Many people find it hard to manage their weight, but people with disability often face challenges that can make weight loss seem near impossible. For most with a disability, losing weight can be more difficult than for those without. It’s a similar story for children with disabilities. Obesity rates for adults with disabilities are approximately 57% higher than adults without disabilities, and obesity rates for children with disabilities are approximately 38% higher than children without disabilities. For people with limited mobility, the stakes can be higher. The key lies in making lifestyle changes that suit your body and your life, such as personalised dietary changes and adaptive exercise.
Understanding the Challenges
Disability and obesity are often considered two separate issues, but they are actually very much intertwined. Unfortunately, people with disabilities are more likely to be obese than others. According to a study, 78.6% of adults in wheelchairs are obese. There are several reasons why wheelchair users may have difficulty losing weight. Many have various physical limitations that contribute to them needing to use a wheelchair. Physical limitations often reduce a person’s level of physical activity, making it more challenging to exercise. Other research has shown that obesity rates among wheelchair users are even higher.
Another factor that can contribute to obesity among wheelchair users is their diet. Many times, wheelchair users cannot prepare their own meals and must rely on others for help. This can make it difficult to control what goes into their food, how many calories they consume a day, and the quality of calories.
The Importance of Healthy Weight
Carrying excess weight is not good for anyone’s health. In Australia, 77% of people with disability say it’s a physical health condition that causes them the most difficulty - with joint and muscle problems (such as arthritis and back problems) being the most common³. Healthy weight is not about a number on the scale. It’s about feeling good in yourself and being able to live well. Even a small amount of weight loss (about 5% of your body weight) can help improve conditions like type 2 diabetes, osteoarthritis, fatty liver disease, and heart disease risk⁵.
Personalized Dietary Changes
A healthy diet alone is not a guaranteed way to lose weight, but it is certainly a necessary component. It is best to start by making small changes first. A nutritious diet helps to regulate metabolism and hunger hormones and provides the body with the energy it needs to function optimally. It also helps to reduce inflammation.
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General Dietary Guidelines
On a positive note, general dietary guidelines can benefit most people. The typical Western diet, high in processed foods and low in fruits and vegetables, has been linked to numerous health issues. Creating healthy eating habits can be hard. It is also important to remember to enjoy what you eat without feeling deprived or overly restricted.
A healthy, balanced diet should be based on the Eatwell Guide. This means:
- Eating at least 5 portions of a variety of fruit and vegetables every day
- Basing meals on potatoes, bread, rice, pasta or other starchy carbohydrates
- Choosing wholegrain with less added sugar, salt or fat, where possible
- Having some dairy or dairy alternatives (such as soya drinks and yoghurts) - choose lower-fat and lower-sugar options
- Eating some beans, pulses, fish, eggs, meat and other protein - aim for 2 portions of fish every week, 1 of which should be oily, such as salmon, sardines or mackerel
- Choosing unsaturated oils and spreads, such as sunflower or rapeseed, and eating them in small amounts
- Drinking plenty of fluids - the government recommends 6 to 8 cups/glasses a day - but try not to have drinks just before meals to avoid feeling too full to eat
If you're having foods and drinks that are high in fat, salt and sugar, have these less often and in small amounts.
However, it's important to remember that the Eatwell Guide is aimed at the general population. Your dietitian or weight management adviser may have specific advice about portion sizes that are adapted for your particular disability.
Mindful Eating and Nutrition
The concepts of mindful eating and nutrition are vital for maintaining healthy weight and improving overall health. Mindful eating encourages individuals to be aware of their hunger and fullness cues, promoting a balanced relationship with food.
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Practical Tips for Dietary Changes
- Reduce Processed Foods: Reducing processed and ultra-processed foods is crucial; about 60% of calories in the average American diet come from these sources, which are linked to various chronic diseases.
- Limit Sugary Beverages: Reducing sugary beverages - known to have no health benefits - is essential for weight management and overall health.
- Incorporate Treats: Completely removing favorite unhealthy foods will rarely succeed. Incorporating occasional treats can help people maintain their diet without feeling deprived.
- Manage Hunger Proactively: Manage hunger proactively by avoiding extreme hunger scenarios. This involves planning and packing healthy snacks to prevent the temptation of unhealthy fast food when hunger strikes.
- Choose Healthier Fats: Consider choosing foods high in fiber and complex carbohydrates like whole grains, fruits and vegetables. Choose healthier fats like olive or canola oils and eat unprocessed foods more often than foods with added sugars, fats and sodium.
- Monitor Eating Habits: Monitor eating habits through the 5 W’s - who, what, when, where, and why - to enhance awareness of dietary behaviors.
- Replace Unhealthy Foods: Consider replacing unhealthy foods in their diets with healthier alternatives. Creating a list of their top unhealthy foods and identifying substitutes can facilitate this process.
Dietary Approaches for Adults with MRDs
Adults with mobility related disabilities (MRDs) represent an underserved group with a high prevalence of overweight/obesity and limited options for weight management. A limited number of trials have addressed different weight management strategies for adults with MRDs. The majority of these trials have employed 1-group, pre-post designs, in small samples (n ≤ 16), over relatively short time frames (≤ 20 wks.) (19-22), and have demonstrated unimpressive results in terms of both mean weight loss, and the percentage of participants losing ≥ 5% of baseline weight.
The Stop Light Diet (SLD)
The Stop Light Diet (SLD), developed for use in children, categorizes foods by energy content: green (eat freely), yellow (eat in moderation) and red (avoid) (24). The SLD is easy to understand and implement when compared with a traditional meal plan diet which requires choosing appropriate foods from an unlimited array of options, making it difficult to prepare a nutritionally adequate reduced energy diet on a consistent basis.
Adaptive Exercise
Adaptive exercise refers to fitness programs that are modified to suit the abilities and goals of people living with an injury, disability, or chronic health condition. Whatever your level of physical ability, there will be an activity or sport for you. Try to choose activities that improve your heart health and muscle strength.
If you can, try to do:
- At least 150 minutes of moderate intensity aerobic activity every week
- Strength and balance exercises on 2 or more days a week
Aerobic activity is particularly important when it comes to losing weight. This is an activity that raises your heart rate, gets you slightly out of breath and causes you to break a sweat. If the gym appeals to you, there's a range of good options for wheelchair users. These can include rowing machines adapted for wheelchair use, and weight machines for resistance exercises. The Activity Alliance runs the Inclusive Fitness Initiative (IFI), a scheme that ensures gyms are suitable for use by people with disabilities.
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Types of Adaptive Exercise
- Wheelchair Exercises: If you use a wheelchair, it’s very possible to build your strength and cardiovascular fitness and manage your weight effectively. Good upper body strength supports weight management and can also improve your everyday function, including transfers and wheelchair propulsion.
- Resistance Bands: Resistance bands are lightweight, affordable, and adaptable. These exercises can be modified to match your mobility.
- Flexibility Training: Improving your flexibility can reduce discomfort and make movement easier.
- Daily Movement: Even light activities like folding laundry, gardening from a seated position, and moving between rooms can contribute to daily movement.
Alternative Weight Loss Treatments
For most people, reducing belly fat when disabled can be more difficult than for those without. There are several alternative options for those unable to lose weight due to their disability. Because patient safety and well-being drive everything we do, we only offer cold laser, vibration, and nutrition therapy for weight loss.
Cold Laser Therapy
Recent advancements in cold laser technology have made it an excellent option for a comprehensive weight loss program. Low-level lasers (or “cold” lasers) are a type of light therapy used for over 50 years in various medical applications. When applied to the skin, these lasers penetrate the tissue and stimulate fat cells to release their contents. This process is called “lipolysis,” and it works by shrinking fat cells. The treatment works by penetrating the skin with low-level lasers that emit a wavelength of light that is absorbed by the fat cells. Typical cold laser therapy for losing weight involves laying on a table while laser light is focused on the targeted areas of the body. Treatments are generally 40 minutes long, 20-minutes each laying on your stomach and back. Cold laser therapy is an alternative for those unable to exercise because it’s passive and painless.
Vibration Therapy
Vibration therapy is a cutting-edge weight loss treatment that is showing significant promise. This therapy makes use of a machine that delivers vibrations to the body. Vibration therapy is a good option for those with disabilities who are seeking a non-invasive weight-loss treatment. Vibration therapy is typically done for 10-15 minutes, one to three times per week. There are no major side effects associated with vibration therapy, although some people may experience mild muscle soreness.
Nutrition Therapy
Nutrition therapy is a broad term that covers everything from dietitian services to bariatric surgery. For the disabled, nutrition therapy may be the most important factor in achieving and maintaining a healthy weight.
Other Treatments (Use with Caution)
- Injections: Injections are a common weight management treatment but are not without risk. Side effects of injections can include nausea, vomiting, diarrhea, headache, fatigue, and dizziness.
- Appetite Suppressants: Appetite suppressants may be an option for those with disabilities who have difficulty controlling their appetite.
- Hormonal Treatments: Hormonal treatments for obesity, such as leptin therapy, are investigational and are not yet FDA approved.
- Surgery: Surgery is a last resort for weight management. Gastric bypass surgery works by creating a small pouch at the top of your stomach and connecting it directly to your small intestine. Gastric sleeve surgery is another common type of surgery. It involves removing a large portion of your stomach, leaving only a small sleeve of your stomach remaining. Surgery is a major decision with many risks and potential complications.
Strategies for Success
- Aim for Gradual Progress: Changes on the scale are not necessarily the most important way to monitor your progress. Progress with weight loss can feel slow at times. There will be good days and hard days - but consistency is more important than perfection. Setbacks are normal. It’s what you do after a setback that matters.
- Hydrate: Drinking water may help you lose weight by reducing your appetite, boosting your metabolism, and helping you to exercise⁶.
- Avoid Fad Diets: Crash or fad diets and intense exercise programs are not sustainable - and can be unsafe.
- Monitor Weight: Weigh yourself often, although it may be challenging for individuals with mobility issues. Accessible scales are increasingly available in clinics and fitness centers, allowing participants to monitor weight more effectively.
- Seek Professional Help: An NDIS exercise physiologist can develop a tailored program to meet your specific needs. At Active Ability, our NDIS exercise physiologists have extensive experience supporting people with disability to reach and maintain a healthy weight. A GP or dietitian can help you to work out your daily calorie needs. You may prefer to have the support of a community weight management service.