Prevalence of Weight Problems among Youth with High-Incidence Disabilities in Residential Care.

Childhood obesity is a significant health problem in the United States. Over the past 30 years, childhood obesity has doubled in children and tripled in adolescents (Ogden, Carroll, Kit, & Flegal, 2012). In 2010, over one third of children and adolescents in the United States were overweight or obese. There are short-term and long-term health and medical consequences of being overweight or obese (Dietz & Gortmaker, 2001; Freedman, Khan, Dietz, Srinivasan, & Berenson, 2001; Freedman, Zuguo, Srinivasan, Berenson, & Dietz, 2007; Guo & Chumlea, 1999; Maffeis & Tato, 2001). For example, children and adolescents who are overweight or obese are more likely to have risk factors for cardiovascular diseases, type II diabetes, bone and joint problems, hypertension, poor glucose tolerance, sleep apnea, certain gastroenterological disorders (e.g., cholelitiasis, gastroesophageal reflux), and social and emotional problems, including conduct disorders, social exclusion, and depression (Duarte et al., 2010; Lobstein, Baur, Uauy, 2004). Moreover, children and adolescents who are obese are more likely to be obese as adults and are at risk for health problems, including heart disease, diabetes, stroke, certain cancers, gall bladder disease, endocrine disorders, and osteoarthritis (Kushi et al., 2006; Lobstein et al., 2004). These health-related conditions impact both the quality of life of the individual as well as cost of health services and care in the United States (Lobstein et al" 2004).For the 189,000 high-risk children and adolescents annually served in residential placements across the United States (Child Welfare League of America [CWLA], 2005), risk for being overweight or obese and the medical conditions and emotional and behavioral problems associated with weight problems may be elevated. Children enter these intensive out-of-home programs due to broad medical, mental health, social, educational, and behavioral needs, which are not well met in the home or other less restrictive setting. These settings are highly supervised, intensive, and therapeutic; however, they are less restrictive than inpatient psychiatric units or juvenile justice corrections facilities (CWLA, 2005; Larzelere et al., 2001).Although specific reasons youth enter residential care vary, in general, youth in care present with higher levels of risk than youth in less restrictive settings. These risks often include educational deficiencies, maladaptive behaviors, high rates of mobility and placement instability, elevated externalizing and internalizing behaviors, and higher rates of psychometric medication usage (Trout et al., 2008). These risks have been found to correlate with many shortand long-term challenges, one of which includes elevated risk for obesity. For example, numerous studies and literature reviews have identified a link between significant weight gain and psychotropic medication usage (for review, see McCloughen & Foster, 2011 ). These studies reveal that the consequences of medicationinduced weight gain may go well beyond health implications, potentially affecting youth self-esteem, depression, and social alienation (Shin, Bregman, Frazier, & Noyes, 2008).Although little research has been conducted on the health and health-related quality of life of children and youth in residential care, in a series of studies, Nelson and colleagues (Nelson, Smith, Duppong Hurley et al., 2013) reported that youth in residential care were more likely to have diagnosed medical problems, including asthma; to use more psychotropic medications; and to use more medical services than youth not in residential programs. In addition, youth who enter residential programs with heightened medical problems have worse mental health outcomes than youth who enter residential programs absent of medical problems (Nelson, Smith, Pick et al., 2013). Moreover, in their research of youth entering residential care, Nelson and colleagues (Nelson et al. …