Focusing on health, not weight loss, best approach

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March is National Nutrition Month, and dieticians across Canada are trying to get the word out to go the healthy route-eat well, live well and feel great. It's nothing new, but remains the best health advice out there.

Gail Marchessault, assistant professor at the department of Human Nutritional Sciences at the University of Manitoba, believes this message is especially important for Aboriginal communities battling obesity and associated diseases like diabetes. Her research has shown that the commonly held belief that Aboriginal people are less concerned about their weight than non-Aboriginal people is not only false, but the reverse is true for some Aboriginal women.

Marchessault recently published her findings in the Canadian Journal of Diabetes. The article, "Body shape perceptions of Aboriginal and non-Aboriginal girls and women in southern Manitoba, Canada", reports that a higher proportion of Aboriginal girls than non-Aboriginal girls want to be thinner. A total of 163 people took part in the study-80 girls and 83 women. Of that total, eight girls were determined to be at risk for developing an eating disorder. Seven of those girls were Aboriginal.

Marchessault said she stumbled across this relationship while doing research for her master's degree. Her original interest was trying to disprove a commonly held belief that low income women are less concerned about their weight, based on the relationship between income and weight-the lower the income, the higher the weight. When she re-analyzed her data for an Aboriginal diabetes conference, the professor was shocked to see the scores of Aboriginal women and girls in her sample to be much higher for weight concern than among the rest of the population in her study. For Marchessault, this carries an important message to health professionals.

"I thought that people who are trying to prevent diabetes, who are working really hard and very concerned about the health situation also need to know that there is this vulnerability and that we as health professionals need to tread carefully."

The professor said it is fine for health professionals to talk about weight control among themselves, but that different tactics should be used in the classroom.

"I think when were talking to school children that we should really be focusing on the factors that are under their control... Essentially, I think we should be talking about eating healthy, being physically active and feeling good about yourself and whatever results when you have a good lifestyle, and that's it. Because when you talk to them about the importance of preventing obesity, I think it's the kids who are already weight preoccupied who are going to hear your message and the ones who you would like to be eating a little better or increasing their physical activity are quite possibly not going to hear your message," said Marchessault. "If the message is weight control, there's a lot of ways to get there, most of which are unhealthy."

In talking to Aboriginal women, Marchessault found that many had had unhealthy weight control behaviours when they were girls.

"We need to be very careful how we talk to girls about weight issues, and I think the message of Nutrition Month to feel good about yourself and to focus more on eating well and enjoying activity is a good one. And that's the appropriate way to deal with weight," she said.

Although this is the only study of its kind in Canada, Marchessault said numerous studies conducted in the United States have had similar results for both boys and girls. For example, a large national study done in the U.S. found higher rates of vomiting for weight control in both Aboriginal boys and girls and higher levels of concern about weight.

Her study also may have revealed some insight as to why the misconception that Aboriginal people are less concerned about weight existed in the first place. Even though the scores indicated that Aboriginal women weremore concerned, the way they talked about weight problems was entirely different, she said.

"The very first question that I asked was, 'Is weight a more important issue to women than to men?' And I just expected everybody would say 'Yes' and then I would get to ask 'Well, why is that the case? What makes weight so important to women?"'

The non-Native women answered as she expected, but half of the First Nation women said no, and those that said yes gave very different reasons, Marchessault said. While non-Native women talked about being judged based on their appearance, Native women denied that that happened.

"It was more that women had a harder time with weight because they gained weight more easily and it was harder for them to lose it than men, and the health issues were discussed. And the women who said that it was not a bigger issue for women than for men talked about, well, they just sort of counted up the number of men and women who are trying to lose weight," said Marchessault. "And that whole discussion of weight and your appearance being central to your identity was not there for the First Nations community women whereas that was really what the focus was for the non-Aboriginal women."

The professor found that life struggles also played a big part in the difference.

"It was quite striking how some of the First Nations community women talked about very large problems that they had overcome, and so weight was sort of further down the list of important worries to them. So the overall impression was quite different even though the number of women who were concerned about their weight and the number of women who wanted to lose weight was much greater for the Aboriginal women."