Healthy Eating

Good nutrition is very important at all stages of life – in childhood it helps the body to grow and develop, and in adulthood it ensures good long-term health and quality of life. But eating a healthy diet is difficult for many people and can be even more challenging for individuals with a disability.

The key to eating well is to enjoy a variety of foods from each of the five food groups that make up the central plate of the Australian Guide to Healthy Eating. Eating these foods means you are most likely to get the right amount of nutrients and help protect the body from chronic disease.

Having a disability does not change the general goals for eating healthily, however some extra things may need to be considered. A dietitian can help with food ideas and meal plans that consider your health needs and your abilities.

There are many resources online that offer information and ideas around healthy eating including: healthy eating at all stages of life; more information about the five food groups and why they are important; tips for eating well; understanding food labels; and food safety.

The Australian Government’s Eat for Health website is a handy resource. To learn more visit:

Online: https://www.eatforhealth.gov.au/

Weight

Maintaining a healthy body weight is important for good health, but every person’s energy needs are different, depending on their activity levels. Ultimately, the “energy in” from food each day must be balanced with the “energy out” expended through exercise and activity.

For people with physical disabilities, energy needs are often related to ability. For example, people who use a wheelchair tend to have less energy needs than those who walk. People with spasticity type cerebral palsy tend to have less energy needs than those with athetosis.

Dietitian reviews are recommended for any person at risk of being either over- or underweight. Reviews will assist you to determine the most suitable foods to meet your needs.

Overweight& Obesity

The percentage of Australians considered to be either overweight or obese is increasing, and it is a problem common in people with disabilities. Carrying too much weight can make movement difficult and goals like walking and transferring become difficult to continue, reducing independence.

Factors that are linked to increased levels of overweight and obesity include:

• Eating more food than the body needs
• Modern lifestyles – for example driving instead of walking and excess time seated in front of computers, televisions and other devices
• Increased availability of food –particularly those that have little nutritional value

Being obese increases the risk of conditions including type 2 diabetes, coronary heart disease, high blood pressure (which can cause stroke), osteoarthritis, sleep apnoea and pressure injuries.

Many people who are overweight often do not eat huge volumes of food, but the foods being eaten are not of high nutritional value. Regular monitoring of weight is recommended.

There are many resources available for information on healthy eating and weight management.

LiveLighter – advice and resources relating to making healthier lifestyle choices

Online: https://livelighter.com.au/

Eat for Health – the Australian Government’s resource for advice on healthy nutrition

Online: https://www.eatforhealth.gov.au/

Dietitians Association of Australia – healthy eating tips and advice about diet

Online: https://daa.asn.au/smart-eating-for-you/

Dietitian reviews are recommended for individualised diet advice, to maintain a healthy body weight and prevent obesity.

Underweight / poor weight gain

Challenges Gaining and Maintaining Weight

Some children with disabilities have difficulty gaining weight and may be underweight for their height and age. This can continue into adulthood, with some people struggling to gain weight and maintain a healthy body weight their entire lives.

Low body weight can lead to:

• Growth failure in children
• Decreased muscle strength
• Reduced ability to cough
• Increased risk of infection
• Constipation
• Osteoporosis
• Pressure injury
• Irritability
• Depression

There are two general causes of low body weight: a lack of correct nutrition to gain and maintain weight; and more energy being expended than is being taken in.

Reasons for not getting the right amount of food include:

• Difficulties with eating and drinking
• Inability to express hunger or thirst
• Requiring assistance with eating and drinking
• Reflux, vomiting or aspiration (food and drink going into the lungs)
• Requiring food textures to be changed before eating or drinking
• Lack of appetite
• Taking a long time to eat and drink
• Constipation

Reasons for excessive energy expenditure include:

• Increased muscle tone e.g. spasticity
• Involuntary movements e.g. athetosis

Healthy diet suggestions for putting on weight include:

• Eating smaller, frequent meals during the day - six small meals and snacks can be easier than three large meals
• Choosing full fat foods over low fat e.g.full cream milk or enriched milk instead of low-fat
• Adding extra energy to food by mixing in extra fats and oils, grated cheese or milk powder
• Including nutritious milk-based drinks such as smoothies and milkshakes into a daily diet
• Exercising regularly- exercise can boost appetite and promotes muscle health. Any regular activity, including gentle stretching, can help

Concerns about poor diet, low weight or weight loss should be discussed with a doctor or dietitian. Dietitians can assist in identifying an ideal weight range and how much food is needed to achieve a slow, steady weight gain.

Constipation

Constipation is the passing of hard, dry stools; it can cause pain, cramping, a bloated abdomen, and reduced appetite for food and drink due to discomfort. 

Constipation is common for many people, but for individuals with physical disabilities – and particularly those with more severe physical problems – it can be a long-term, recurring problem due to:

• Poor fluid or fibre intake
• Poor muscle tone
• Reduced movement in the stomach and surrounding organs
• Lack of overall bodily movement
• Some medications

There are some simple steps that can assist in preventing constipation:

• Increased fibre intake – at least 30g per day of high-fibre foods such as porridge, wholemeal bread, fruit and vegetables.
• Increased fluid intake – between 6 and 8 cups (about 250ml per cup) per day of fluid is recommended, including includes water, fruit juices, cordial, smoothies, tea, coffee and whole fruit.
• Exercise – physical activity can assist in promoting good movement of the stomach and intestine.
• Standing – holding the body in an upright position can assist the movement of the stomach and intestines
• Medications – in some cases medication may be required to ease constipation.

Dietitians can assist in identifying food and drinks that will help to prevent constipation. The Australia Government’s Eat for Health website also provides advice and information on increasing fibre intake and maintaining a healthy diet. To learn more:

Online: https://www.eatforhealth.gov.au/guidelines

Physiotherapists can also provide assistance with constipation, through recommendations for physical movements, standing programs and massage.

See your GP for advice on long-term management of constipation. Medication prescribed for constipation should be reviewed regularly, and laxatives only used when other methods do not provide relief.

Fluid

Adequate fluid intake is essential for maintaining good health – the human body can survive for weeks without food if necessary, but only days without water.

Regular fluid intake is needed to make up for losses from the skin, lungs and urine. Recommended fluids include water, fruit juices, cordial, smoothies, tea, coffee and whole fruit.

The amount of fluid needed varies depending on body size, temperature and activity levels. For most people, between 6 and 8 cups (about 250ml per cup) per day is recommended.

Higher fluid intake is necessary in some circumstances, for example:

• To prevent constipation on a high-fibre diet
• During pregnancy and breastfeeding
• If vomiting or diarrhoea is present
• In hot conditions
• During periods of vigorous or very physical activity

If fluid intake is too low, physical abilities such as walking and transferring, concentration and general health can be affected.

Osteoporosis

Osteoporosis is a condition where the bones become weak and porous and can break with little or no pressure. Osteoporotic breaks can cause a great deal of pain and decreased quality of life. Up to 50 per cent of adults with disabilities, including cerebral palsy, have low bone mineral density and are at increased risk of osteoporosis.

Risk factors for osteoporosis include:

• Lack of weight bearing
• Low intake of dietary calcium and poor vitamin D status
• Low body weight
• Menopause due to sudden decrease in oestrogen
• Decline in male hormones
• Some medication, including steroids and anti-seizure medication
• Dietary factors including high salt intake, high protein diet, excessive caffeine (more than 8 cups coffee per day) and regular heavy alcohol intake

Vitamin D

Vitamin D is an important component in the prevention of osteoporosis, as it helps the body use calcium to strengthen bones.

There are two primary sources of Vitamin D:

• Diet – foods such as eggs, oily fish, liver and some spreads
• Sunlight – about 10 to 15 minutes per day of safe sun exposure is recommended to boost vitamin D levels

Vitamin D supplements may be recommended for individuals whose levels are low.

There are many useful resources for information and advice about osteoporosis.

Osteoporosis Australia – advice and online assessments

Online: www.osteoporosis.org.au

Online: http://www.knowyourbones.org.au/

The Australian Government’s Eat for Health website – information on vitamin D and nutrition

Online: https://www.eatforhealth.gov.au/guidelines

SunSmart – advice on safe sun exposure and vitamin D

Online: www.sunsmart.com.au