Overweight and obesity among adults with intellectual disabilities who use intellectual disability/developmental disability services in 20 U.S. States.

Researchers phoned the adults who use state disability services in 20 U.S. states. They asked each person’s height, weight, age, sex, and where they lived. The team then grouped people by diagnosis and housing type to see who carried extra weight.

They used the same BMI cut-offs doctors use for the general public: 25 kg/m² for overweight, 30 for obesity.

Overall, adults with intellectual disability had about the same obesity rate as other U.S. adults. But three groups stood out: women with ID, people with Down syndrome, and those with mild ID were all heavier. People living with family were more obese than those in group homes, mostly because they had milder disabilities and different supports.

Down syndrome pushed obesity risk up the most, even after age and sex were held constant.

Rasing et al. (1992) saw the same red flag in a smaller UK sample. Their early warning makes the new U.S. numbers look like a long-running trend, not a fluke.

McQuaid et al. (2024) adds a twist: among middle-aged adults with Down syndrome, extra weight did NOT bring the usual metabolic problems except high leptin. So the higher BMI you see is real, but standard cardio risks may not apply.

Smith et al. (2014) shows the gap starts young: only teens with ID in Special Olympics were heavier, not the little kids. Together the studies draw a life-span arc—disparity appears in adolescence and persists into adulthood.

You now know which clients to screen first: women with ID, anyone with Down syndrome, and adults living at home. Add a food-security screener (Mert et al. 2026) and plan exercise that respects lower peak heart rates (Ouk et al. 2015). Target teens early, keep activity fun and routine (J et al. 2010), and track leptin rather than chasing every pound if metabolic labs look fine.