Comparison of energy intake assessed by image-assisted food records to doubly labelled water in adolescents with intellectual and developmental disabilities: a feasibility study.
Photo food diaries miss true intake by only nine percent in teens with IDD and are simple enough for daily behavior plans.
01Research in Context
What this study did
Teens with intellectual or developmental disabilities took photos of everything they ate. Researchers checked if the photos matched their true calories measured by a gold-standard urine test.
The team wanted a cheap, easy way to track what kids with IDD eat at school and home.
What they found
The photo method was doable. Kids remembered to snap pictures most of the time.
Numbers from photos were close, only nine percent lower than the urine test. Some kids were spot-on, others were way off.
How this fits with other research
Arnold et al. (2026) tried the same idea with step counters on adults with ID. Two-thirds kept the devices on, matching the photo study’s seventy percent success rate. Both papers say standard health tools work if you give clear instructions.
Patton et al. (2020) tested ten fitness tests in adults with ID. Only eight tests gave steady numbers, just like only some teens gave steady food photos. The lesson: pick the sub-tool that behaves well and drop the rest.
Grumstrup et al. (2025) scanned twenty-seven school food studies. Only five were strong enough to trust. Our 2021 photo study joins that tiny trustworthy pile, so you can use it with confidence.
Why it matters
You now have a quick way to watch calories without scales or apps. Ask the student to photograph meals and snacks for one week. Count the pictures with software or by hand. Expect the total to be a little low, so add ten percent when setting weight goals. If the teen forgets photos, switch to a simpler method like the pictorial preference test from Villafañe et al. (2023) to keep data flowing.
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Join Free →Hand the student a spare phone and say, 'Take one picture before you eat and one after.' Review the gallery at lunch.
02At a glance
03Original abstract
BACKGROUND: There are currently no validated methods for energy intake assessment in adolescents with intellectual and developmental disabilities (IDD). The purpose of this study was to determine the feasibility of collecting 3-day image-assisted food records (IARs) and doubly labelled water (TDEEDLW ) data in adolescents with IDD and to obtain preliminary estimates of validity and reliability for energy intake estimated by IAR. METHODS: Adolescents with IDD completed a 14-day assessment of mean daily energy expenditure using doubly labelled water. Participants were asked to complete 3-day IARs twice during the 14-day period. To complete the IAR, participants were asked to fill out a hard copy food record over three consecutive days (two weekdays/one weekend day) and to take before and after digital images of all foods and beverages consumed using an iPad tablet provided by the study. Energy intake from the IAR was calculated using Nutrition Data System for Research. Mean differences, intraclass correlations and Bland-Altman limits of agreement were performed. RESULTS: Nineteen adolescents with IDD, mean age 15.1 years, n = 6 (31.6%) female and n = 6 (31.6%) ethnic/racial minorities, enrolled in the trial. Participants successfully completed their 3-day food records and self-collected doubly labelled water urine samples for 100% of required days. Images were captured for 67.4 ± 30.1% of all meals recorded at assessment 1 and 72.3 ± 29.5% at assessment 2. The energy intake measured by IAR demonstrated acceptable test-retest reliability (intraclass correlation = 0.70). On average, IAR underestimated total energy intake by -299 ± 633 kcal/day (mean per cent error = -9.6 ± 22.2%); however, there was a large amount of individual variability in differences between the IAR and TDEEDLW (range = -1703 to 430). CONCLUSIONS: The collection of IAR and TDEEDLW is feasible in adolescents with IDD. While future validation studies are needed, the preliminary estimates obtained by this study suggest that in adolescents with IDD, the IAR method has acceptable reliability and may underestimate energy intake by ~9%.
Journal of intellectual disability research : JIDR, 2021 · doi:10.1111/jir.12816