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NCHPAD - Building Healthy Inclusive Communities

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Obesity is a Major Concern for Youth and Adults with Disabilities


James H. Rimmer, Ph.D., Director
James H. Rimmer, Ph.D., Director
You can't read or listen to the news media for very long without hearing something about the rising tide of obesity in the United States and other industrialized countries. No one is quite sure how to solve the problem, albeit everyone knows how it happens: eating too much and moving too little. Among people with disabilities, the obesity epidemic is even worse than in the general population. In two national data sets (1994-1995 National Health Interview Survey and 1998-1999 Behavioral Risk Factor Surveillance System) and one local data set (Chicago), the prevalence of overweight, obesity, and extreme obesity, defined by a person's body mass index or BMI, was substantially higher than in the general population.

Obesity is linked to many health problems, including type 2 diabetes, heart disease, depression, and arthritis. Among people with disabilities, an additional problem is the worsening of secondary conditions such as pain, fatigue, deconditioning, social isolation, and difficulty performing activities of daily living. Excess weight makes it more difficult to push a wheelchair, perform transfers, or even lift the arms above the head. Compensatory movements meant to conserve energy or complete the task can lead to overuse injuries or a serious fall.

The lack of successful health promotion interventions for weight management in youth and adults with disabilities substantially limits our understanding of how to reduce future health risks. We need to understand what factors (i.e., antecedents) are associated with higher levels of obesity among individuals in different disability subgroups. For example, in some individuals obesity may be related to poor diet or nutritional knowledge, inadequate levels of physical activity, or use of certain weight-gaining medications (e.g., anticonvulsants, antipsychotics, steroids). For others, environmental factors may play a greater role, including overprotective parents (in youth), unsafe neighborhoods, and lack of physical and programmatic access to recreational and exercise facilities and programs.

Some experts are now referring to the American lifestyle as "obesogenic," which reflects a society where tasty, high-calorie foods are only an arm's length away at any hour of the day, and watching TV, sitting in front of a computer screen, or playing sedentary video games fills much of the day. Some people are consuming 'toxic' levels of fat and sugar that place their bodies in a state of emergency, with blood glucose and blood cholesterol levels reaching levels that over time will incur substantial damage to vital organs. While the manufacturers of these tasty foods continue to find clever ways to entice us to eat more of their products, those of us on the exercise side of the equation fight an uphill battle to keep the body moving and away from the refrigerator. People with disabilities have an even greater challenge because of their higher unemployment rate, which forces them to remain in their homes for much of the day and in closer proximity to food. Boredom and watching TV lead to higher food consumption.

Youth with disabilities also struggle with their weight. They either have little access to social activities after school or on the weekends, or are discouraged from becoming physically active because of barriers in the built environment. With nothing else to do, they often turn to TV or video games - sedentary behaviors that are usually accompanied by food consumption.

While obesity is a serious public health concern in the general population, it must become an equally important concern among people with disabilities. The disparity in excess body weight between people with and without disabilities demonstrates a critical need to better understand how and why these differences occur.


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