The issue of weight is of concern to most individuals. This is due to cultural and societal issues that constantly bombard us with messages about what is acceptable and what is not. Images and ideas about ideal body size and shape begin the moment an individual is born. It starts with assessments of birth weight not by healthcare professionals for health reasons but by how big or small the baby is by family and friends. The conditioning of being the right size and weight intensifies through life from family, friends and especially through the media.

Having a health issue can affect your weight. Medications, the ability to move your body, and your medical condition are all factors. For some individuals, their medical condition can lead to difficulty in chewing, swallowing, and food tolerance, making it difficult to maintain weight. The results of medical conditions can affect metabolism and weight, such as tone (spasticity), which can lead to the body’s increased use of calories.

For others, weight gain is a secondary complication of their health concern. Any healthcare condition that affects mobility can lead to weight gain, especially if you are unable to move your body as you are accustomed. Even individuals without health challenges who lead sedentary lifestyles (those with low activity levels) can take in more calories than expended. Some individuals find that their life’s enjoyment centers around the intake of food.

To maintain weight, the number of calories taken in must match the number of calories expended. This is true but reaching this goal is not as simple as once thought. For many years, individuals have been told to just push the food away. We now know, this is not easy as it is not the solution. Weight management is an extremely complicated issue that includes physical, psychological, genetic, emotional and lifestyle issues. For individuals with paralysis, expenditure of calories is another part of the challenge.

There has been a lot of news lately about diabetic medication for type II diabetes being used for weight loss (not insulin for type I diabetes). If you are diabetic type II, the drugs metformin, Trulicity, Rybelsus, and Ozempic, have been noted to help with weight loss however, you still need to monitor your diet and exercise your body. You still need to follow your diabetic program to receive results.

The semaglutide type of diabetes type II medication has been reformulated at a higher concentration and approved by the FDA for weight loss combined with a low calorie and exercise plan. You do not need to have diabetes, type II to take this drug for weight loss. The approved drug is called Wegovy (semaglutide). The drug affects a hormone in the gut called glucagon-like peptide-1 (GLP-1) agonist. GLP-1 signals your brain to slow your appetite and curb hunger. Dosing begins low and increases over five months. Since it is a new drug, a generic form is not offered. Pricing is around $1300 per month and may not be covered by your insurance or payor.

To be eligible for this medication treatment, you must have a BMI of 30 kg/m2 or greater or a BMI of 27 kg/m2 or greater and at least one weight-related condition (e.g., high blood pressure, type 2 diabetes, or high cholesterol). You can calculate your BMI here.

How this drug affects diet and weight control in an individual with spinal cord injury, head injury, or disease affecting messages sent to the brain is unknown. If the gut sends the message to the brain to curb eating, it may not arrive if the nerve impulses are interrupted, slowed, or miscommunicated to or from the brain.

There are some side effects that could seriously affect your body as well. Side effects listed by the FDA are as they apply to everyone, not just those will nerve impulse transmission issues. Some could severely affect those with nerve issues. Side effects are:

• Nausea (44%)
• Diarrhea (30%)
• Vomiting (24%)
• Constipation (24%)
• Stomach pain (20%)
• Headache (14%)
• Tiredness (11%)
• Heartburn (9%)
• Dizziness (8%)
• Stomach swelling or bloating (7%)
• Burping (7%)
• Low blood sugar in people with type 2 diabetes (6%)
• Gas (6%)
• Stomach problems due to infection (6%)
• Acid reflux (5%)

Some other side effects reported which would particularly apply to those with nerve issues include:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• changes in vision
• fast heartbeat
• gallbladder problems (fever, upper belly pain, yellowing of the eyes or skin, clay-colored stool)
• kidney injury (trouble passing urine or change in the amount of urine)
• low blood sugar (feeling anxious; confusion; dizziness; increased hunger; unusually weak or tired; increased sweating; shakiness; cold, clammy skin; irritable; headache; blurred vision; loss of consciousness)
• lump or swelling on the neck
• pancreatitis (stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting)
• suicidal thoughts, mood changes
• trouble breathing
• trouble swallowing

Side effects that usually do not require medical attention but may impact those with neurological issues include: (report these to your doctor or health care professional if they continue or are bothersome):

• constipation
• diarrhea
• headache
• heartburn (burning feeling in chest, often after eating or when lying down)
• nausea
• pain, redness, or irritation at site where injected
• passing gas
• upset stomach
• vomiting

Warnings include the possibility of developing:

• Thyroid Cancer
• Inflammation of the pancreas (pancreatitis)
• Gallbladder Disease
• Low blood sugar
• Kidney damage
• Eye problems in people with type 2 diabetes (diabetic retinopathy)
• Increased heart rate
• Suicidal thoughts and actions

These are a lot of warnings and can be overwhelming, but this is not written for intimidation. The better educated you are about the risks and benefits of any treatment, the better choices you can make about the care that is needed for the uniqueness that is you. The idea of a pill that can help you lose weight is still a fantasy. This medication has some serious concerns for individuals who might not be able to participate in the exercise portion of the treatment as well as for those with messengering nerve issues. This is not to say that this treatment is not an option for you, just be aware of your individual needs. As always, speak with your healthcare provider about your thoughts on the decision to participate in the treatment. Nurse Linda

Pediatric Consideration: Small children can have weight control issues due to overfeeding. A typical caloric intake may not be appropriate for your child’s needs and mobility. Formulas that provide almost pure nutrition can lead to increased weight and early body development. Speaking with the dietician who will develop an appropriate plan is necessary.

Teens may find the idea of taking a medication for weight loss appealing. However, it may not be the ideal treatment for their situation. Speak to your teen’s healthcare professional. You will need the resources of the dietician and may need the resources of a therapist to help deal with issues concerning the health of your child. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.