So you gained five pounds in the last year; no big deal. It’s probably not enough for anyone to notice. But think about it: What’s five pounds a year? It’s twenty pounds in four years. Fifty pounds in ten years. One hundred pounds in twenty years! Were you planning to be around in twenty years? Imagine carrying 400 Quarter-Pounders around on your back every minute of your life. Yikes!

How Big a Problem?
Don’t get the wrong idea. Every SCI survivor is not becoming obese. In fact, according
to one study of almost 300 survivors ­ all injured between 20 and 50 years ago ­ the average weight gain was only about one pound a year. But, some individuals had gained as much as 20, 25, 30, or even 40 pounds in just three years. For them, and for others who do gain a lot of weight, the results can be very serious.
What happens when disabled people gain weight? All the same things that happen to
nondisabled people: They face a much greater risk for heart attacks, strokes and other
complications from clogged arteries, respiratory or breathing problems, diabetes, kidney and gall bladder diseases, arthritis and some kinds of cancer. Obese people become less active, and they may lose self-esteem.
And there’s more. Probably most important are all the “side effects” of obesity ­ side effects that plague the spinal cord injury survivor more than the nondisabled person­like loss of function, skin problems, decreased mobility, less independence, higher costs, and a decreased quality of life. Probably all of these problems occur sooner in the SCI survivor, and with less actual pounds gained.

Weight Gain Is a Big Deal
Why? Besides putting you at risk for some very real health poblems, excessive weight
gain can create other kinds of dilemmas­ones that only are magnified when the bigger body is paralyzed or weak.
First, there's the increased risk of injury you face if you're overweight. SCI survivors use their arms to do the work that legs once did, and arms start aching, paining, and giving out long before legs do. Research is showing that SCI survivors are at risk for shoulder pain, joint deterioration, even things like rotator cuff tears, simply because of the amount of stress they place on their arms. It's a problem that affects quads: A 1993 study found that over half of its participants with long-term quadriplegia also had pain in the shoulders. A few had it in the elbows, wrists and hands, too.
In addition to the risk of injury, there's also the risk your skin faces. If your bulkier body can’t avoid hitting that wheelchair tire when you transfer, or if you just can’t turn yourself in bed, your skin may pay the price. Excess weight also puts more pressure on the skin. As people gain weight, skin folds develop which trap moisture, greatly increasing the risk of skin sores.
Then there are the cost, comfort and convenience issues. A bulkier body may not fit in those awful, tiny airplane seats. Wide, first-class seats cost more. If you need to get a wider wheelchair, more doors, hallways and aisles will become inaccessible. Special equipment costs more. And, if you’re not able to do all of your own care, it’s harder on your attendant too. In fact, it may be even harder to find attendants. If attendants think that lifting you will cause them back problems, they won't be eager to sign on. Then you have another problem that may mean more $$$.

Does Anyone Ever Win the Battle of the Bulge?
Millions of nondisabled people struggle with unwanted weight. For SCI survivors, the struggle may be even harder. First, following spinal cord injury, the body’s metabolism changes; how we use food we eat and the fat we store is altered. In short, we use up less energy than we did before our injuries ­ and, the higher the level of spinal cord injury, the less energy we seem to need.
We also know that lean body mass­meaning muscle tissue ­ decreases after spinal cord injury. At the same time, the amount of body fat increases. In fact, much of the muscle tissue below the level of the injury may be replaced by fat. This happens even if you don’t look or feel like you’ve gained weight or gotten “wider.” This is partly because you're less active than before your injury, and partly because how your body itself works is changed by the injury. The result: It's much easier to become obese, even by overeating just a little.
This combination of changed metabolism and decreased muscle mass, along with an often lower activity level, means that even the "Ideal Body Weight" charts used by doctors and insurance companies may not be the best guides. Several authors have reduced those charts by 10-15%. Using their suggested guidelines, the average 5'4" spinal cord injured woman should weigh between 110-125 lbs.; the average 5'11" spinal cord injured man should weigh between 145-160 lbs. To figure your own ideal body weight, find your height and frame size on an insurance chart, and subtract at least 10% from the weight that's given.

What to Do…
Move past the denial. In one study of long-term SCI survivors, only half of those who had gained 20 or more pounds felt that their weight was a concern. The truth is that very few of us can afford to gain 20 pounds!
Weight control ­ not gaining in the first place ­ or, if necessary, weight loss, is what's needed.
The two standard components of responsible weight management are exercise and diet. They work the same for nondisabled people and for most people with SCI.
Yet for some people, especially those aging with overuse injuries, exercise can be a problem. It just may not be possible to maintain an exercise program capable of shedding excess pounds without risking new overuse injuries or aggravating old ones.

Diet, then is your basic tool, and a sensible diet, though difficult, is possible:

• Low fat, high fiber diets are best; some may need a little modifying if other medical conditions like diabetes, skin breakdown, or high cholesterol are problems. Some advice? Cut back on fat and empty calories like those found in alcohol, pop, and sweets.
• Fruit juices, too are a threat. If you drink quarts of cranberry or other juices every day, you’re getting too many calories from fructose. Don’t cut down on all fluids, just those full of calories.
• Eat two or three small meals each day. When you fast or routinely skip meals, your metabolism, which is already lowered by your SCI and lack of exercise, tends to be lowered even more. Result: you burn fewer calories and store more fat.
• Learn to read labels. Even foods labeled “fat-free” may not be low calorie. Fat-free bakery goods, for example, can be loaded with sugar. Keep track of your eating habits: Do you go back for seconds, even when you're not hungry? Do you snack while watching TV? These are behaviors you can change once they're identified.
• Many people eat because of stress, boredom, or anxiety. Finding others ways of dealing with these emotions is a way to deal with overeating.
• If you need more advice, or if you have other medical issues that might be complicating the picture, see a Registered Dietitian
  

Motivation:
People who are highly motivated can go straight to a strict low cholesterol, low fat, low-calorie diet. But most of us are better at negotiating: Keep the pie for dessert, but give up fast food burgers for lunch. Have that one beer with dinner, but then drink water instead of pop during the day. Pick one or two things you're willing to do, and stick with them. Add others later. Most motivated people, even those who don't­or can't­ exercise, still can lose weight with diet alone. Finding that motivation is up to you.

Resources:
You can call:

• the Consumer Hotline at the American Dietetic Association (800 366-1655)
• the National Dairy Council (800 426-8271)
  

Or write to:

• the Food & Drug Administration, Consumer Affairs, H7E-88. 5600 Fishers Ln. Rockville, MD 20857
  
• American Heart Association, National Center7320 Greenville Ave. Dallas, TX 75231
  

This is one of more than 20 educational brochures developed by Craig Hospital while it was a federally-funded Rehabilitation Research & Training Center on Aging with Spinal Cord Injury. The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.

For a hard copy of a METS brochure, click on your selection above and hit the "print" button on your browser. If you'd like to ask for one directly from Craig Hospital, you can contact us by telephone at 303-789-8202, or you can e-mail us at HealthResources@craighospital.org.