Obesity is one of the most common nutritional problems in people with spina bifida.
Obesity may be a cosmetic concern for affected individuals. More importantly, however, obesity is a major health threat. In adults, obesity has been linked to high blood pressure, diabetes, osteoarthritis, abnormal cholesterol metabolism, heart disease, sleep apnea, and psychological problems.
Similar health consequences occur for children and adolescents who are obese. Psychological problems are of special concern for developing children, who may be negatively stigmatised by others if they are obese and thus develop poor self-esteem, greater risk for isolation from peers, and depression.
How Obesity Develops
All energy intake (measured in Kilocalories (Calories)) comes from food that is eaten and then used by the body to meet its needs. Obesity results when a person's intake of calories exceeds his or her energy needs for bodily functions (metabolism, physical activity, the thermal effect of food, and growth). Similarly, weight loss results when the body uses more calories than are taken in through eating.
Continued excessive intake, however, will lead to storage of energy in the form of fat (weight gain), and continued insufficient intake will force the body to use stored energy (fat and other tissue like muscle) for the calories it needs to function (weight loss).
Special Concerns for Individuals who have Spina Bifida
Obesity is an even greater health problem for people who have spina bifida.
Obesity further limits mobility and self-help skills, leading to a spiralling problem of decreased energy use and weight gain, making it harder for the individual to keep up with peers in social and work situations. It adds to the amount of pressure on skin, thus increasing the already high risk of skin breakdown, particularly in areas that are insensate or become consistently wet.
Social rejection, which may already be a problem due to others' lack of sensitivity and understanding of disability, may be worsened. And activities of daily living, particularly independence in dressing, continence management, and hygiene, may be negatively affected by difficulties in moving a large, heavy body and decreased ability to reach private areas of the body.
Very young children who have spina bifida usually grow at about the same rate as their non-disabled peers and are quite physically active, so they usually do not become obese. As they grow older, however, children who have spina bifida, especially those who also have hydrocephalus, are at very high risk for developing obesity. Beyond age six at least 50% of children who have spina bifida are overweight, and in adolescence and adulthood over 50% are obese.
There are many reasons for this.
Neurological impairments that lead to even slight mobility problems make it harder for individuals who have spina bifida to be physically active.
Due to the requirements of school and work for sedentary activity, and due to the increasing difficulty of moving a larger body that has a mobility impairment, school age children who have spina bifida typically become less active as they grown older.
Small children grow rapidly and so they require a large number of calories for growth. Older children and adults have slower growth, however, and on average those who have spina bifida will not become as tall as their non-disabled peers. So, those with spina bifida have fewer requirements for growth, as well.
Studies have shown that people with spina bifida have less lean body mass than their peers, and even when other factors like physical activity are equal, they have a lower basic metabolic rate (fat cells have slower metabolic rates than other cells like muscle cells).
In some families, food is used to try to compensate for the child's disabilities. (‘At least he or she can enjoy eating.’).
Preventing Obesity - a Family Affair
Preventing obesity for individuals who have spina bifida is a family affair that must begin early in a child's life and continue indefinitely. If healthy eating and exercise habits are established early on, they can become part of a very enjoyable lifestyle, rather than one that is perceived as a life of deprivation.
Most eating behaviours and food likes and dislikes are learned in the context of home and family. When a child has spina bifida and family members are somewhat frustrated by their inability to correct their child's underlying disabilities; making this contribution to health and well-being can be very rewarding.
Strategies for Success
Help the child view food as a necessity for growth and activity rather than as a reward for managing the difficulties of daily living.
Children can learn about good nutrition as they help plan family meals and shop for ingredients. Remember, children cannot consume food that is not available! Caregivers need to purchase nutritionally sound, healthy foods using the ‘Food Pyramid’ as a guide.
Food should be eaten at regular times during meals that are pleasant and that take enough time for individuals to eat slowly and realise when their hunger has been satisfied. Treats and snacks should be limited to times when a little extra energy is really needed and should be both nutritionally sound and enjoyable.
The second important strategy is to help children who have spina bifida enjoy exercise. Physical activity has two benefits; it burns calories and can decrease hunger by resetting the body's ‘thermostat.’
Most physical activities that other children enjoy can be adapted for children who have mobility impairments. Small children can be even more active as they learn to complete some helpful tasks around the house. Such activities not only burn calories, but also help children feel good about themselves as capable people who can help others.
Once people become obese, losing weight is hard to achieve. Most can only lose about 10% to 15% of their body weight, and even these individuals usually regain this weight after their strict program of diet, exercise, and behaviour modifications is withdrawn.
If an individual is motivated to lose weight and limits caloric intake while also increasing exercise, weight can be reduced. The assistance of a nutrition consultant may help in such cases, since a very low calorie diet - 1,000 calories per day or even less - may be needed.
Trying to do too much at once is often overwhelming and self-defeating. Small weight losses should be celebrated, (but not with food!) because they really are important!
In summary, individuals who have spina bifida are very likely to become obese unless they, with the help of their families and friends, prevent gaining too much weight during their childhood and adolescence.
Obesity has many negative consequences, so it needs to be prevented or managed to achieve optimum health and quality of life. The benefits of healthy eating and sufficient exercise for individuals who have spina bifida are numerous and important, and last throughout life.
Perhaps no other single intervention will make such a positive contribution to long-term good health and quality of life.