Without appropriate modification of dietary intake following SCI, energy intake readily exceeds daily energy expenditure, thus predisposing persons with SCI to undesirable weight gain (Cox et al. 1985). Obesity is a common secondary complication of chronic SCI and is associated with adverse metabolic sequelae. In a large South Korean sample of individuals with SCI, obesity rate were reported to be 43.4% in those with physical disabilities and 34.6% for those without physical disabilities (Oh et al. 2012). Despite widespread emphasis on obesity-related health risks in persons with SCI, limited research has been carried out to address this problem. There is a lack of information regarding the health outcomes of weight loss in this population. In addition, there are limited educational resources available on nutrition issues and weight control for this high-risk group (Chen et al. 2006).
In a RCT by Gorgey et al. (2012), nine males with chronic SCI were randomized to 12 wk of resistance training plus a diet program or a diet program alone. After the intervention, groups were comparable in body weight and levels of subcutaneous and visceral adipose tissue. However, the treated group had significantly greater increases in skeletal muscle cross sectional areas, insulin growth factor, and fat-free mass; they also experienced reductions in intramuscular fat percentage, the ratio of visceral to subcutaneous adipose tissue, the ratio of plasma insulin to plasma glucose, and triglyceride and HDL-C levels. Resistance training therefore has the benefits of increasing favourable body composition regions through skeletal muscle hypertrophy, which in turn can lead to improvements in carbohydrate and lipid metabolism.
Chen et al. (2006) conducted a study to assess the effect of a weight-loss program on body weight, body mass index, waist and neck circumference, skinfold thickness, fat versus lean mass, bone mineral content, blood pressure (BP), serum lipids, hemoglobin, albumin, eating habits, nutrition knowledge, bowel function and indicators of psychosocial well-being. A total of 16 subjects with chronic SCI who were overweight or obese completed the intervention program (N=16). Subjects attended 90-minute counseling sessions once per week for 12 weeks, led primarily by a Registered Dietitian. The dietary approach emphasized high-fiber, nutrient-dense foods (e.g., fruits, vegetables, grains, cereals) and the moderation of meats, cheeses, sugars and fats (Weinsier et al. 1983). The program included exercise and behaviour modification. Reported results included an average weight loss of 3.5 kg (3.8% of initial weight), significant reductions in body mass index, anthropometric measures and fat mass. Lean mass, hemoglobin, albumin and bone mineral content were maintained. There was no significant change in BP or LDL cholesterol, although there was a significant decrease in HDL cholesterol. There was a trend between weight lost and decrease in waist circumference, increase in nutritional quality of diet, increase in fiber consumption and decrease in time required for bowel movements. Changes in psychosocial and physical functioning were also reported.
There is level 1b evidence (from one RCT; Gorgey et al. 2012 and one pre-post study; Chen et al. 2006) that an intervention program combining diet and exercise is effective for reducing weight among overweight persons with SCI.
A combined diet and exercise program can help patients reduce weight following SCI without compromising total lean mass and overall health.