Tag Archive for: women’s health

Osteoporosis in Canadian Women: Building Strong Bones for a Healthy Life

Author: Shali Tayebi, MSc Global Health, University of Copenhagen | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: February 12th, 2021

Osteoporosis is a metabolic bone disease that is a major public health issue. It also places a tremendous physical, emotional and mental burden on those who it afflicts. Over 200 million people worldwide are affected by osteoporosis. There are 2.2 million people with osteoporosis in Canada; a country with a growing and ageing population [3,7]. 

The disease is characterized by weakening bones, which increases the risk of fractures. Most often, people live with bone loss for many years without knowledge of their condition until their first fracture — most commonly in their hip, wrist, or spine. Physical consequences can include reduced mobility, disability, chronic pain, loss of height, and premature death [7]. 

Subsequent psychological effects can follow. This includes depression in reaction to living with a chronic condition and anxiety stemming from a fear of future injuries and falling. People may experience a social decline through the loss of social duties and social isolation [7]. 

Causes

The causes of osteoporosis are grouped into primary and secondary classifications. The primary group mainly consists of older individuals experiencing changes in hormone levels after reaching menopause and from chronic low dietary calcium. In the secondary group, low bone mass is a side effect of other health conditions [3]. 

Risk Factors

More than 80% of cases in Canada are women. This increased risk is due to several factors. First, women tend to have thinner, smaller, and less dense bones than men. Women often also have longer life spans than men and are more likely to make up a bigger portion of those with osteoporosis in older demographics. Lastly, a bone mass loss can be attributed to the sex-exclusive biological event of reaching menopause due to dramatic hormonal changes.

Other notable co-risk factors include small body size (weighing less than 127 pounds), eating disorders, missing menstruation for at least three consecutive months (amenorrhea), and genetics. Ethnicity affects the prevalence of osteoporosis through the correlation of bone mineral density (BMD) [3]. In one study conducted by Keen and Reddivari (2020) in the United States, the highest prevalence rates were noted in Indigenous Americans with 11.9%, Asians 10%, Hispanics 9.8%, Caucasians 7.2%, and Black Americans 4% [3].

Prevention

Building strong bones and using preventative strategies is essential in maintaining good health later in life. New bone generation slows down with age compared to bone loss, so early prevention is critical. By 18 years of age, women have already developed 90% of their bone mass. Thus, it is crucial to minimize health problems that impede building bone mass early in life, such as eating disorders, poor diets, and lack of physical activity. Once reaching adulthood, it is important to adopt healthy habits and activities so that the natural degradation of the bones is reduced. Exercise, especially weight-bearing activities that work the body against gravity, such as dancing, tai chi, yoga, running, and walking, help build strong bones and prevent bone loss.

Mitigation strategies include lifestyle changes, such as cessation of smoking, reducing alcohol consumption, and adequate calcium and vitamin D intake. The amount of calcium one needs depends on the person’s age. Since the body does not produce calcium, it needs to be consumed through foods such as milk, cheese, tofu, soy-milk, breakfast cereals, and leafy green vegetables. If the daily calcium intake is insufficient, the body uses calcium found in the bones which weakens them over time. 

Vitamin D assists the body to absorb calcium from the consumed foods and supports bone growth and reformation. The skin can naturally make vitamin D through sun exposure. But the amount needed varies depending on one’s skin tone, use of sunscreen, the season, and age. Foods such as salmon, tuna, and egg yolks can also be a good source of vitamin D. Notably, Health Canada recommends that people over 50 years of age take daily vitamin D supplements, since obtaining sufficient vitamin D exclusively through diet and sunlight can be difficult [7]. 

Burden in Canada  

In a report by the Canadian Institute of Health Research (2016), the national costs attributed to osteoporosis fractures in 2011 cumulated to $4.6 billion. This is an 83% increase since the previous 2008 report [2]. The increase in expenditures are explained by the rise in admissions for acute care, rehabilitation, and complex continuing care [2]. Such findings also underlie the necessity of using more healthcare resources and preventative care for this disease [2]. 

In assessing Canada’s different elements of osteoporosis care, the health care system performs generally quite well – there are short wait times for hip fracture surgery and integration of various risk assessment algorithms [1]. However, further initiatives could be taken, such as a nation-wide fracture database to track incidence rates and monitor the delivery of healthcare. Osteoporosis is also not officially recognized as a health priority in many provinces [1]. 

Most importantly, there is a salient gap in best-known practices of care and the actual services that are provided [7]. Of those with an osteoporosis-related injury, less than 20% received a BMD diagnosis test or any medication within one year of the fracture [7]. 

Factors contributing to this inadequacy are multidimensional. In the context of the patient, there is compromised access to proper testing and treatment, lack of recognition of risk, and lack of healthcare provider awareness.  At a health system level, there is an insufficient alliance between hospitals and community health systems, and poor communication between clinicians over secondary prevention of fracture responsibilities [7]. 

Osteoporosis disease is a heavy burden on public health and women’s health in particular. It is important to raise awareness around the risk factors and encourage women to make long-term lifestyle changes to prevent osteoporosis. Exercising and reducing harmful behaviours such as smoking and drinking alcohol are essential steps in maintaining strong bones. Osteoporosis prevention and treatment need to be a strategic priority within the public health system throughout the country. 

References

1. Amgen Canada. (2020, October 20). New Scorecard Reveals Critical Need to Make Osteoporosis a National Health Priority. Cision. https://www.newswire.ca/news-releases/new-scorecard-reveals-critical-need-to-make-osteoporosis-a-national-health-priority-806500026.html

2. Hopkins, R. B., Burke, N., Von Keyserlingk, C., Leslie, W. D., Morin, S. N., Adachi, J. D., … & Tarride, J. (2016). The current economic burden of illness of osteoporosis in Canada. Osteoporosis International, 27(10), 3023-3032.

3. Keen, M. U., & Reddivari, A. K. R. (2020). Osteoporosis In Females. StatPearls [Internet].

4. National Osteoporosis Foundation. (2020, December 21). What Women Need to Know. https://www.nof.org/preventing-fractures/general-facts/what-women-need-to-know/

5. “Osteoporosis Canada.” Osteoporosis Canada |, 4 Jan. 2021, osteoporosis.ca/. 

6. Osteoporosis | Womenshealth.gov. (2019, May 20). Womenshealth.Gov. https://www.womenshealth.gov/a-z-topics/osteoporosis

7. Public Health Agency of Canada. (2020, November 27). Osteoporosis and related fractures in Canada: Report from the Canadian Chronic Disease Surveillance System 2020 – Canada.ca. Government of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/osteoporosis-related-fractures-2020.html

Photo by Lucas Favre on Unsplash

Mental Health Awareness Beyond Anxiety and Depression: Shedding Light on the Body Image Problem

Author: Kaylee Misener, Clinical Psychology PhD student at University of British Columbia Okanagan | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: January 28th, 2021

In a 2003 New York Times interview, Dr. Susie Orbach, a sociologist at the London School of Economics and Political Science, said “we’re still not fully recognizing that the body-image problem is a public health emergency”. Unfortunately, this statement still rings true today. 

As a graduate student in clinical psychology and the president of the Mental Health Awareness and Advocacy Club at the University of British Columbia Okanagan (UBCO), addressing mental health stigma and promoting positive mental health is a particular passion of mine. However, throughout  my education and work in mental health, I find the same themes continue to receive most of the focus during events like Bell Let’s Talk Day. Events that promote awareness have made profound shifts in our cultural landscape regarding mental health in recent years, particularly for mental health challenges related to depression and anxiety. 

This year, I would like to draw attention to the mental health challenges related to body image and disordered eating. Despite their pervasive and serious nature, as noted by Dr. Orbach, these challenges are massively underrepresented in the broader discussions on mental health awareness. As a body image researcher and advocate, I have seen how these issues are often trivialized, dismissed, and underfunded. 

Why does body image matter?

Body image is a broad term pertaining to thoughts and feelings about one’s body. It also includes body-related behaviours one engages in.[1] Negative thoughts and feelings about one’s body are associated with a myriad of negative psychosocial outcomes including depression, low self-esteem, unsafe sex practices, smoking, increased anxiety, and school avoidance. Negative body image also predicts lower levels of physical activity and disordered eating behaviours, and is associated with increased dieting and weight gain.[7,8] 

Notably, negative body image is also one of the strongest predictors of eating disorders.[9] While less attention is directed towards their study, eating disorders are associated with the highest mortality rate across mental health disorders, outside of substance use disorders.[10] Despite these concerns, negative body image is so pervasive, particularly among women, that it is commonly referred to as “normative discontent,” indicating how normal it is to be unsatisfied in one’s relationship with their body and how much work we have left to do in this area.

What is positive body image?

While the findings noted above underscore the prevalence and severity of body image concerns, we also know that positive body image can significantly benefit overall health and well-being. For example, positive body image predicts favourable health outcomes such as increased physical activity, and decreased dieting, smoking and alcohol use.[11] Positive body image is also associated with lower rates of depression, higher self-esteem, and even greater use of sun protection.[12] 

Positive body image is commonly misunderstood as simply loving one’s appearance. However, this misconception misses the true essence of positive body image. Rather, it encompasses respecting the body by attending to its needs, accepting the body despite its perceived flaws, appreciating the body for its functionality, and working to protect ourselves from harmful outside influences such as those included in the media or physical harms.[13] 

How can we move toward positive body image?

Given the significant concerns associated with negative body image and the notable benefits associated with positive body image, it is tempting to wish we could wave a magic wand and create universal positive changes in body image overnight. While we may not have that magic wand, there are evidence-based strategies that can be used to improve one’s relationship with their body. 

  1. Positive People: Surround yourself with body positive people and minimize the time you spend engaging with dieting friends and diet culture. 
  2. Focus on Values: List the things you like about yourself and others that have nothing to do with physical appearance. 
  3. Be Critical: Be a critical consumer of the media and messages from the diet industry. Consider who profits from you feeling like you need to change. 
  4. What Will You Give Up: Consider what you give up to pursue idealized body shapes. Would you rather spend that time with friends, pursuing your dreams, or enjoying your life?
  5. Enjoy Movement: Engage in types of physical activity that you enjoy. Consider movement in the context of taking care of your body instead of punishing it. 
  6. Focus on Functionality: Celebrate all the things your body does for you. Make a list of everything and reflect on why those functions are important to you. 
  7. Hit Unfollow: Unfollow anyone on social media that makes you feel bad about yourself. Use social media to your benefit by following accounts which make you feel good. 
  8. Self-compassion: Try responding to yourself as you would a dear friend. Try self-compassion meditations or a workbook. 
  9. Mindfulness: Stay in the present moment and meet it without judgement. That includes your body.  

The above suggestions are just the tip of the body image iceberg. Often, the first step is simply starting the discussion on body image issues, particularly in the context of mental health. Everyone has a body and everyone has a relationship with their body. It is only through increased awareness and stigma reduction that societal-level shifts can be made to promote positive body image. By starting on the individual level and starting small, we can be part of this necessary wave of change. 

References
  1. Cash, T. F. (2004). Body image: Past, present, and future. Body Image, 1, 1-5. doi:10.1016/S1740-1445(03)00011-1
  2. Paxton, S. J., Neumark-Sztainer, D., Hannan, P. J., & Eisenberg, M. E. (2006). Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of Clinical Child & Adolescent Psychology, 35, 539–549. doi:10.1207/s15374424jccp3504_5
  3. Schooler, D. (2013). Early adolescent body image predicts subsequent condom use behavior among girls. Sexuality Research and Social Policy, 10, 52-61. doi:10.1007/s13178-012-0099-9
  4. Howe, L. J., Trela-Larsen, L., Taylor, M., Heron, J., Munafò, M. R., & Taylor, A. E. (2017). Body mass index, body dissatisfaction and adolescent smoking initiation. Drug and Alcohol Dependence, 178, 143–149. doi:10.1016/J.DRUGALCDEP.2017.04.008
  5. Vannucci, A., & Ohannessian, C. M. (2018). Body image dissatisfaction and anxiety trajectories during adolescence. Journal of Clinical Child and Adolescent Psychology, 47, 785–795. doi:10.1080/15374416.2017.1390755
  6. Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244-251. doi:10.1016/j.jadohealth.2005.12.001
  7. Hayden-Wade, H. A., Stein, R. I., Ghaderi, A., Saelens, B. E., Zabinski, M. F., & Wilfley, D. E. (2005). Prevalence, characteristics, and correlates of teasing experiences among overweight children vs. non-overweight peers. Obesity Research, 13, 1381–1392. doi:10.1038/oby.2005.167
  8. Sonneville, K. R., Calzo, J. P., Horton, N. J., Haines, J., Austin, S. B., & Field, A. E. (2012). Body satisfaction, weight gain and binge eating among overweight adolescent girls. International Journal of Obesity, 36, 944–949. doi:10.1038/ijo.2012.68
  9. Rosenvinge, J. H., & Pettersen, G. (2014). Epidemiology of eating disorders part II: An update with a special reference to the DSM-5. Advances in Eating Disorders, 3, 198-220. doi:10.1080/21662630.2014.940549
  10. Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13, 153-160. doi:10.1002/wps.20128
  11. Andrew, R., Tiggemann, M., & Clark, L. (2016). Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study. Developmental Psychology, 52, 463–474. doi:10.1037/dev0000095
  12. Gillen, M. M. (2015). Associations between positive body image and indicators of men’s and women’s mental and physical health. Body Image, 13, 67-74. doi:10.1016/j.bodyim.2015.01.002
  13. Tylka, T.L. (2011) ‘Positive psychology perspectives on body image’, in T.F. Cash and L. Smolak (Eds) Body image: A handbook of science, practice and prevention, 2nd edition (pp. 56–67), New York: Guilford.
  14. Neighbors, L. A., & Sobal, J. (2007). Prevalence and magnitude of body weight and shape dissatisfaction among university students. Eating Behaviors, 8, 429-439. doi:10.1016/j.eatbeh.2007.03.003
  15. Stice, E., & Shaw, H. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53, 985-993. doi:10.1016/S0022-3999(02)00488-9
  16. Duenwald, M. (2003, June 22). Body Image: One size definitely does not fit all. The New York Times. https://www.nytimes.com/2003/06/22/health/body-and-image-one-size-definitely-does-not-fit-all.html

Women’s Health in Review: 2020

Authors: Arrthy Thayaparan and Alex Lukey (Blog Coordinators)

Published: January 15th, 2021

With the dawn of a new year, many are hoping to move past the tumultuous events of 2020. But who can blame them? 2020 will be memorialized in future history books as the year the world came crashing down. In particular, women felt the strain with increases in domestic violence and economic consequences disproportionate to men. For much of the past year, the news and social media painted a grim picture of the world. So it begs to question, did anything good happen in 2020? Is there hope that 2021 will be any better?

In fact, there were many triumphs in women’s rights and health in 2020. While 2020 was a year of unprecedented challenges, the year also highlighted the resilience of women across the globe. Below, we’ve highlighted several successes in 2020 worth celebrating as we begin the new year. 

Argentina legalizes abortion

After 12 hours of debate and tension, Argentina’s Senate voted and legalized abortion. Historically seen as a conservative region, this decision is a major victory for women and activists fighting for the right. It is believed that hundreds of thousands of underground abortions are performed in Argentina every year. The new abortion laws would legalize the procedure and ensure safe practices for women choosing to undergo it. The arrival of these new laws also brings hope for surrounding Latin American countries, in the desire that they will follow suit and also legalize the procedure. 

Pakistan banned virginity tests

A few weeks ago, the high court of Lahore, Pakistan outlawed the use of virginity tests on female rape survivors. Justice Ayesha Malik stated that invasive tests had no legal basis or medical requirement for them to be carried out. Additionally, the practice was deemed a humiliating offense on victims with dangerous potential to re-traumatize them. While the judgement will only apply in the state of Pubjab, it was nevertheless a historic moment for Pakistani activists and the feminist movement. 

25th anniversary of the Beijing Declaration on women’s rights

This year marks the 25th anniversary of the Fourth World Conference on Women, which set a historic agenda for women’s rights. At this conference, over 30,000 activists and representatives from 189 countries adopted a declaration and platform to oversee the equal rights and opportunities of all women. However, other than celebrating this historic event, the anniversary is a wake-up call for countries committed to the declaration. No country has fully delivered or is close to the 2020 goals envisioned by the conference. With COVID-19 exacerbating inequalities and risks for women, it becomes even more essential to continue pushing for women’s rights and women’s health in the coming years. As Hillary Clinton so rightly phrased at this very conference 25 years ago, “Women’s rights are human rights, and human rights are women’s rights.”

Two women scientists awarded Nobel prize in chemistry

Emmanuelle Charpentier and Jennifer Doudna were awarded the 2020 Nobel Prize in chemistry for their work on gene-editing technology. Their tool, known as CRISPR-Cas9, has already had encouraging results in experimental treatments for sickle cell disease. The women mark the eighth and ninth women to ever receive this award since 1901. Despite previous history of women receiving the honour, Charpentier and Doudna make history as the first all-female winners for the Nobel’s chemistry stream. 

Vast improvements of sex inclusion in biological studies

Since the 1990s, the limitation of sex-biased studies and the need for the inclusion of females has been highlighted in research. A 2009 report by Beery and Zucker further highlighted sex-inclusive practices and policies that could mitigate biases and prompted the United States National Institutes of Health to implement a policy that required researchers to consider sex as a biological variable. The policy was intended to ensure equal representation of males and females in studies but received backlash by those who saw the change as unnecessary, time consuming, costly, and complicated. Now over ten years later, a follow-up study has found that the policy has significantly helped in increasing the number of sex-inclusive studies across most biological fields. While much work is still required, there is hope that the scientific community is aware and starting to understand the need for sex-inclusive research. 

Ground-breaking mRNA research is foundation to COVID-19 vaccine

Dr. Katalin Karikó is one of the co-developers of a method that utilizes synthetic mRNA to fight disease. Her discovery is now the foundation of the COVID-19 vaccine. But her story hasn’t been an easy one. After leaving her native Hungary in 1985, Karikó became a researcher at Philadelphia’s Temple University and later at University of Pennsylvania’s School of Medicine. For years she attempted to gain funding for mRNA research, which was deemed too financially risky to fund. She was later demoted from her position at UPenn and underwent a hard battle with cancer, but Karikó stayed true to her ideas. Eventually, she was able to make her discovery, alongside former UPenn colleague Drew Weissman, and is finally receiving recognition for her work. 

Oxford-AstraZeneca vaccine brings hope

Dr. Sarah Gilbert is a Professor of Vaccinology at the University of Oxford, who has recently made waves in the world with her team’s Oxford-AstraZeneca vaccine. Interim data showed that the highly effective vaccine provides 70% protection from COVID-19, but some believe that slight alterations can lead up to 90% protection. Dr. Gilbert’s team has been working to create vaccines for Ebola and MERS for several years. As such, their expertise with these viruses enabled them to design a COVID-19 vaccine soon after Chinese scientists had published the genetic structure of the virus. 

Moving forward into 2021

Without question, the events of 2020 disproportionately impacted women. The stories and events we’ve highlighted here are evidence of women’s determination to advance despite adversity.  While 2021 will undoubtedly bring many more challenges, as shown here, these writers are confident that women will continue to rise to the occasion.