Spinal Cord Injury Update

Summer 2008: Volume 17, Number 3

Weight Management after Spinal Cord Injury

By Suparna Rajan, PhD, Catherine Warms, PhD, ARNP, and Barry Goldstein, MD, PhD

Being overweight is a common problem for people with spinal cord injury (SCI). Some research shows that two out of three people with SCI are overweight. Excess weight gained after SCI is difficult to lose, and it is hard to maintain weight over time and avoid putting on extra pounds. In part this is due to a reduced ability to move freely. The higher the injury, the more difficult it is to move, stay active, and exercise. A person with a cervical SCI will have more difficulty moving compared to someone with SCI in the lower spine. The same is true for the completeness of an injury. A person with an incomplete injury who is able to walk will likely burn more calories than a person who has a complete injury and uses a wheelchair full time.

Body fat basics

Excess fat affects overall health and increases risks for chronic conditions, including high blood pressure, diabetes and sleep apnea. Weight gain can also make it harder to transfer and push a manual wheelchair. Besides total fat, the location of fat in the body in people with SCI may also be important. Body fat is located both under the skin and inside the abdomen (intra-abdominal or visceral fat). As in the general population, some people with SCI carry excess fat in their midsection (abdominal fat), which may further increases risk for many health problems. So, just knowing your weight isn’t enough; you need an estimate of body fat.

How is body fat estimated?

For many years, reference tables showing the ideal weight for a given height have been used in SCI. In general, clinicians and researchers believe that people with SCI should ideally weigh 10% less than people of similar height who do not have SCI. However, this is an estimate. Ideal weight standards have not been developed for people with SCI.
Body Mass Index (BMI), a measure of weight in relation to height, has been a popular tool to estimate body fat. BMI calculators are available on the Web (http://www.nhlbisupport.com/bmi), and anyone with a BMI over 25 is considered to be overweight. Because of the differences in active muscle and body fat distribution after SCI, however, using BMI cut-points established for able-bodied individuals may underestimate body fat.
Measuring the distance around your waist or neck using a tape measure provides an estimate of fat in the upper body. A waist circumference over 40 inches in men and over 35 inches in women may increase chances of developing health problems and can help gauge the extent of excess body fat in SCI.

In general, measurements developed for the non-disabled public to determine if a person is overweight probably do not apply to persons with SCI. More research is needed.

Weight loss methods for SCI

There is some research evidence that people with SCI can achieve weight loss safely. A 12-week weight loss program using a combination of diet, physical activity and behavior modification techniques in a group of 16 people with SCI resulted in weight loss and improvements in BMI, waist and neck circumference, total fat mass, diet behavior, and measures of psychosocial and physical functioning (Chen et al., 2006). This was a small study, however, and more studies are needed.

There are other medical and surgical treatments for obesity that have been used in people who do not have SCI. Medications are sometimes prescribed but many side effects, some of which were serious, have been reported. Surgical procedures for treating obesity also have known complications. Research is needed to determine if these strategies are safe and effective for weight loss in persons with SCI.

Currently, little is known about obesity management in SCI. While it is widely assumed that weight management is difficult following SCI, there has been little weight-loss research in this population so far, and health care providers often cite examples of people with SCI who have maintained a healthy weight following SCI or lost weight gained following injury.

What have you tried?

We are interested in learning more about what people with SCI do to lose or maintain weight, and what strategies have or have not worked. To do this, we are conducting a research study asking people with SCI about weight management. Any person with SCI is eligible to participate in this survey. The survey can be completed by yourself or with assistance from others.

For more information about this research study, see our SCI Weight Management Study announcement at: http://sci.washington.edu/info/newsletters/articles/08_sum_weight_study.asp.

Resources

Eat Right Home-Based Weight Management Program for Individuals with SCI, a 12-week program from the University of Alabama, includes a video and workbook. Web site: http://www.spinalcord.uab.edu/show.asp?durki=77527&site=1021&return=2158; phone: 205-934-3283.
National Center on Physical Activity and Disability (NCPAD) is an information center on physical activity for persons with disabilities. Web site: http://www.ncpad.org; phone: 800-900-8086.
Nutritional Guidelines for Individuals with SCI, UW SCI Forum presentation. Read the report or watch the video at http://sci.washington.edu/info/forums/reports/nutrition.asp.
Centers for Disease Control and Prevention (CDC) general information about physical activity and nutrition. Web site: http://www.cdc.gov/nccdphp/dnpa/physical; phone: 800-311-3435.

References

Buchholz AC, Bugaresti JM. A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury. Spinal Cord. 2005 Sep;43(9):513-8.
Chen Y, Henson S, Jackson AB, Richards JS. Obesity intervention in persons with spinal cord injury. Spinal Cord. 2006 Feb;44(2):82-91.
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, Md: National Heart, Lung, and Blood Institute; 1998. NIH publication 98-4083.