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Dimensional Extremes

Overview

Dimensional extremes are body types that differ significantly from others in being either substantially smaller or substantially larger than most others. In the case of dwarfism, it is a genetic condition and the individual may have no limitation other than size in relation to the environment. For people who are morbidly obese, the condition carries substantial risks of a range of co-occurring limitations in strength, stamina, respiratory issues and other chronic health conditions. In either case, the intersection with the physical and social environments can be disabling.

Who Is Affected

• People of small stature (e.g. dwarfism)
• People with extreme obesity
• This category does not cover anorexia nervosa because the implications for access are covered within Mental Health Disorders.

Dwarfism

Dwarfism is a medical or genetic condition that usually results in an adult height of 4'10" or shorter, among both men and women, although in some cases a person with a dwarfing condition may be slightly taller than that.

By far the most frequently diagnosed cause of short stature is achondroplasia, a genetic condition that results in disproportionately short arms and legs. (The term "disproportionate" is meant only as a point of comparison with people who do not have achondroplasia or any other type of skeletal dysplasia. The arms and legs of a person with achondroplasia are perfectly appropriate for someone with that genetic condition.) The average height of adults with achondroplasia is 4'0".

Proportionate dwarfism—that is, a short-stature condition that results in the arms, legs, trunk, and head being the same size in relation to each other as would be expected with an average-size person—is often the result of a hormonal deficiency, and may be treated medically.

Although achondroplasia accounts for perhaps 70 percent of all cases of dwarfism, there are approximately 200 diagnosed types, and some individuals with dwarfism never receive a definitive diagnosis. Other genetic conditions that result in short stature include spondyloepiphyseal dysplasia congenita (SED), diastrophic dysplasia, pseudoachondroplasia, hypochondroplasia, and osteogenesis imperfecta (OI). As one might expect from their names, pseudoachondroplasia and hypochondroplasia are conditions that are frequently confused with achondroplasia; diastropic dysplasia occasionally is, too. OI is characterized by fragile bones that fracture easily.

Obesity

During the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 30 percent of U.S. adults 20 years of age and older—over 60 million people—are obese.

This increase is not limited to adults. The percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6–19 years, 16 percent (over 9 million young people) are considered overweight.

Health Implications

These increasing rates raise concern because of their implications for health. Obesity has outdistanced smoking as a risk to the health of Americans. Obesity is the extreme end of being overweight. Both categories are determined by the Body Mass Index (BMI) that considers weight in relation to height. A BMI of 30 or over is considered obese. Of special concern for providing access is those who have extreme obesity.

In an editorial in the Chicago Tribune of September 25, 2006, John McCarron cites the following facts about the current trends relative to obesity and the seriousness of the problem:

• American Medical Association: "Obesity is the fastest growing health problem in the United States. ... Approximately 64 percent of the adult population is either overweight or obese. These statistics herald potentially devastating health, economic and social consequences for our nation. People who are overweight or obese have a greater probability of developing high blood pressure, high blood cholesterol or other lipid disorders, Type 2 diabetes, heart disease, stroke and certain cancers. ... Approximately 300,000 U.S. deaths a year are associated with this condition."
• Institute of Medicine: "Over the past three decades, the childhood obesity rate has more than doubled for pre-school children ... and it has more than tripled for children aged 6 to 11 years."
• National Institutes of Health: "Nearly 21 million people in the United States—7 percent of the population—have diabetes, the most common cause of blindness, kidney failure and amputations in adults and a major cause of heart disease and stroke. ... The prevalence of Type 2 diabetes has risen dramatically in the last 30 years, due mostly to the upsurge in obesity."
• Surgeon General of the United States: "Health problems resulting from overweight and obesity could reverse many of the health gains achieved in the U.S. in recent decades. ... The total direct and indirect costs attributed to obesity amounted to $117 billion in the year 2000."

There is little question that the dimensional extreme of obesity is not just about accommodating size but about providing services to a group of survivors with a strong likelihood of many kinds of functional limitations.

Looking at the Impacts

Dwarfism

Most dwarfs have no limitations beyond dealing with the lack of fit between their bodies, the built environment and products of all kinds. Most people are adept at knowing assistive technology that will reduce the disabling impact of the environment. An example of the array of assistive technology products can be found on the Little People of America website.

OsteoGenesis Imperfecta (OI)

There is one form of dwarfism that presents a different set of challenges in the built environment that is popularly known as “brittle bone syndrome,” or medically as, osteogenesis imperfecta (OI). It is a genetic disorder characterized by bones that break easily, often from no known or apparent cause. Many people with OI also have hearing loss (see Hearing) and many have serious dental problems. Scoliosis (curvature of the spine) is common. Most people with OI use wheelchairs (see Movement & Mobility). Osteoporosis is an almost universal consequence and can worsen the risk of broken bones with age.

For survivors with OI, it is important to recognize the degree to which small issues like getting in and out of bed or transferring to a shower chair can be harmful.

Obesity

The limitations of obesity covered here deal with the lack of fit between bodies, the built environment and products of all kinds. Weight-bearing functions of furniture and grab bars and railings, for example, if not matching with a person’s weight can be disabling. Hand dexterity can be reduced if the environment expects small fingers to carry out a task.

Among the many catalysts for obesity noted in the medical literature is long term exposure to domestic violence. Given the unceasing alarms about the “epidemic” of obesity in the US and the growing prevalence among children, the issue will continue as a societal pattern for some time to come and providers will almost inevitably have to address the needs of survivors who are obese.

Co-Occurring Health Problems and Functional Limitations

The co-occurring health problems and attendant functional limitations common to people with obesity will increase through time as obese children age into adults. Being overweight or obese increases the risk of many diseases and health conditions, including the following:

• Hypertension
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Osteoarthritis
• Sleep apnea and respiratory problems
• Some cancers (endometrial, breast, and colon)

For more information on these conditions see Respiratory Functions, Stamina & Fatigue, and Cognitive Functions.

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