Reframing Weight Loss for Wheelchair Users

I’d like to start this conversation about weight loss with a simple suggestion: Let’s stop talking about weight loss. For one, weight loss is a loaded term and almost guaranteed to spark fights over diet versus exercise, what type of diet works best, what types of exercises burn more calories, and on and on. Add in disability, and there’s a whole other layer of variables to argue about.

It’s exhausting. And not in the “I just had a good workout and now feel tired and content” kind of way, but in the “good lord, we have countless experts trying to find the best ways to lose weight and it’s still so damn hard, what’s the point, I just want some French fries” kind of way.

Instead of jumping into that debate, let’s roll back and look at the bigger picture. Usually, when people want to lose weight, the weight itself isn’t the primary motivating factor. Do you really care about the number? Or would you like to have more energy, make it easier to transfer and navigate your world, and worry less about secondary health issues? If you want to transform your body, try focusing on what you are gaining, not what you’re trying to lose.

As Ellen Stohl wrote about her own weight-loss journey in New Mobility 15 years ago: “I rolled away with something much more important than the svelte figure I’d been hoping for in the first place: In the vain effort to simply look better, I learned how to live better.”

Health and wellness journeys are different for everyone. I’ll be sharing some of my own insights from 25 years as a wheelchair user with a C7 spinal cord injury, but yours may be different. Please share your stories of what has and hasn’t worked for you.

Start with Activity

When I was a freshman in college, I weighed around 165 pounds and had a significant quad belly. I was heavier, and doughier, than I needed to be. But what really annoyed me was that I wasn’t strong enough to do a lot of the things I wanted to do — like push around a hilly campus without exhausting myself or do a floor-to-chair transfer. I started working out with the goal of getting stronger, not losing weight. But a funny thing happened. As I got stronger, I also started to lose weight. After a few years, rather than restricting my diet to keep weight off, nutrition became a means of keeping muscle on.

In 2018, I wrote a deep dive into metabolism for wheelchair users. Fortunately, that article still holds up to current research, and if you want a better idea of how paralysis and varying levels of function affect how much energy you burn throughout the day, it’s worth a read. But the main point is that while wheelchair users typically burn fewer calories on inactive days than nondisabled people do, on active days wheelchair users typically burn just as many calories as our nondisabled counterparts. Elizabeth Broad, a sports dietician who works with the U.S. Olympic and Paralympic teams, summed up the paradox nicely: “The higher the level of your spinal cord lesion, the more important it is for you to maintain a regular activity level.”

Now, this doesn’t mean that you have to turn into a gym bro. (Or gym bra? Gym betty? What’s the preferred term for women who like to get shredded?) For some, doing simple workouts at home is a more accessible option than going to the gym. For others, having positive peer pressure is important. I personally shudder at the thought of having people cheer me on as I crank out some reps, but there’s a reason CrossFit is a thing, and gyms are often willing and able to adapt their classes to wheelchair users’ needs. If you’re one of those people who likes people, group fitness classes like Zumba provide fun and motivation that solo workouts never will.

For those who need to train for something more tangible than “get stronger,” head to practice with a local adaptive sports team, or sign up for a race. If you hate one sport, try another. Just because you get bored with one type of activity doesn’t mean you’ll hate all fitness pursuits — it just means you haven’t found your schtick yet.

For maximum health benefit, experts recommend people do both regular resistance/strength training and cardiovascular activities. The Adapt To Perform YouTube channel has a trove of both cardio and resistance workouts for wheelchair users. And if you want something more tailored, wheelchair user Christina Chambers (IG: @christina_chambers) provides personal training sessions over Zoom.

Of course, not every wheelchair user can work out on their own. Having significant physical limitations means that you simply don’t have as many muscles to move. It’s hard to shoulder-shrug or head-dance your way to better health. If you have a high level of disability, functional electrical stimulation bikes like those from Restorative Therapies or Myolyn offer many of the benefits of self-powered exercise. These bikes are expensive, often costing around $15,000, but they’re one of the only options available for maintaining physical activity when you’re on the low end of the function spectrum. Myolyn does offer a solid funding guide that covers grants, assistive-technology loans, crowdsourced fundraising and more.

Improving Nutrition

The reason I started with activity is because scientific weight-loss research is remarkably consistent: Changing your diet alone does not typically result in sustained weight-loss. Most dieters lose weight in the short term and then start regaining some or all the weight that they lost.

One of the biggest reasons is that when your body loses weight, it responds by slowing your metabolism and increasing the hormones that make you feel hungry. The more weight you lose, the harder your body fights it. The increased hunger and decreased energy you feel when you’re on a diet isn’t you being weak-willed — it’s ancient hormones trying to keep you alive in what your body thinks is a food-scarcity situation.

This is why modern weight-loss drugs like Ozempic are so effective. They slow down those hunger hormones, so even when you lose weight, you don’t feel hungrier. For many, these types of drugs can feel like a path out of obesity when nothing else has worked. A couple of things to consider, though: First, when you stop taking the drugs, those hunger hormones come back. The drugs are so new that there isn’t a lot of research into how well people can keep off weight once they stop taking the drugs. Second, there is some research that people taking these drugs also lose muscle mass along with fat. For wheelchair users who don’t have a lot of strength to lose, this could be a concern. Wheelchair users should also consider side effects like bloating, gastrointestinal pain and bowel issues.

For people with higher levels of disability, it’s likely that to reduce excess fat and improve health, you’ll need to reduce overall calorie intake. There’s no getting around the fact that someone with a C4 injury level is going to have fewer energy requirements than an active T10 para.

Whatever your level of function, it can be helpful to reframe your eating mindset away from restriction. To improve both body composition and health, food quality is just as important as quantity. So instead of strictly cutting calories or chopping whole groups of nutrients from your diet, try adding more healthy, unprocessed foods to your everyday diet.

Eating more “perimeter of the grocery store foods” like vegetables, beans and legumes, nuts, good fats, whole grains, and lean, unprocessed proteins will naturally lead to less hunger, even if your total calories are lower. For an illustration, try eating your way through 200 calories of broccoli.

Ultraprocessed foods — think fast food, chips, crackers, sandwich breads, frozen dinners, packaged snack foods and a whole lot more — are an efficient way to ingest calories, but they usually leave you wanting more. If you can add healthier foods to your diet, then your muscles, gut biome, cardiovascular health, and energy levels are all likely to be better off.

Nutrition Tip

“There is a healthy way to lose weight, reduce fat and maintain muscle without starving yourself. The trick is to stabilize blood sugar and insulin levels by eating more meals. Eating four-to-five small meals a day, consisting of low glycemic foods (e.g., proteins and complex carbohydrates like fruits, vegetables, whole grains and legumes) can take off weight. Also, this will help give you more sustained energy levels throughout the day and improve your bowel routines.”

— Joanne Smith, certified nutritionist,
from her article “Weight Loss — More is Less“