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Spinal Cord Injury and Obesity Sam Ho & Glen W. White, Ph.D. Research and Training Center on Independent Living at the University of Kansas This training sponsored through a grant from the Christopher and Dana Reeve Foundation Special thanks to… • The Christopher and Dana Reeve Foundation • Centers for Disease Control • Ann Sullivan Center of Perú • Dra. Liliana Mayo and Staff members • Scott Richards, Ph.D. – Spain Rehabilitation Center, University of Alabama at Birmingham • Suzanne Groah, M.D., M.S.P.H. – National Rehabilitation Hospital, Rehabilitation Research & Training Center on Secondary Conditions in the Rehabilitation of Individuals with Spinal Cord Injury Special thanks to… • Sam Ho • Jaime Huerta • Monica Ochoa • And special thanks to Julio Chojeda for translation of materials from English to Spanish… Acknowledgement of sources used for this presentation: Deconditioning & Weight Gain – RTCIL Overweight & Obesity - CDC What are Overweight and Obesity? – NHLBI Clinical Assessment and Management of Obesity in Individuals With Spinal Cord Injury: A Review Nutrient Intake and Body Habitus After Spinal Cord Injury: An Analysis by Sex and Level of Injury Nutrition Guidelines for Individuals with SCI – University of Washington National Center on Physical Activity and Disability Measuring Height Without a Stadiometer Documenting Disparities in Obesity and Disability Presentation Review • Define Obesity • Describe Causes of Obesity • List Risk Factors for Obesity • Detail Diagnosis of Obesity • Examine Consequences of Obesity • Discuss Deconditioning • Learn How to Prevent Obesity What is Obesity? • Obesity is the condition defined by having a high amount of extra body fat. • “Overweight” and “obese” are not equivalent terms. Cause of Obesity • The general, underlying cause of obesity is a lack of ENERGY BALANCE. • This means that one consumes more energy from food and drink than they use through metabolism and physical exertion. Excessive Caloric Intake • One contributor to energy imbalance is consuming too much energy from food and drink. Either by: – Eating too much food AND/OR – Eating high calorie, high fat foods Insufficient Caloric Output • The other contributor to energy imbalance is not burning enough energy due to any of the following: – A low basal metabolic rate (BMR) – Being generally inactive – Not engaging in regular exercise What is a calorie? • The dietary calorie is the amount of energy it takes to raise the temperature of 1 kilogram of water 1° Celsius. – 1 gram fat equals 9 calories – 1 gram protein equals 4 calories – 1 gram carbohydrates equals 4 calories • One pound of fat is equivalent to 3500 calories. Who is at risk to be obese? • EVERYONE! – In Peru: • 26% of males are obese • 24% of females are obese • Wheelchair users are at an even greater risk for obesity Personal Risk Factors • Unhealthy diet – High calorie – High fat • Lack of exercise – Lack of motivation – No access • Paralysis – Makes exercising difficult – Deconditioning Personal Risk Factors • Stress – Can lead to overeating – Convenient foods aren’t always healthy • Insufficient sleep – Leads to imbalance off appetite hormones • Increased ghrelin • Decreased leptin Personal Risk Factors • Aging – Slower metabolism – Decreased muscle mass • Genetics – Disposition to slower metabolism – Mutation in leptin receptors Environmental Risk Factors • Lack of accessible locations to exercise • Not knowing how to exercise in a wheelchair • High cost of exercise facilities • Lack of transportation to exercise facilities • Busy work schedules – Stress – Loss of sleep • Lack of access to healthy foods Deconditioning • Deconditioning is the sum of the changes to the body’s organ systems as a result of inactivity. – i.e. The loss of fitness • A decrease in activity following a spinal cord injury can cause deconditioning. • Deconditioning can be reversed through exercise, proper nutrition, and adequate rest. Deconditioning • One important aspect of deconditioning is the loss of certain muscles’ abilities to do physical work. • This can happen in any muscle that isn’t exercised regularly (including the heart). Diagnosis of Obesity • • • • High Body Mass Index Skin fold thickness test Weight gain Increasing waist circumference Body Mass Index • Body Mass Index (BMI) is an estimate of body fat calculated from one’s height and weight. • The formula for BMI is: BMI = Weight (in kg)/[Height (in m)]² Body Mass Index • BMIs correspond to the following categories: Body Mass Index Category Below 18.5 Underweight 18.5-24.9 Normal Weight 25.0-29.9 Overweight 30.0-39.9 Obese 40.0 and above Extremely Obese Body Mass Index • BMI is not perfect in diagnosing obesity – Difficulty of measurement – Loss of weight due to atrophy • For people with SCI the BMI above 22.0 is usually considered overweight • Body fat percentage is often a better tool Skin Fold Thickness Test • Used to measure body fat percentage • Calipers measure thickness of skin folds at certain points on the body • Is not perfectly accurate • IS a good tool to see weight gain or loss over time Effects of Obesity • Those who are overweight or obese have a higher likelihood of developing: Heart disease Stroke Type 2 diabetes High blood pressure High cholesterol Osteoarthritis Gallstones Sleep apnea Liver disease Gallbladder disease Gynecological problems Certain cancers (breast, colon, endometrial) Chronic inflammation Effects of Obesity for those with SCI • Increased risk for pressure sores • Adds difficulty to transferring into and out of wheelchair • Increased joint pain • Suppressed respiratory system – heavy breathing – wheezing Prevention/Treatment • Maintaining a healthy weight is dependent on: – Eating a healthy diet – Exercising regularly – Getting plenty of sleep – Staying hydrated Diet • Wheelchair users tend to have a lower metabolic rate than their counterparts who don’t use wheelchairs • Someone with SCI should consume less calories than would normally be suggested based on their age, weight, and sex. • It is often helpful to keep a food diary of everything one eats and drinks, along with their caloric content. Daily Calorie Needs • A good approximation for calories needs is based on one’s ideal weight. – For those with paraplegia it is suggested that they eat 27.9 times their ideal weight (in kg) calories per day. – For those with quadriplegia it is suggested that they eat 22.7 times their ideal weight (in kg) calories per day. • Ideal weight can be determined using one’s height and their target BMI. Source: University of Washington Example • How many calories should a 170 cm male with paraplegia eat daily to maintain a healthy weight? 1. What BMI should they aim for? • 21.9 is the upper limit of the “Normal” range [for people with SCI] 2. What is their ideal weight? • • 21.9 = (Ideal Weight) / (1.70 m)² Ideal Weight = 63.29 kg 3. How many calories should they eat per day? • 27.9 x 63.29 kg = 1766 calories Fat • One aspect of good nutrition is having a diet low in fat. • As a general rule, calories from fat should not exceed one quarter of one’s total calories. Vitamins & Minerals • It is also important – not just for maintaining weight – that people with SCI get enough vitamins, minerals, and fiber in their diets. • Due to lower caloric intake, it is often difficult to acquire all required nutrients. • So people with SCI need to make their calories count. Food Pyramid Food Pyramid Food Group Grains Vegetables Fruits Dairy Meat & Beans Daily Suggestion 6 ounces 2.5 cups 2 cups 3 cups 5.5 ounces Exercise • Being in a wheelchair necessitates some creativity when it comes to developing an exercise regimen. • However, there are several ways in which an individual with SCI can stay physically active. Wheelchair Exercises • Wheelchair pushups – help with pressure relief as well • Resistance bands • Latex stretch bands Wheelchair Pushups • Make sure brakes are on • Each hand on arm rests (or wheels if no armrests) • Push down extending both elbows, elevating body from seat • Elevate buttocks from wheelchair surface 3 seconds or longer Resistance Bands/Latex Stretch Bands • Chest press – Band behind back • Shoulder press – Band under wheelchair • Bicep curl – Band under wheelchair Wheelchair Accessible Exercise Equipment • Arm ergometers (handcycles) • Multi-gym pulley systems • Free weights – Milk jugs full of water – Canned goods Wheelchair Sports • • • • • Basketball Tennis Handcycling Track & Field Dancesport Areas to Focus On • Flexibility – Decreased risk of muscle tears • Posture – Decreased risk of pressure sores • Range of Motion • Building strength Tips for Starting an Exercise Regimen • Make sure to warm muscles up before exercising and stretch afterwards • Gradually increase the length and frequency of your workout sessions • Stay hydrated • Log when and how long you exercise • DO NOT exercise seven days a week – Exercise strenuously AT MOST 5 days a week Sleep • Sleeping the 7 to 9 hours a night recommended by doctors is another important factor in maintaining a healthy weight. Weight Control Measures to AVOID • • • • Fasting Laxatives Stimulants Smoking to reduce appetite Review of Today’s Session Today we: • Defined Obesity • Described Causes of Obesity • Listed Risk Factors for Obesity • Detailed Diagnosis of Obesity • Examined Consequences of Obesity • Discussed Deconditioning • Learned How to Prevent Obesity