Maintaining an ideal weight is difficult for many people. For those who have reduced energy requirements, such as people with a spinal cord injury (SCI), maintaining a healthy weight can be more challenging. There are many barriers, including difficulties with increasing energy expenditure. This article discusses these challenges along with the increased health risks of diabetes and coronary heart disease seen within this population. Through a review of the literature, some practical solutions are provided. These include having weight management programmes starting soon after injury, education including carers’, and focusing on behavioural change techniques as part of a multidisciplinary approach to encouraging a healthy lifestyle, lifelong.