Anthropometric1

Inclusive Approach to Anthropometric Body Measurement Assessments Inclusive Approach to Anthropometric Body Measurement Assessments JANUARY 2024 TORONTO Inclusive Approach to Anthropometric Body Measurement Assessments Copyright © 2024 by January 2024 is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted. By Shelly Philip LaForest, MN, RN, Professor Michelle Hughes, MEd, RN, Professor Dr. Lisa Seto Nielsen, PhD, RN, Associate Professor Dr. Nadia Prendergast, PhD, RN, Assistant Professor Maggie MacEachern, BA, MBA student Diane MacEachern, MScN, NP-PHC, Professor Raquel Lashley-Trambulo, MN(c), BScN, RN, Professional Practice and Simulation Coordinator Dr. Erin Ziegler, PhD, NP-PHC, Assistant Professor Michelle Simpson, MScN, RN Safiyya LaForest, BSc student Dr. Jennifer Lapum, PhD, RN, Professor This book is best viewed via the online, Pressbooks format so that you can view the videos and interactive activities . However, a PDF format is made available. “Inclusive Approach to Anthropometric Body Measurement Assessments” is an open educational resource (OER) created for undergraduate nursing students at the introductory level. The resource introduces students to body measurements, but does so in an inclusive manner. This resource is a unique contribution to

nursing education as content is theoretically informed by an inclusive approach to assessment that incorporates culturally responsive techniques related to race/ethnicity, gender/sex/ sexual orientation, body sizes/types, and ability/disability. It is part of the first health assessment resource that is informed by clinical judgment with the goal to facilitate students’ clinical decision making and ability to prioritize care by recognizing and acting on cues and signs of clinical deterioration. Interactive clinical judgment activities and formative assessments to evaluate a student’s learning are integrated throughout the resource. The integration of clinical judgment throughout this resource will support students’ capacity to enhance patient safety and equitable health outcomes as well as their success in writing national nursing exams to become licensed to work as a Nurse. Introduction | 1 This OER builds on existing open resources specific to health assessment including: Physical examination techniques: A nurse’s guide: https://pressbooks.library.torontomu.ca/ippa/ Vital sign measurement across the lifespan: https://pressbooks.library.torontomu.ca/vitalsign2nd/ Part I: Introduction to Health Assessment for the Nursing Professional: https://pressbooks.library.torontomu.ca/ assessmentnursing/ Part II: Introduction to Health Assessment for the Nursing Professional can be found at: https://pressbooks.library.torontomu.ca/assessmentnursing2/ Introduction to communication in nursing: https://pressbooks.library.torontomu.ca/ communicationnursing/ Documentation in nursing: 1st Canadian edition: https://pressbooks.library.torontomu.ca/documentation/ The complete subjective health assessment: https://ecampusontario.pressbooks.pub/ healthassessment/ All of the listed OER are published under an open license. Thus, you can use them for free or modify them to suit your student and course needs with appropriate attribution.

Introduction | 3 Contact information and Acknowledgments Contact Information Shelly Philip LaForest, MN, RN, Professor, School of Community and Health Studies, Centennial College, Toronto, Ontario, slaforest@centennialcollege.ca Dr. Jennifer Lapum, PhD, RN, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University (formerly Ryerson University), Toronto, ON., Canada, jlapum@torontomu.ca @7024thpatient

4 | Inclusive Approach to Anthropometric Body Measurement Assessments Learning Outcomes • Apply skills related to anthropometric body measurements. • Understand the racist origins of anthropometric body measurements. • Examine the impact of unreliable anthropometric body measurements. • Integrate inclusive and anti-racist approaches to anthropometric body measurements.

height, weight, body mass index (BMI), waist and hip circumference, waist-to-hip ratio, and waist-to-height ratio. It is important to first note that these measurements are not diagnostic tools and should never be used alone in assessing a person’s health. Anthropometric body measurements are important in healthcare and are assessed and evaluated for several reasons: • Broadly speaking, these measurements can provide information about a client’s state of health, nutritional status, and help evaluate risks associated with certain diseases. • In particular, these measurements help determine a client’s growth throughout the lifespan (e.g., development and patterns) and potential growth problems such as growth delays in children. • In primary care or long-term care, these measurements help evaluate trends over time such as weight loss or weight gain or height loss associated with aging and disease processes. • In acute care and also with chronic illnesses, weight measurements can provide information about fluid gain and fluid loss and are also important in relation to the calculation of certain medication dosages particularly with children. • Sometimes, it is important to elicit a baseline weight which is then reassessed at each healthcare visit and in certain cases, daily. 6 | Inclusive Approach to Anthropometric Body Measurement Assessments In this chapter, we will problematize anthropometric body measurements and discuss an inclusive approach Contextualizing Inclusivity The dominant discourse about health and well-being in nursing and medicine is one that focuses on weight centred discussions (O’Hara & Taylor, 2018). And yet,

these discussions negate a myriad of factors related to health and well-being. Additionally, it has been found that dieting is a strong predictor of weight gain (O’Hara & Taylor, 2018). Thus, we need to shift these discussions so that they are focused on health and well-being , the social determinants of health, and factors contributing to health equity (O’Hara & Taylor, 2018). Clinical Tips The limitation of one-time body measurement assessments is that they are restricted to one point in time. It is best to consider trends in body measurements across a period of time. Introduction to Anthropometric Body Measurement Assessments | 7 An interactive H5P element has been excluded from this version of the text. You can view it online here: https://pressbooks.library.torontomu.ca/ bodymeasurements/?p=22#h5p-1 References O’Hara, L., & Taylor, J. (2018). What’s wrong with the ‘war on obesity?’ A narrative review of the weight-centered health paradigm and development of the 3C Framework to build critical competency for a paradigm shift. Sage Open, 8(2). https://doi.org/10.1177/ 215824401877 Public Health Ontario (2023). Health equity. https://www.publichealthontario.ca/en/Health-Topics/Health

existed for many years. In many of today’s cultures (including Western society), a thinner body often suggests an illusion of health (Farrell, 2011). But this is not necessarily true, and it is important to NOT assume someone is healthy just because they are thin. Additionally, when a person does not fit this thin ideal, their body image and personal identity can be adversely affected leading to and/or exacerbating physical and mental health issues. We live in a culture where fat shaming is normalized; people who are overweight and obese are stigmatized and made to feel ashamed of and blamed for their body size and medical issues that may arise (Dolezal & Spratt, 2022; Spratt, 2021). The cultural stigma surrounding weight/obesity inhibits the ability to fully examine health issues and health outcomes (Farrell, 2011). This stigma can limit individuals (such as healthcare providers) to identify and Problematizing Anthropometric Body Measurement Assessments | 9 recognize medical concerns versus aesthetic concerns (Farrell, 2011). Contextualizing Inclusivity In the context of healthcare, a neoliberal discourse can be marginalizing because it can negate the influence of social determinants of health. It also reinforces a shaming/blaming discourse in which the individual is solely responsible for their weight. Similarly, while body positivity and the Health At Every Size movements have recently come to frame wellness as acceptance and empowerment, this also places an onus on the individual to achieve “health” and prove health through other forms of measurement such as blood pressure, heart rate, and cholesterol levels (Gibson, 2022). It is important to see how such

discourses may place a moral obligation on individuals to project health, whilst ignoring the social and biological influences which may constrain efforts (Gibson, 2022). These kinds of discourse can have a negative impact on physical and mental health in which the person may gain additional weight as a result of a negative feedback loop (Brewis & Wutich, 2019; Meulman, 2019). The stigma surrounding obesity can also lead to eating disorders and mental health conditions such as depression (Chakravorty, 2021; Puhl et al., 2014). It assumes that obesity is a choice and negates social 10 | Inclusive Approach to Anthropometric Body Measurement Assessments determinants of health such as structural and socioeconomic factors (Dolezal & Spratt, 2022). This neoliberal and shaming/blaming discourse is problematic because: it assumes a singular notion of health; it assumes that access to healthy food choices and healthy lifestyles is equal across populations; and does not address the complex causes of obesity (Spratt, 2021). Knowledge Bites See FoodShare TO’s (2021) panel titled “ Dismantling fat shaming and weight stigma in health and wellness spaces .” This panel discussion problematizes the singular

146470012110483 12 | Inclusive Approach to Anthropometric Body Measurement Assessments Inclusive Approaches to Anthropometric Body Measurement Assessments Although it is important to assess and evaluate anthropometric body measurements, how you do so is just as important in order to promote inclusivity. An inclusive approach to body measurement assessment is an approach that works towards ensuring that clients feel valued, involved, and heard. It is also an approach that aligns with and supports what is important to the client as opposed to what is important to you as a healthcare professional – these two do not always align. An important component of inclusive approaches is anti-racism . Anti-racism involves an active approach to centring the voices of racialized people and dismantling all forms of racism including systemic and institutional racism (Hassen et al., 2021). It is important to recognize that racism affects every aspect of a racialized person’s life (Prendergast, 2023). And that means, racism affects body measurement assessments and evaluations. Although we will get deeper into this discussion, you need to consider how you can engage in anthropometric measurements from a critical and anti racist stance.

For example, in order to do so, one must critically examine and reflect upon concepts of power and oppression. An anti-racist approach must actively challenge whiteness : which “is not about being white … [but about] the racial power which has claimed normative dominance” and continues to nurture, sustain, and reproduce racist institutions and systems (Patel, 2021). Recall the history and origins of these measurements and whether they apply to all bodies. As a nursing professional, it is important to consider what you Inclusive Approaches to Anthropometric Body Measurement Assessments | 13 can do to ensure body measurement assessments are performed in an inclusive manner. See Table 1 for guiding principles of inclusive practice to anthropometric body measurement assessments. Table 1± Principles of inclusive practice to anthropometric body measurement assessments

Consider whether and how a body positive approach is appropriate Actively listen to the client and amplify their voice Avoid generalizations when assessing clients There is evidence showing the role of unconscious bias surrounding weight and racism (Lofton et al., 2023). This unconscious bias influences healthcare professionals’ anti-fat attitudes (FitzGerald & Hurst, 2017). You should reflect on your own unconscious biases because they can have a negative effect on clients’ health and wellness. For example, it has been found that Black clients who are overweight (in comparison to white clients who are overweight) report poorer healthcare provider communication including spending less time with them and explaining things less clearly (Wong et al., 2015). A body positive approach is the acceptance of all bodies at any size, shape, ability or any other characteristic. Focusing on a client’s strengths is important, but it is also important to not lay the onus regarding health on the client solely. Thus, a body positive approach must be used cautiously. Keep in mind that there are many social determinants of health that influence health and wellness and that clients cannot fully control all factors that influence their body or these factors are outside of the control of clients (e.g., racism, safe housing, access to food). You should engage in conversations and assessment in ways that are non-judgmental and empathetic. It is important to spend time listening to all clients and amplifying their voices. Their experiences and stories are vital to helping you understand factors in their life that may influence their health and body measurement findings. Additionally, what is important to them should help inform your thinking and approach. Normal anthropometric body measurements can sometimes be a misnomer considering the many factors that influence weight among other measurements. Thus, you should avoid generalizations in terms of merely inferring from broad principles and standards. Rather, you should consider each person as an individual and recognize variations. Inclusive Approaches to Anthropometric Body Measurement Assessments | 15 Avoid reliance on one measurement in time in assessment practices

Avoid reliance on one anthropometric body measurement related to clients Recognize the multi dimensional causes of obesity An anthropometric measurement only provides a one-time snapshot of the client’s health and well-being. Considering trends over time and over multiple anthropometric measurements provides a more comprehensive overview of their health and well-being. Also, considering that measurements can fluctuate (e.g., weight can fluctuate on a daily basis and throughout the day due to factors such as hormones and fluid intake), it is important to consider weight ranges. For example, you may ask the client: “what is your normal/usual weight range?” Evidence concerning the various anthropometric body measurements continues to shift in terms of which ones best predict disease and mortality. Currently, it is best to use a combination of body measurements (more to be discussed later in this chapter). There is the misperception that the sole cause of obesity is behavioural-related (i.e., eating too much and an inactive lifestyle) when in fact the causes of obesity are multi-dimensional and also much more complex. It is important to consider the social, economic, genetic, environmental, metabolic and hormonal dimensions as well as factors related to one’s physical and mental health. For example, trauma can contribute to weight gain or weight loss. Contextualizing Inclusivity Supporting a client’s agency and providing choice is important in terms of sharing information with clients about their body measurements. For example, it may not be important to a client to know their weight. Rather, 16 | Inclusive Approach to Anthropometric Body Measurement Assessments they may monitor their weight/size by the fit of their clothes. Additionally, body measurements may not be

individuals cannot access food, often due to financial reasons, and results in inadequate nutritional intake (Raphael et al., 2020). Food insecurity has become a major issue in Canada as the cost of inflation and groceries continue to rise, and clients who are food insecure may make choices that do not support their health and well being including healthy weight and nutrition goals. Clinical Tip 1. Explain the purpose of anthropometric body measurements and how information will be used (to determine the broader picture of a client’s health). 2. Ask for client consent to collect information. 3. Seek permission to touch as needed to complete assessments and/or measurements. 4. Listen to the client to gain a better understanding of their health from their perspective, to identify any influencing factors, and their personal health goals. 18 | Inclusive Approach to Anthropometric Body Measurement Assessments 5. Be mindful of your non-verbal cues/body language when measuring clients. You may come across as being judgemental without that intent. 6. Avoid commenting on a client’s weight-related physical appearance, body shape and size (e.g. you have such skinny legs, you have a bit of a tummy).

Activity: Check Your Understanding An interactive H5P element has been excluded from this version of the text. You can view it online here: https://pressbooks.library.torontomu.ca/ bodymeasurements/?p=26#h5p-2 References FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Med Ethics,18, Article 19. https//doi.org/10.1186/s12910-017-0179-8 Lofton, H., Ard, J., Hunt, R., & Knight, M. (2023). Obesity among African American people in the United States: A review. Obesity: A Research Journal, 31(2), 306-315. https://doi.org/10.1002/oby.23640 Patel, N. (2022). Dismantling the scaffolding of institutional racism and institutionalising anti-racism. Journal of Family Therapy, 44(1), 91-108. https://doi.org/10.1111/1467-6427.12367 Inclusive Approaches to Anthropometric Body Measurement Assessments | 19 Prendergast (2023). An introduction to anti-racism for the nursing professional: A focus on anti-Black racism. https://pressbooks.library.torontomu.ca/antiracismnursing/ Raphael, D., Bryant, T., Mikkonen, J. & Raphael, A. (2020). Social Determinants of Health: The Canadian Facts. Oshawa: Ontario Tech University Faculty of Health Sciences and Toronto: York University School of Health Policy and Management. http://www.thecanadianfacts.org/ World Health Organization (2008). Waist circumference and