A quick guide to keeping your weight under control.
By Patricia Gottschalk, RD
Weight management is an ongoing quest undertaken by millions of people in North America. For individuals with a spinal cord injury (SCI) or other mobility impairment, weight management is both more important and more difficult.
Why Is It More Important?
- • Studies have shown that people with SCI are more prone to diabetes, dyslipidemia and cardiovascular disease than the general population. This may be linked to a sedentary lifestyle or the presence of central obesity (as measured by waist circumference).
• Carrying excess weight makes tasks like transferring much more diffi cult. In effect, being overweight can limit your independence.
• If you gain weight, you may outgrow your wheelchair. Purchasing a new chair is a major expense, to be avoided if at all possible.
Why Is It More Difficult?
Individuals with a spinal cord injury require fewer calories. A person’s resting energy requirement or Basal Metabolic Rate (BMR) is the energy required, when the body is at rest, to support all the basic metabolic functions. Because those with SCI lose muscle mass and the remaining muscle is denervated, they have less metabolically active tissue. This means that, even when sleeping, they use less energy than someone without an SCI. There is insuffi cient evidence to support an exact amount, but studies show that this reduction in BMR is anywhere from 7%-55%. Actual energy requirements vary with age, sex, weight, height and activity level, and can be accurately determined only by using indirect calorimetry, commonly available only in research settings. Your weight will be stable when Energy In (i.e. calories consumed) = Energy Expended (i.e. calories used). To lose weight, you have to either limit calories consumed (eat less) or expend more energy (do more), or some combination of the two. For many with an SCI, the ability to increase activity is somewhat limited. This makes the focus on diet even more important.
What is a good diet?
• It is fairly easy to lose some weight by following a restrictive, very low calorie diet for a brief period of time. This may help you meet a short-term goal of immediate weight loss. However, it may be diffi cult to follow for the long term, and may not be a healthy diet.
• The most successful “diets” result in lifestyle changes that modify portion sizes, cooking methods and food choices. A healthy meal plan includes all the food groups. The results may be slower to realize, but the effects will last a life time.
Special considerations for SCI:
- • Fiber is essential for bowel regulation. To follow a consistent bowel routine, it is important to regulate the type and amount of fi ber in the diet. How much and what type depends on the individual, but if you have a system that works for you, it is best to continue. Soluble or viscous fi ber (examples are oats, psyllium, apples and bananas) adds bulk and softens the stool, but does not necessarily help with evacuation of the bowel. Insoluble fiber (for example wheat bran) also adds bulk to the stool, but also speeds transit time through the gut and aids in elimination. Fiber comes mainly from cereals and grains, fruits and vegetables. It is tempting to eliminate “carbs” to try to lose weight, but whole grains have the most concentrated amounts of fi ber. Include two to three servings of a high fiber cereal or grain product daily while trying to lose weight.
• Fluid is required for several reasons. First, adequate fluid is needed to promote optimal kidney function. Fluid also works with fiber and acts like a sponge, holding fl uid and thus softening the stool. A high fi ber diet with inadequate fluid may increase constipation. As you lose weight by breaking down fat, fluid helps get rid of the by-products from this activity. As with fiber, the exact requirement for fluid varies from one person to another. As a general rule, try drinking at least 8-10 cups of fluid a day. Water is always the best, but when trying to lose weight, avoid the higher calorie fluids, especially those that provide no nutritional value, such as regular soda.
• Calcium is needed for bone health. When we are unable to perform weight bearing or resistance exercise, we are less effi cient at depositing calcium into our bones, and may develop osteoporosis. Dairy products are the best food source of calcium. Consider including 3 servings of low fat milk products daily, even when dieting. If you need to cut back even more, be sure to include a calcium supplement.
• Fat is the most concentrated source of calories. When watching your weight, try to reduce added fat by avoiding fried foods, choosing lean meats and low fat dairy products and avoiding baked goods. The saturated fat in these foods can lead to elevated cholesterol levels. Using low fat salad dressings and limiting the use of butter and margarine or vegetable oil to about 1 teaspoon per meal are ways to decrease fat intake.
• Protein is essential to maintaining skin integrity. The target is 1 gram/kg body weight per day and more protein may be necessary to promote wound healing. Speak to your doctor before initiating a high protein diet because excessive protein intake may contribute to kidney stones.
When not to diet It is not a good idea to try to lose significant amounts of weight when your body is trying to cope with added stress.
Examples are:
- • Wound healing requires a significant amount of protein (1.2-1.5 g/kg/day) and enough calories to ensure that the extra protein you are eating gets used for healing, not for energy.
• Fighting infection is hard work, and your body will require adequate energy.
• When preparing for surgery, focus on weight maintenance to prevent you from becoming malnourished. Studies have shown that people who are better nourished when surgery takes place have faster healing, fewer complications and shorter hospital stays.
This doesn’t mean you can’t modify your intake in the situations listed above. While it is not a good idea to strive for significant weight loss during these times, you can ensure that you are eating a healthy diet, but refraining from gaining weight. A slight weight loss of 1-2 pounds per month would be acceptable in most situations.
How do you know if a diet is working for you?
- • You are losing 1 to 4 pounds a month.
• You have enough energy to do the things you have always done.• Your bowel is functioning well.
• Your urine is clear.
• Above all, you are happy with yourself!
Patricia Gottschalk, RD, is a dietician at Lyndhurst Centre, Toronto Rehab in Toronto, Ontario.
