People with mobility impairments are especially at risk in the war on obesity. Here’s how you can use the food you eat to win the battle.
By Linda A. Cronin
No matter where they live many Americans face a battle every day. Everywhere we turn, we see the headlines: Americans Becoming Fatter, The Most Obese Nation, First Lady Declares War on Obesity. If the US continues on this path, children today will have a shorter lifespan than their parents. And when it comes to managing their weight, people with spinal cord impairment or disabilities (SCI/D) often face an even bigger problem.
The majority of people with SCI/D initially lose weight upon their injury because of the trauma to the body and a sped-up metabolism. But over time, the metabolism slows down again and changes. After SCI/D, how a person’s body uses food and stores fat is altered. A person’s body uses less energy after injury than before, and the higher the injury, the less energy needed. Also, lean tissue mass/ muscle decreases after SCI/D, while the amount of fat increases. According to information by Craig Hospital in Denver, fat replaces much of the muscle below the level of injury, making it much easier to become obese or overweight.
Pounds Adding Up
I know 5 pounds doesn’t seem like much. It never does to me. But if you gain 5 pounds this year and 5 pounds next year and the year after, four years later, you have gained 20 pounds; in 10 years, 50 pounds.
But don’t get overwhelmed. According to the CDC, no matter what your weight loss goal is, even a modest reduction in weight—5 to 10% of your body weight—is likely to produce health benefits, such as improved blood pressure, blood cholesterol, and blood sugars. While you still may be overweight or obese, a modest weight loss can help decrease your risk of chronic disease.
And those risks are many. People who are overweight face a larger risk of high blood pressure, heart attacks, strokes, respiratory or breathing problems, kidney and gallbladder disease, arthritis and some types of cancer. In addition, people with SCI/D can face a loss of mobility, increased risk of pressure sores, increased risk of injury, loss of independence, and decreased quality of life. As people gain weight, their skin develops folds which gather moisture also increasing the risk of skin sores.
So what can you do? The first thing is to educate yourself and determine if you need to lose, maintain, or gain weight. To do this, you must determine your current weight. You may need to go to rehab hospital, a community hospital, or a doctor’s office, someplace with a roll-on scale. Weigh yourself in the wheelchair and then subtract the weight of the wheelchair. As time goes by, we all know when we are gaining or losing weight by how our clothes fit or by measurements taken with a tape measure. But to start, you should get an actual weight to determine where you are.
Ideal Weight?
How much should you weigh? For people with SCI/D, traditional weight charts don’t apply, explained Vickeri Barton, RD CD Nutritionist, Harborview Medical Center at a SCI/D Forum. (SCI/D.washington.edu/info/forums/reports/nutrition.asp) She stated that to compensate for reduction in muscle mass to determine a proper weight range for people with SCI/D., the general rule is to subtract 5 to 10% for paraplegia and 10 to 15% for quadriplegia from traditional weight charts.
Body Mass Index (BMI) also needs to be considered. This is a calculation of how much fat a body has and is just as important as total weight. Unfortunately, there are no charts that I could find that specifically refer to people with disabilities or SCI/D. There are many websites that have traditional BMI calculators. One can be found at www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html Barton explained that traditional BMI charts often underestimate the amount of fat a body has after SCI/D. Perhaps a nutritionist, a physical therapist, or a doctor can help you determine your amount of body fat and calculate your BMI.
It is also important to determine how many calories you need each day when trying to gain, maintain, or lose weight. According to Apinder Grewal MS RD, Senior Registered Dietitian, Kessler Institute for Rehabilitation, a calorie intake of 23 calories/kg per day is recommended for a person with quadriplegia and 28 calories/kg per day for a person with paraplegia. A kilogram is equal to 2.2 pounds. If you are already overweight, your calculation should be based on your ideal body weight. Grewal explained, that to lose a pound a week, you must increase energy spent or cut calories from your diet equal to 3,500 calories.
And to gain a pound, you must add 3,500 calories. This equals about 500 calories a day. Do not try to cut back the calories too rapidly, and be careful to not let your daily intake get below 1,500 calories. According to the CDC, people who lose weight gradually and steadily are more likely to keep it off than those who go on a crash diet. The key is to cut calories in a way that works for you while maintaining a healthy diet.
Healthy Eating and Exercise
What is a healthy diet? No one food supplies all the nutrients you need for a day. A healthy diet emphasizes fruits, vegetables, whole grains and low-fat or fat-free milk and dairy products. It includes lean meats, poultry, fish, eggs, beans and nuts. And it is low in saturated fat, trans fat, cholesterol, sodium, and added sugars, stated Grewal. More specific information is available at www.mypyramid.gov.
When you are trying to lose weight, remember fad diets do not work. A successful diet supplies a balance of nutrients and is something that can be maintained over time. We’ve all heard of the cabbage soup diet, the cookie diet, the juice diet etc. but while you may lose weight in the short term, when you return to your old ways of eating so does the weight.
To live a healthy life and especially when you’re trying to lose weight, you must remain as active as physically possible. If you use a manual chair, pushing the chair throughout the day can help you burn calories and remain active. For those who are able, aerobic arm exercise can help. If you can exercise, it’s important to do so, but if you cannot, don’t despair. You can still control what and how much you eat. As a power wheelchair user and one who cannot exercise, I know it’s more difficult to lose weight but it is not impossible. It all comes down to taking in fewer calories than you use. It may be a good idea to contact a registered dietitian for a consultation and nutrition education. They can help you create an eating plan you can stick to over time. Registered dietitians are dietitian that have passed the American Dietetic Association (ADA) competency exam and are known as Registered Dietitians (RD).
Many dietitians are also licensed or certified by individual states, stated Grewal. On the website of the ADA, (www.eatright.org/) is a link you can press to find a registered dietitian in your area. Keep an eye out for weight loss tips in the coming months.
Linda A. Cronin is a freelance writer and poet. Her first book of poems, Dream Bones, is available from WordTech Editions at amazon.com and barnesandnobles.com. For more information on Linda and her writing and poetry go to www.lindacronin.net .
