Sex and Gender-based Analysis of this topic
Definition
According to Health Canada’s classification of body weight, overweight and obesity are defined as a body mass index (BMI) of 25 or higher. Specifically, the categories are: Pre-obese (25.00-29.99) and Obese (more than 30.00), which is further classified as Obese class I (30.00-34.99), Obese class II (35.00-39.99), and Obese class III (more than 40.00). Based on data from the 2007/2008 Canadian Community Health Survey (CCHS), approximately 27% of women in Canada are deemed overweight and 16% obese [1]. Using the BMI guidelines, over 40% of women in Canada have a body weight that falls above the ‘normal’ range. Excess weight has been associated with numerous chronic conditions including arthritis, high blood pressure, type 2 diabetes, repetitive strain injuries, depression, and coronary heart disease [2].
Sex Issues
Compared to men, women who are considered obese have a higher risk of developing arthritis and high blood pressure. Sex-specific health risks of obesity for women also include endometrial cancer, ostmenopausal breast cancer, menstrual abnormalities, impaired fertility, and increased complications in pregnancy [2]. The BMI measurement lacks sex-sensitivity and, as a result, women may be disproportionately classified as outside of the ‘normal’ weight range due to typical differences in height/stature between men and women. On average, women are shorter than men, which may result in a higher proportion of women being deemed outside the ‘normal’ BMI range [3]. For example, according to the Public Health Agency of Canada, women are more likely to be labeled as obese class II and class III because of this sex difference in height [4]. Furthermore, women’s bodies contain a higher percentage of fat reserves for reproduction purposes (i.e., storage of hormones, pregnancy, lactation) compared to men’s bodies.
Gender Issues
Body weight is a sensitive issue for many women in a culture where a woman’s self-worth is often tied to her appearance, and subsequently, to her weight. Women often develop a sense of poor body image, including body dissatisfaction and poor self-esteem [5]. Even women who are within and below the ‘normal range’ report body dissatisfaction, which may also be related to decreased satisfaction in other areas of women’s lives (e.g., career, family, friends) [6].
Diversity
Age, ethnicity, and socioeconomic status influence body weight [3]. Overweight and obesity rates increase with age and peak for women between 65-69 years and then begin to decline at age 70 [1]. However, in recent decades rates of obesity appear to be rising fastest among young adults and adolescents [7-9]. By early adulthood (18 to 24yrs) more than one third of women exceed the range of healthy body weight (12% obese; 22% overweight); by age 45, 60% of women carry excess weight [10]. In Canada, the rates for overweight and obesity are higher for Aboriginal women living off-reserve compared to non-Aboriginal women [1]. Similarly, data from the First Nations Regional Longitudinal Health Survey suggest that First Nations women have higher rates of overweight and obesity compared to other women in Canada [11].
Equity
Social inequalities, such as poverty and lack of education, are important aspects related to the discourse on body weights. According to data from the 2007/2008 CCHS, low income and lower levels of education are related to higher rates of overweight and obesity [1], a finding replicated in other studies [12-14]. Women without a grade 12 diploma or other post-secondary education/training may be relegated to low-paying jobs [15]. Thus, low-income women may face higher levels of food insecurity and lack access to healthy food options instead turning to inexpensive, yet nutritionally poor, foods and snacks [16,17]. Disproportionally high rates of poverty and low levels of education may contribute to the high rates of overweight and obesity among Aboriginal women [18,19]. However, various social and economic disadvantages related to obesity (e.g., stigmatization, discrimination, social isolation, job loss, low wages) may also lead to lower socio-economic status [6] and result in an increase of both acute and chronic illness among women, which may lead to weight gain [20,21].
Critique
The relationship between weight and health is complex, with considerable debate in the literature as to a direct relationship between the two [22]. Although BMI is the most commonly used measure of healthy weight, it does not necessarily provide an accurate measure of overall health [23] as it does not differentiate between weight that is based on fat or muscle and other lean tissues, nor does it take into account different body shapes and sizes or capture nutritional status [3]. Health Canada has recognized the limitations of BMI and acknowledges that alternate measures of body weight (e.g., waist circumference, waist-to-hip ratio, skin fold measurement) may be useful. Additionally, Health Canada recognizes individual variability associated with specific BMI and states that BMI should not be the sole measure of a person’s health risk [24]. Re-focusing the emphasis on nutrition and physical activity may help contribute to the physical, emotional, and social well-being of women and girls.