Don’t cheer the scale: Doctors and dieticians untangling body size from health | Health & wellbeing

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Brock McLean says it was “almost destiny” that he would aspire to play in Australian Football LeagueFollowing in the footsteps of many family members.

“I was very much an all or nothing person – everything I did was flat out,” he says.

McLean’s AFL career lasted more than a decade. From the beginning, he loved pushing his body to the limit, training up to 20 times a week. After several injuries, he went on a strict diet “to lose just a few kilos” to reduce his risk of injury.

“And it helped: my performance was really good. It confirmed to me that this was the right thing.”

Gradually, McLean became obsessed with food: weighing each item, and weighing himself before and after eating. He believed this focus was giving him an edge as a footballer.

“Everything was tied into it…Without football, I felt completely useless.”

Then a coach told him to lose more weight to improve his foot speed, which his nutritionist warned against. But, concerned about missing time due to injuries, McLean wanted to do everything he could to ensure he could play.

He deprived himself of certain foods, entered a cycle of binge eating, suffered terrible guilt, and repeatedly made himself vomit.

“If I jump on the scale and I get nervous [a certain weight]I used to think, ‘Oh my God, I’m gaining weight, I won’t be able to play’… I was struggling with depression, and that’s when suicidal thoughts became a problem.”

He attempted suicide on 23 August 2017.

“I’m very lucky that I was found by my partner then… I realized I needed to see a psychologist and keep working on my issues.”

Helen Bird, an education services manager at the eating disorders charity, the Butterfly Foundation, says there is growing recognition of the prevalence of disordered eating in sport – which can affect players at any level – and a growing number of sporting group support. Contacting them for. ,

The AFL and AFLW abandoned the skinfold test, which involves using calipers to measure the thickness of the skin and underlying fat at specific locations on the body. For draft prospects in 2021, Experts are now questioning the usefulness of measures like weight and body composition as indicators of athletic performance and health more broadly.

Australia celebrates victory after Australia's Courtney Wynne scores a successful penalty goal to defeat France in the FIFA Women's World Cup 2023 quarter-finals.
The Compete Performance team, which provides nutritional support to the Matildas, stopped weighing players two years ago – saying it came at the expense of player performance and had no clear purpose. Photograph: Darren England/AAP

In 2022, a little writer Study of 22 AFLW players After finding no significant correlation between pre-season body composition measures and match performance, there were calls for practitioners to prioritize factors such as aerobic fitness and muscular strength.

The Compete Performance team, which provides nutritional support to the Matildas, stopped weighing players or monitoring body composition two years ago – saying the metrics often came at the expense of player performance, and its There is no clear objective.

Alicia Edge, co-CEO of Compete, says there is a widespread emphasis on weight and performance in many areas of sport.

“When we’re looking at the research, the only real connection we’ve found is that there’s a connection between lean mass and our ability to perform, but when we’re looking at body fat there’s no clear connection. Is,” Edge says. Advanced Sports Dietitian.

“So if we’re looking at that cultural [idea] While always aiming for ‘lighter is better’, we are basing it on our own assumptions rather than what the research is telling us.’

Edge and the other Compete co-CEO, Dan Edge, began to question the role of these measures in 2016.

“We started to fully understand that whenever we’re dealing with weight or body composition, it’s an interval measurement, it’s a trait. If the problem is considered to be body fat, or whatever, then ‘eat less or train more’ is really an oversimplified solution that doesn’t appreciate the person behind the data.

Weight and body composition can still be discussed, Edge says. But they’ve developed a new screening tool to track progress without those metrics, which also helps them understand clients’ relationships with food and other influences on their health behaviors.

“When we get to know someone, we are considering their occupation, culture and environment, as well as mental, social, financial and physical well-being – all of those impacts.”

Focusing on controlling something uncontrollable can increase anxiety, she adds, because body weight and composition are not predictable outcomes.

Professor Amanda Sallis of the University of Western Australia says: “Body size is influenced by a combination of dozens, if not hundreds, of factors.”

“You have major players like genetics, and environment – ​​food, physical activity, stress environment… We also have our past and emotions – if someone goes through adverse childhood experiences, it depends on How much they eat, move, and their stress, and all of that has an impact on the shape of our existence.”

She says that while many people believe that size depends on “personal preference and willpower”, in reality “it is more complex than it is often understood”.

Sallis has written several books on weight management and is now running a clinical weight loss trial using total meal replacement products, an approach she insists should not be adopted without medical supervision.

BMI – a calculation with Roots in the development of eugenics – Relevant only at the population level. Sallis says it won’t provide information about one’s metabolic health, which should be a priority.

“Even if a person’s BMI may be very high, for example, when looking at their blood sugar or glucose levels, a doctor cannot tell whether they have risk factors for heart disease, diabetes, etc. Are not.

“There’s some good evidence that waist circumference above a certain number is more likely to be associated with metabolic diseases, while waist circumference below a certain number is more likely to be associated with metabolic diseases, and it’s different by age and gender and things like , but it’s not an absolute indicator, nor is BMI… it’s all just probabilistic.”

Recent National Eating Disorder Strategy Marks weight stigma as a risk to physical and mental health. However, experts have pointed to a disconnect Between research and “weight-focused” resources available online (this includes). federal government), many of which still include BMI calculators.

Canberra-based GP Dr Liz Sturgis says feeling criticized for any reason, including body size, can cause people to avoid seeking health care.

“We know that women with larger bodies have lower rates of cervical screening, they have fewer presentations for breast screening. All of these things mean that if you have a larger body, you’re going to have worse health outcomes than someone with a smaller body,” says Sturgis, who is also a primary care researcher at Monash University.

Dr. Fiona Willer, an advanced dietitian, says weight stigma can also lead people to celebrate weight loss, while the underlying causes may be catastrophic.

“The overlap between people who lose weight intentionally and those who lose weight unintentionally can be quite significant. Someone may be suffering from some type of cancer and may be losing weight because of it, but because they’re also trying to diet at the same time, they don’t realize that it’s not the diet, it’s that they’re actually I’m dying and nobody’s picked it up yet.”

Sturgis says making assumptions about health based on body size is risky for any patient, and she warns against “promoting the scales.”

Many of his patients are low-income and have food insecurity, so losing weight can lead to concerns about malnutrition.

“If someone is overdosing on laxatives, exercising inappropriately, not having money for food — none of those things are good,” says Sturgis.

She weighs patients only when they are happy to be weighed, as one of several measures – with a focus on noting any changes over time and understanding the driving forces. “I like to focus on, ‘How is life right now?’ …not just numbers.”

“There are a lot of people who have very low body weight and have really bad cardiovascular outcomes for all kinds of reasons. So whenever we send health messages, either in individual counseling or in public health messages, that if your body No “Big, you’re right…it’s really useless.”

If a patient has “fat” or body fat that is causing health problems — the WHO definition for obesity or overweight that Sturgis uses — and wants to address that, she says they have support. should be done.

“But we live in a society that is incredibly biased against people with larger bodies… and you don’t want to support any kind of industry that involves body shaming, so it’s hard to walk that path.” Is.”

Willer, who runs a business training health professionals in a size-inclusive approach, says that people with larger bodies often expect their health professionals to raise the topic of weight and fear that they will be denied access to health care because of their size. Will be ‘gate-capped’.

'It doesn't matter what you're good at, it doesn't matter what you're bad at, you're a human being and you deserve love and compassion,' says Brock McLean, who now Quite healthy, pictured with his wife Stephanie.
‘It doesn’t matter what you’re good at, it doesn’t matter what you’re bad at, you’re a human being and you deserve love and compassion,’ says Brock McLean, who now Quite healthy, pictured with his wife Stephanie. , Photograph: Brock McLean

“Size-inclusive practice understands that weight is nothing – but usually the most relevant thing about someone’s high body weight is how they have been treated because of it.

“Size-inclusive practice supports someone who is present in their body at that moment, and seeks treatment for whatever their current complaint is, preventing starvation or weight change before addressing the health condition they are presenting with.” is not required.”

Dr Mark Morgan, chair of the Royal Australian College of General Practitioners’ quality care specialist committee, is overseeing the new edition of the Red Book which will include updated guidelines for GPs to screen for weight-related health problems.

He says it is important that everyone feels respected when participating in general practice, noting that the terms “overweight” and “obesity” have specific definitions in the medical context so that physicians, researchers and epidemiologists have a common language. Can use. But, “for individuals, these definitions may not apply and may have little to do with health,” he says.

“In conversational English, words can be offensive and cause stigma. “It is therefore important for health professionals to exercise utmost sensitivity in discussions about a person’s weight and its relationship to health.”

Brock McLean, who is now much healthier, says he would emphasize that self-worth does not come from external factors, including physical appearance.

“Children are taught to have high self-esteem if they are particularly good at something… whereas self-worth teaches you the concept that no matter what you are good at, even if you are bad at something “Whoever you are, you are a human being and you are deserving of love and compassion.”

, Dr Willis and Dr Sturgis urge anyone struggling with how they feel about their body or eating habits to seek support from their GP and ask that they receive size-inclusive care. Where can it be found?

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