After a brain injury, spinal cord injury or complex orthopaedic trauma, body composition and calorie requirements often change and many clients end up gaining significant amounts of weight later in their recovery.1, 2  This weight gain occurs for the following reasons:

1. Reduced muscle mass and reduced metabolic rate.  This is a result of the inflammation, inactivity and/or inadequate calorie or protein intake which often occur within the first few months after the injury.
2. Disrupted signals for hunger and fullness due to damage to the brain or spinal cord.  This leaves the person with no way to tell how much food their body needs.
3. Reduced levels of physical activity (or less movement in general).  This could be due to being bedbound, wheelchair bound or having difficulties with mobility and results in the client burning fewer calories.
4. Consuming a diet high in calories, fat and/or refined carbohydrates.  This could be due to taste preferences, these foods being more accessible and easy to prepare, the person having difficulty with shopping or preparing healthy foods or just lack of mental capacity or knowledge around nutrition.
5. Pituitary dysfunction (particularly after brain injury).  This condition negatively affects hormone levels, thyroid function and metabolic rate.3
6. Medication-induced weight gain.  Several commonly used medications have a known side effect of contributing to weight gain.  These include anti-psychotics, anti-depressants, anti-convulsants, diabetes medication and corticosteroids.  Check out our previous blog post on medication-induced weight gain more information

How can we help clients reduce overeating?

No one wants to spend their life weighing or measuring their food.  That’s why at Specialist Nutrition Rehab, we try to use a “least restrictive” approach when helping clients get their desired outcomes.  Here are the four strategies that we’ve found easiest to implement:

1. Switch to a 25cm (10″) plate

Over the last century, plate sizes have increased 23% from 24cm (9.6 inches) to 29.5cm (11.8 inches). 4  Unsurprisingly, people serve bigger portion sizes on bigger plates, because the quantity of food simply looks smaller.4  Switching back to a 24-25 cm plate can help reduce calorie intake, often without people being aware of it.  The same applies to bowls and glasses.

2. Promote more vegetables – the Portion Plate Method

The fastest and easiest way to radically change someone’s eating habits is to implement the portion plate method.  This is where someone divides their plate up so that 1/2 of their plate is non-starchy vegetables (or fruit), 1/4 their plate is protein and 1/4 their plate is starch or carbohydrate (preferably whole grains).  Clients can just visualise this division on their own plate, or they can buy one that has the sections already marked out.  Here are a few options:

• portion plate with markings (ceramic)
• portion template guide to use with your own plate
• portion containers with lids for lunches and freezing

3. Use hand sizes to estimate portions

An alternative to using a portion plate, would be for someone to use their hands as a guide to portion sizes. Vegetables should be two cupped handfuls, starch no more than the size of your fist and protein the size of the palm of your hand.  Check out this poster for visual prompts.

4. Encourage more fluid

Many people mix up the body’s signals for hunger and thirst and most clients after a major injury don’t drink enough.  Here are some clever water bottles and cups to help prompt clients to drink more:

• water bottle with time markings down the size – this helps clients visually see how much they need to drink during the day and divides it into one hour intervals.
• Hidratespark water bottle – this “smart” water bottle lights up when it’s time to drink and and can send a text reminder as well!  The water bottle also syncs to an app, so the client or support worker can track their fluid intake.
• Droplet hydration reminder – this mug flashes and plays a personalised message throughout the day to remind someone to drink.
• Ulla hydration reminder – this device attaches to any water bottle, cup or glass.  It monitors when someone drinks and flashes when it’s been too long since their last drink.

If you know of other products, gadgets or have other tips on ways to reduce portion sizes and increase fluid intake in this population, then please get in touch so we can share your ideas with others!  We would also be happy to help, if you have a client in need of a dietetic assessment. You can contact us at 07787 603863 or info@specialistnutritionrehab.co.uk.

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