Obesity and Overweight Problems Among Individuals 1 to 25 Years Following Acute Rehabilitation for Traumatic Brain Injury: A NIDILRR Traumatic Brain Injury Model Systems Study

Past Research:
Obesity is a major public health problem within the United States (US), leading to secondary medical conditions such as high blood pressure, high cholesterol, type 2 diabetes and much more. The rate of obesity is nearly 60% higher for adults with disabilities in comparison to those without disability.

Initially after a traumatic brain injury (TBI), the person may lose weight because of reduced appetite and increased metabolism as the body heals. However, as recovery progresses, the individual’s appetite returns to normal while activity level may remain lower than before the injury resulting in weight gain, This weight gain phase often continues and is made worse as the individual begins to experience insomnia, depression, chronic pain and medication side effects, all of which contribute to weight gain. Additionally, studies have indicated that those individuals who are classified as “obese” at the time of their injury often have other medical complications throughout their recovery.

This Study:
The purpose of the current study was to identify risk factors that can increase the chances of obesity after brain injury. In addition, the relationship between obesity and other functional and health outcomes were studied. The study used a sample from the Traumatic Brain Injury
Model Systems (TBIMS) National Database (NDB). Model system participants are interviewed at 1, 2, 5, 10, 15 and 25 years after injury. Information pulled from the database included weight category (i.e., underweight, normal weight, overweight), socioeconomic characteristics, race, gender, health variables (e.g., did they have high blood pressure or some other illness), overall satisfaction with life as well as severity of the initial TBI.

Data from participants’ most recent follow-up interview showed that 2.5% of the participants were categorized as “underweight”, 38.7% were “normal weight” 36.2% were “overweight” and 22.6% were considered “obese.” Participants who were 5 or more years post-injury were more likely to be obese. Regarding age, results indicated that: 1) participants aged 16 to 29 or 80 years of age or older were most likely to be normal weight. Females were more likely to be of normal weight and less likely to be overweight when compared to males. Individuals in a vegetative state at follow-up (i.e., those exhibiting very little responsiveness to the external world) were more likely to be underweight or normal weight and less likely to be overweight or obese. Perhaps most interestingly, several health conditions were associated with current weight. Participants with a history of high blood pressure, heart failure or diabetes were less likely to be normal weight and more likely to be obese.

Who May Be Affected By These Findings:
Individuals with traumatic brain injuries, healthcare providers, and researchers.

Caveats:
As the timing of the development of weight problems was not able to be assessed, the authors could not determine whether increased weight contributed to or caused the health conditions. However, the findings do highlight the importance of monitoring, preventing, and managing weight as it relates to health conditions after injury. Problems with weight following TBI typically involve many aspects of life and can be a complex issue to address. Individuals who have sustained a TBI may need to consider their unique circumstances (neuroendocrine dysfunction, medications, cognitive impairment, self-control, access to resources) with regard to nutrition and exercise recommendations for the general population.

Bottom Line:
The results of this study indicated that after a TBI, individuals are at increasingly higher risk for becoming overweight or obese in the years after the injury. These results highlight the importance of monitoring weight closely; identifying causes of weight gain and addressing barriers to the development of a healthy lifestyle after TBI.

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