Body image: love the body you’re in

1 March 2012

Nursing Review talks to Professor Jenny Carryer – who has an enduring research and personal interest in the topics — about eating, exercise, body-size, and health.

Dieting is futile, bad practice, and bad science. Jenny Carryer says nurses should know clinically and personally that any attempts at reduction dieting are totally unsubstantiated in research literature.

“The natural history of reduction dieting is consistent weight gain over the period of dieting,” she says.

But nurses aren’t exempt from worrying, at times, that they are clinically or unfashionably overweight.

Carryer acknowledges almost all women at some stage in their life stress “hugely” about their size, how they eat, and how they exercise. “It’s a constant source of stress”.

“It is a stress that woman really could do without, particularly nurses whose working lives are already so stressful.”

So if nurses are going to eat and exercise – healthily, not obsessively – what should they be trying to do?

Carryer says there have been fads and trends over the years with sometimes a complete reversal of what was seen as good advice. However, a clear research picture is emerging about the most useful ways to eat for good health and weight management.

These include:

• Eating healthy protein at every meal

• Eating low-glycaemic index carbohydrates rather than highly processed carbohydrates

• Eating unsaturated fats and minimising saturated fats like dairy products

• Eating a good variety of vegetables and fruit.

She says it is quite remarkable how many of our meals no longer have protein in them as we’ve become predominantly cereal and bread-based in how we eat. Eating healthy protein such as fish, chicken, beans, nuts, or lean red meat may make you feel full longer and help stave off hunger pangs.

Eating low-glycaemic index carbohydrates – like whole grain breads or porridge rather than white bread and white rice – also causes less spikes in blood sugar as they are digested more slowly.

Carryer says nurses can get trapped in a high carbohydrate diet, as sandwiches are awfully portable and easy and quick to prepare. The alternative of protein and low-glycaemic carbohydrate meals take a lot more time and thought.

The exercise evidence, of course, is that fitness is really, really important, says Carryer, and being fit probably negates most of the consequences of being overweight.

Nurses are not immune to being technically overweight, though the majority of nurses who work on wards probably walk miles every day, says Carryer.

“They well exceed their 10,000 plus steps, so it is highly likely that the majority of nurses working in acute environments are pretty fit and they should be pleased about that and celebrate their fitness.”

Don’t beat yourself up

Carryer says another dimension for busy nurses is that a large number are also caring for “elderly parents, children, and everybody else beside” and find it very hard to put themselves first.

“So they probably do very easily fall into the trap of eating badly because they simply haven’t been able to create time for themselves.”

Carryer says stress and shift work also has an impact on nurse’s health. She points to interesting work by Auckland-based nutritionist Libby Weaver (author of Accidentally Overweight) into the stress hormone cortisol levels, the metabolism of carbohydrates, and obesity. (See also article Shiftwork nursing: sugar, snacking and erratic eating.)

“If there’s one thing I’ve learnt from my extensive research and reading is that the notion that body size is as simple as ‘energy in and energy out’ is just not that simple. It’s much, much more complex than that.”

“That’s why I come back to the really simple message that stressing about it and going on yo-yo diets is probably the most counterproductive thing that anyone can do.”

Nurses – whether they themselves struggle to maintain a healthy weight or count amongst the effortlessly slim – must also remember not to make assumptions about people’s diet or exercise habits based on their appearance.

“It comes back to a very fundamental rule of nursing: everything should start with a really careful assessment.”

She says one of her Masters students, Nicola Russell, has been interviewing large women about their experience of general practice services and found the women extremely knowledgeable about the causes of obesity and extremely committed to trying exercise, but all had still experienced being given advice by doctors and nurses “as if they were clueless”.

“The key message would be – and this is after 15 years of reading anything ever written in this area – that we should take the clinical focus off people’s size and focus on working out with people how they can eat the most healthily and get the most exercise given their own personal circumstances.

“So the kind of advice you might give to a poverty stricken mother-of-five could be vastly different to what you might give to a 50-year-old woman living with just her husband, a well-paid job and plenty of time to herself.”