Finding Balance

By Anna Quon

For most of my life I’ve thought of myself as a fat person. I was always a sturdy little kid (“chunky,” someone said, to my mortification), but around the age of 10, my excess weight really became noticeable, and made me miserable. Since then I’ve battled my weight, sometimes with extreme bouts of dieting and exercise. Now, at age 37, I am about 100 pounds overweight. When I look in the mirror, I wonder, how did this happen?

I know how it happened. I am a mental health consumer, and I eat more, and more calorie-rich foods, when I am depressed. I also exercise less. When I was 30, I ended up in the mental hospital again, and was already losing my svelte, inline-skating self to bags of salt-and-vinegar chips. When I started taking an antipsychotic medication that is known to cause an increase in appetite and weight gain, all hell broke loose, and for several years my weight climbed steadily.

But I’d rather be overweight, even obese, than psychotic and depressed. My psychiatrist seems to agree that I have done so well mentally and emotionally on my current medication that she doesn't feel it’s the right time to change it, though she has agreed to and even encouraged a reduction in dosage.

There are a lot of us around — mental health consumers who, due at least in part to our medications, have blossomed into fat people. But we’re not the only ones. The percentage of Canadians who are overweight or obese has risen dramatically in recent years. Statistics Canada states that, according to the 2004 Canadian Community Health Survey, 23.1 percent of Canadians aged 18 or older, or an estimated 5.5 million adults, had a body mass index (BMI) of 30 or more, indicating that they were obese. (To read more about BMI, see “Measuring Up," below.)

The stigma associated with being fat – namely, that fat people are lazy, gluttonous and unattractive – can have a negative impact on how we look at, and feel about, ourselves. But excess weight also comes with health risks, including type 2 diabetes, cardiovascular disease, high blood pressure, osteoarthritis, stroke, some forms of cancer and gall bladder disease.

Research suggests that people with disabilities are more likely to be overweight or obese than other population groups — and women with a disability are twice as likely to be obese as women without.

There are several reasons why people with disabilities may have problems with weight. These include medical conditions that affect metabolism, medications that increase appetite, reduced mobility, lack of exercise, reduced muscle mass (muscle burns more calories than other tissue), eating habits affected by depression, anxiety, boredom or frustration, dependence on others, such as family members or attendants, to provide meals, and lack of knowledge about nutrition and weight management.

On the other hand, some disabilities, or certain phases of a disability, can cause weight loss. Some progressive conditions, such as multiple sclerosis, can cause swallowing difficulties, which can result in inadequate nutrition intake and weight loss. Karen Gibson, a dietitian at the Nova Scotia Rehabilitation Centre in Halifax, sees a lot of people with spinal cord injuries (SCI). “It is common for individuals to lose weight post-injury as nutrition and energy needs are very high following trauma.”

Gibson’s colleague, dietitian Cathy Doyle, says this is also true of people who have had strokes. “During the acute phase, there is an increase in their metabolic rate, causing unintentional weight loss and depletion of their protein stores,” says Doyle. These people are initially placed on a high-protein, high-calorie diet to replace what they’ve lost. Then, to reflect their lower activity level, they are switched to a high-fibre, high-fluid, heart-healthy eating plan to reduce their risk of having another stroke. “Maintaining an active lifestyle is one of the biggest problems,” says Doyle.

Another, says Gibson, is that people continue to eat the way they’re used to before they acquired a disability. “Individuals with a disability burn fewer calories, and therefore need fewer calories to maintain their weight,” she explains. “Weight gain results when people resume pre-injury eating habits.” Those habits, especially for young people with SCI, may include many high-calorie snacks and fast food items. Gibson talks to newly injured people about the risks associated with weight gain. Often, a desirable body weight means one that’s lower than what is recommended for the general population.

Gibson says, “It is recommended that an individual with paraplegia weigh 10 to 15 pounds less than prior to their injury, and people with quadriplegia weigh 15 to 20 pounds less than they did prior to injury.” Often it’s the people assisting a person with a disability who first notice the weight gain. “Added weight can make transfers more challenging and interfere with activities of daily living,” says Gibson. “If you gain weight, it changes how you fit in your wheelchair, and this can increase the risk of skin breakdown.”

Prevention is key, says Doyle. She and Gibson often recommend a strict diet that includes lots of fruits and vegetables, at least five to six servings a day. They educate people with disabilities and their families about heart-healthy food choices and the importance of watching portion size. At the rehabilitation centre where they work, they invite former clients to share their experiences about life after rehab, highlighting ways to prevent unwanted weight gain.

The good news is that losing just five to 10 percent of body weight through better nutrition and exercise can lead to improved health and well-being.

Weight can be a sensitive issue for many, but Halifax resident Dan MacLellan, who was a university student when he acquired a disability, is open about his struggle. Formerly a trim 165 pounds and active in a lot of sports, he was involved in a motor vehicle accident that caused quadriplegia at age 19. MacLellan quickly lost his appetite for hospital food, and four months after the accident, his weight plunged to 114 pounds. Weight gain didn’t become a concern until 20 years later, around age 40, when he reached 200 pounds.

Five years ago, MacLellan decided to try a strict diet that was fashionable at the time and lost 30 pounds in eight months. “I thought that was quite incredible because my body is not that active,” he says. But after that success, he slipped back into his old eating habits and gained back the weight he’d lost.

Now, he’s trying a diet that is more in line with his eating preferences. It includes a lot of fruit, which he loves, and allows some high-carbohydrate foods, such as pasta and bread.

“Pick a diet that fits your lifestyle and stay away from fad diets,” MacLellan advises. He also recommends paying attention to portion sizes. When having a barbecue, MacLellan now cooks up four-ounce servings of beef instead of the hefty one-pound steaks he used to make.

Amanda Domier, the advocacy facilitator at the Canadian Down Syndrome Society in Calgary, has recently begun her own journey toward weight loss. She attended a community college session on nutrition, where she learned strategies for modifying her eating habits. She keeps a food journal, makes healthy choices by reading food labels, and limits certain foods and drinks, such as cookies and diet pop, to “treat days” every second day.

Domier says she has been overweight for a long time, and many people with Down Syndrome share that problem. Research shows that children with Down Syndrome need, on average, 200 to 300 fewer calories per day than children without Down Syndrome. They also may be more prone than the general population to certain medical conditions, including diabetes and hypothyroidism. Underactivity and a lack of knowledge about meal preparation (or the lack of a say in what is prepared) may also be factors.

Domier sometimes has a negative body image. “I was just a big person who has no feelings,” she says. Losing weight is a priority for her to feel better physically and emotionally, and she has educated herself on making better food choices. “It’s not just about being strict, but knowing what are good and bad choices.” For example, she says, low-fat choices can be better than no-fat ones, which can be higher in sugar.

One of the most important things Domier has learned is to feel good about herself, no matter what her size. For me, this has been a hard lesson to learn. I had problems with depression earlier in my life that I relate in large part to my feelings of self-hatred because of my weight.

Today, although I am heavier than at any other time of my life, I am also happier and more confident. My weight seems to have stabilized, and though I am technically obese, I have an overall feeling of well-being and comfort with my body that I did not have when I was thin and practically starving myself to be that way.

That is not to say I don’t want to lose weight – I do. I’m eating more tofu, whole grains, legumes and vegetables, which in the past seemed to cut down on my sugar cravings, and I’m increasing my activity level. I’m also feeling slightly more accepting of myself. I’ve been reading fat-positive literature, such as the anthology Shadow on a Tightrope: Writings by Women on Fat Oppression (Aunt Lute Books), and have begun to realize the enormous damage the stigma of being overweight has had on me and other people, especially women, including those with disabilities.

I admit that, for a lot of reasons, including the way other people view me, I’d rather be thinner. I am working towards a healthier weight, but already I can share the good news that it’s possible to be active and happy at the same time as being fat.

Anna Quon is a freelance writer who lives in Dartmouth, Nova Scotia. She is a regular contributor to Abilities. You can read more health articles online at the Abilities website, www.abilities.ca.

Measuring Up

Body mass index (BMI) is a ratio of weight and height and is used to assess an adult’s health risk associated with being under- or overweight. A BMI of 18.5 to 24.9 is considered healthy, while a BMI above 30 is considered obese. You can calculate your BMI at www.cdc.gov/nccdphp/dnpa/bmi/index.htm but note that these guidelines may not apply to some people with physical disabilities. For example, people who have quadriplegia may weigh less than is recommended for the general population, but they also have reduced muscle mass in their arms and legs. Talk to your physician or a dietitian about your ideal weight range.


Food for Thought

Dietitian Karen Gibson shares simple ideas to improve your nutrition.

* Eat a healthy breakfast, such as whole grain toast with peanut butter, a banana and a glass of low-fat milk, every day.
* Eat at least three pieces of fruit and two servings of vegetables every day. People who eat fruit and vegetables more often are less likely to be overweight.
* Choose fresh fruit instead of juice. It has fibre and is more filling.
* Chose whole-grain breads instead of refined white breads.
* Include heart-smart fats, such as olive and canola oils and those found in nuts. Choose non-hydrogenated margarine and limit total fat intake to three to six teaspoons daily.
* Choose lean cuts of meat, poultry and fish. One serving is the size of a deck of cards.
* Limit nighttime snacking. Select low-cal choices such as low-fat popcorn, fresh fruit, low-fat yogurt, or baked tortilla chips and salsa.
* Choose low-fat dairy products.
* Limit intake of fried food.
* Avoid crash diets and gimmicks – these can be dangerous! Talk to your physician or a dietitian about safe, healthy ways to manage weight.

Online Info

Read about healthy weight and well-being at these Internet hotspots.

Weight Control and Arthritis: Information on controlling your weight
http://arthritis.about.com/od/weight
Information on weight, diet and exercise while living with arthritis.

Centre for Research on Women with Disabilities, Baylor College of Medicine
www.bcm.edu/crowd
Information to improve the health and expand the life choices of women with disabilities.

The Illinois Center on Health, Nutrition, Physical Activity and Disability
www.ncpad.org/nutrition
Features fact sheets on nutrition and specific disabilities.

Dietitians of Canada
www.dietitians.ca
Learn about Canada’s Food Guide to Healthy Eating, take a quiz, find a dietitian in your area and much more.