title: Clinical assessment and management of obesity in individuals with spinal cord injury: a review.
abstract: BACKGROUND
  Diagnosing and managing obesity in individuals with spinal cord injury (SCI) remain challenging.
  
  
  METHODS
  Literature on the epidemiology, impact, and management of obesity in individuals with SCI was reviewed.
  
  
  RESULTS
  Although nearly 66% of individuals with SCI are either overweight or obese, little guidance is available to measure and monitor obesity in the clinical setting. The use of anthropometric indices and specific cut points available for able-bodied persons is limited by the body composition changes that follow SCI. Indices of upper body obesity warrant examination in SCI because they provide an index of central obesity, which is more closely linked to some obesity-related conditions than is overall obesity. Investigations into the sequelae of excess body fat and its distribution are also needed in SCI because past research in this area has been inconclusive. Although limited, evidence regarding obesity interventions in SCI may be promising.
  
  
  CONCLUSIONS
  The best anthropometric tool to define obesity in the clinical setting remains unknown. SCI-specific assessment tools and a better understanding of the sequelae of excess body weight will lead to better targeting of prevention and treatment efforts. More research is needed on the individual components of a weight management program unique to SCI. Until then, providers are urged to use a team approach and draw on existing resources and applicable research in able-bodied individuals to facilitate weight management in individuals with SCI.
authors.affiliation: VA Puget Sound Health Care System, Seattle, Washington, USA. suparna.rajan@va.gov
authors.forename: Suparna
authors.initials: S
authors.lastname: Rajan
authors.forename: Marguerite J
authors.initials: MJ
authors.lastname: McNeely
authors.forename: Catherine
authors.initials: C
authors.lastname: Warms
authors.forename: Barry
authors.initials: B
authors.lastname: Goldstein
mesh_terms: D001823:Body Composition; D006801:Humans; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000628:therapy*