From loss of mobility and independence to co-morbidities, obesity can severely impact your life. Fortunately, it can be reversed
In a previous lifetime, in the early 1970s, I was in medical school at Wits University. One of my teachers was the renowned Professor Harry Seftel. He famously equated obesity and its complications with “sloth and gluttony”, emphasising sloth and gluttony with forceful glee. I had the impression that behind those words was an implication of “serves you right, you are the cause of your obesity, diabetes, hypertension and whatever other complication of obesity”.
For persons with a SCI, obesity is a common problem that cannot glibly be passed off as the consequences of sloth and gluttony. It is far more complex than that. Yet the consequences of obesity are as dangerous to persons with a SCI as for the able-bodied, if not more so.
To combat obesity, we must first understand the types of obesity that afflict us, the dangers and complications.
Types of obesity
The most commonly used indicator of dangerous obesity is the measurement of your waist circumference. The pop group Freshlyground believe that “pot-bellied” men make great lovers, and Queen praised the virtues of “fat-bottomed girls” who make the rocking world go ‘round.
The truth of the matter is that pot bellies and fat bottoms impact on waist circumference. The complications of an excessive waist circumference are life threatening. So, what should you look out for?
Subcutaneous fat is fat that’s found under your skin. Too much subcutaneous fat can be a sign that you have too much visceral fat, which lies deep within your abdominal cavity and surrounds your organs.
The loss of muscle mass in the afflicted part of the body (related to the level of the spinal cord lesion) is common in persons with a SCI. This is known as sarcopenia.
When sarcopenia is associated with excessive body fat, it is known as sarcopenic obesity. This condition is increasingly recognised for complicating the management of obesity-related conditions both clinically and functionally.
Dangers of obesity
Complications of obesity, and particularly of an excessive waist circumference, includes diabetes, hypertension, heart attacks, strokes, and an increased predisposition to pressure sores and sleep apnoea, to name but a few.
Obesity also impacts on the routines of daily living where excessive weight make, for example, transfers, dressing and turning in bed difficult for carers (and yourself if you are still able to function independently).
Addressing obesity
Weight management is the best way to address and prevent obesity. This is done through diet, exercise and behaviour modification. These are supplemented by medications and surgical interventions, but both are fraught with complexities and should be kept as last resorts in instances of morbid (gross) obesity.
Adjusting your meals
Persons with a SCI are at a high risk of gaining weight because of reduced physical activity and loss of muscle mass. As a rule of thumb, the higher the spinal cord lesion, the greater the chance of becoming obese.
Dietary management is very individualised. There are a few basic pointers, but in order to ensure that you get the appropriate nutrients and minerals as well as the appropriate balance of fat, protein and starch in your diet, it is advisable to manage your diet under the guidance of a dietician.
Crash-diets may result in rapid weight loss but are almost invariably associated with complications relating to loss of essential nutrients. It has been shown that, at best, the one-year outcome of a crash diet is equivalent to that of a controlled diet over a longer term.
However, in many instances, once the crash diet has achieved the desired weight loss, people return to their normal eating habits and regain the weight lost during the diet. This is because the hunger centres in the brain did not have time to adjust to a lower calorie intake, following on the diet.
So, unless there is good discipline following the crash diet, our brain’s hunger centres entice us to eat as we did before the diet.
In conclusion, make use of a dietician to structure a diet for you. Follow the diet and any adjustments to the diet made by the Dietician. Be patient with the speed of weight loss and persevere.
If you are unable to reach a dietician, there are some general steps that can help. It is important to remember that as a person with a SCI, you require less calories per day than when you were able-bodied. You can reduce your overall food portion by about 10 percent.
Cut back significantly on fat, butter and cooking oils. Reduce your meat and starch (pasta, bread and mielie meal) portions. Increase your vegetable and fruit intake. Drink at least two litres of water per day. Steer clear of fizzy cooldrinks, sweets, chocolate and concentrated fruit juices.
If you feel healthy and full of energy as you slowly lose weight, all is well. However, if not, write down your diet and take it to a doctor or dietician for further guidance.
Get moving
Exercise is not just about becoming stronger. It is good for the heart, lungs and your state of mind. It is a great way to burn excess fat.
Additionally, exercise helps to stabilise your core, trunk and shoulders, which is vital for independent transfers, for example. Without a stable trunk and shoulders, our arms become fairly useless no matter how strong they are.
Even passive exercise offers great benefits by stretching spastic muscles and preventing tendons from shortening, which causes contractures. Finally, exercise can help you socialise or just enjoy the sport of your choice whether it is athletics, rugby, basketball or tennis.
For persons with a SCI, exercise must be managed by a person with the required proficiency, for example a biokineticist or physiotherapist, as far as possible. A medical professional should evaluate your physical needs and your ability to work toward those needs.
The exercise programme must be designed to allow you to carry on by yourself. Where assistance is needed, the options include training your carer to assist or scheduling regular sessions with a biokineticist or gym trainer.
The beauty of exercise is that no matter what types you do, you become tired as you use energy, which burns fat helping you to lose weight and reduce your abdominal circumference, which means a healthier you!
Building better habits
Behaviour modifications is all about identifying cravings and then addressing the triggers that result in over-eating, which contributes to weight gain. A few ways to change your behaviour includes:
- Goal setting and self-monitoring: Set yourself realistic weight-losing goals and a timeline with the help of your doctor or dietitian. Monitor your progress by recording your weekly progress. Weighing yourself may be a challenge for a person with a SCI. Instead, check your abdominal circumference to monitor your progress.
- Stimulus control: Recognise the temptations of your hunger centre and counter it with (for example) a glass of water rather than a slab of chocolate, which is also a much cheaper option.
- Slow eating: Take your time when eating. Chewing your food thoroughly helps to manage your hunger centre.
- Increasing physical activity: Formal exercise programmes, as discussed above, are important. In addition, try to do as many of your daily activities independently as your abilities allow. Don’t ask your carer to do things that you can do for yourself.
- Social support: Include friends and family in your weight-loss goals and ask them to encourage you in your efforts. Also invite them to celebrate your achievements with you.
Last resorts
There are many adverts for wonder products. Steer clear! Also avoid the so-called weight- loss clinics that charge an arm and a leg for rapid weight loss. Rather work with a dietitian or your doctor.
Bariatric surgery has been shown to be successful, but only if performed by a select few multi-disciplinary units with proven track records. It is also not just a case of having the surgery and all is solved. The aftercare is intense and very expensive. It should only be considered in the morbidly obese.
In conclusion, diet, exercise and behaviour modification, all under expert supervision, is the ideal combination for successful weight loss. So, here’s wishing you all the very best in your endeavours to shrink your abdomens and becoming healthier, more dynamic and sexier versions of yourself.
