Over the last 6 months, reports on the "obesity crisis" have been mounting both in Singapore and overseas. "Obesity" has become a dirty word, and most of the articles covering this issue emphasize the negative impacts that excess weight has on our health. As a nutrition coach and personal trainer who is seen as a paragon of health, I'd like to share something with you about what I've experienced personally growing up, as well as what I've learned from it.
If you live in Singapore or have friends or children who've attended local schools within the past 20 years, you may have heard of a weight loss program implemented in schools called the Trim and Fit programme ( TAF Club).
The programme started in 1992; it was an annual school health screening exercise where children aged 9-18 were tested for vision, growth and development based on height and weight, hearing, a basic medical check-up by the doctor, a basic spinal test and immunisation. If you failed to meet "healthy" guidelines, you became a member of TAF whether you liked it or not. Just 4 years after TAF had been implemented, I was first placed in TAF club based on my BMI ( a value based on weight [in kg] over your height squared [in centimetres] ). Later, when I entered secondary school at age 13, I was once again classified as overweight. I was officially in the "TAF club", with the target aim of reducing BMI.
The school had all of us in TAF skip recess-- the only 30-minute break time for meals-- and replace it with exercise. Now, it makes perfect sense to increase our activity level in the hope that our excess weight would be reduced. But you have no idea HOW it was carried out, in my school at least. First off, the area where all of us "TAF girls" had to exercise was right in front of the school canteen-- in front of hundreds of other school mates. What this meant is that we couldn't hide the shame of belonging to TAF. Everyone automatically knew. Even worse, we had to face the embarrassment of exercising in front of an audience of our "normal" peers.
It didn't help that the teacher in charge was somewhat of a tyrant who was overweight herself due to a thyroid disorder. She screamed and yelled at us at the top of her lungs in the hope of motivating us while reprimanding us for being "lazy and fat", which had the opposite impact it was intended to have. Sometimes she would call us names and say that we weren't allowed to eat during recesses because we were "fat."
At the time, I didn't understand how this experience impacted me, since it felt normal to be categorized with the other TAF girls. Now, I realize, that it affected me in many ways, including:
- being fearful whenever I stepped on the weighing scale again and worrying that, if my BMI goes above 24, I would be labelled as "fat" again, and exposed to ridicule. It didn't help at all that TAF, if read backwards, spells "FAT". How "apt" for trying to motivate or inspire us to get more fit;
- not enjoying exercising and feeling ashamed of exercising in a group. I didn't enjoy my time in TAF or the activities they made us do one bit.
- living in fear after TAF, feeling condemned, stigmatized and labelled as if my body shape was my fault. It impacted my confidence profoundly, and made me believe that I would never be able to lose weight or excel in sports. Hanging around with the fit and lean girls made me self-conscious of the way I looked, and I would try my best to make my pinafore belt looser.
Things did not improve initially in junior college- in fact, they got worse as my body developed and my perceptions changed. I wanted to be active but I was scared of my body and concerned that I'd be too slow to join my friends. In that first year, I still bordered on being overweight, but by the second year, thanks to increased running during PE and an added workload, I dropped 10 lbs. in two months. My school teachers were concerned with my health, because my weight loss was really fast and significant. I didn't think it was a bad thing-- in fact, I enjoyed the "skirt" hanging loose on my hips. My mind was subconsciously fixed on aesthetics. Later on, I found a studio that ran fitness classes to improve
I was later fortunate to find a studio that ran fun-filled classes working on improving cardiovascular health, core strength, co-ordination and flexibility through dance and fitness routine. It felt great that the emphasis was on enjoying ourselves and the instructors were all very encouraging. For the first time in my life, I felt so free as I was able to connect my limbs and body to move to what my heart felt and mind thought. My fitness and confidence level improved while my weight continued to decrease.
A couple of years later, after my chemotherapy for Hodgkin's Lymphoma ended, I found a new sanctuary with the bar and weightlifting. I fell in love with the bar not for the aesthetics initially but more of a way of connecting with the inner strength I knew existed within me pre-cancer days.
So, why does our culture put so much stake on "looking good," and why does the media have a tendency to showcase women's bodies in photos without their heads? Isn't it finally time that we pay more attention to the real issues fuelling this "obesity crisis" and focus on improving lifestyle habits rather than emphasizing aesthetics?
A recent Harvard Public Health article, "The Scarlet F" highlighted findings that "weight stigma may be as harmful to the body in itself as poor diet and physical inactivity." It listed the negative impacts of weight stigma to be as rampant and as powerful as racial stigmatisation. Women who experience this type of weight prejudice may also be at a higher risk of bullying, depression, suicide, eating disorders, and other harmful addictions. Weight stigma can also impair their prospects in education, careers, romantic relationships, and physical activity.
These experiences add unnecessary stressors on their already burdened lifestyle and the environment they are in, leading to even more unhealthy weight gain. A 10-year study on the impact of such stigmatisation and the chronic stress it puts on the body shows that it also leads to changes in all the other body defence systems ( particularly the HPA axis dysfunction).
Among women, weight stigmatisation and fat shaming are now more common than racial discrimination, according to Rebecca Puhl and her colleagues at the Rudd Centre of Food Policy and Obesity at the University of Connecticut.
It's in our human nature to want to belong to a safe and nurturing environment, ESPECIALLY for women. Women and girls are predispositioned and culturally conditioned to combat environmental stressors in a "tend and befriend" way rather than in "fight or flight" mode -- both responses being the body's natural mechanism against any perceived threats. What this means is that for women, instead of constantly putting them in an environment where they feel unsafe, threatened and have perceived themselves as fighting alone, they actually do better in an atmosphere of protection of their kind and befriending in social groups where they feel welcomed.
This also means that, as fitness professionals and coaches, we should not be training women in the same manner that men are trained or force them to do exercises that do not feel comfortable or safe to them. Condescending tones, yelling, or scare tactics are generally not appropriate in group classes or private sessions with women who are focused on weight loss.
By using encouraging, self-esteem boosting modes of training, we help to reduce the hyper-loaded activity on their hypothalamus-pituitary-axis, which can have a positive impact in significantly reducing any inflammation, improving mental and emotional well-being and thereby reducing weight in a healthy and sustainable way.
So what can we do to tackle the "obesity crisis"?
1. The traditional FOOD PYRAMID we've relied on for so long is outdated. As of 2014, Singapore's Health Promotion Board has ditched this model and replaced it with MyHealthyPlate, which emphasizes consumption of vegetables and fruits. Harvard School of Public Health's "Healthy Eating Pyramid" focuses on both exercise and diet control instead of just the eating plate alone. This sets a right framework and mindset shift towards a healthier living, and should be implemented widely.
2. Shifting the emphasis from weight loss, numbers on the scale, and body mass index (BMI) to monitoring health biomarkers such as blood lipid levels, insulin levels, cholesterol, liver fat, aerobic fitness and mental wellness will offer a clearer picture on overall health and steer us away from the overemphasis on aesthetics. "Focusing on healthy habits rather than numbers on a scale may be more effective for both weight and health in the long run..Too much emphasis on weight loss, sets people up for failure and increases their risk of shame. " - says, Erica Kenney, a researcher with the Harvard Chan School’s Prevention Research Center on Nutrition and Physical Activity. Placing someone, especially at a young age, as overweight or obese based on mainly BMI, just may lead them to eating disorders and depression as they move into adulthood, leading to further weight gain and other health issues.
3. Media and advertising are powerful forces in influencing the perspectives and emotions of people. Publishers should shift to adopting a more realistic choice of words and pictures when publishing articles related to weight and fitness, instead of constantly using images of skinny white women or headless bodies. More can be done from the media to promote body positivity, including popular celebrities, leaders and social media stars/influencers. An emphasis on body positivity may lead to less weight gain or eating disorders since we tend to eat less when our psychological health is intact.
4. There are other supportive measures which can be made at the government and corporate level. Offering accessible, reasonably priced locally farmed veggies and fruits at the supermarkets and restaurants would be a big win in Singapore. Currently, it's really difficult to access this kind of produce. Incentivising hawker stands and school cafeterias to prepare their menus according to the healthy eating pyramid would also be helpful. We could also tax sweets and sodas just like we do alcohol and cigarettes, and the tax collected could be used mainly to support measures related to obesity prevention at schools, workplaces and households. Some cities in the US and the U.K. have already begun implementing this, and though there is an ongoing debate and yet any conclusive data to prove its effectiveness, "taxing" on such beverages may perhaps change our mindset into thinking how these items are NOT necessities.
5. At the individual level, for myself, at least, I have adopted the following practices and incorporate them to the best of my ability, because I have learn to accept my body is beautiful at any age or size, be it 0 to 8, and shift my focus towards health and strength:
- Mindfulness: It can't be said enough but being more mindful in an ever-noisy world helps to keep me grounded and centered, making my health a top priority.
- Being "selfish" with my environmental exposure: This may sound narcissistic from a girl with an Asian upbringing, and no, I am not out on a mission to take everything in sight, but rather, I am selective of my environment. It can be a very empowering and uplifting feeling too (and if you want to read more on how to be "selfish", read " To Move Out of Self-Sabotage, Get Selfish: Here's How" from Aimee).
- Being empathetic to myself and to others: This includes taking time to understand and accept the changes to my body is going through at age 33, what my emotions and thoughts are telling me, and not wallowing in self-pity or negative self-talk or hatred upon myself. And above all, not blaming myself for my weight or dress size!
Although we have a long way to go, Singapore IS making some positive steps in the right direction. For one, the TAF program was removed and replaced with a Holistic Health Framework (HHF) in 2007. The club is now called "ActiveKids" for students who are overweight, but is open to all who want to participate. I am hopeful that more positive lasting changes to combat rising weight-related health challenges are right around the bend.
April 2016 http://www.straitstimes.com/singapore/obesity-also-rising-in-singapore
June 2017 http://www.straitstimes.com/singapore/singapore-risks-hitting-obesity-rates-of-15-in-seven-years
June 2017 http://www.straitstimes.com/opinion/st-editorial/weighty-trend-not-to-be-taken-lightly
Perceived Weight, Not Obesity, Increases Risk for Major Depression Among Adolescents
Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment
Perceived Weight Discrimination and 10-year Risk of Allostatic Load among US Adults
Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight.
Childhood Obesity - Issues of Weight Bias https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181194/#B1
Social media and Obesity
Psychological consequences of obesity: Weight bias and body image in overweight and obese youth
Soda Taxes Can Protect Health in Asia https://www.bloomberg.com/view/articles/2016-02-23/soda-taxes-can-protect-health-in-asia
Can a sugar tax stop obesity? http://edition.cnn.com/2016/08/31/health/sugar-tax-obesity/index.html
A soda tax - will it change anything? http://www.obesityaction.org/educational-resources/resource-articles-2/nutrition/a-soda-tax-will-it-change-anything
Obesity Stigma: Important Considerations for Public Health
Obesity - can we stop the epidemic https://www.hsph.harvard.edu/magazine/magazine_article/obesity/
The Trim and Fit Program in Singapore
Mar 2017 - http://www.straitstimes.com/singapore/a-more-holistic-approach-to-a-childs-health-and-fitness