Transcript CDC What are Overweight and Obesity?

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