Abstract
Background
People with physical disabilities (PWD) have an increased risk of obesity and related comorbidities compared with people without physical disabilities (PWoD). Previously identified contributors to weight loss maintenance pose challenges to PWD. However, it is not known if PWD experience less success in weight management.
Methods
Six hundred and nine participants in the International Weight Control Registry (IWCR) were eligible for this analysis (PWD, n = 174; PWoD, n = 435). Self‐reported weight history metrics were compared using general linear models. Perceived weight history category was compared using Chi‐squared tests. Importance of diet and physical activity strategies for weight management were compared using Wilcoxon rank‐signed tests.
Results
PWD reported higher current body mass index (BMI) (36.1 ± 0.7 vs. 31.0 ± 0.5; p < 0.0001) and more weight loss attempts (9.1 ± 0.7 vs. 7.1 ± 0.4; p = 0.01) than PWoD. Current weight loss percentage (PWD 13.0 ± 1.0; PWoD, 13.0 ± 0.6; p = 0.97) and weight loss category (χ 2 [3, N = 609] = 2.9057, p = 0.41) did not differ between the groups. There were no differences in any weight strategy between PWD who were successful and those who regained.
Conclusions
PWD and PWoD in the IWCR achieved similar levels of weight maintenance success. However, higher BMI and more weight loss attempts suggest that PWD may face challenges with weight management. More research is needed to identify strategies leading to success for PWD.
Keywords: obesity, physical disability, weight loss maintenance
People with physical disabilities (PWD) have an increased risk of obesity and related comorbidities compared with people without physical disabilities (PWoD). Previously identified contributors to weight loss maintenance pose challenges to PWD. This article explores weight history of PWD enrolled in the International Weight Control Registry to compare weight management efforts between PWD and PWoD.
1. INTRODUCTION
People with physical disabilities (PWD) have disproportionately higher rates of obesity. 1 , 2 The World Health Organization defines disability as an inability to perform activities in the manner or range considered normal for that individual. 3 Physical disabilities can include spinal cord injuries, multiple sclerosis, cerebral palsy, hearing and visual impairments, amputations, and many more. 1 These disabilities can impact physical functioning, movement, memory, communication, mental health, and social relationships among others. 1 , 4 Among PWD, obesity increases the risk of pressure injuries, 5 obesity‐related diseases such as type 2 diabetes, hypertension, and dyslipidemia, 5 , 6 and can result in muscle wasting leading to declines in mobility. 5 While some studies have been able to successfully produce weight loss in PWD, 7 , 8 producing weight loss is only part of the battle. Several studies have attempted to understand weight loss maintenance in people without physical disability (PWoD) 9 , 10 , 11 , 12 , 13 , 14 ; however, no studies have investigated weight loss maintenance in PWD.
PWD may face unique barriers to achieving and sustaining the changes in diet and physical activity that have previously been identified to be integral for loss maintenance. 15 , 16 , 17 , 18 Factors such as high physical activity participation 19 , 20 or access to healthier food options 21 , 22 , 23 , 24 present challenges for PWD. In addition, PWD face barriers to accessing healthcare and often report unmet healthcare needs. 25 , 26 Many PWD rely on Medicaid, which does not cover most dental services as well as many other health‐care needs. 26 Providers have also reported Medicaid as a barrier due to lower reimbursement rates. 26 So, while PWD may have access to health care, actual health care needs are often not met for this population. While these have been proven to impact overall health for PWD, it is not clear if weight loss or maintenance is actually more difficult for this population.
Since the 1990s, several registries collecting data relating to weight management efforts have been developed. In general, these registries have required participants to lose a substantial amount of weight (e.g., 30 pounds for the National Weight Control Registry 27 ) and maintain that weight loss for a prolonged period of time to be included. Strategy registries have identified as important to weight loss maintenance include a high level of physical activity, 28 , 29 use of diet logs, 29 , 30 and reducing portion sizes. 29 , 31 More recently, the International Weight Control Registry (IWCR) was developed to capture longitudinal information regarding weight management strategies, including weight history data, as well as behavioral, environmental, psychological, and economic contributors to weight management. 32 The IWCR was to include those who have been successful at losing and maintaining weight, as well as those without maintenance success or without success with losing any amount of weight. However, enrollees were not assessed for disability status upon enrolling in the IWCR; thus, no investigations on weight management for PWD have been completed for this population within the IWCR.
The purpose of the present study was to better understand if and how weight loss maintenance success differs between PWD and PWoD and to compare strategies for weight loss between PWD who were successful versus regained lost weight. It was hypothesized that PWD will lose less weight than PWoD and achieve successful weight loss maintenance less frequently than PWoD. Further, it is hypothesized that among PWD, those using an assistive device for ambulation will have less weight loss and achieve weight loss maintenance success less frequently than PWD who do not use an assistive device. Finally, it is hypothesized that PWD successful at weight loss maintenance will rate weight loss strategies consistent with those previously identified (i.e., reducing portion sizes, keeping food logs, high level of activity) to achieve success higher than PWD that regains.
2. METHODS
2.1. Participants
Figure 1 depicts participant recruitment and enrollment. For the present study, all participants who completed initial enrollment into the IWCR between December 2020 and October 2021 (n = 1373) were assessed for presence of disability. Out of this sample, 452 responded with 91 reporting disability. In addition, a new sample of PWD was recruited using emails to past research participants and through health record systems.
FIGURE 1.
Depicts participant enrollment, retention, and inclusion in the statistical analysis.
2.2. Measures
Disability status and use of assistive devices were assessed in a survey asking about presence of disability or any condition that limits mobility and about use of assistive devices for ambulation. This survey was designed by the research team. Individuals were allowed to select multiple disabilities and multiple assistive devices used for ambulation as appropriate. Listed disabilities to select from included amputation, paralysis, osteoarthritis, rheumatoid arthritis, myasthenia gravis, edema, Friedreich ataxia, cerebral palsy, multiple sclerosis, spinal cord injury, spina bifida, blindness, peripheral neuropathy, diabetic retinopathy, Parkinson's disease, traumatic brain injury, stroke, muscular dystrophy, macular degeneration, postural orthostatic tachycardia syndrome, joint pain, and other, and assistive devices included cane, walker, crutches, rollator, push wheelchair, power wheelchair, guide dog, white cane, rollator, upper or lower limb prosthetic, reacher tool, ankle‐foot orthoses, or other. Self‐reported weight history, including information on current weight, most amount of weight lost, and number of previous weight loss attempt as also collected during initial enrollment.
Current weight loss status (kg) was calculated by subtracting lifetime maximum weight from current weight. To calculate the current weight loss percentage, current weight loss status (kg) was then divided by lifetime maximum weight and multiplied by 100 to get the percent value. Participants also self‐identified as one of four weight loss categories upon study entry: (1) Successful, those who are successful at losing weight and successful at maintaining lost weight for at least 1 year, (2) Regain, those who successfully lost weight but regained the weight they lost, (3) Unsuccessful, those who were not able to lose weight, or (4) Interested, those attempting weight loss for the first time. Finally, participants were asked to rank the importance of various diet and exercise strategies during the time they lost the most weight. Participants were asked to rank their importance using a 5‐point Likert scale, with one representing not important at all, and five representing extremely important. The questions related to these strategies were based on questions used in the National Weight Control Registry to rank bevaoirs associated with weight loss maintenance success. 33
2.3. Statistical analysis
All study data were collected and managed using REDCap electronic data capture tools hosted at the University of Alabama at Birmingham. 34 , 35 REDCap is a secure, web‐based software platform designed to support data capture for research studies, providing (1) an intuitive interface for validated data capture; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for data integration and interoperability with external sources. 34 , 35
All analyses were completed using SAS (version 9.4, 2002–2012 by SAS Institute Inc.). Participant characteristics were compared by disability status (PWD vs. PWoD) using Chi‐squared tests for categorical data or paired t‐tests for continuous data. Participants were categorized into groups based on the presence of disability (yes/no) and weight history parameters (lifetime maximum weight and body mass index [BMI], current weight and BMI, most amount of weight lost, number of weight loss attempts, and current weight loss status and percentage) were compared between groups using general linear models. These models were adjusted for age and sex. Chi‐squared tests were used to compare frequencies of weight loss and weight loss maintenance success between PWD and PWoD. Further, among PWD, participants were categorized based on use of assistive device for ambulation (yes/no) self‐reported in the questionnaire using general linear models, adjusted for age and sex. Finally, the importance of weight loss strategies used was compared between PWD in the Successful versus Regain groups using the Wilcoxon rank‐signed test due to a lack of normality in these data. Finally, when analyzing multiple outcome measures, p‐values were not adjusted in order to minimize the risk of Type II error. 36 All methodologies were approved by the Tufts University Institutional Review Board (#13075).
3. RESULTS
Figure 1 presents participant enrollment and eligibility for analyses. Six hundred and nine participants were eligible for the analyses and 174 were identified as having a physical disability or mobility limiting condition. Baseline characteristics of participants are presented in Table 1 by group (PWD vs. PWoD). In both groups, the majority of participants were female (PWD, 82.2%; PWoD, 75.4%) and non‐Hispanic white. The average age for PWD was 57.1 ± 1.0 years, which was higher than PWoD 51.8 ± 0.7 (p < 0.001). There were no differences between PWD versus PWoD by race, ethnicity, or sex; however, PWD hid a higher frequency of lower income, not being employed, and a lower frequency of higher income and having full‐time employment.
TABLE 1.
Participant characteristics.
| Parameter | PWoD (n = 435) | PWD (n = 174) |
|---|---|---|
| Age, M (SE) | 51.8 (0.7)* | 57.1 (1.0)* |
| Race, n (%) | ||
| American Indian or Alaska native | 1 (0.2) | 0 (0.0) |
| Asian | 11 (2.5) | 2 (1.1) |
| Native Hawaiian or other Pacific Islander | 1 (0.2) | 0 (0.0) |
| Black or African American | 65 (14.9) | 32 (18.4) |
| White or Caucasian | 313 (72.0) | 127 (73.0) |
| More than one race | 5 (1.1) | 6 (3.4) |
| Other | 2 (0.5) | 1 (0.6) |
| Unknown | 4 (0.9) | 1 (0.6) |
| Prefer not to specify | 33 (7.6) | 5 (2.9) |
| Ethnicity, n (%) | ||
| Hispanic or Latino | 16 (3.7) | 6 (3.4) |
| Not Hispanic or Latino | 377 (86.7) | 155 (89.1) |
| Prefer not to specify | 3 (0.7) | 2 (1.1) |
| Unknown | 0 (0.0) | 3 (1.7) |
| Prefer not to specify | 35 (8.0) | 8 (4.6) |
| Female, n (%) | 328 (75.4) | 143 (82.2) |
| Income, n (%) | ||
| Less than $25,000 | 34 (7.8)* | 39 (22.4)* |
| $25,000–$49,999 | 58 (13.3) | 42 (24.1) |
| $50,000–$7999 | 98 (22.5) | 35 (20.1) |
| $80,000–$130,000 | 114 (26.2) | 30 (17.2) |
| Greater than $130,000 | 94 (21.6)* | 20 (11.5)* |
| Did not report | 37 (8.5) | 8 (4.6) |
| Employment status, n (%) | ||
| Full‐time employment (35 h a week or more year‐round) | 251 (57.7)* | 44 (25.3)* |
| Part‐time employment | 41 (9.4) | 18 (10.3) |
| Unemployed, actively seeking employment | 10 (2.3) | 10 (5.7) |
| Not employed, not seeking employment (student, retired, home‐make, disabled, etc.) | 100 (23.0)* | 99 (56.9)* |
| Did not report | 33 (7.6) | 3 (1.7) |
Note: Displays characteristics of participants with versus without disability. Continuous and categorical variables were compared between groups (people without vs. people with disability) using t‐tests and chi‐squared tests respectively.
Abbreviations: M, mean; PWD, people with physical disability; PWoD, people without physical disability; SE, standard error.
* denotes group differences (p < 0.001).
Information on types of disability present and use of assistive devices is reported in Table 2. The most common disability or mobility limitation reported was joint pain (70.1%) and osteoarthritis (48.9%). Among PWD, 56 reported using an assistive device for mobility (32.2% of PWD). Of those who used an assistive device, the devices reported most frequently were cane, reacher tool, and push wheelchair (Table 2).
TABLE 2.
Disability and assistive device use.
|
Condition |
N (% of PWD) (n = 174) |
|---|---|
| Joint pain | 122 (70.1) |
| Osteoarthritis | 85 (48.9) |
| Edema | 27 (15.5) |
| Peripheral neuropathy | 26 (14.9) |
| Spinal cord injury | 22 (12.6) |
| Paralysis | 18 (10.3) |
| Multiple sclerosis | 17 (9.7) |
| Stroke | 12 (6.9) |
| Rheumatoid arthritis | 11 (6.3) |
| Traumatic brain injury | 10 (5.7) |
| Macular degeneration | 7 (4.0) |
| Cerebral palsy | 7 (4.0) |
| Blind | 3 (1.7) |
| Diabetic retinopathy | 3 (1.7) |
| Parkinson's | 3 (1.7) |
| Amputation | 3 (1.7) |
| Muscular dystrophy | 2 (1.1) |
| Spina bifida | 2 (1.1) |
| Postural orthostatic tachycardia syndrome | 1 (0.6) |
| Other | 70 (40.2) |
| Assistive device use | N (% of users) (n = 56) |
|---|---|
| Cane | 44 (78.6) |
| Reacher tool | 18 (32.1) |
| Walker | 15 (26.8) |
| Push wheelchair | 15 (26.8) |
| Power wheelchair | 12 (21.4) |
| Rollator | 11 (19.6) |
| Ankle‐foot orthoses | 10 (17.8) |
| Crutch | 3 (5.4) |
| Other | 3 (5.4) |
Note: Presents reported physical disabilities or conditions limiting mobility in the study sample and use of assistive devices.
Abbreviation: PWD, people with physical disability.
3.1. Weight history
Frequency of PWD and PWoD in each weight category is presented in Figure 2. Chi‐squared test revealed no differences in the frequency of weight category between PWD and PWoD (χ2 (3, N = 609) = 3.8380, p = 0.2795). When comparing the Successful versus Regain groups using the Chi‐squared test, there was a trend for PWD to be in the Regain group at a higher frequency than PWoD (χ2 (1, N = 519) = 3.7294, p = 0.0535); however, this did not reach statistical significance.
FIGURE 2.
Weight loss category of individuals with and without physical disability. Compared using the Chi‐squared test. There were no differences in the frequency of weight category by group (people with physical disabilities vs. people without physical disability). PWD, people with physical disability; PWoD, people without physical disability.
Weight history of PWD and PWoD is presented in Table 3. In the whole sample, PWD reported a higher current and lifetime maximum weights and BMIs and more weight loss attempts compared to PWoD. When comparing the maximum amount of weight lost, there were no differences between PWD and PWoD. In both groups, the average current weight loss percentage was 13.0%, with no differences between the groups. Additionally, Table 3 presents comparisons between PWD and PWoD who self‐identified in the “Successful” or “Regain” weight loss group.
TABLE 3.
Weight history of individuals with and without disability.
| Parameter | Without disability | With disability | P value |
|---|---|---|---|
| Whole sample | (n = 372) | (n = 147) | |
| Lifetime maximum, kg | 102.2 (2.7) | 117.0 (4.5) | 0.0055 |
| Lifetime maximum BMI, kg/m2 | 36.8 (1.0) | 42.3 (1.7) | 0.0074 |
| Max loss, kg | 20.8 (0.8) | 22.4 (1.3) | 0.3060 |
| Current weight, kg | 86.2 (1.3) | 100.6 (2.1) | <0.0001 |
| Current BMI, kg/m2 | 31.0 (0.5) | 36.1 (0.7) | <0.0001 |
| Current weight loss status, kg | 16.2 (2.4) | 15.5 (4.0) | 0.8786 |
| Current weight loss percent, % | 13.0 (0.6) | 13.0 (1.0) | 0.9702 |
| Number of previous weight loss attempts | 7.1 (0.4) | 9.1 (0.7) | 0.0141 |
| Successful | (n = 153) | (n = 47) | |
| Lifetime maximum, kg | 102.7 (6.1) | 108.0 (11.5) | 0.6853 |
| Lifetime maximum BMI, kg/m2 | 36.5 (2.4) | 40.1 (4.5) | 0.4758 |
| Max loss, kg | 22.5 (1.4) | 24.6 (2.7) | 0.4985 |
| Current weight, kg | 75.2 (1.4) | 84.7 (2.5) | 0.0010 |
| Current BMI, kg/m2 | 26.5 (0.5) | 30.9 (0.9) | <0.0001 |
| Current weight loss status, kg | 27.3 (5.8) | 24.6 (11.1) | 0.8277 |
| Current weight loss percent, % | 20.3 (1.1) | 21.7 (2.0) | 0.5577 |
| Number of previous weight loss attempts | 6.8 (0.6) | 8.2 (1.2) | 0.3168 |
| Regain | (n = 219) | (n = 100) | |
| Lifetime maximum, kg | 101.9 (2.0) | 121.2 (3.1) | <0.0001 |
| Lifetime maximum BMI, kg/m2 | 37.1 (0.7) | 43.4 (1.1) | <0.0001 |
| Max loss, kg | 20.6 (0.8) | 19.2 (1.2) | 0.3223 |
| Current weight, kg | 94.1 (1.8) | 108.1 (2.6) | <0.0001 |
| Current BMI, kg/m2 | 34.3 (0.6) | 38.6 (0.9) | <0.0001 |
| Current weight loss status, kg | 7.9 (0.7) | 11.7 (1.1) | 0.0053 |
| Current weight loss percent, % | 7.5 (0.5) | 9.3 (0.8) | 0.0641 |
| Number of previous weight loss attempts | 7.2 (0.5) | 9.5 (0.8) | 0.0283 |
Note: Presents weight history of people with and without disability in the International Weight Control Registry. Compared using general linear models and presented as mean (standard error). All models adjusted for age and sex. Max loss variable also adjusted for lifetime maximum weight.
Abbreviations: BMI, body mass index; kg, kilograms; m, meters.
Among Successful, PWD and PWoD had similar lifetime maximum weight and BMI, maximum weight lost (kg), lifetime weight loss status, and number of attempts, with the only difference in these groups being that current weight and BMI were higher among PWD. In the Regain group, PWD and PWoD had similar maximum kg lost, and while there was a trend for PWD to have higher current percent weight loss, this did not reach statistical significance (PWD, 9.3% ± 0.8; PWoD 7.5% ± 0.5, p = 0.0641). PWD in the Regain group had higher lifetime and current weight and BMI, and more weight loss attempts than PWoD in the Regain group.
Data related to weight history of PWD who use versus do not use an assistive device are presented in Table 4. No results reached statistical significance; however, there was a trend for those who used assistive devices to have higher lifetime maximum BMI, current BMI, and have less weight loss.
TABLE 4.
Weight history of people with disability with and without assistive devices.
| Parameter | No assistive device (n = 91) | Assistive device (n = 56) | P value |
|---|---|---|---|
| Lifetime maximum weight, kg | 113.4 (3.7) | 122.4 (5.1) | 0.1582 |
| Lifetime maximum BMI, kg/m2 | 40.7 (1.4) | 44.8 (1.9) | 0.0831 |
| Max weight loss, kg | 25.3 (1.4) | 20.7 (2.1) | 0.0813 |
| Current weight, kg | 97.0 (3.2) | 104.5 (4.2) | 0.1612 |
| Current BMI, kg/m2 | 34.6 (1.1) | 38.1 (1.5) | 0.0624 |
| Current weight loss status, kg | 15.0 (1.7) | 17.9 (2.3) | 0.3008 |
| Current weight loss percent, % | 13.2 (1.2) | 13.8 (1.7) | 0.7611 |
| Number of previous weight loss attempts | 9.2 (1.0) | 9.6 (1.3) | 0.7915 |
Note: Presents weight history of people with physical disabilities who do versus do not use assistive devices for ambulation in the International Weight Control Registry. Presented as mean (standard error).
Abbreviations: BMI, body mass index; kg, kilograms; m, meters.
3.2. Weight loss strategies
The importance of various dietary and physical activity strategies of PWD in the successful group versus PWD in the regain group weight is presented in Table 5. There were no differences in any strategy between successful PWD and PWD based on weight history group.
TABLE 5.
Strategies for weight loss.
| Strategy | Success (n = 47) | Regain (n = 100) | Z | P value |
|---|---|---|---|---|
| Dietary | ||||
| Reducing portion sizes | 68.2 | 76.0 | −1.1 | 0.2779 |
| Decreasing fat | 81.9 | 76.8 | 0.7 | 0.5124 |
| Decreasing carbohydrates | 70.7 | 74.8 | −0.6 | 0.5800 |
| Decreasing sugar | 77.4 | 71.7 | 0.8 | 0.4269 |
| Increasing low‐calorie foods | 75.3 | 72.7 | 0.4 | 0.7195 |
| Increasing protein | 72.0 | 74.2 | −0.3 | 0.7634 |
| Eating low glycemic diet | 78.5 | 70.3 | 1.1 | 0.2602 |
| Skipping meals | 66.7 | 75.9 | −1.3 | 0.1982 |
| Cutting out snacks | 73.5 | 72.0 | 0.2 | 0.8424 |
| Logging food | 69.2 | 75.5 | −0.9 | 0.3877 |
| Counting calories | 68.6 | 75.8 | −1.0 | 0.3160 |
| Not eating out | 73.8 | 73.4 | 0.1 | 0.9559 |
| Using meal replacements | 68.9 | 75.7 | −1.0 | 0.3403 |
| Physical activity | ||||
| Aerobics | 72.8 | 73.1 | 0.0 | 0.9669 |
| Walking | 75.3 | 71.2 | 0.5 | 0.5835 |
| Yoga | 73.8 | 70.4 | 0.5 | 0.6046 |
| Resistance training | 73.4 | 73.5 | 0.0 | 0.9931 |
Note: Compares reported importance of strategies used weight loss between people with physical disabilities who were successful at weight loss maintenance versus those who regained lost weight. Comparing using Wilcoxon Rank‐Signed test, with scores presented as mean rank.
4. DISCUSSION
The present study was aimed to learn more about differences in weight management between PWD and PWoD enrolled in the IWCR. Across the four weight history categories, there were no differences between PWD and PWoD in category frequency. So, while current literature suggests that PWD face potential barriers to weight loss maintenance, 19 , 21 , 22 , 24 , 37 results from this study indicate that PWD and PWoD have similar weight management success. Across the whole sample, PWD and PWoD are maintaining 13% weight loss on average, indicating that PWD can be successful in achieving and maintaining a significant weight loss. These results are contrary to the prevailing view that PWD have a more difficult time with weight loss and maintenance than PWoD due to barriers to health commonly identified in this population. 37 , 38 However, it is important to note that this study found that PWD had more weight loss attempts than PWoD, which could indicate that it may take longer for PWD to find what leads to success. Elucidating factors related to success for PWD is critical for tailoring future programs to be more successful for this population and reducing the number of attempts before finding success. This was especially true in the Regain group across PWD and PWoD, with PWD having two more weight loss attempts on average, despite still experiencing regain. This finding also supports the goal of inclusion science, which is to include PWD in existing health promotion research to allow for direct comparison of PWD and PWoD, instead of operating on opposite tracks, in order to learn more. 39
Within each weight history category analyzed, PWD had a higher current BMI and lifetime maximum BMI, which could suggest that PWD are more susceptible to weight gain. When comparing PWD and PWoD in the Successful group, the only difference between the groups regarding weight history was a higher current weight and BMI for PWD. These results align with current literature, which suggests that PWD are at higher risk for obesity PWoD, 6 , 40 , 41 as the data reflected significantly higher current weight in PWD compared to those without. Even among those successful in the present study, the current BMI for PWoD was in the overweight range (26.5 kg/m2), while PWD current BMI is in the obesity range (30.9 kg/m2). Similarly, when comparing those in the Regian group, PWoD would be categorized as class 1 obesity (34.3 kg/m2), while PWD would be categorized as class 2 obesity (38.6 kg/m2). 42 This could mean that PWD are still at risk for conditions associated with obesity, despite weight loss efforts. At a higher BMI, PWD could still be experiencing comorbid conditions related to obesity and disability, such as pain, risk for chronic diseases, and limitations related to mobility. It is important to continue follow up with this sample to determine long‐term consequences of the higher BMI.
Data comparing PWD using or not using assistive devices found no differences in weight history between the two groups. While there was a trend for PWD that use assistive devices to have higher lifetime maximum BMI, current BMI, and less weight loss (kg), none of this reached statistical significance. This could be because the most commonly used devices were canes, reacher tools, and walkers, which are typically associated with a higher degree of mobility and fewer limitations than other devices, such as wheelchairs. In addition to exploring disability‐specific considerations for weight loss maintenance, more research is needed regarding the use of assistive devices during weight loss. This could include an investigation of strategies leading to weight management success especially for individuals using wheelchairs.
This study was unable to identify strategies that were different for PWD who were successful versus PWD in the Regain group. Several factors could have impacted this outcome, namely that the IWCR included successful participants, consistent with previous registries, but also those who regained lost weight, which was missed by previous registries. Additionally, the questions used during this assessment might not be sensitive enough to capture true differences between behavior. PWD often face higher rates of poverty and unemployment than PWoD, 43 which could directly impact physical activity routines, access to healthy foods, and other factors which were not appropriately assessed in this work. A more in‐depth analysis of various physical activities and dietary behavior may be needed to identify contributing factors allowing successful participants to achieve their success with weight loss maintenance.
Several limitations exist in the present study. All the data collected for this study were self‐reported, including weight loss category and current weight information. This is a notable limitation of this work, and future investigations should consider using objective data in similar investigations. Additionally, the lifetime weight loss status percentage was approximately 13% in both PWD and those without disability. The high weight loss percentage indicates that this sample is more successful compared to other data regarding weight loss maintenance. 9 , 14 , 44 For enrollment into the IWCR, much of initial recruitment was conducted through previous research participants from clinical trials related to obesity treatment. It is possible that this led to a biased sample, with more successful people completing the IWCR. In addition, people who have had more success with weight loss may be more likely to enroll in the study, leading to a self‐selection bias in the sample. Furthermore, within the sample of PWD, the most common types of disability included joint pain and osteoarthritis, with few people having disabilities that may lead to more limitations such as multiple sclerosis, stroke, spinal cord injury, etc. It is important that these groups are targeted for recruitment in the future to learn more about weight loss maintenance in these populations. In addition, future research could examine how environmental, psychosocial, and behavioral factors are associated with weight loss maintenance success among PWD for the development of more effective clinical programs tailored to this population. Finally, it is important to consider the cyclical nature of physical disability and obesity. While disability can result in obesity, often obesity also results in a physical disability or limited mobility. 45
To our knowledge, this is the first study of its kind attempting to compare weight management among PWD and PWoD. Future researchers should work to include PWD in weight management research as disability is common among obesity and vice‐versa. Future work should emphasize early prevention of obesity in this population as well as stronger treatment programs and options created specifically to decrease the known barriers for PWD.
CONFLICT OF INTEREST STATEMENT
Dr. Roberts founded the iDiet, a web‐based behavioral weight loss program (www.theidiet.com), and is a Board member of Danone. Dr. Hill has ownership interests in Shakabuku LLC. He has received research grants from the National Cattleman's Beef Association and owns a patent for the Energy Gap. He has received consulting fees from Gelesis and has stock options in the company. The remaining authors have no relevant conflicts of interest to disclose.
ACKNOWLEDGMENTS
The authors would like to acknowledge the participants in the International Weight Control Registry. SBR and JOH co‐founded the IWCR. JOH, SBR, RDS, AMG, SKD led the process of identifying questionnaires for inclusion in the baseline IWCR. JGC created the questionnaire to include people with disabilities and was the primary contributor to the manuscript. JEF, JGC, and TKC managed the data collection and built the disability‐related questionnaires into the data management system. JGC conducted data analysis, aided by TKC and RDS. JOH, SBR, RDS, and AMG provided critical revisions to the manuscript. All authors have read and approved the final manuscript. The IWCR was launched in the United States with a grant from the NIH awarded to the Nutrition Obesity Research Center (NORC) at the University of Alabama Birmingham (NIH project number 3P30DK056336‐19S1, primary sponsor for JOH); a grant from the United States Department of Agriculture awarded to Tufts University (USDA/ARS project number 8050‐51000‐105‐00D, primary sponsor for SBR); a grant from the NIH awarded to the University of Colorado NORC (NIH project number 2P30DK048520‐26, secondary sponsor); and a small, 1‐year unrestricted gift from Gelesis Inc.
Clina JG, Sayer RD, Gorczyca AM, et al. Weight history of individuals with and without physical disability in the International Weight Control Registry. Obes Sci Pract. 2024;e733. 10.1002/osp4.733
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