Health Behaviors--Weight Management
- Dietary Behaviors
- Obesity as a Common Secondary Condition
- Disparity in Overweight and Obesity
- Barriers to Weight Management
- Clinical Guidelines for Obesity
- Measurement Issues
- Negative Body Image
- Low Rates of Physical Activity
- Here's what you can do
- Managing Weight, [English] [Spanish], a newsletter from the series "Removing Disabilities Disparities from Women's Health", 2005, Volume 1, Number 1
- Health Behaviors Table of Contents
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 percent believed that they followed a healthy diet. In a national study, 77 percent 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 percent 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 percent 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 percent of persons with disabilities are obese compared to 15.1 percent 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 percent) compared to women without limitations (21.6 percent);
5. the highest percentage of obesity (52 percent) can be found among women age 45-64 with 3 or more limitations, double the statistic (26.1 percent) of women with no limitations.
Additionally, Healthy People 2010 reports that, based on data collected between 1991 and 1994, only 35 percent of women with disabilities were at a healthy weight compared to 45 percent of women without disabilities. Among women with arthritis, only 37 percent were at a healthy weight, compared to 47 percent 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.
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, 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.
See more general information on physical activity and women with disabilities.
The first step in managing your weight is learning about key concepts, such as calories, carbohydrates, body mass index, low-fat diets, low-carb diets, and weight loss programs. The following resources can lead you to a wide range of links to more information about diets and weight management.
Calculate your body mass index, National Heart, Lung, and Blood Institute, National Institutes of Health
How many calories you need, Children's Nutrition Research Center, Baylor College of Medicine
Weight Management, National Women's Health Resource Center
Healthy Eating for a Healthy Weight, Centers for Disease Control and Prevention
Delicious Decisions, American Heart Association