OBESITY
Similar to the general population (132), excessive weight can be problematic in individuals with spina bifida. Secondary to paralysis and wheelchair mobility, obesity increases the risk of decubiti.
In addition, there is increased stress with physical activities on the upper extremities. Self-image, social adaptation, and acceptance are also compounding factors with obesity and spina bifida. The development of positive self-image is greatly affected by social relationships (133).Body mass index is not as useful, as height calculations may be difficult to do accurately. Subscapular skin-fold thickness is more reliable to assess for obesity. Opportunities for physical exercise are fewer than those for age-matched peers without disabilities. Therefore, preventative anticipatory guidance regarding weight and exercise should be part of the comprehensive care and education for individuals with spina bifida from an early age, as weight loss may be difficult once the child/adolescent or adult is overweight. It may be difficult for children and adolescents to grow into their weight secondary to shortened stature (see the following section). Recommended diet guidelines include decreased caloric intake by 10% to 20%, and a diet low in fat and carbohydrates and high in protein and fiber, with proper vitamin supplementation (74).