Document Type
Article
Abstract
Background:
Children and adolescents with intellectual and developmental disabilities (IDD) are at greater risk for obesity and poor obesogenic behaviors (e.g., physical activity, screen time, diet, sleep) than their typically developing counterparts. The Structured Days Hypothesis (SDH) suggests that in typically developing children and adolescents, obesogenic behaviors worsen during periods of reduced structure (e.g., weekend or summer vacation). However, children and adolescents with IDD have unique factors that may alter how structure (i.e., pre-planned, segmented, adult supervised, out-of-home programs) influences obesogenic behaviors. Therefore, the objective of this systematic review and meta-analysis is to examine obesogenic behaviors during periods of more and less structure among children and adolescents with IDD.
Methods:
A comprehensive search of PubMed, PsycINFO, Embase, and Web of Science was performed through the end of 2024 based on the PICO framework. Studies were eligible if they included youth with IDD and measured obesogenic behaviors across contexts with differing degrees of structure. Two reviewers independently completed the screening process, extracted all relevant information, and evaluated methodological quality using the NHLBI tool. Results were synthesized using fixed- and random-effects meta-analyses and visually represented with forest plots.
Results:
A total of 4,236 papers were screened with 323 full-text articles retrieved. After screening, 33 total studies were identified (physical activity = 23, sedentary behaviors = 12, sleep = 11, diet = 1). Meta-analyses indicated that the standardized mean difference of physical activity (Random = 0.27, [95%CI: 0.13–0.40], p < 0.00), and diet (0.16, [95%CI: 0.03–0.29], p = 0.02) aligned with the SDH while sleep (Random = -0.01, [95%CI: -0.16-0.14], p = 0.88), sedentary and screen time (Random = -0.01, [95%CI: -0.38-0.36], p = 0.95) did not align.
Conclusion:
Periods of greater structure were associated with more favorable physical activity and diet outcomes among children and adolescents with IDD, although evidence for dietary behaviors was limited. Findings support the relevance of the SDH in this population while highlighting substantial gaps in the literature, including small study numbers and methodological heterogeneity. Future research using rigorous, longitudinal designs is needed to better understand the relationship between structure and obesogenic behaviors among children and adolescents with IDD.
Digital Object Identifier (DOI)
Publication Info
Published in International Journal of Behavioral Nutrition and Physical Activity, Volume 23, 2026.
Rights
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver http://creativecommons.org/publicdomain/zero/1.0/ applies to the data made available in this article, unless otherwise stated in a credit line to the data.
APA Citation
Kiely, K. P., Brazendale, K., Hill, M., Burkart, S., Beets, M. W., Adams, E. L., Armstrong, B., St. Laurent, C., Hogan, A., White III, J. W., Finnegan, O., Culverhouse, J., Holmes, A., & Weaver, R. G. (2026). Obesogenic behaviors during structured periods among children and adolescents with intellectual and developmental disabilities: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 23.https://doi.org/10.1186/s12966-026-01881-5