Obesity has already been declared an epidemic. More than 72 million people, which is more than one-third of adults, are obese in America. The demographic few talk about, however, are people with disabilities.
Staying fit is a rarely discussed challenge for disabled people, despite people with intellectual or learning disabilities and mobility limitations being the most prone to being overweight or obese.
For this piece, the conversation will be different. We’ll look at how weight gain affects people with disabilities, what factors contribute to their weight gain, and how it can be managed.
What Defines Being Overweight or Obese?
Overweight or obese are used to describe weight ranges greater than what is generally considered healthy for a given height. These terms also identify the ranges of weight that research has shown increases the likelihood of certain diseases and health problems.
Body Mass Index
The body mass index (BMI) calculates overweight and obesity ranges. This number typically correlates with a person’s amount of body fat.
For adults, a BMI between 25 and 29.9 indicates you’re overweight. A BMI of 30 and above is considered obese.
Among children, the CDC defines overweight as a BMI at or above the 85th percentile and lower than the 95th percentile on the CDC growth charts. Any child with a BMI at or above the 95th percentile is considered obese.
People with Disabilities
For people with disabilities, the standard methods for calculating a person’s ideal weight or BMI don’t always apply.
For instance, someone with a physical disability may weigh less than recommended for the general population. However, the person may not be underweight or overweight when the reduced muscle mass in the arms or legs is considered.
It is thus advisable to see a doctor or dietician to fully determine whether the weight is at the acceptable range given the underlying condition.
Waist circumference is often used to assess health risks based on weight. It measures the amount of fat carried around your middle and is at times used together with BMI.
Generally, a higher waist measurement indicates a higher health risk.
However, most doctors and dieticians don’t rely on it alone as it can provide inaccurate results. For instance, some patients with underlying medical conditions such as an enlarged abdomen will have a larger waist circumference but not necessarily a high BMI to make them obese or overweight.
In Australia, the NHS classifies waist circumference into 3 categories for men and women. There is “not at risk,” “increased risk,” and “substantially increased risk” of developing chronic conditions.
The NHS uses different cut-offs for men versus women. In most cases, those in “increased risk” and “substantially increased risk” categories are grouped under “increased risk” or “very high risk.”
Factors That Make People with Disabilities More Prone to Weight Gain
A few key factors contribute to higher obesity rates among disabled people.
Certain medications keep weight on, making it difficult for people with disabilities to lose weight. These medications include antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and sedatives.
Genetics and the patient’s environment may also determine how much weight they gain from medication.
People with disabilities that affect their mobility often suffer from pain which hinders their physical activity. Achieving balance is difficult for most of them, and unanticipated weight shifts can be dangerous.
Therefore, going out to the gym, taking a walk, or even going out shopping at the grocery store can be a real challenge.
Poor Access to Equipment and Facilities
More needs to be done to make certain areas and equipment more accessible to disabled people.
For instance, a good mobility scooter can help a disabled person with physical pain perform a few physical exercises. However, poorly designed scooters can cause a fall and further damage to the person.
Most parks and gyms are also inaccessible to people with disabilities. For instance, some gyms are located on top floors that can only be accessed via the stairs. The elevator or lifts may also not be friendly to the disabled.
Disabled people can have trouble cooking which makes maintaining a healthy diet difficult. Silverware, glasses, and plates usually rest in cupboards and different places at different heights around the kitchen. Accessing them becomes rather difficult.
Most grocery stores also don’t cater to disabled customers. Those experiencing physical pain may need some places to sit down as they do their shopping.
With such facilities missing and accessibility within the kitchen being a challenge, take-outs are the safest option for the disabled. However, they are not healthy.
There’s a strong link between being overweight or obese and decreased income or deprivation within the general population. In the Health Survey of England, the study revealed that 39% of women in the second-lowest household income were obese compared to 17% in the highest-income households.
However, this effect was not seen in men.
18% of the children from low-income households were also obese compared to 9% in the highest-income households.
Disability affects a person’s income. Having a disability of any kind can make you or your family more prone to living in poverty, which can counterintuitively make you more prone to obesity.
Underlying Health Problems
Studies have found links between certain underlying conditions or syndromes and increased risk of obesity.
One study shows that individuals with Down Syndrome (DS) have an increased risk of obesity. They also have an increased prevalence of diabetes, increased risk of cardiovascular disease, and poorer serum lipids1.
This affects both children and adults, with DS patients having more body fat than others.
Other factors such as lower metabolic rate, delayed development, lower muscle tone, which affects physical activity, and endocrine problems such as hypothyroidism make Down Syndrome patients more likely to gain weight.
On the other hand, Prader-Willi Syndrome (PWS) leaves individuals with an overwhelming desire to eat or a constant feeling of hunger. This rare genetic condition is often challenging for carers and parents to manage.
Moreover, children and adults with PWS have a reduced muscle tone, a shorter stature, and behavioral problems that make sticking to a healthy diet difficult. This makes them more prone to obesity and other underlying conditions.
How to Bring Up the Conversation
It can be challenging bringing up a weight conversation with someone you’re taking care of. You don’t want to come across as fat shaming.
Moreover, people with learning disabilities have varying degrees of ability, comprehension, and support. Some may be unable to cook, have no control over their shopping habits, may not live near food shops, or may have limited access to kitchen equipment.
It would be best to be very practical when bringing up the conversation and formulating a plan.
The critical thing is making them understand the health risks of being overweight or, in some cases, underweight. This conversation should also be had with any caregivers or support workers. This will allow them to make lifestyle changes necessary to manage weight gain.
Moreover, you need to ensure that the conversation and plan you formulate are within your rights, especially as a caregiver.
Most people with disabilities are protected by laws that give them decision autonomy, not unless, following an assessment, they have been judged to be incapable of making decisions.
The caregiver or parents should also be aware of proper dietary or physical exercise habits that would help weight loss for the disabled person. That would make the entire exercise productive and effective.
Setting goals will go a long way in making yourself or the person with a disability more comfortable and more prepared to tackle the lifestyle changes needed to manage weight gain.
People with learning disabilities, for instance, have a challenge communicating or learning new skills. Start by discussing the weight management goals with the individual.
You can use resources such as “easy read” leaflets on diet and exercise for people with learning disabilities to pass the information more effectively.
When setting goals, ensure you’re realistic about what you want to achieve. Sometimes, preventing further weight gain may be the more realistic goal than weight loss. Your environment will also play a massive role in setting these goals.
Ways to Manage Weight Gain
It is critical to start managing your weight gain to see any tangible results. The following are a few things you can do.
This cliché advice still works effectively. However, for people with disabilities, the approach is slightly different.
Plan your meals a week in advance, with the support of a caregiver. If the disabled person is mentally or intellectually challenged, plan for them or with a caregiver or support worker.
You can even use pictures if reading is a problem.
Focus also on the snacks eaten between meals. Go for healthier choices such as fruit instead of biscuits or sugar-free squash instead of sugary drinks.
If take-outs are the most common option, try making healthy choices from the menu. You can seek help from the staff to get healthier meals to eat.
Also, take note of your portion size, or ask the support worker or caregiver to encourage smaller portions at mealtimes. You can have a half-plate-full of vegetables or salads at mealtimes.
A dietician or general practitioner may also advise on the best foods to take based on medication.
Annual Health Checks
You can have a general practitioner check for any medical issues causing the weight gain. They may recommend different medications if the ones prescribed affect your weight.
You can have a person with learning disabilities registered on the GP’s learning disability register in Britain. Registered learning disability patients get annual health checks where weight issues are discussed.
Physical exercise is vital in managing weight. For overweight individuals, physical exercise helps burn calories. For underweight individuals, physical exercise stimulates appetite that helps in weight gain.
Start participating in physical activities that you enjoy and fit your routine. If you need help or the person you’re taking care of needs help, make sure you’re available for support and ensure that the physical exercises are done.
Mobile adults aged 19 to 64 should be active every day, with at least 30 minutes of moderate-intensity aerobic activity. These activities can be cycling or fast walking. It is advised that you follow this regime for at least 5 days a week.
For the disabled, these activities can be broken down into smaller, manageable chunks. For instance, you can have three short 10-minute walks to cover the 30-minute quota for the day.
In Britain, organizations such as Special Olympics Great Britain give people with learning disabilities opportunities to get involved in sports and live a healthier lifestyle. In the US, the Special Olympics offers many ways for those to get involved.
A weight loss surgery can effectively manage weight gain in people with disabilities, especially if other weight loss regimes have failed. Research shows that excess weight loss from the procedure ranges from 12% to 86%2.
Moreover, bariatric surgery offers extended benefits such as improved quality of life, resolution of certain morbidities such as Type II diabetes, hypertension, sleep apnea, respiratory distress, and reduced psychological tension within the family.
You can get various forms of bariatric surgery, ranging from gastric bypass to gastric sleeve, each with its benefits and reasons for recommendation over the other. The best thing to do is get in touch with a bariatric surgeon who’ll advise you on the way forward.
Possibility of Being Underweight
Most people with disabilities will experience weight gain. However, some people with disabilities will suffer from unexpected weight loss.
Contributing Factors To Weight Loss
These are some factors that contribute to weight loss among people with disabilities.
- Particular medical conditions that affect the body’s metabolism
- Reduced muscle mass
- The person becoming more active
- Difficulty eating and swallowing
- Medications that decrease appetite
- Dependence on caregivers and family members to provide food
- Eating habits affected by anxiety, depression, or frustration
- Poor knowledge of weight management and nutrition.
Weight Management Is Possible for the Disabled
Being overweight or obese is a mountain to climb for the disabled. However, weight management is still possible. You need to have a candid conversation about it and employ practical methods to achieve the desired weight loss.