My relationship with food and exercise in the post-natal period and how it relates to new year’s resolutions: Part 1

Dr Breanne Kunstler (BBiomedSci, BHealthSci, MPhysio, PhD). 

Physiotherapist, behaviour change scientist and run coach. 

A little about me

I gave birth to a healthy and lively baby girl almost four months ago on 13 September 2019. I ate foods to fuel my pregnant body and exercised to keep myself fit and strong, all with the aim of growing a healthy baby while keeping myself healthy, throughout my entire pregnancy. This approach, as well as the perceived inability to eat large quantities of food due to general discomfort and heartburn, led to a very healthy pregnancy (Image 1). I ate when I was hungry, stopped eating when I was full and exercised when and how I wanted to. This was so simple; I was just acting on intuition. Childbirth was bloody hard, the recovery painful and the sleepless nights that ensued were relentless. Pretty standard experience I’d say.

Image 1: Me in my third trimester at my baby shower (credit: Facebook)

The focus on weight loss in the post-natal period

Australian adults have been reported to be more obese than ever before, with pregnancy weight gain considered a significant contributor to long term weight gain in women and their offspring. Women often try to change their diet practices in the post-natal period with the aim to change the way they feel about their body shape, often written as “bouncing back” or reclaiming their “pre-baby body”. A focus on eating well and exercising for good health is a great goal to have. However, that doesn’t mean that women (post-natal or not) should necessarily feel the need to focus on losing weight and being thin, which is often promoted by post-natal fitness bloggers and the like (Image 2), occasionally with some regret once they realise the negative impacts their words can have on other women (Image 3). 

Image 2: Maria Kang asks us what our excuse is for not looking so fit after having three kids. You can be forgiven if this image infuriates you as it did millions of others (credit: Facebook).

Image 3: Mums worldwide were upset at the ‘fat shaming’ implied by Maria Kang’s post (credit: Wordpress)

My relationship with food and exercise in the post-natal period

Since giving birth, my focus has primarily been on eating healthy foods to support the development of my child (she is exclusively breastfed) and exercising to maintain my mental health. However, this has resulted in cutting a lot of ‘bad foods’ and a focus on not gaining weight so I can be a healthy role model, which has resulted in me becoming the thinnest I have ever been. But is being thin and classifying foods as ‘good’ or ‘bad’ the traits of a good role model? Can’t we be healthy at any size? Shouldn’t parents (and any human, really) focus less on how we look and more on how healthy we are, how we feel and how we behave?

New year’s resolutions and mental short cuts to weight loss

We tend to think about setting new year’s resolutions as we approach the end of December each year. We fixate on what we don’t like about ourselves to identify things that we can change. We often think about what we can change to make ourselves happier, and this often involves finding a way to improve our health, usually by losing weight. Unfortunately, it’s common for new year’s resolutions to fail (Image 4).

Image 4: Resolutions often fail, despite our best intentions to succeed (credit: Facebook)

Invariably, a lot of us tend to think about improving our health in the new year. This a great thing to do and deserves to be commended. But, unfortunately, many of us take the mental shortcut straight from ‘improving health’ to ‘losing weight’, as if we assume that weight loss is the only way to achieve good or optimal health. As a result, our new year’s resolutions become about weight loss and dieting. These weight loss resolutions often involve going on a diet (paleo, keto, low carb, low fat, high protein, shakes, meal plans, lemon detox, cabbage soup…the list goes on) and exercising much more than we ever have before to achieve a certain weight by a certain time (e.g. lost 10kgs in 10 weeks or before my sister’s wedding). Why can’t our resolutions involve changing our behaviours to achieve good health rather than specifically focus on losing weight? Then it’s a happy side effect if weight loss happens at the same time, and we wanted that to happen.

Here are several examples of behaviours we can participate in to improve our health (note that I haven’t mentioned ‘weight loss’ in any way):

1. travel more;
2. eat more vegetables, or better follow Australia’s healthy eating guidelines;
3. go for a short walk more often, or better follow Australia’s physical activity guidelines;
4. quit smoking;
5. quit using illicit drugs or prescription drugs inappropriately;
6. eat dinner as a family;
7. attend more of our kids’ activities;
8. spend less time on electronic devices;
9. reduce our waste (e.g. eat more leftovers, recycle more, purchase less and shop sustainably);
10. sleep more;
11. address work-life balance concerns so we can feel less stressed at the end of the day;
12. get help to improve our sex life;
13. read more books;
14. drink less alcohol;
15. wear sunscreen daily;
16. spend more time with people we like and less time with those we don’t;
17. expand our social circle; and
18. find a partner we enjoy being with.

The list goes on. Really, it does.

Why don’t we set resolutions that focus on achieving good health, rather than weight loss?

The answer lies in our environment. We tend to associate health with losing weight and thinness. As I write this I am exposed to ads on TV telling me that I should start a diet (Image 5) and get a gym membership so I can look like an Instagram ‘fitspo’ model. I am yet to see one ad that encourages me to change my behaviours to simply live a happy and balanced life. It’s little wonder why we think that new year’s resolutions must focus on weight loss, unpalatable diets, unenjoyable exercise and the ‘thin’ or ‘athletic’ ideal. Yikes. 

Image 5: We have seen images like this everywhere, especially at the end of the year (credit: Simple Nourished Living)

Diet culture and its stranglehold on our ideals

Diet culture involves the things we see in our environment that tell us that weight loss through dieting is necessary to live our best life. It makes many body sizes appear unhealthy even if the individual is considered healthy (i.e. metabolically healthy, psychologically healthy, socially healthy etc.), encourages people to rely on external cues to know when and how to eat (e.g. fasting diets tell you when you can eat, rather than you responding to internal hunger cues), makes exercise appear as a punishment or a way to become thin rather than something to enjoy, and suggests that one’s self-worth depends on their size.

Diet culture encourages us to fixate on appearance and can increase our susceptibility to disordered eating, which can be experienced by people of all sizes and be just as deadly as being severely obese. This high quality study demonstrates that the risk of you dying from all causes is similar whether your BMI is 18 (underweight) or 40 (severely obese), suggesting your chance of dying from disease is not less if you are thin. Diet culture creates this fixation on constantly bettering ourselves, where better = healthy = thin, and the way to be healthy and thin is to diet. It’s time to challenge this.

Thinness is not necessarily healthy. Fat is not necessarily fatal. ‘Diet culture’ really wants you to believe that it is. In fact, in some cultures and societies, fatness is desirable as it might imply wealth and health through the ability to remain nourished. Fat has been found to be protective from some conditions, encouraging people to label this finding as an obesity paradox, as if it’s absolutely inconceivable to think that someone who is overweight or obese could have any better health outcomes compared to people who weigh less. Thinness just equals thinness. If you want to be thin, then do so, live your life the way you want, but don’t think that just being thin makes you healthy or that fatness is unhealthy. We need to view these constructs more holistically and individualise our assessment; it is possible for someone who is overweight or obese to be healthy on medical tests (metabolically healthy). It is also possible for someone who is considered 'normal weight' to be metabolically unhealthy. Diet culture can be harmful as it takes our attention away from being healthy and towards more superficial things like the size of our thighs.

It’s time to stop dieting and adopt a more holistic approach to health

It is well established that diets don’t work well, because weight is often regained and people become susceptible to weight cycling (so could diets then be a way to gain weight, rather than lose it? I’ll leave that thought with you). Why is dieting something that we continue to do when the evidence is clearly there to say that it doesn’t result in the weight loss and health outcomes we seek? Would we continue to deliver toxic chemotherapy to people with cancer if we did not have evidence to say that it works? NO! So why do we punish ourselves by only drinking shakes for lunch while our friends and family enjoy a delicious chicken wrap only to lose weight that we will regain, leading to another weight loss resolution for 2021?

Health is possible at every size, so is poor health. It’s time to stop looking at only size or weight as a key indicator of health and look at other indicators, such as the presence or absence of objective outcomes like irregular blood lipids and fasting blood glucose levels, and more subjective outcomes like feeling physically and mentally well. Health and thinness do not go hand in hand, neither does happiness and thinness, so maybe it’s time we start to move away from letting diet culture govern our behaviours, and our resolutions, and instead focus on the bigger picture of health.

Health is a broad concept. The World Health Organisation defines health as “…a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” So, if we want to be healthier in 2020, then shouldn’t we be focusing on more than just weight loss? Shouldn’t we (and our resolutions) focus on all things in our lives that might be compromising our physical, mental and social wellbeing? In doing that, I think we need to focus less on weight loss and more on what is really important. It’s time to focus on ways of eating, exercising and participating in other behaviours that can support physical, mental and social wellbeing instead of just focusing on being thin.

But how do we do this? I will explore my thoughts on the ‘how’ in part 2 but, for now, why don’t you think about how you can improve your health that goes beyond the number on the scales? If you want to, that is.

Disclaimer

This post is not intended to be interpreted as diet or health advice. I am not a nutritionist or dietician. I have degrees in health science and physiotherapy and work as a research fellow in behavioural science. I write this post as a personal reflection of my own experiences during the previous four months of my life since having my first child. If this blog post creates any questions for you or if you want to explore any of the principles discussed above further, then please seek assistance from a qualified dietician or nutritionist.