Obesity in Children with Physical Challenges: Taking a Path in the Right Direction

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The bleachers are filled with anxious parents cheering for their sons and daughters. Socializing with the surrounding crowd, the parents share grins of pride and exchange encouraging words. One of the common bonds among members of this audience is that their children—the players on the court—all have physical challenges. Many of the kids are in wheelchairs and most are wearing prostheses or orthopedic bracing of some kind, but all of them are smiling enthusiastically. This is a typical scene at No Limits Sports Day, where kids with physical challenges are invited to participate in a sampling of adaptive sports. Most of the children have limited exposure to exercise options, and many of them have been excluded from sports altogether.

Held at the All People's Life Center, Tampa, Florida, and co-sponsored by Shriners Hospitals for Children-Tampa, No Limits Sports Day provides an open playing field that offers an outside track for wheelchair racing and adaptive bicycling. Inside the gymnasium are basketball courts for wheelchair competitions and converted tennis training courts. Coaches guide the participants in an exercise room with a variety of equipment, and down the hall can be found dance and karate classes. A resource table with information on available community and national activities is provided, as well as pamphlets on nutrition and guides to a healthier lifestyle. Athletes present motivational talks at the "lunch and learn" to exemplify how sports have improved their lives and helped direct their ambitions.

No Limits Sports Day was established to educate this population and their families on ways to achieve a healthier lifestyle.

No Limits Sports Day participants join in a game of adaptive basketball. Photograph courtesy of Shriners Hospitals for Children-Tampa, Florida.

Obesity is a prevalent side effect of children with disabilities. Its onset often begins when children are very young, especially for those who use wheelchairs either full or part time. Due to a sedentary lifestyle, the balance of caloric intake and calories burned is disproportionate, often resulting in weight gain. To complicate matters, the lack of muscle mass in many children, especially those with spina bifida, means these children must expend even more energy to use the calories consumed.

Because children with physical challenges are deprived of so many activities, parents tend to reward with food treats since the dinner table is an equal "playing field" for everyone. It is difficult for parents to resist this type of reward system. The food-reward cycle and its inevitable consequences continue to mount as the child ages. Braces, such as RGOs that enable a child to walk, become more difficult for the parent to don and doff as the child gains weight. The child requires excessive amounts of energy to walk with the added burden of increased weight, so they resist using their orthoses, often creating conflicts in the home. Consequently, the RGOs spend more time in the closet than in use and are eventually abandoned. The result is increased time in the wheelchair, compounding weight-gain issues.

The solution to obesity in children with physical challenges lies with the parents, health professionals, and community support groups that advocate for healthier lifestyle choices. As a professional, you can promote education for nutritional balance by referrals to certified nutritionists and/or resources found locally or on the Internet. Organizations such as the YMCA can sponsor adaptive sports programs to include those with physical challenges. Promoting the Paralympics through posters displayed in your office can encourage young potential athletes. Interactive computer games are a terrific source of exercise for all skill levels and abilities. These games also even the playing field, which enhances self-esteem.

Perhaps one of the most valuable tools in the fight against obesity is an open dialogue from the very first introduction of the medical professional to the family. As witnesses to the cycle of obesity, we have a responsibility to warn parents of what may be an impending problem. As difficult as such honesty can be, an ounce of prevention can be worth pounds of cure. Fighting obesity in children with physical challenges is a team effort that can be won. The solution is to find the right path that enables the child to successfully achieve a healthy lifestyle forever.

Janet Marshall, CPO, LPO, is a pediatric specialist at Shriners Hospitals for Children-Tampa, Florida. She is the president of the Association for Children's Prosthetic-Orthotic Clinics (ACPOC).

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