A healthy approach to fitness

  • Lin-Fan Wang, MD
More and more healthcare providers are taking a nuanced approach to  the association of obesity with cardiovascular health, longevity, and quality of life. They are recognizing that the numbers on a scale, or a Body Mass Index, don’t tell the whole story about someone’s health or fitness level.
Part of this stems from the recognition that most ‘traditional’ weight loss programs are unsuccessful over the long term.  And that the ultimate goal of any serious weight loss program is improved health and mobility – so why not focus on that from the outset?  
It’s a trend that I find refreshing, as a family doctor who works with an extremely diverse set of patients, in a practice that is primarily LGBTQ-focused.
That’s why I was excited to read about a study published last month in the journal Women’s Health Issues, looking at the relationship between lesbian and bisexual women with body image, weight loss, and better health.  
The background: back in 2011 the Institute of Medicine (IOM) released a major report on the health of LGBT Americans.  Among its findings was that lesbian and bisexual women have a greater prevalence or likelihood of obesity, compared to the general population. Other studies have noted this as well.
The following year the Office on Women’s Health, which is part of the U.S. Department of Health and Human Services, launched the Healthy Weight in Lesbian and Bisexual Women initiative, enrolling groups of lesbian and bisexual women aged 40 and older in 10 cities across the U.S. 
An important aspect of this program, as lead author Dr. Jane McElroy explained, was to create an environment in which these women felt safe and accepted in their identity, where some of the unique stressors associated with being a sexual minority were acknowledged and understood.
One of the factors these researchers had noted was that attitudes about body image and weight loss tend to differ in lesbian and bisexual women as compared to their heterosexual counterparts. Generally speaking, they noted a greater acceptance of larger body size, better body acceptance and self-esteem within lesbian/bisexual communities.  
With that in mind, the Healthy Weight program was designed to focus on achieving health and physical fitness, rather than weight. 
Women in the program were given specific objectives, including: to cut their consumption of alcohol and sugar-sweetened beverages in half; and to increase their total minutes of physical activity by 20%.  In addition, some were given smart pedometers, while others took classes on mindfulness for stress reduction or intuitive eating. 
An impressive 95% of women in this study achieved one or more of the objectives that had been defined for nutrition, physical activity, or quality of life. More than half of these women met goals for physical activity and increases in fruit and vegetable consumption.   
The authors of this study found that weight loss was not a priority for most participants - but rather, what they wanted was to feel healthy and be more active.  As a provider, that’s exactly the outlook I would encourage for someone in my care. 
The issue of body weight can be highly stigmatized in our culture - particularly for women. In working with LGBTQ individuals, who have often experienced stigma and discrimination in other areas of life, I think it’s important to be careful in the way we approach this conversation.
For example, I never consciously do not focus on body weight with a patient, unless that person brings it up to me. Instead I talk about the importance of a healthy diet, exercise, and mental health.  I try to focus more on the other markers in cardiovascular health - such as blood pressure, cholesterol - which can be more useful.
As healthcare providers, if we only emphasize weight loss, patients may feel discouraged, further stigmatized, or like they are “failing” when they don’t see results. By shifting the emphasis to better health and developing positive habits, we can help patients succeed and feel better about themselves. 

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