Answers On Weight

Reprinted from PN/Paraplegia News February 2013

No one wants to be obese, and knowing how and why we gain weight goes a long way toward staying healthy.

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Most people with spinal-cord injury (SCI) know they have unique health concerns. They also know it’s important to have answers to questions about preventing or managing health problems.

Weight gain is a serious health concern. The problem is that most people with SCI don’t know the facts about obesity. They need questions answered!

How Do I Gain Weight?

Everyone’s weight is largely dependent on body metabolism.

Simply put, your metabolism is the way your body converts the food you eat into the energy your body burns to function. You gain weight if you eat more calories than you burn. You lose weight if you eat fewer calories than you burn.

Most people with SCI aren’t as active after injury as they were before. This inactivity is largely due to limited mobility, so those with higher levels of injury tend to be less active than individuals with lower levels of injury.

People who are less active need fewer calories to function. People gain weight when they don’t lower their calorie intake to match their lower calorie needs or increase their activity level to burn more calories.

If these adjustments aren’t made, people become overweight and obese as they lose muscle and develop excess fat.

Am I Overweight or Obese?

The Body Mass Index (BMI) is commonly used to measure body fat.

If you search the Internet for “BMI calculator,” you can find free online programs that provide your BMI using your height and weight. You can calculate your BMI score using a simple mathematics formula.

A BMI score between 20 and 25 is a healthy range. A score between 25 and 30 is in the overweight range, while numbers 30 and above indicate obesity.

Your BMI score is a basic indicator of health. Being overweight usually means you have more body fat than you need for the best overall health. Being obese usually means you have an unhealthy amount of excess body fat.

How Accurate Is the BMI?

There is currently no clear-cut estimate on how common obesity is in the SCI population. If you look at research that uses the BMI, results suggest that more than half of the SCI population are obese.

However, BMI may not be an accurate measure for people with SCI.

A pound of muscle is smaller than a pound of fat, so muscle takes up less space in the body. This means two people can weigh the same, but the person with more muscle is going to be slimmer.

BMI does not distinguish between muscle weight and fat weight, but research suggests this is an important difference when measuring body fat on people with SCI.

On one hand, research using BMI suggests more people with paraplegia are obese when compared to those with tetraplegia. However, research that looks specifically at fat shows more people with tetraplegia have an unhealthy amount of excess body fat when compared to those with paraplegia. This suggests people with paraplegia usually have more of the heavier muscle mass, and people with tetraplegia usually have more fat.

Am I Obese?

A Four Compartment Model seems to be the most reliable way to identify obesity.

This test measures total body fat, mineral, water and protein to determine if a person is obese. However, most people do not have access to this method of testing.

Waist size is probably the best measure of obesity for people with SCI. People who are obese usually have fat around the waist. This type of fat is linked to greater obesity-related health problems. This is true even if BMI falls within the normal range.

You can measure your waist size by placing a measuring tape around your abdomen (place the tape at your upper hip bone and measure horizontally). The risk for obese-related health problems is higher for people with a waist size greater than 40 inches for men and 35 inches for women.

How Does Obesity Affect Health?

The Centers for Disease Control and Prevention (CDC) collects research results on obesity in the general population.

The CDC reports that obesity is associated with a higher risk for a broad range of health problems:

-  Coronary heart disease

-  Type 2 diabetes

-  High blood pressure

-  High cholesterol

-  Gall bladder disease

-  Liver disease

-  Stroke

-  Reproductive health issues

-  Obstructive sleep apnea

-  Cancers


Not only do people with SCI have the same higher risk for health concerns associated with obesity as people in the general population, but they also have a higher risk for additional medical conditions:

-         Pressure ulcers

-         Urinary tract infections

-         Pain

-         Spasticity

-         Pulmonary embolism

-         Deep vein thrombosis

-         Carpal tunnel syndrome (observed in people who are obese and push a manual wheelchair)


Additionally, excess weight often limits physical mobility, so people with SCI who are obese are less likely to participate in community activities.

Social inactivity can negatively affect physical and psychosocial well-being along with quality of life.

How Do I Improve My Health?

The goal is to reduce obesity while maintaining or increasing lean mass.

Diet alone may result in a reduction in calorie intake, but there may be a loss in muscle mass. Physical activity alone may improve muscle mass, but the physical activity may not be enough to burn more calories to counterbalance caloric intake.

It’s the combination of diet and physical activity that appears to be the answer for people with SCI.

For more information, talk with your doctor or visit


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