HEALTH
PROMOTION—General Information
Weight Management
Obesity as a Common Secondary Condition
Disparity in Overweight and Obesity
Clinical Guidelines for Obesity
Low Rates of Physical Activity
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Highlights
Most women with physical disabilities report
with confidence that they follow a healthy diet. However, when asked about
specific dietary behaviors, most
fall short of their intentions.
A
few studies have investigated dietary behaviors of women with physical
disabilities. In one study of the health status of women with cerebral palsy,
52% believed that they followed a healthy diet. In a national study, 77% of women with physical disabilities
reported that they believed they ate a balanced diet.
Approximately half of women with
disabilities surveyed in a study of health promoting behaviors of women with
disabilities, said that they often chose a diet that was best for their health,
but only 19% reported often eating at least five servings of fruits and
vegetables daily, and 46% limited the amount of fat in their diet. The disparity
between perceptions of “healthy diet” and reported fruit and vegetable intake
may indicate that women with disabilities are overestimating their healthy
dietary behaviors. All participants reported high self-efficacy or confidence
for engaging in healthy dietary behaviors. Confidence in their ability to
engage in a behavior, therefore, exceeded their actual engagement in the
behavior.
No known study to date has
investigated dietary behaviors across different disability types or levels of
functional limitations or specifically examined nutritional barriers for women
with physical disabilities.
Overweight
and obesity are common secondary
conditions for women with disabilities. According to Healthy People 2010, only 35% of women with disabilities were at a
healthy height compared to 45% of women without disabilities.
Obesity
is more prevalent among adults with disabilities than among the general
population. Rates of overweight and obesity are much higher among women with
disabilities than among women without disabilities. According to analyses of
data from the 1994-1995 National Health Interview Survey:
1.
24.9%
of persons with disabilities are obese compared to 15.1% of those without
disabilities;
2.
rates
of obesity were the highest among people with lower extremity mobility
difficulties;
3.
overweight
persons with severe mobility limitations were significantly less likely to
attempt to lose weight than those who were overweight but did not have mobility
difficulties;
4.
women with three or more limitations were
significantly more likely to be overweight (43.2%) compared to women without
limitations (21.6%);
5.
the highest percentage of obesity (52%)
can be found among women age 45-64 with 3 or more limitations, double the
statistic (26.1%) of women with no limitations.
Additionally, Healthy People 2010 reports
that, based on data collected between 1991 and 1994, only 35% of women with
disabilities were at a healthy weight compared to 45% of women without
disabilities. Among women with arthritis, only 37% were at a healthy weight,
compared to 47% of women without arthritis.
Factors
explaining the disparity of
overweight and obesity among women with disabilities are not well understood.
Overweight and obesity is associated
with lower socioeconomic status for women in the general population, and the
highest burdens of overweight and obesity are among Mexican-Americans and
blacks. Other factors associated with obesity in the general population include
family history and behavioral factors, such as poor nutrition, sedentary lifestyle,
and frequent dieting.
It is known that, regardless of gender,
race/ethnicity, or age, people with disabilities have higher rates of obesity
than people without disabilities. Although non-disabled men have slightly
higher rates of obesity than non-disabled women, among people with
disabilities, women have higher rates of obesity than men.
Some factors associated with obesity in
women with disabilities may be similar to those for women without disabilities.
For example, women with disabilities have higher rates of poverty and lower
income. However, women with disabilities likely have other vulnerabilities that
help explain the high rates of overweight and obesity.
Characteristics of a woman’s disability
may make her more prone to weight gain. For example, women with rheumatic
conditions may take steroids, such as prednisone, which are known to cause
significant weight gain. Many women with disabilities face significant barriers
to adequate diet and physical activity behaviors; a discussion of these barriers
to physical activity and nutrition follows below.
The biggest contributing factors to
overweight and obesity for women with disabilities are still unknown.
Women with disabilities encounter significant barriers to weight management.
Both
men and women with disabilities confront disability-related, environmental, and
other barriers to weight management. These barriers include constraints in
physical activity and healthy diets.
Women with disabilities encounter
serious barriers to increasing physical activity. These include lack of
transportation, money, and accessible fitness centers, lack of knowledge about
capabilities for exercise, lack of knowledge or skills needed to engage in
physical activity, lack of social support, concern with crime, and fatigue and
pain.
Women with disabilities also
encounter several barriers to healthy diet. Women with severe mobility
impairments may rely upon a personal assistant or family member for meal
preparation and grocery shopping. This may present difficulties when a woman
with a disability wishes to change her lifestyle and engage in healthier eating
habits. Having a mobility limitation
or experiencing fatigue or pain may also cause a woman to make unhealthy food
choices that are more convenient or easier to prepare. Furthermore, women are
often frustrated by the inability to obtain dietary information that takes
their disability or condition into consideration. Some research suggests that
certain conditions and disabilities may alter a woman’s nutritional needs.
Few clinical guidelines
for obesity offer suggestions for counseling overweight persons with mobility
impairments.
While
obesity screening guidelines have been developed, few suggestions exist for
counseling overweight persons with disabilities. The current established
recommendations for weight loss include reduced-calorie diets, increased
physical activity, and behavioral therapy or weight management programs.
However, these recommendations rarely take into account reduced metabolism,
difficulty in obtaining informed recommendations for diet and exercise
appropriate for disabling conditions, physical inability to engage in aerobic
activity, limited access to fitness facilities that can accommodate people with
severe mobility impairments, and psychosocial issues that may accompany
mobility limitation.
Measurement issues for
people with mobility impairments present significant challenges in efforts to
research and set clinical guidelines for weight management in this population.
Even
the basic measurement of weight itself can be problematic for women with severe
mobility limitations who are unable to use standard weight scales, which are
unable to accommodate wheelchairs or other assistive devices.
Body Mass Index (BMI), a calculation
which requires accurate weight and height measurements, is one of the most
widely used measures to determine whether or not an individual is overweight.
However, this measure fails to consider factors such as muscle atrophy or limb
loss, or difficulties in obtaining height measurements for people who have limb
contractures or severe scoliosis. Self-reported weight and height measurements,
often used to calculate BMI in research of people with disabilities, may be
flawed.
These very basic challenges make it
more difficult for researchers, physicians, and other health care professionals
to identify women with disabilities who are overweight.
Such measurement issues also make
weight management efforts more difficult. Although a variety of wheelchair
scales are manufactured, these scales are rarely available in doctor’s offices
or health clinics. Women who are unable to stand on a standard scale may not
have regular access to a scale that will accommodate their wheelchairs, and
they often do not have the ability to measure their progress towards their
weight loss goals.
Overweight women with disabilities may develop negative body image. Low self-esteem,
depression, and stress may be associated with overweight and obesity.
Research
has documented that many people who are overweight develop a negative body
image. Furthermore, excessive weight is associated with low self-esteem, which
may be caused by societal stigmas, self-blame, discrimination, or cultural
ideals. Stress and depression, alarmingly prevalent among women with physical
disabilities, are also associated with weight problems. Stress and depression
may serve as triggers for overeating and weight loss relapse. However, the relationship
between obesity and depression is not yet fully understood.
Women with
disabilities are much more likely to have very low levels of physical activity than non-disabled women.
For
more general information on physical activity and women with disabilities,
please click here.
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Highlights