Weight after SCI: the good, the bad and the ugly

The Journal of Spinal Cord Medicine, 2017 · DOI: 10.1080/10790268.2016.1248705 · Published: March 1, 2017

Spinal Cord Injury Endocrinology Physiology

Simple Explanation

A recent study reported a mean body weight reduction 1 year after acute spinal cord injury (SCI). The study tracked changes in Body Mass Index (BMI), a measure of obesity. While the initial study is valuable, changes in BMI or body weight alone do not accurately reflect the changes in body composition following SCI. The real problem is that obesity among the SCI population is underreported. People with SCI can have high body fat even at a normal BMI.

Study Duration

1 year

Participants

1094 adults with acute spinal cord injury

Evidence Level

Not specified

Key Findings

1
Persons categorized as overweight or obese at baseline experienced overall weight loss over 1 year, while those initially characterized as underweight or of normal weight appeared to gain weight.
2
There is a decrease in fat-free body mass (FFM) after SCI, which reduces resting metabolic rate.
3
People with SCI are fatter than able-bodied controls at the same BMI. A BMI of 25 kg/m2 in able-bodied people translates to >30% body fat in people with SCI.

Research Summary

A recent study showed weight loss in SCI patients, but the author argues that BMI alone is insufficient to assess health in this population due to changes in body composition. Body composition, particularly the ratio of fat mass to fat-free mass, is significantly altered after SCI, leading to underreporting of obesity. More accurate and accessible methods for assessing body composition are needed to address the underreported obesity epidemic in the SCI population.

Practical Implications

Improved Body Composition Assessment

Develop and validate a quick, easy, and inexpensive clinical tool to accurately report body composition changes in the SCI population.

Accurate Obesity Identification

Consider people with chronic SCI and BMI values >22 kg/m2 as being at high risk for obesity and obesity-related chronic diseases.

Targeted Interventions

Implement interventions that address excess adiposity, especially abdominal adiposity, to mitigate the metabolic syndrome and its associated risks in individuals with SCI.

Study Limitations

1
BMI is an inadequate measure of health in SCI patients.
2
Current body composition assessment methods are often time-consuming, expensive, or inaccurate.
3
The obesity epidemic in the SCI population is underreported.

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