest Group (US-DSMIG). Each member of the expert panel was asked to read each recommendation and give feedback on both the strength of the recommendation and strength of the evidence. We also conducted a focus group with the expert panel in which they provided additional feedback on aspects of the recommendations to refine, clarify and, in some cases, to expand upon. Recommendations which did not demonstrate strength of the recommendation and strength of the evidence were removed (n = 1). The remaining 8 recommendations were updated based on feedback from the expert panel (e.g., providing additional detail or modifying the language). The remaining recommendations were shared with two panels of caregivers who provided feedback on the clarity of the recommendations. The caregivers were also asked to comment on how feasible it would be to implement the recommendations based on their lived experiences. The recommendations were again modified based feedback from caregiver panel and included adding additional details about physical activity.
Key Recommendations for Weight Management in Youth with DS
- Monitoring Weight and Growth: For youth with DS under the age of 2, clinicians should monitor weight and follow weight-for-length trends at each health care visit. For youth with DS 2 years of age or older, weight and height should respectively be measured on a standard stadiometer and scale, ideally with the individual in a gown without shoes on and plotted on the Down syndrome-specific charts for weight and height. Universal calculation and classification of body mass index (BMI), calculated as weight (kg)/height(m)2, is recommended for routine visits, and at least annually starting at the age of 2 years. Given that youth with DS have altered body composition including a higher prevalence of central adiposity compared to youth without DS and that the extent to which BMI captures excess body adiposity in youth with DS is not known, the use of BMI alone may not be accurate enough to detect excess adiposity in this population. Thus, waist circumference should be measured routinely and at least annually. Waist circumference should be measured at the midpoint between the lower margin of the least palpable rib and the top of the iliac crest, using a stretch-resistant tape that provides a constant 100 g tension. The waist circumference to height ratio should also be calculated - a weight circumference to height ratio of >0.5 indicates excess central adiposity and is associated with higher risk of metabolic syndrome.
- Screening for Health Conditions: DS is associated with several health conditions that have independent associations with dietary intake and physical activity pattern of youth with DS, and may contribute to the development of obesity. Clinicians working with youth with DS should screen for and monitor these health conditions to aid in the prevention or treatment of obesity, and families should be aware of how these risk factors may influence diet or physical activity. Glaucoma, visual field defects, and keratoconus are diseases of the eye that can limit vision. Intestinal disorders characterized by obstruction can cause loss of appetite. Poorly controlled Celiac disease can cause inflammation of the cells lining the intestinal tract, resulting in poor absorption of nutrients and inadequate calorie absorption. Poorly controlled Celiac disease can also cause changes in bowel habits including increased stooling frequency and diarrhea, which can cause weight loss. Slight weight increases along with decreased appetite gain can also be the result of abdominal bloating, another symptom of poorly controlled Celiac disease. Following a gluten-free diet may result in low intake of fiber, Vitamin D, Vitamin B12, and folate. Inadequately controlled hypothyroidism can result in changes in appetite and weight changes. Uncorrected congenital heart disease can lead to decreased physical activity and participation in sports due to fatigue with exertion. Diseases of the heart valves can develop during childhood and adolescence that may cause fatigue and a decreased desire to engage in physical activity. Inadequately controlled sleep apnea can result in daytime fatigue and a decreased desire to engage in physical activity. Inadequately controlled sleep apnea may result in a lower metabolism, which can lead to weight gain. Poor muscle tone can make participating in exercise and sports difficult, resulting in less physical activity. Arthritis and joint pain can limit physical activity. Loose ligaments (ligament laxity) and other causes of poor joint stability can limit physical activity capacity. Low bone density is common in individuals with DS. Emotional eating can be seen with Anxiety and Depression which is often associated with increased caloric intake and consumption of unhealthy foods. Depression can cause a decreased desire to engage in physical activity. Cancer treatments can cause appetite loss and weakness resulting in decreased physical activity levels.
- Addressing Feeding Difficulties: Feeding difficulties are common among infants, children, and adolescents with DS. Early feeding difficulties can result in protein-calorie malnutrition or inadequate fluid intake, and may require increased calories, modified textures, modified consistency, or alternative methods of feeding to achieve adequate weight gain with minimal aspiration risk. Maladaptive mealtime behaviors can make weight management harder. Caregivers of youth with DS report high frequency of food selectivity, continued eating in the presence of food, swallowing without enough chewing, and eating (or drinking) large amounts of food (or caloric beverages) in short periods of time. Eating large amounts of food in a short period of time is a predictor of rapid weight gain and higher body fat in preschool-age children. Youth with DS should have early and continued access to support for developing and maintaining skills in functional chewing, food preparation, and self-feeding, with focus on less processed alternatives to ultra-processed foods.
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