Nutrition and Weight Management for People with Diabilities, Volume 10

Inside this Issue

Proper nutrition and weight management are key factors in maintaining good health

It is extremely important for people of all ages to eat a healthy diet that meets their nutritional needs and does not contribute to excessive weight gain. However, eating healthy and controlling weight is not always easy to do, particularly for people with disabilities.

Persons with disabilities may find it more difficult to control their weight because they may not have independent choice in selecting the foods they eat. In addition, physical limitations may reduce their ability to exercise regularly. Due to disability-related limitations some people may lack the time, energy or ability to prepare healthy meals. They also may need to take medications that can contribute to weight gain. Good nutrition may be a major challenge for persons who have difficulty chewing and swallowing.

Difficulty Shopping and Cooking

Persons with disabilities that affect their mobility may find it difficult to get to a food market and to reach products on upper store shelves. It also may be hard for persons who live independently to prepare and cook fresh ingredients such as vegetables, fruits and meats. Individuals who have spastic conditions that affect their arms and hands may find chopping and cutting foods to be a very slow and time consuming task. Those who use a wheelchair may have trouble reaching the top of the stove to check or stir cooking foods. As a result of these limitations, persons with disabilities often end up ordering take-out or fast food from restaurants or eating TV dinners.

Community Residence May Offer Limited Food Choices

Persons who live in community residences may have little influence over the type of foods served. Meals served in a residence often reflect foods the consumers and staff have grown accustomed to preparing and eating over the years. For example, a review of menus of several community residences showed a high proportion of high fat foods, such as pizza, luncheon meat, hot dogs and TV dinners. Limited cooking skills and nutritional awareness of staff members also may serve as barriers to healthy diets in a community residence.

Aides May Choose Easy to Prepare Foods

Individuals living independently who rely on personal care aides for meal preparation, may find that the aide's scheduled visits do not coincide with meal times. The aide may not have time to shop for fresh ingredients or to cook nutritious foods that may be desired by the consumer. Instead, the aide may choose foods that are easy to prepare, such as canned soups and prepared meats that may be high in fat and salt. The meals may be prepared in advance and stored in the refrigerator to be heated up later at meal time.

Overcoming Weight Management Barriers

Despite these barriers, persons with disabilities can achieve a healthy lifestyle that includes proper nutrition and moderate exercise. Recent research has shown that even small lifestyle changes can make dramatic differences. The keys to a successful weight management program are education, motivation and development of realistic goals. As outlined in this newsletter, a growing number of organizations that serve persons with disabilities are conducting nutrition education programs to help people get started on the road to better health. For information on programs in your area, contact your primary care provider or local independent living center.

Health & Wellness Resources

American Cancer Society www.cancer.org
American Diabetes Association www.diabetes.org
American Dietetic Association www.eatright.org
American Heart Association www.heart.org
National Cancer Institute www.cancer.gov
National Institutes of Health, Osteoporosis and Related Bone Diseases www.niams.nih.gov/Health_Info/Bone/
National Osteoporosis Foundation www.nof.org
WomensHealth.gov www.womenshealth.gov
5-A-Day www.fruitsandveggiesmorematters.org/

Persons with Disabilities Twice As Likely to be Obese

The increasing weight gain and obesity of American men, women and children has been widely publicized. But there has been less attention given to the fact that persons with physical, emotional and sensory disabilities are nearly twice as likely to be obese as the general population.

A recent survey conducted by the Centers for Disease Control showed that 27.4% of adults with disabilities were obese, compared to 16.5 % of those without disabilities. Substantial differences existed between men with disabilities, 25.5% of whom were obese, versus only 17.7% of men without disabilities An even greater difference was shown among women with disabilities, 29.1% of whom were obese, compared to 15.3% of women without disabilities. Overall, the differences were greatest among persons 45-64 years old. In this age group 34.4% of persons with disabilities reported obesity compared to 19.5% of those without disabilities.

African Americans and Hispanics with disabilities had the highest rates of obesity among those who participated in the survey. Nearly 36% of African Americans with disabilities were obese, as were 31% of Hispanics, compared to 25.7% among whites.

In New York State, the estimated prevalence of obesity among persons with and without disabilities was slightly lower than that in the national survey population. In New York, 25.3% of persons with disabilities were obese compared to 27.4% in the national survey population; 14.3% of New Yorkers without disabilities were obese versus 16.5% in the national survey population.

It should be noted that the survey data, including height and weight, were self reported by individuals participating in the survey. Disability was defined on the basis of responses to either of the following questions: Are you limited in any way in any activities because of an impairment or health problem. If you use special equipment or help from others to get around, what type do you use.

Centers for Disease Control & Prevention, State Specific Prevalence of Obesity Among Adults with Disabilities, MMWR, 2002:51(805 - 808)

Graph showing percentage of adult New Yorkers who are obese by age group and disability status. For 18 through 44 years, 20.4% of those with a disability are obese compared to 12.7 percent of those with no disability. For 45-64 years, 34.8% of those with a disability are obese compared to 16.8 percent of those with no disability. For 65 years and over 24.2% of those with a disability are obese compared to 15.4 percent of those with no disability.

Learning How to Eat Healthier and Stretch Food Dollars

Recognizing the potential barriers to healthy eating and weight management for persons with disabilities, some organizations have begun offering nutrition and cooking classes for consumers and staff of community residences and for persons with disabilities who live independently.

Access to Independent Living of Cortland County

We did a survey of consumers in our program about what they wanted to learn. Healthier eating and cooking was the overwhelming response.
Fran Pizzola, Executive Director.

So many persons with disabilities don't know about nutrition. They have never been taught. It is an important independent living issue.
Susan Lewis, Independent Living Advocate Access to Independent Living of Cortland County

Access to Independent Living of Cortland County partnered with Cornell Cooperative Extension to provide two six-week nutrition classes for persons with disabilities who live independently. The programs were conducted at the Access Center for two hours each week by a Cornell Community Nutrition Educator.

Smart Shopping & Stretching Food Dollars

The first six-week course focused on how to purchase healthy and economical foods. Consumers were taught how to read grocery store ads in the newspaper and plan meals around healthy foods that were on sale. The class learned how to check ingredients and compare weights and prices on packaged food products. They also learned what to watch for in selecting fresh vegetables, fruits and meats. Price differences between store brands and name brands were pointed out, as well as the fact that prices are usually lower in a large supermarket versus a local convenience store. One afternoon was devoted to learning how to stretch food dollars and create a nutritious and economical casserole by using food items you may have in the cupboard.

Learning to Cook Simple Recipes

The second six-week course focused on basic nutrition and learning to cook easy, healthy recipes. The Access Center has a fully accessible kitchen with stove, sink and cupboards adapted to persons with disabilities. In addition to learning how to use the kitchen, the group also learned how to change recipes to make them healthier. Participants learned to use the FDA Food Guide Pyramid to guide their choices toward a healthier diet and lifestyle. Controlling weight by exercising portion control was also a key message of the program.

The students agree that the best part is cooking simple meals and eating the results of their efforts. Each recipe is easy to prepare because it uses no more than 5-6 ingredients. Recipes, which emphasize low fat ingredients, include vegetable lasagna, chili, fruit smoothie, spicy gingerbread, low fat chicken fingers, yellow rice and strawberry shortcake.

The Access to Independent Living of Cortland County agency plans to continue offering nutrition programs with Cornell Cooperative Extension so other consumers can benefit from the training. For additional information, contact Access To Independence of Cortland County, Inc. www.cilcortland.org (607) 753-7363.

people cooking

Richard

Richard, who has attended both of the nutrition classes, reports, "I now read the labels on food products when I shop. I learned to look at the quantity and units on packages, and I also use coupons to stretch my food dollars. The nutrition class was awesome. I am now drinking more milk and eating more healthy foods. I enjoy cooking and eating the foods. My favorite is chili with corn bread. I made it at home and I am going to make it for my brother."

Heather

Heather, who took the nutrition class says, "I enjoyed it very much. We had a wonderful teacher. She has a sense of humor and does interesting activities. I changed my outlook about calcium. I realized that I need to have more dairy products and calcium. My most favorite recipe is fruit smoothies. I shared that recipe with my friends. I also like the chili and corn bread and the strawberry shortcake."


Chili with a Hat On
Ingredients for Chili
  • ¼ cup minced onions
  • ½ cup chopped green peppers
  • 1 pound ground beef
  • 2 tablespoons cooking oil
  • 1 (8 ounce) can tomato sauce
  • 1 tablespoon catsup
  • 1 teaspoon each chili powder & salt
  • dash of black pepper
Ingredients for Hat
  • ½ cup flour
  • ¾ cup corn meal
  • 2 teaspoons baking powder
  • 1 teaspoon salt
  • 1 tablespoon sugar
  • 1 egg beaten
  • ½ cup low fat milk
  • 2 tablespoons cooking oil
Directions
Heat oven to 400°F. Cook ground beef and drain grease; set aside. In a large skillet brown onions and peppers in oil until browned. Add beef, tomato sauce, catsup, and spices; turn into a 2-quart casserole. Set aside.

For topping: Sift together flour, corn meal, baking powder, salt, and sugar. Combine beaten egg and milk. Add to flour mixture stirring just until mixed. Stir in oil. Spread on top of chili. (If there's a great sale on corn muffin mix, go ahead and use ½ package in place of topping mixture.)

Bake for 25 minutes or until browned. Makes 6 servings.

Finger Lakes Independence Center

The Finger Lakes Independence Center teamed up with the Food Bank of the Southern Tier-Operation Frontline and Cornell Cooperative Extension of Tompkins County to run a six week, two hour per week cooking class for persons with disabilities entitled Eating Right. The program promotes self-sufficiency by providing low income and at-risk individuals with cooking, nutrition and food budgeting skills they need to improve their health and live independently.

Hands-on cooking experience

The first hour of the class was devoted to meal preparation and cooking. A volunteer chef worked with nine participants, leading and assisting them in the preparation and cooking of nutritious meals. Each participant learned basic cooking skills using a hands- on approach.

"Our goal is to teach people how to cook healthy meals to get them in the habit of cooking rather than running to a local fast food place on a nightly basis."
Jeff Boles, Peer Counselor Finger Lakes Independence Center

Using the Food Guide Pyramid

During the second hour participants spent time with a nutrition educator from Cornell Cooperative Extension who covered a section of the Food Guide Pyramid each week using visual aids and participatory games. This exercise was designed to show the importance of a well balanced diet and the nutritional value of certain foods. The educator also did a nutritional analysis with each person and worked with individuals on specific areas of nutritional improvement and weight control.

Economical Food Shopping

During the fifth week the class took a trip to a local food market. Each person was given $10 to purchase the ingredients for three nutritious meals. The class made use of the following tips to stretch their food dollars:

  • Check grocery store ads for specials each week
  • Check the reduced price produce section in the store
  • Look for specials in the meat department - get a rain check if the sale items are not are available
  • Look for low-priced products that you can get more than one meal from.

This program was so well-received by the initial participants that the Finger Lakes Independence Center is repeating it again this Spring. For additional information contact Finger Lakes Independence Center (607) 272-2433 www.coachboles@hotmail.com

Eat Smart New York

Free Nutrition Education Workshops Offered by Cornell Cooperative Extension

Trained Community Nutrition Educators conduct group presentations or one-on-one home visits to help limited income individuals learn how to eat healthy and stretch their food dollars.

The educators are trained to work with youth, teens, seniors and persons with disabilities.

The educators use fun activities, field trips and hands on cooking sessions to help participants learn to: stretch their food dollars, cook from scratch, serve healthy snacks and meals, use the FDA Food Guide Pyramid and control their weight for optimal health.

All of the Eat Smart New York services are FREE and participants get to keep all the food they prepare.

Contact your county office of Cornell Cooperative Extension to learn more about this program or to arrange a nutrition workshop for consumers with disabilities living independently or in a community residence.

Poor Nutrition Leads to Obesity & Health Problems

Poor nutrition can contribute to excessive weight gain which is associated with many chronic health problems.

Due to ever increasing rates of obesity within the U.S. population, the Centers for Disease Control has ranked obesity among the top ten leading health risks to be reduced by 2010. In 2001, more than 44 million Americans were obese, representing an increase of 74% since 1991. The estimated annual cost attributed to treating obesity-related diseases is $117 billion.

Poor nutrition and obesity contribute to the following health concerns and medical problems:

  • heart disease
  • high blood pressure
  • stroke
  • respiratory problems
  • diabetes
  • cancer
  • gallstones
  • osteoarthritis
  • fatigue
  • bladder dysfunction
  • bowel dysfunction
  • depression
  • sleep problems
  • urinary tract infections
  • allergies & allergic reactions
  • side effects from medications
  • lowered life expectancy

Living Well with a Disability

State Awards Grants to Eight Organizations

Eight organizations have been awarded grants from the State Health Department's Disability & Health Program to help persons with disabilities improve their health status and quality of life.

The Living Well with a Disability Program is an eight-week wellness course taught by trained facilitators to groups of 8-12 adults with disabilities. The program is designed to help participants set health improvement goals, such as increased physical activity and proper nutrition, and make progress toward achieving their goals. A key objective of the program is to help persons with disabilities prevent and manage secondary health problems.

Organizations that received State grants of approximately $4,500 each to conduct the program in 2003 are: Finger Lakes Independence Center, Tompkins County; Access to Independence of Cortland County; People Inc. of Erie County; Eastern Paralyzed Veterans Association, Queens; Options for Independence, Onondaga County; Northern Regional Center for Independent Living, Jefferson County; The Resource Center, Chatauqua County; and Westchester Institute for Human Development in Westchester County .

The Disability & Health Program expects to fund additional organizations in the coming year. For information about the Living Well with a Disability RFP, call Fran Stevens at (518) 474-2018.

(Previous issues of "On Target" on other wellness topics are available from the New York State Department of Health's web site at http://www.health.ny.gov/community/disability/on_target/target.htm

New York State Department of Health
Disability and Health Program
Riverview Center
150 Broadway, 3 West
Albany, New York 12204

"On Target" is also available on audio cassette or in large print. For a copy, contact the Disability and Health Program at (518) 474-2018 or www.health.ny.gov (Disability and Health Link)

The "On Target" newsletter is part of People First, a series of health and wellness materials for people with disabilities, their family, friends and health care providers. Health education materials for people with disabilities are also available through the Department of Health's web site at www.health.ny.gov. Just click on the Information for Consumer's icon, and go to the Disability and Health page.