Planning Weight Loss After Spinal Cord Injury

Planning Weight Loss After Spinal Cord Injury

Posted by AskNurseLinda on Dec 17, 2018 10:36 am

A balanced diet is necessary to maintain health for individuals with or without spinal cord injury and other types paralysis. People get the nutrients needed for health from a general diet that consists of proportions of proteins, grains, fruits, vegetables and dairy. As recently discussed, you can better understand the elements of a healthy diet by visiting the US Government website:

There are times when diets need to be modified after certain spinal cord or other paralysis related health conditions occur. This includes weight gain. Weight is affected by the number of calories taken in and by the number of calories used. Many people look for a magic formula to control weight but this ratio of calories in vs calories out is the formula.

Weight is related to the number of calories taken in to number of calories used by the body. There is a certain number of calories that are required by the body to maintain human functioning. Life maintaining calories include an amount to keep the brain fed, the heart beating, the lungs breathing and other necessary body functions. Energy expenditure accounts for the rest of the calories to keep our bodies going.
The number of calories required by each individual is variable by age, body type and function. The number of calories is less for young and older individuals, peaking in the adolescent to middle years. People who are generally larger in bone and body structure require a slight bit of more calories than the petite individual. There are also temporary times when a bit more calories are needed such as when body metabolism is sped up due to hypermetabolism as with a fever. These times and body types only require a minimal number of increased calories from normal intake.

The number of calories needed just to maintain life is a bit different for everyone. A good example is the old adage of pregnancy. I am sure you have all heard, ‘she is eating for two’. This gives license for people to overeat. However, in early pregnancy only on average an extra 200 calories are needed. Late pregnancy about an extra 400 calories are needed-per day. Shockingly, that is just an extra 4-6 bites of food a day depending on the number of calories in the dish. Overeating is easily done.

People have many misconceptions about eating. The reasoning is that food is so desired by humans. It is what keeps us going. In fact, food tastes good, very good. Human history encourages us to eat. Humans used to have to store fat to survive through famines. People who ate little did not survive. The genetic code for eating was passed on by the people who ate heartily and survived. As you can see, we are all up against genes.

Today, most people have ready access to food. Sometimes, finances can create a type of famine as finding the money to buy a nutritious diet can be a challenge. More people, however, have enough money that they buy above and beyond what they can or should consume. Simplicity in meals can go even further. It is much easier and less hassle to buy readymade, processed, high calories foods that do not require the work and often the cleanup of food preparation. These fast foods add huge numbers of calories to a meal.

Extra weight can make activities more challenging especially when moving about. This is true for individuals with or without paralysis.  Transferring and doing pressure releases is more difficult with extra weight. Not only is lifting yourself to move your body more of a challenge, but extra weight also puts far more pressure on your joints, shoulders, elbows, wrists and fingers. It can be more difficult to lift yourself to clear for transfers. It is difficult to raise your body completely for pressure releases as well as the extra weight quickly creates more pressure on boney prominences. Fat does not disperse pressure that is needed in skin care. Fat cells add pressure to boney prominences.

Following a dietary plan will help. If you are not sure how many calories you should be taking in, talk with your healthcare professional.  The number of calories needed will be different depending on your body type and functional abilities. Typically, most payors allow for a nutritional consult with a dietician one time per year. They can help you set a diet plan tailored to your needs. There are sample diet plans available online but be sure you choose a verified plan such as on MyPlate. Portion sizes are also indicated on that site.

A Body Mass Index Chart (BMI) provides information about being over or under weight. Another alternative is a weight chart which are available online for men and women. Follow either chart for your height to find the range of suggested weights. Establish how many calories you are eating by keeping a food diary. There are many electronic programs available for free that will calculate the number of calories, proteins, carbohydrates, etc. for each food you enter.  

Losing weight takes a long time. Do not expect results over night. Aim for 1-2 pounds of weight loss per week. Starvation in dieting will not last over the long term and the health consequences are great. For example, not eating a balanced diet can lead to other health concerns such as cardiac issues, mental problems, lack of energy and pressure injury.

Many people want that ‘quick’ diet. There is an abundance of weight loss products that promise fast results. Most typically, these are diuretics that will over work your kidneys and dehydrate your body. The scale will show that you are lighter, but the ‘weight’ will return with fluid intake. Other products that can permanently harm your kidneys when overused include diet sodas, sugary drinks, meal substitutes like liquid breakfasts and some energy drinks. Our old friend, water is the best fluid. Stick with real food but in moderation, emphasizing portion control.

The other part for a weight loss program is activity. Move your body where you can. Have someone move your body for you where you are challenged. This is called passive movement. It will help stimulate blood flow, provide exercise to your muscles, stretch out spasms, reduce your risks for deep vein thrombosis, jiggle your bladder to reduce your risk of urinary tract infection and move the muscles in your bowel for movement.

There are exercises that you can do. Moving each body part is a start. Repetition and resistance are a part of effective exercise. Doing a pressure release is necessary and helpful but lifting your arms 10 times in a row is better for exercise. Therabands are large elastic sheets that come in various strengths. They are available at your local drugstore or discount store. Using these for exercise adds resistance to your movement which also enhances your exercise.

Weights can also add resistance. Weights can be purchased, or you can do reps while holding a can of soup or a small milk container. You can add water to the container to slightly increase the weight as you gain strength. The handle of the milk container makes it easier to hold. Foam or tape around the handle will make it easier to grasp. Different household items that weigh more can create the same outcome as your strength improves.

Do not start out with exercise at a top pace. Even if you feel like it, begin slowly and with your health professional’s approval. Your health professional can examine you for hidden medical problems that can become worse with exercise such as a deep vein thrombosis (DVT) or low bone density.

Begin with just a few repetitions of exercise to each part of your body and build up over weeks. Depending on your ability, your upper body may progress faster than your lower body. Creating a chart with 5-10 reps added to your exercise routine will keep you on track and reduce the risk of muscle strain injury. Do not feel like you need to keep an Olympian pace to your exercise routine. You are not in a competition. Add slowly but steadily. If you feel you are at your limit, slow down for an extra week.

Be sure you exercise each part of your body either actively by moving your body yourself or passively, when someone else moves your body. While you are moving a body part, think about that part moving. If your toes are being moved, think about wiggling your toes. Many people do not visualize their body moving. However, body movements can sometimes be discovered when exercising. Think about moving your toe when your toe is being moved and think about your toe not moving when the exercise has stopped. Do this for all of your body parts while exercising. Odd, random movements might be discovered that can be harnessed into other functional activities.  This makes exercise very motivating.

Some people notice their bodies changing after spinal cord injury due to lax muscles. You might notice your hips wider when sitting or a pouchy stomach. Don’t confuse this with extra weight. Untoned muscles will look bigger than before spinal cord injury. Edema might also be noted which is not an increase in body fat but a collection of fluid in the extremities or even in the lower back. Edema can be treated medically. Exercise or movement helps reduce edema as well.

Weigh yourself to assess if you are gaining weight. If you cannot stand, you will need to use a wheelchair scale. This is not an item that you probably would want to purchase as it is used so infrequently. Wheelchair scales are around in the community. Your healthcare provider’s office might have one although many do not. You can contact your local hospital which will usually allow people to weigh themselves on their wheelchair scale periodically. Long term care centers have wheelchair scales as well. Some industrial businesses or even your local grocer might have a scale for weighing product. Inquire about those for use. Be sure you weight yourself in and out of your chair but with the same attachments, cushions, splints, braces, etc. so you get your precise weight.

Weight is a concern for individuals who lack activity. If you think you might need to lose weight, check with your healthcare provider. Monitor your eating and move your body. Overtime, you will see your weight heading in the right direction.  Nurse Linda

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