Spinal cord injury, no mobility — How can I lose weight?

Dear Reader,

Many people, whether they are unable to exercise or just don't like it, have wondered whether weight loss without physical activity is possible. Basically what weight loss comes down to is this: weight stays stable when we take in the same amount of calories that we expend. If we eat more energy than we use, we store it for later, i.e., we put on pounds. Some people accomplish weight loss by limiting caloric intake, others by upping their energy expenditure though exercise, and many people use a combination of both strategies to lose weight.

One pound of body fat is equal to about 3500 calories. In order to lose a pound per week, a person would have to create a daily deficit of about 500 calories. Weight-loss of a pound per week is generally considered safe and in about a year would add up to more than 50 pounds. A person's caloric needs can be determined in a number of different ways. One option is the Calorie Control Council's Healthy Weight Calculator. After you enter some basic information, the calculator will show your weight maintenance calorie needs. Subtract 500 calories and the result will be the number of calories you could consume daily for your one pound per week weight loss goal. You could also take a look at Food Guidelines — How much is a serving? in the Go Ask Alice! Nutrition and Physical Activity archives to read about the guidelines for a healthy eating plan.

As you mentioned, it would be very helpful to develop a personalized eating plan with a dietitian to make sure you lose weight healthfully, safely, and without incurring any nutritional deficiencies. You can also look for a registered dietitian on the American Dietetic Association website or ask your health care provider for a referral.

It sounds like you have extremely limited and painful mobility right now, although it's not clear if all forms of exercise will be off-limits forever. Often, once a spinal cord injury has been stabilized and a person has been rehabilitated to her or his fullest potential, establishing an exercise routine can be beneficial to staying healthy and maintaining functional capacity. An exercise program can be tailored to meet the unique needs of an individual with an injury — some plans can be as simple as turning the head or lifting the arms. There are physical therapists who work specifically with people who have spinal injuries and teach exercises for prevention of stiffness in joints, maintenance of muscle, and for minimizing/managing pain. Depending on your abilities, the physical therapist may suggest the use of special equipment such as a hand bike, or the "Equalizer" and "Uppertone Gym," two multi-station weight machines adapted for those in wheelchairs with limited fine motor movement.

You can find out more about physical therapists and physical activity for people with spinal cord injuries through:

• American Physical Therapy Association
• Christopher and Dana Reeve Paralysis Resource Center
• Paralyzed Veterans of America: Education Foundation
• NCPAD's fact sheet on Spinal Cord Injury

It is certainly a challenge to lose weight with an injury that keeps you sedentary. With dietary modifications, the possible addition of some small, gentle movements, the support of family, friends, and professionals, and setting some realistic health goals, you may very well be on your way to shedding the accumulated pounds. Best wishes,