Obesity and Disability

What's the Problem?

Obesity is common, serious and costly. In the United States, about 2.4 million more adults were obese in 2009 than in 2007. A person who is overweight or obese has an increased risk of various diseases and medical conditions such as:

• heart disease;
• type 2 diabetes;
• high blood pressure;
• stroke;
• liver and gallbladder disease;
• gynecological problems; and
• certain cancers.

Disability, defined as functional limitations in vision, hearing, mobility, cognition (acquiring knowledge), expressive communication, or physical or mental impairments that limit life activities, can complicate this risk still further. For example, environmental factors may make it difficult or dangerous for people with disabilities to exercise. Nutritious food may be costly for people with disabilities who have limited incomes. According to the Centers for Disease Control and Prevention (CDC), adults with disabilities have a 58% higher obesity rate than adults without disabilities. Health care costs of obesity that are related to disability are estimated at approximately $44 billion dollars each year.

What is Meant by Overweight and Obesity?

Overweight and obesity are terms that identify ranges of weight that are greater than what’s generally considered healthy at a given height. Being in the overweight or obese range can be the result of behavioral and environmental factors, or more rarely, genetic factors.

Overweight and obesity are commonly determined by BMI – Body Mass Index. BMI is a number calculated from a person's weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for people in weight categories who might have an increased risk of health problems. An adult who has a BMI between 25 and 29.9 is considered overweight, while a BMI of 30 or higher is considered obese. Obesity increases the likelihood of certain diseases and health problems.

Who's at Risk?

Keeping a healthy weight can be challenging for anyone. It requires commitment, support, and access to resources. However, people with disabilities face many challenges to maintaining a healthy weight that go beyond those faced by the general population. These individuals may be at a greater risk of being overweight or obese due to:

• difficulty with chewing or swallowing food, or with its taste or texture;
• medications that can contribute to weight gain, weight loss, and changes in appetite;
• physical limitations that can reduce a person’s ability to exercise;
• pain;
• a lack of energy;
• a lack of accessible environments (for example, sidewalks, parks, and exercise equipment) or equipment that can enable exercise;
• a lack of access to healthier food;
• a lack of resources (for example, money, transportation, and social support from family, friends, neighbors, and community members).

Can Obesity Be Prevented among People with Disabilities?

Everyone, whether they have a disability or not, can maintain a healthy lifestyle by doing a combination of the following:

• eating healthier food in appropriate portion sizes;
• engaging in moderate physical activities on a daily basis, as their condition allows it;
• getting check-ups regularly;
• consulting with health professionals to help with medication or pain management, or to identify appropriate physical activity options.

Given additional challenges that people with disabilities are more likely to face to maintain a healthy lifestyle:

• Health professionals should receive training in how to meet the needs and support healthy lifestyles of people with disabilities.
• Health professionals can ensure that their facilities are accessible and provide services that meet all of the health needs of their patients, beyond the disability.
• Health programs should be designed to include people with disabilities.
• Fitness facilities can ensure that their equipment and programs are accessible and inclusive.
• Accessible transportation options should exist within the community.
• Policies that mandate access to resources and environments can be enforced to facilitate a healthy lifestyle for people with disabilities. Such regulations are provisions of the Rehabilitation Act of 1973, as amended, and the Americans with Disabilities Act of 1990, as amended.

Policies and programs are currently being designed to promote a healthy lifestyle at school, work, and in the community for everyone. These must also be designed in order to address the specific needs of individuals living with a disability.

The Bottom Line

• People with disabilities face many barriers to good health.
• People with disabilities are at risk of being overweight or obese. Their functional limitations can affect how they interact with their environment and may limit their accessibility to health care, fitness facilities, and healthier food options. In addition to these reasons, they face many of the same factors that put the general public at risk.
• Overweight and obesity increase the risk of serious diseases and health conditions for everyone, including people with disabilities.
• Obesity is a common, serious and costly problem that requires action from everyone: an individual’s healthy behavior change, a community’s effort to foster a healthy environment, and changes to policies that promote healthy lifestyles.

Case Example

• Before her spinal injury, Jenny was an avid runner. She now uses a wheelchair and has limited use of her legs. Without regular physical activity, Jenny naturally began to put on weight. After consulting with her physician and other individuals with paralysis, Jenny found new ways to get physically fit by using accessible community resources that included a pool with a lift so that she could safely get into the water to swim. She set reachable goals, and with the support of friends and family, she continues to lose weight and maintain a physically active lifestyle.