Applying Lifestyle Medicine to Improve Health Outcomes in People With Intellectual and Developmental Disabilities

Abstract

Individuals with intellectual and developmental disabilities (I/DD) and autism spectrum disorder experience disproportionately high rates of chronic disease, often exacerbated by systemic care barriers. Despite these concerns, interventions for this population rarely target overall health and wellness and often rely on practices that can contribute to poor health outcomes. This retrospective review includes data collected at The Center for Discovery, a residential care program for people with severe and complex disabilities. This analysis evaluates health outcomes among 295 adults with I/DD, including autism, who received a comprehensive lifestyle medicine intervention. Prevalence rates of chronic conditions among those receiving the intervention were compared to national and New York State disability benchmarks. Results suggest an association with substantially lower prevalence of key conditions, including obesity, diabetes, and hypertension, with a median risk ratio of 0.325 (range: 0.23-0.76) compared to U.S. population benchmarks. These findings suggest that participation in an integrated lifestyle medicine model, SynergE6® Healthspan Model, could be associated with lower chronic disease prevalence among adults with I/DD. Because this was a retrospective observational study using external benchmark comparisons, prospective controlled studies are needed to determine whether these associations are causal.

“Daily routines, including mealtimes, sleep–wake schedules, and vocational activities, occur with consistent timing, which is essential for promoting stability and reducing stress and anxiety.”

Purpose

According to the Centers for Disease Control and Prevention, ¹ six in ten U.S. adults have at least one chronic disease, accounting for 90% of the nation’s $3.8 trillion in annual healthcare expenses. ² For individuals with intellectual and developmental disabilities (I/DD), including autism spectrum disorder (ASD), the situation is even more concerning. Recent research shows that the majority of autistic individuals have at least one co-morbid condition. ³ Despite these findings, treatment programs serving those with I/DD rarely incorporate health-promoting activities. Instead, many rely on practices that negatively affect health, such as using highly processed foods as behavior reinforcement and offering sedentary instructional environments. People with I/DD also commonly encounter healthcare access barriers, resulting in untreated medical conditions. ⁴ The purpose of this data review was to evaluate health outcomes among individuals with I/DD who received a lifestyle medicine approach in comparison to U.S. population controls.

Setting

This review includes data from The Center for Discovery (TCFD), which is a nationally recognized nonprofit in New York providing leading-edge education, healthcare, and residential services for more than 1,700 children and adults with complex disabilities, profound autism, and significant medical needs.

Intervention

Model

To enhance care and reduce chronic disease burden, TCFD developed the SynergE6® Healthspan Model (Figure 1), a holistic, evidence-based approach providing comprehensive, connected, and compassionate care.

Figure 1.

The SynergE6 Healthspan Model components have the potential to function synergistically to support metabolic and emotional health.

The Environment component emphasizes accessible outdoor spaces, ample natural light, well-designed transitional areas, structured routines, individualized visual supports and socially engaging leisure and vocational activities. Previous research demonstrates that these strategies are associated with improved health and behavioral outcomes.^5,6 Eating and Nutrition focuses on individualized therapeutic dietary approaches that prioritize whole-foods and limit ultra-processed foods, contributing to overall better health. ⁷ Energy Regulation targets increased physical activity and the promotion of healthy sleep patterns, yielding broad benefits across domains essential to quality of life.^8,9 Emotional Regulation emphasizes predictability, autonomy, and self-efficacy through the integration of communication and coping skill development into daily routines. Additional therapies, including music therapy and creative arts interventions, further support emotional regulation and reduce stress. ¹⁰ The Evaluation and Evidence-Based Education and Treatment components function as integrative, wraparound elements that deliver individualized, data-driven care subject to continuous refinement. As part of this comprehensive framework, TCFD operates an onsite medical clinic utilizing a patient-centered medical home model where a primary care physician coordinates care across external specialists and participates as a member of the multidisciplinary team.

Implementation

Environment. All residents participate in highly structured and socially engaging activities, with access to nature and outdoor activities often several times per day, regardless of mobility status, except in cases of extreme weather conditions. Daily routines, including mealtimes, sleep–wake schedules, and vocational activities, occur with consistent timing, which is essential for promoting stability and reducing stress and anxiety.

Eating and Nutrition. The Center for Discovery operates its own certified organic, Demeter-certified biodynamic farm, which serves as the foundation for the whole-foods diet provided to residents. A team of registered dietitians works closely with TCFD chefs to create nutritious, seasonally inspired menus featuring farm products including produce, eggs, herbs, and goat cheese. Ultra-processed foods are intentionally avoided, ensuring meals are prepared with minimally processed ingredients.

Exercise. Daily vocational tasks for those who are ambulatory are designed to encourage physical activity, often alternating between seated and movement tasks. Structured exercise programs are offered several times per week with adapted programs for those who are non-ambulatory. Examples include walking, hiking, biking, swimming, balance and strength circuits, and stationary exercise equipment.

Emotional Regulation. Residents who engage in interfering or high-risk behaviors, including aggression and self-injurious behavior, receive individualized behavior support plans that identify and reinforce coping skills through ongoing practice across daily activities. In addition, a trauma-informed, Center-Wide Positive Behavior Intervention and Support plan provides staff with strategies to facilitate emotional regulation, including offering choices, supporting effective communication, delivering clear and consistent instruction, and responding compassionately to individual needs. The strategies outlined in this plan are implemented across all TCFD programs and are applied consistently for all residents.

Evaluation and Evidence-Based Treatment. To support ongoing assessment of progress and overall health and to guide modifications to the treatment program, data are collected daily, as applicable, regarding behavior, bowel movements, sleep duration and disturbances, menstrual cycles, and seizure activity. When concerns related to nutrition or weight emerge, food logs are implemented to track dietary intake and inform treatment planning.

Staff Adherence. To promote adherence to the SynergE6 model, all staff are trained on the components during orientation with additional training provided throughout the year. Program managers align recreational and vocational activities with the SynergE6 when developing plans and schedules to ensure that all components are implemented daily. Finally, staff are provided with practical ways to apply these strategies in their own lives, enhancing their understanding while supporting workforce wellbeing in a profession often affected by high rates of burnout and turnover.

Outcomes

Health outcome data were analyzed for 295 adults (18+) with I/DD from the TCFD residential program, including 172 diagnosed with ASD. The mean age was 35.9 (ASD subgroup: 26.5). All residents received the SynergE6 intervention.

Prevalence estimates were calculated using integrated clinical data from the electronic health record (EHR) and electronic medication administration record (eMAR). ¹¹ Clinician-documented diagnoses, laboratory results, medication administration data and vital signs were reviewed to identify confirmed cases. Estimates are presented with 95% Wilson score confidence intervals and descriptively compared with published benchmark prevalence estimates for U.S. adults and adults with disabilities in New York State. ¹² Risk ratios (RRs) summarized the relative prevalence of chronic conditions among adults residing at TCFD compared to benchmarks. Additionally, COVID-19 outcomes were compared across populations.

Across all chronic conditions examined, prevalence estimates among TCFD adults were substantially lower than national and state disability benchmarks (Table 1). For almost all conditions, including hyperlipidemia, hypertension, diabetes and obesity, prevalence estimates in both the full I/DD population and the ASD subgroup were consistently low.

Table 1.

Prevalence (95% CI) and Risk Ratios (RR) for TCFD Residents vs U.S. and NY Disability Populations.

Condition	Cases/n	TCFD %	95% CI	US%	RR vs US (95% CI)	Disability %	RR vs Disability (95% CI)
All I/DD population
High cholesterol	39/281	13.90%	10.3%–18.4%	32.80%	0.42 (0.32-0.57)	39.30%	0.35 (0.26-0.47)
High blood pressure	32/295	10.80%	7.8%–14.9%	48.10%	0.23 (0.16-0.31)	35.70%	0.30 (0.22-0.42)
Diabetes	9/295	3.10%	1.6%–5.7%	11.60%	0.26 (0.14-0.50)	16.70%	0.18 (0.10-0.35)
Cancers	11/295	3.70%	2.1%–6.6%	9.60%	0.39 (0.22-0.69)	8.40%	0.44 (0.25-0.79)
Obesity	28/292	9.60%	6.7%–13.5%	42.40%	0.23 (0.16-0.32)	37.00%	0.26 (0.18-0.37)
Overweight	68/292	23.30%	18.8%–28.5%	30.70%	0.76 (0.62-0.93)	31.00%	0.75 (0.61-0.93)
Ideal body weight	174/292	59.60%	53.9%–65.1%	26%	2.29 (2.09-2.52)	28.10%	2.12 (1.93-2.33)
ASD subgroup
High cholesterol	10/149	6.70%	3.7%–11.9%	32.80%	0.20 (0.11-0.37)	39.30%	0.17 (0.09-0.31)
High blood pressure	5/172	2.90%	1.2%–6.6%	48.10%	0.06 (0.03-0.14)	35.70%	0.08 (0.03-0.19)
Diabetes	2/172	1.20%	0.3%–4.1%	11.60%	0.10 (0.03-0.40)	16.70%	0.07 (0.02-0.28)
Cancers	5/172	2.90%	1.2%–6.6%	9.60%	0.30 (0.13-0.72)	8.40%	0.35 (0.15-0.82)
Obesity	17/169	10.10%	6.4%–15.5%	42.40%	0.24 (0.15-0.37)	37.00%	0.27 (0.17-0.43)
Overweight	44/169	26.00%	20.0%–33.1%	30.70%	0.85 (0.66-1.09)	31.00%	0.84 (0.65-1.08)
Ideal body weight	99/169	58.60%	51.0%–65.7%	26.00%	2.25 (1.98-2.56)	28.10%	2.08 (1.84-2.37)

Risk ratios consistently indicated a substantially lower prevalence of chronic conditions at TCFD. Across most outcomes, risk ratios were below 0.5, indicating conditions occurred at less than half the prevalence observed in comparison populations. Many observed risk ratios corresponded to reductions of 70% and more, particularly in the autism subgroup. Incidences of ideal body weight in both the full I/DD and ASD subgroups were more than twice that of the comparison groups.

Despite the high medical complexity of TCFD residents and their elevated risk for COVID-related morbidity, there were no deaths and minimal serious medical complications among the cohort of 182 individuals residing at TCFD during the height of the pandemic. For comparison, the death rate in state-managed residential facilities for people with I/DD in New York was 14%. ¹³ The low rate of severe complications observed during the pandemic aligns with the model’s focus on metabolic health, suggesting a potential role for comprehensive lifestyle care in reducing high-cost COVID-related hospitalizations, estimated in New York State as $272,746 for a complex stay (ICU, vent) or $72,163 for a non-complex stay per person. ¹⁴

While our findings indicate a substantially lower prevalence of chronic conditions compared to national and state disability benchmarks, these comparisons are limited by demographic variances between our residential cohort and the generalized control populations. Most notably, the mean age of the full cohort (35.9 years) and the ASD subgroup (26.5 years) is on average younger than the broader adult disability population. ¹⁵ Because the prevalence of metabolic conditions typically scales with age, ¹⁶ this age gap introduces a confounding variable. Conversely, our cohort is characterized by severe and complex I/DD and profound autism. This higher clinical acuity typically elevates baseline metabolic risk ¹⁷ relative to the broader, generalized disability population, potentially counterbalancing the age-related risk reduction. Future prospective studies utilizing age-matched and acuity-adjusted control groups are needed to isolate the precise impact of the intervention from these demographic confounders.

Lessons Learned

The findings from this observational review demonstrate a possible association between participation in the SynergE6 Healthspan Model and a lower observed prevalence of several chronic conditions among adults with intellectual and developmental disabilities when compared to published national and New York State population data. Importantly, this study was designed as a retrospective quality improvement analysis rather than a prospective intervention clinical trial. Without a randomized controlled trial, it is not possible to determine whether the SynergE6 Model itself was responsible for the observed differences. Other environmental, clinical, or demographic factors may also have contributed. Because this study lacked a randomized or matched comparison group and relied on external benchmark data, these findings should be viewed as hypothesis-generating rather than explicit evidence that the SynergE6 Model caused the observed differences. Further prospective controlled studies are needed to determine whether these associations are truly a causal relationship. If the observed associations between lower chronic disease prevalence and the SynergE6 Model are confirmed in future prospective studies, they may translate into meaningful reductions in healthcare utilization and costs, which is particularly important given the rising cost of healthcare ¹⁸ and the decrease in providers. ¹⁹

A primary limitation of this study is the inability to statistically adjust the risk ratios for confounding variables such as age, sex, and specific genetic syndromes, as we relied on aggregate external benchmark data for our control populations. Future prospective studies utilizing matched control groups are necessary to isolate the specific impact of the SynergE6 Model from these confounding factors.

Although these findings should be interpreted with caution, they strongly suggest that integrated lifestyle medicine models warrant further evaluation as a potential strategy to improve health outcomes among people with intellectual and developmental disabilities. If future studies confirm these associations, the results could have important implications for healthcare delivery, reimbursement models, and policies aimed at improving health equity in this highly vulnerable population.

ORCID iDs

Theresa Hamlin https://orcid.org/0000-0002-6546-2316

Conor Anderson https://orcid.org/0000-0002-8182-409X

Johanna F. Lantz https://orcid.org/0000-0001-8778-4562

Jennifer Franck https://orcid.org/0009-0009-4966-3976

Helena le Roux Ohm https://orcid.org/0009-0002-6880-7540

Ethical considerations

This was a retrospective data review initiated as an internal quality assurance project to investigate how our lifestyle medicine approach is impacting our residents. While our initial intention was not publication, we felt our results were worth sharing as they provide compelling support for using a lifestyle medicine approach for people with autism and other developmental disabilities.

Data Availability Statement

Research data will not be shared due to sensitive nature of population.*