Beyond the Scale: Rethinking Healthcare and Pelvic Health Solutions

October 27, 2023

In the past few years, there has been more attention paid to discussions around weight and its relationship to health outcomes – particularly in medical settings.

When an individual is seeking medical attention, the health provider may emphasize the role that weight plays in the individual’s ailment: some professionals may recommend weight loss as a primary health solution whenever they have a patient with a higher-than-recommended BMI (i.e., the professional takes a weight-centric approach to treatment)[1]. More recently, however, the presence and impact of weight stigma has been highlighted in discussions around healthcare and treatment. Specifically, more attention is being paid to how weight stigma is associated with overweight individuals experiencing subpar healthcare and worsened health outcomes.[2]

Weight stigma, also referred to as weight bias or weight-based discrimination, refers to harmful negative attitudes or beliefs directed towards individuals based on their weight – particularly regarding people with obesity.[3] While obesity is related to higher risk of several medical conditions[2], an overemphasis on weight often overshadows the complexities and markers of good and poor health. Moreover, weight stigma itself is associated with adverse outcomes for mental and physical health[4] and can perpetuate harmful stereotypes and other serious consequences within healthcare settings[5]. While weight is one factor to consider in the context of assessing one’s health, it is only one of many factors that should be considered (i.e., a weight inclusive approach).

Limitations of Weight-Centric Health

  • Health is a multidimensional concept that encompasses physical, mental, and social well-being – and a person’s weight alone does not capture these aspects. In fact, it’s arguably impossible to quantify ‘health’ using any single number.
  • Weight is not necessarily a reliable indicator of physical health for several reasons: it does not distinguish between muscle, fat, bone, and other tissues, it does not account for where fat is distributed in the body, and weight does not provide information about an individual’s lifestyle behaviors (such as diet, exercise, sleep, and stress management).
  • Body Mass Index (BMI) is a commonly used metric and number that describes an individual’s weight.
    •  BMI solely considers weight in relation to height, without distinguishing between muscle and fat mass. It also does not consider other crucial determinants of health, such as genetics, age, sex, and overall fitness level.[4]
    • BMI also does not consider the distribution of fat throughout the body, which is a more accurate indicator of health risks.[6]

Weight and Pelvic Health

Our pelvic floor is a group of muscles sitting at the base of our spine that controls our bladder and bowel. It is also vital structurally, as it supports the pelvic organs and has a key role in core stability; and is involved in sexual functioning.

Common (fixable) pelvic floor issues include bladder urgency and incontinence, painful sex, postpartum pressure and prolapse, and chronic pelvic pain conditions like endometriosis, among others. These conditions can greatly impact our ability to feel good doing the things we love, and physiotherapy is the first line of treatment for pelvic floor rehabilitation. Having a healthy functioning pelvis and pelvic floor is related to our quality of life and sense of empowerment in our bodies.

The pelvic floor doesn’t work in isolation. It functions like a trampoline and as part of your core to absorb weight and pressure from above, and shock absorb from impact on the ground below. There is a correlation between weight and pelvic floor health; the more pressure there is from above, the more work the pelvic floor has to do to support the pelvic organs and keep us functioning. Research shows that being overweight, and/or having a higher waist circumference, is a risk factor for pelvic floor disorders like prolapse.[7] It is important to note that the term ‘risk factor’ does not mean there is an absolute cause and effect between weight and pelvic health concerns. There are people with higher-than-recommended weight without pelvic floor concerns, and people that are within the recommended weight window who do have pelvic health symptoms.

Implications for Pelvic Health Treatment

While some health providers might default to ‘losing weight’ as the first or only treatment approach for clients, this is a redundant assumption and disregards many other controllable and treatable factors. It can alienate and shame the client, and undermine their capacity for improvement.

Like all other muscles in the body, the pelvic floor can be trained to support the specific needs of that body and that body’s activities. Pelvic floor physiotherapy can help improve strength, endurance, and coordination of the pelvic floor, which can help meet the support needs based on the weight and pressure from above, and resolve symptoms without any weight loss.

When considering pelvic floor rehab in people with a higher than recommended BMI, a recommended and non-weight centric approach is to train the pelvic floor and surrounding muscles to function well in the client’s existing body. If you’re a health provider that tends to assume the impact of weight on pelvic floor without assessing and treating other factors, we urge you to consider how to train the pelvic floor for, and in acceptance of, that body.

Beyond the Scale

If you have been shamed about your body size and had your pelvic floor symptoms, or other health symptoms, attributed solely to your weight, there is so much more that can be done for you. Finding a health provider who understands the harms of a weight-centric approach, and assesses and understands health from a holistic and multifactorial approach, is crucial to supportive, validating, and effective healthcare.

 

This blog post was written in collaboration with WellIntel Talks, with the aim of increasing access to evidence-based wellness information. WellIntel Talks is a collection of expert mental health and wellbeing Speakers whose mission is to make high-quality, evidence-based information accessible in the community. All of their Speakers have achieved at least a Master’s degree and are experts in their field, so rest assured that their wellness education is reliable, objective, and science-based. Browse their wide variety of talks here.

 

Written by:

The Cheerful Pelvis and WellIntel Talks 

 

 

 

 

References

  1. Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & Calogero, R. M. (2014). The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. Journal of Obesity, 2014, 983495–18. https://doi.org/10.1155/2014/983495
  2. Health Effects of Overweight and Obesity (2022, September 24). Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/effects/index.html 
  3. Weight bias. Obesity Canada. (2022, July 20). https://obesitycanada.ca/weight-bias/ 
  4. Emmer, C., Bosnjak, M., & Mata, J. (2020). The association between weight stigma and mental health: A meta‐analysis. Obesity Reviews, 21(1), 1-13. https://doi.org/10.1111/obr.12935
  5. Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity “epidemic” and harms health. BMC Medicine, 16(1), 123–123. https://doi.org/10.1186/s12916-018-1116-5
  6. Khanna, D., Peltzer, C., Kahar, P., & Parmar, M. S. (2022). Body Mass Index (BMI): A Screening Tool Analysis. Cureus, 14(2), e22119. https://doi.org/10.7759/cureus.22119
  7. Abrams, P., Andersson, K., Apostolidis, A., Birder, L., Bliss, D., Brubaker, L., Cardozo, L., Castro‐Diaz, D., O’Connell, P. R., Cottenden, A., Cotterill, N., de Ridder, D., Dmochowski, R., Dumoulin, C., Fader, M., Fry, C., Goldman, H., Hanno, P., Homma, Y., … Wein, A. (2018). 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence.. Neurourology and Urodynamics, 37(7), 2271–2272. https://doi.org/10.1002/nau.23551