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INTRODUCTION

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Health care for people with disability is not commonly discussed in health education, particularly in medical education, despite the increasing prevalence of people with disability within the United States. Clinicians have reported discomfort in managing the health of people with disability,1 and people with disability often report negative experiences with their health care because of the practitioners’ lack of knowledge.2 There are clear health and health care disparities noted when comparing the care people with and without disability receive.3,4 This is especially true for women with disability.5,6,7 In general, disability is associated with obesity, and women with disability represent a large proportion of those with obesity and disability.

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This chapter focuses on obesity and women with disability by providing definitions and background about the scope of the problem, presenting knowledge about nutrition and exercise or physical activity needs of women with disability, describing outcomes from weight management programs and interventions, and posing recommendations for practice. It is hoped that practitioners will better appreciate the needs and issues of women with disability as they relate to healthy weight management.

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SCOPE OF THE PROBLEM

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Definitions

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Disability holds many meanings for professionals and consumers alike. Most people identify disability by diagnosis: cerebral palsy, spinal cord injury (SCI), multiple sclerosis, macular degeneration, or rheumatoid arthritis. Disability actually describes the mismatch between an impairment (e.g., loss of function of one side of the body due to a stroke or hemiparesis) and the environment (e.g., need to climb 5 steps to access a medical appointment); changing the environment with a ramp decreases the “disability” by allowing more independence or access. The World Health Organization has successfully promoted identifying disability by function: problems with mobility, self-care, cognition, vision/hearing, and living independently.8 There is also often reference to activities of daily living (ADL), such as bathing and dressing, instrumental activities of daily living (IADL), such as shopping and driving, and employment or ability/limitations to work when discussing disability.

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The US surveys (self- or family report) are increasingly using 6 functional disability characteristics (i.e., mobility, self-care, vision, cognition, independent living) to identify disability; however there is no etiology given for that specific disability of limitation. Thus, disability statistics in the United States identify limitations for any reason, including aging, injury, mental health, chronic diseases, and other defined conditions. A current review of national disability surveys noted four survey types (national household surveys; surveys of health, disability, aging, and long-term care; surveys of youth, education, and transition; and other surveys), for a total of 40 surveys that capture some elements of disability.9 Data can be compared among surveys because of sampling, weighting, and other analyses that differ; some surveys have been updated or modified and cannot be compared to previous years. There are few registries (inclusive of all or most people who carry ...

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