Exploring Food-Related Coercion in Intellectual Disabilities: A Study on Challenges and Support in Norway

Monica Røstad,1 Richard Whittington,1– 3 Erik Søndenaa1,2 1Department of Mental Health, Norwegian university of Science and Technology (NTNU), Trondheim, Norway; 2Brøset Center for Research and Education in Forensic Psychiatry, St. Olav’s University Hospital, Trondheim, Norway; 3Department of Health Service Research, University of Liverpool, Liverpool, UKCorrespondence: Monica Røstad, Email [email protected]: This article explores the use of coercion to address significant food-related challenges among individuals with intellectual disabilities in Norway. The goal was to examine how food-related coercion differs from non-food coercion and to document the challenges and support methods, given the limited information available on this topic. The study aims to enhance understanding and potentially reduce the use of coercion.Methods: The study analyzed coercive decision documents from municipalities using quantitative cross-sectional and cohort-longitudinal designs. The cross-sectional design included 120 decisions from 2020, comparing food-related (44) and non-food-related (76) coercion. The cohort-longitudinal design tracked the 44 individuals subjected to food-related coercion from 2018 to 2021, identifying characteristics of these decisions over four years.Results: In the cross-sectional analysis (n=120), food-related coercive measures were linked to overweight, diagnoses of stomach and intestinal issues, and general somatic health challenges. The average age was higher. The cohort-longitudinal study (n=44) highlighted a distinction between challenges related to consuming food and managing food itself. There was limited support and follow-up from general practitioners and clinical dietitians.Discussion: The study discusses the relationship between health knowledge and behavioral challenges in implementing coercion to regulate access to food and drink. It also addresses how behavior regulation can overshadow the need for measures related to preventing and managing lifestyle challenges.Conclusion: There is a need for comprehensive expertise in health and lifestyle diseases within services for people with intellectual disabilities. The lack of follow-up from general practitioners and dietitians, along with the absence of systematic interventions, indicates a significant gap in support for issues related to obesity, overeating, and uncritical food intake. Legislation aims to prevent significant damage and the use of coercion but may overshadow underlying lifestyle diseases by focusing on behavioral challenges without addressing lifestyle issues.Keywords: intellectual disability, coercion, food related challenges, municipal services, executive skills, nutrition