Annual assessment of weight and associated health-related conditions is recommended for all patients with spinal cord injury (SCI). 

Weight Assessment
Use of BMI is very limited in identifying weight-related health risks for individuals with SCI because BMI does not differentiate between fat mass and fat-free mass. Although many patients with SCI may present as having a healthy weight, they commonly have excess fat around the waist, which is associated with a greater likelihood for the development of obesity-related health conditions.

Although a four compartment model (estimates of total body fat, mineral, water and protein content) is optimal for determination of body composition, weight-related health risks may be estimated using the patient's current Actual Body Weight (ABW) and Ideal Body Weight (IBW).

Step 1: Calculate Ideal Body Weight (IBW)
Male

• 106 + (6 x number of inches over 5' in height) = IBW

Female

• 100 + (5 x number of inches over 5' in height) = IBW

Step 2: Adjust IBW for injury type
Paraplegia

• Decrease IBW by 10-15%

Tetraplegia

• Decrease IBW by 15-20%

Step 3: Assess weight-related health risks using patient's current Actual Body Weight (ABW)

• Pathologic Obesity = ABW > 200% of IBW
• Obesity = ABW > 150% of IBW
• Overweight = ABW > 120% of IBW
• Normal = ABW > 90 to 110% of IBW
• Mildly Underweight = ABW < 80% to 90% of IBW
• Moderately Underweight = ABW < 70% to 80% of IBW
• Severely Underweight = ABW < 70% of IBW

Considerations
Not only do patients with SCI have the same health concerns associated with being overweight, obese, or underweight (i.e. malnourished) as those in the general population, they are also at greater risk for secondary medical complications of SCI.

It is, therefore, important to annually evaluate the patient's nutrition and exercise regimens for treatment and prevention of weight-related health concerns.

• Nutrition
• Exercise

References
Yarar-Fisher C, Chen Y, Jackson AB, Hunter GR. Body mass index underestimates adiposity in women with spinal cord injury. Obesity (Silver Spring). 2013 Jun;21(6):1223-5

Chen Y, Henson S, Jackson AB and Richards JS. Obesity intervention in persons with spinal cord injury. Spinal Cord. 2006 Feb;44(2):82-91.

Pai MP, Paloucek FP. The origin of the "ideal" body weight equations. Ann Pharmacother. 2000 Sep;34(9):1066-9.

Buchholz AC, Bugaresti JM. A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury. Spinal Cord. 2005 Sep;43(9):513-8.

Gater DR, Jr. Obesity after spinal cord injury. Phys Med Rehabil Clin N Am. 2007 May;18(2):333-51, vii. Review.

Laughton GE, Buchholz AC, Martin Ginis KA, Goy RE. Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord. 2009 Oct;47(10):757-62.