Over two-thirds of persons with SCI suffer from obesity associated cardio-metabolic consequences. Obesity is likely to impact their social, recreational activities, quality of life and impose socio-economic burdens. Recent reports highlighted that central obesity defined by increased both waist and abdominal circumferences are likely to impose significant health risks after SCI. The central obesity is characterized by increased visceral adipose tissue (VAT); which has been identified as an independent risk factor in different clinical population. In persons with SCI, VAT has been independently associated with impaired glucose tolerance, insulin resistance and dyslipidemia. It has been linked to secretion of pro-inflammatory cytokines. The symposium will review 1) recent evidence about the role of increasing VAT on increasing pro-inflammatory cytokines and inhibited mitochondrial health in persons SCI. This imbalance of increasing inflammation and diminished anabolic growth factors is likely to increase cardio-metabolic risk factors in men with SCI . 2) Therefore, the development and validation of anthropometric cut-offs are highly necessary for this population to establish accurate guidelines that is population specific. This anthropometric cut-off may also distinguish those who are risks of developing central obesity, metabolic syndrome and cardiovascular disorders in persons with SCI. 3) It is still unclear what is the role of exercise on visceral adiposity and central obesity. Recent evidence suggests that maintenance of the size of trunk muscles may attenuate the increase in VAT and lead to favorable metabolic profile. Furthermore, SCI individuals find it difficult to reduce caloric intake because of poor dietary habits. There has been limited success in use of some techniques such as surface electrical stimulation with androgen replacement therapy, robotically assisted locomotor activity and recently exoskeletal robotic therapy. Techniques for treatment of morbid obesity used in non SCI populations such as gastric sleeve surgery have not been utilized frequently in those with SCI, but successful cases have been reported.

1) Reciprocal findings of VAT and Trunk muscles in altering Cardio-metabolic Profile in Men with SCI (20 minutes).
Dr. David Dolbow will review and discuss the existing literature regarding the role of VAT in influencing cardio-metabolic risk factors in men with SCI. The presentation will highlight the relationship between trunk muscle and increasing VAT as well as altered metabolic profile in men with SCI.

2) Proposed SCI Anthropometric cut-offs for Central Obesity and Cardio-Metabolic Risk Factors. What is the role of exercise? (20 minutes).
Dr. Gorgey will highlight established evidence of using both waist and abdominal circumferences to identify those at risks of developing central obesity and altered cardio-metabolic profile in men with SCI. Finally, the effects of 16-week resistance training combined with testosterone replacement therapy (TRT) on anthropometrics and muscle quality in men with SCI will be highlighted.

4) Potential approaches to management of obesity in SCI (20 minutes)
Dr. Gorman will discuss some of the approaches available to manage obesity in those with chronic SCI including resistance training with electrical stimulation, robotic and exoskeletal training, along with limited experience with gastric banding techniques.