CILT’s Peer Links Volume 9, Issue 1 November 2007 Weight Management for People with Disabilities © Better Health Channel; 1999/2007; Victorian Minister of Health Research suggests that people with disabilities are more likely to be overweight or obese than other population groups. On the other hand, some people with disabilities are prone to unwanted weight loss. For example, a person who has a physical disability may lose muscle mass, or may find it difficult to eat and swallow. There are various management strategies that can help a person with a disability successfully manage their weight. See your doctor or dietitian for expert advice. Contributing factors For people with disabilities, some of the contributing factors that may lead to unwanted weight gain or weight loss could include: * A particular medical condition that affects the body’s metabolism. * Reduced mobility and lack of regular exercise. * Reduced muscle mass. * Medications that may increase or decrease appetite. * Eating habits may be affected by depression, anxiety, boredom or frustration. * Dependence on family members or caregivers to provide meals. * Poor knowledge of nutrition and weight management. Calculating a person’s appropriate weight There are many ways to calculate a person’s ideal weight for their height (such as the body mass index, or BMI), but these methods don’t always apply to people with a disability. For example, a person with a physical disability may weigh less than is recommended for the general population, but the guidelines do not take into account any reduced muscle mass in their legs or arms. Generally, for someone who is overweight or obese, a helpful guide is the waist to hip ratio - if the waist measurement exceeds the hip measurement, the person may need to lose weight. The benefits of losing just 5 to 10 centimetres off the waist can significantly reduce the risk of many conditions, including diabetes and heart disease. Always see a doctor or dietitian for help in calculating a person’s ideal weight range, and for strategies on achieving a goal weight. Healthy diet suggestions for people who want to lose weight It’s a good idea to see a dietitian for advice on how to achieve a slow, healthy weight loss. Some suggestions include: * Eat a healthy, balanced diet - breads, cereals vegetables and fruits should make up the bulk of the diet. Meats and low fat dairy foods should be eaten in smaller portions. Foods that are high in fat (such as fried foods) should be eaten sparingly. * Increase fibre - high fibre foods offer a sensation of fullness and satisfaction without the calories. Aim for around 30g of fibre each day. * Adapt existing recipes - most recipes can be converted to low fat meals with little effort. For example, use non-stick cookware to eliminate the need for cooking oils, and replace cream with non-fat yogurt. Grill, bake or roast rather than fry. Cut fat from meat, and choose low fat or non-fat versions of dairy products. * Don’t overeat - excess calories lead to an increase in weight. It is best to eat foods that are lower in fat and to avoid eating when you are not hungry. * Read labels - packaged foods include nutrition information on their labels. Make a habit of reading these labels when shopping, and choose foods that are lower in fat. * Exercise regularly - any type of regular exercise program will boost a person’s metabolism and help burn calories. * Healthy diet suggestions for those wanting to gain weight - See your dietitian for advice on how many kilojoules you need to consume each day to achieve a slow, healthy weight gain. Suggestions include: * Eat more often - eating six or more small meals and snacks throughout each day can help boost the appetite. * Use favorite foods - foods that arouse little interest are likely to be left on the plate. A person is more likely to eat if favorite meals and snacks are provided. Make sure that the diet has a range of healthy foods. * Choose full fat foods - extra calories are needed to achieve weight gain, so choose full fat rather than low or non-fat food products. * Add extra kilojoules to meals - mixing grated cheese, polyunsaturated margarine, dried milk powder or yogurt into favorite meals adds extra kilojoules without having to eat a large quantity of food. * Exercise regularly - any type of regular physical activity, even gentle stretching, can help stimulate a flagging appetite. Exercise can also help to gain muscle tissue. Find an eating style that suits you best - Maintaining a healthy weight is only possible in the long term if an ‘eating style’ that suits the person is chosen. For example, some people prefer eating three main meals each day, while others prefer to eat more regularly to include snacks as well as meals. Talk to a dietitian about your eating preferences so they can draw up a dietary plan that is sustainable. Exercise is important Proper weight management relies on exercise too. People with certain disabilities may have reduced mobility, but it is important to remember that any degree of activity is helpful. For example, a person confined to a wheelchair can still lead a very active lifestyle. Exercising in water is often easier for people with certain disabilities, as the buoyancy offers support. Even gentle stretching can prevent muscle contraction and wasting. An individually planned exercise program is an important weight management strategy, so see a doctor or physiotherapist for further information. Where to get help * Your doctor * Dietitian * Support group Things to remember Research suggests that people with disabilities are more likely to be overweight or obese than other population groups. Some people with disabilities are prone to unwanted weight loss. Methods of calculating an ideal weight range don’t always apply to people with disabilities - see a doctor or dietitian for guidance and expert advice. Fibre and Constipation Some people with disabilities suffer from constipation. Contributing factors can include the medications that they may take, low levels of physical activity, insufficient fluids and a diet that may be too low in fibre. Increasing the amount of fibre in the diet not only treats constipation but also lowers cholesterol, may reduce the risk of various cancers and bowel diseases, and improves general health and well-being. Two main types of fibre The two broad categories of fibre include: Soluble fibre - softens the feces by absorbing water and helps slow the rate of digestion and lower blood cholesterol and blood glucose. It is found in a range of foods including legumes, fruits, vegetables and oat bran. Insoluble fibre - helps prevent constipation and other associated disorders, such as hemorrhoids, by adding bulk to the feces and making the food products pass more quickly through the bowel. It is found in a range of foods including wheat bran and wholegrain cereals and breads. Fibre keeps the digestive system healthy because it encourages the passage of food and wastes through the digestive system (peristalsis), and reduces the risk of bowel diseases such as chronic constipation and irritable bowel syndrome. Fibre may also reduce the risk of various cancers, particularly those of the bowel. Fluid is also important. Fibre can only help to relieve constipation if there is enough fluid in the diet for it to be able to do its work. Fibre absorbs water to produce a soft and bulky stool. Everyone should drink at least 7-8 cups of fluid each day, particularly in hot weather. Some people with a disability may need to be reminded to drink regularly. Water is the best drink. Inactivity can cause constipation. Some people with a disability have conditions that affect their mobility, and this can also be a reason why a person is constipated. A person with a disability needs to be as active as possible each day, as every little bit of regular exercise helps. Fibre can help with other health problems. A diet rich in fibre can help in many ways, including: * Weight management - obesity increases the risk of a range of health problems, including diabetes and heart disease. Fibre is key to healthy weight management. Since it is indigestible, it provides a sensation of fullness without the kilojoules. * Atherosclerosis - high blood cholesterol is a contributing factor in the development of atherosclerosis (narrowing of the arteries), which can cause a range of health problems including high blood pressure and heart disease. Soluble fibre (for example: legumes, fruits and vegetables) helps to reduce blood cholesterol. * Diabetes - a diet high in soluble fibre is digested and absorbed more slowly, which leads to lower blood glucose levels. How much fibre? Dietitians generally recommend about 30g of fibre every day. Packaged foods such as breads and cereals include nutrition information labels, which can help you to calculate your fibre intake, and nutrition books often include fibre charts. A dietitian can provide information to individuals on the type and quantities of foods that need to be eaten to achieve 30g of daily fibre in the diet each day. Examples of the fibre content in some foods include: * Four slices of wholemeal bread - about 7g * Half a cup of baked beans - about 7g * Two medium pieces of fruit - about 6g. General cautions Changes to eating habits should be made with some care. For example: * A sudden increase in dietary fibre can upset the digestive system and cause symptoms including flatulence (gas) and abdominal pain. It is better to slowly increase the amount of fibre in the diet over a period of several weeks. * Diets that are too high in fibre can hinder the absorption of certain minerals including iron, zinc and calcium. Avoid consuming more than 35g of fibre per day. * Do not use fibre supplements unless you have checked with your doctor or dietitian, since these products can aggravate or cause constipation, particularly if you don’t drink enough fluids. Some people with a disability have swallowing problems. Many fibre supplements thicken when added to fluid and this may cause a person with swallowing problems to choke. * It is important to drink sufficient fluids. It may be helpful to always include a glass of water at each meal or snack. Where to get help: * Your doctor * A dietitian * Support group Things to remember Some people with disabilities suffer from constipation. Contributing factors can include medications, low levels of physical activity, insufficient fluids and a diet that is low in fibre. Dietitians generally recommend about 30g of fibre every day. 2007-2008 Toronto Public Health's Flu Vaccination Clinics It’s that time of year again. Summer has passed, autumn has arrived, and unfortunately, so has the flu season. Toronto Public Health’s flu vaccination clinics for the 2007-2008 influenza season will open on Tuesday October 30, 2007. For more details about flu prevention, please see the insert in your packages. Have a safe and healthy winter! Gateway to Screening: A Participatory Needs Assessment of Women with Mobility Disabilities -Project Update By Nancy Barry The Centre for Independent Living in Toronto (CILT) recognized the need to increase the level of awareness of screening for breast, cervical and colorectal screening among disabled women in the Toronto area. Partnerships were then developed with the following agencies in order to write a proposal and seek funding: * Canadian Cancer Society * Marvelle Koffler Breast Health Centre at Mount Sinai Hospital * University of Toronto, Faculty of Nursing * Springtide Resources * Anne Johnston Health Station * St. Michael’s Hospital * Ismaili Cancer Support Services. The project is funded and supported by the Canadian Cancer Society, Diversity Champion Team who provides direct and in-kind support for the project. They will also ensure that the project reflects the diversity that exists in Toronto and that recommendations from the research will be carried forward in a meaningful and sustainable way. We wanted to explore the experiences and needs of women with mobility disabilities when they access breast, cervical and colorectal cancer screening by conducting a community-based participatory project that would carry out a qualitative needs assessment. In qualitative needs assessments, the aim is to gain personal insight from individuals or groups as to the nature and impact of a particular situation (Kaufman, R. & Fenwick, W. Needs Assessment: Concept and Application. Educational Technology Publications, Englewood Cliffs, New Jersey 07632, 1979). We are pleased to announce that we have completed our five focus groups, in which we spoke with approximately 16 women. The Gateway Team is currently entering the data analysis phase of the project where we will be carefully going over the transcripts from all of the focus groups and compiling the results into a comprehensive report. At this time, on behalf of the Gateway Project Team I would like to convey our sincere thanks to all of the women who participated in the focus groups. Your input and voices were invaluable to the outcome of this project. Stay tuned for future updates! Breast Health Awareness Workshop for Women with Disabilities Breast Health starts with you knowing your own breasts, just like you know your face or hands. Most breast problems can be treated if they are discovered early enough. This workshop will take place at a Breast Centre, where you will have the opportunity to actually tour the facility and learn more about what actually takes place during a routine mammogram. Linda Muraca, a nurse clinician at the centre, will be talking to us about the importance of routine breast screening, regular checkups, good nutrition and maintaining an overall healthy lifestyle for women, while dispelling some of the common myths about breast cancer. This exciting event will happen: Tuesday November 27, 2007 6:00 pm to 8:30 pm Marvelle Koffler Breast Centre, Mount Sinai Hospital 600 University Avenue, Room #1285C (University & Dundas). Please RSVP to Nancy (x27) or Kimberly (x34) before November 20, 2007 at (416) 599-2458, or by TTY at (416) 599-5077. Attendant services will be available. Other accommodations may be available upon request. Accommodation requests must be made before November 9, 2007. Light refreshments will be served. Coffee Club Update By Nancy Barry Until further notice, the Coffee Club will not be meeting again. I want to take this opportunity to thank Carmen McGee for volunteering his efforts and dedication toward the Coffee Club. The Coffee Club was originally Carmen’s idea, and he graciously volunteered one Saturday each month to “host” the event at Dufferin Mall, and did a wonderful job! Thank you Carmen. If you have any questions/concerns about the Coffee Club please contact Nancy at CILT. Revisions for coffee club events are currently under consideration. We would like to hear your ideas about how we could make the coffee club work more effectively. While Dufferin Mall seems to be a great location for people, it is very difficult to have a large group meet in a food court, especially when the mall is so busy. Unfortunately, it is not possible to reserve tables in a food court in the same way that we are able to make reservations at restaurants for the Diner’s Club. So if the Coffee Club is to continue in the future, we have to come up with a different way to meet. Any and all ideas are welcome. Your feedback is really needed so please call Nancy. Thank you. Diner’s Club Update By Nancy Barry On behalf of Tessa Wall-Bergen, November’s Diner’s Club host, we send apologies to all members who went to Moxie’s on November 13th at Fairview Mall. Tessa was the host and had forgotten to make reservations for the group at the restaurant. Had she called ahead, she would have discovered that Moxie’s was no longer located at Fairview Mall. She feels badly about it and asked me to apologize on her behalf. Volunteering to host a Diner’s Club event is an important commitment. At CILT, we believe in the consumer’s right to make his or her own choices and decisions. That is how the concept of the Diner’s Club host originated. The Diner’s Club has always been a consumer-driven group, and as such, the members are in charge of running their own group. However, it appears that the same few people consistently volunteer to host events. It is important that everyone takes responsibility and pitches in. As the Peer Support Coordinator, I am here to support you and if you feel that you need assistance with hosting an event, I am more than happy to provide you with that support. Hosting an event isn’t really that difficult. All you have to do is: * Choose a restaurant that you have been to and that you know your fellow Diner’s Club members would enjoy, making sure that it is accessible, including the washrooms. * Call me with details—pick a date, the address, closest main intersection, type of cuisine (food), and price range of an average meal. * A week before the event, call me to find out how many people are interested in coming, and call the restaurant to make a reservation. * It’s that simple! 1 - 2 - 3! In the New Year I hope to hear from more of you who wish to host an event. As human beings, it’s easy to point fingers at others when things go wrong, but when it comes to pitching in as a “team”, it’s important to remember that everyone makes mistakes and as peers we need to be there to support each other, in good times and in bad. If the Diner’s Club is to continue, we need to have support from more members. There are 120 names on the mailing list, and at least 15 to 20 of those people come out to events on a regular basis but have not yet hosted an event. We would love to hear from. Remember, without a host, there can’t be a party! Future Visions Consulting By Gwen Reid, Career Specialist Future Visions Consulting is aiming to empower people to see their own freedoms. This is accomplished by providing individuals with a resume and cover letter within two days, via e-mail as well as three free revisions. This enables them to market themselves to potential employers as quickly as possible. The career specialist will help clients access the hidden job market and assist them with interview skills and other networking strategies. Each client will be assisted individually while focusing on their unique needs, values, goals and abilities. Clients will receive follow-up once every three months for an entire year after the initial consult. Unlike other agencies that place clients on waiting lists, there is no waiting list to become a client of Future Visions Consulting. The career specialist will focus on client abilities that help them reach their potential, versus the barriers that are usually faced in the job market by people with disabilities. Alternate work options such as small business, working partially from home, and job sharing could also be explored. Future Visions Consulting will network with existing organizational contacts through orientation sessions and regular contact with program coordinators, to create potential contacts which will assist clients in finding job placements. Gwen Reid, owner of Future Visions Consulting, has extensive experience in career counseling and group facilitation. She has worked in career facilitation, as an advocate for more that 10 years, and also has extensive knowledge working with diverse populations. As a woman with a physical disability who has been employed in a variety of fields, and is now a small-business owner herself, Gwen can help clients to identify barriers and to overcome challenges within the workplace. For more information, please contact Gwen Reid, Career Specialist at Future Visions Consulting, at 416-873-6893 or by email at futurevisionsconsulting@hotmail.com 5th Youth Weekend Retreat A Life Skills Weekend Retreat Program offering independence workshops, recreation activities and social opportunities for youth with disabilities will be taking place in early January 2008. You are invited to share the following information with any youth who may be interested: * Young adults 16 to 25 years of age who have a physical disability and/or acquired brain injury * Who want to become more independent, are motivated to work on skills related to independence, have the ability to participate actively within a group, and are medically and emotionally stable Program offered in partnership with Bloorview Kids Rehab and Ontario March of Dimes 5th Youth Weekend Retreat Location: Teen Ranch Conference Centre in Caledon Village (near Orangeville) Dates: January 11-13, 2008 Cost: $ 200.00 If you have questions, please contact Julie Osbelt at (416) 425-6220 ext. 3298. PLEASE NOTE THESE IMPORTANT DATES: * Wednesday November 28, 2007: (Information Night at Bloorview Kids Rehab- pick up an application package) * Friday December 14, 2007 (Deadline for Applications)