Chapter 6 – Anthropometric Body Measurement Assessment
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 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
|
Principle |
Considerations and examples |
|
Broaden your understanding of unconscious (implicit) biases surrounding weight |
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). |
|
Consider whether and how a body positive approach is appropriate |
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. |
|
Actively listen to the client and amplify their voice |
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. |
|
Avoid generalizations when assessing clients |
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. |
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Avoid reliance on one measurement in time in assessment practices |
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?” |
|
Avoid reliance on one anthropometric body measurement related to clients |
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). |
|
Recognize the multi-dimensional causes of obesity |
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, they may monitor their weight/size by the fit of their clothes. Additionally, body measurements may not be important or even a factor in how clients monitor their health and quality of life.
As you reflect on the various anthropometric body measurements, it is important to recognize that the suggested norms vary based on sex, ethnicity, and age (WHO, 2008). In this chapter, a preliminary understanding of how these vary based on body size/frame, body composition, and body fat distribution is shared.
Knowledge Bites
An inclusive approach to anthropometric body measurements involves attention to intersectionality in terms of the interconnected nature of social identities (e.g., race-gender-sexuality-class-ability). For example, weight stigma is interwoven within these social identities and also the discrimination that may arise from them. Attention to intersectionality will help you understand how weight stigma is interwoven with multiple forms of oppression and institutional injustice; measures of the physical body are deeply rooted in white superiority, patriarchy, ableism, capitalism and colonialism.
You should consider the social determinants of health when discussing anthropometric measurements, weight, and obesity management. Food insecurity is when 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
- Explain the purpose of anthropometric body measurements and how information will be used (to determine the broader picture of a client’s health).
- Ask for client consent to collect information.
- Seek permission to touch as needed to complete assessments and/or measurements.
- 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.
- Be mindful of your non-verbal cues/body language when measuring clients. You may come across as being judgemental without that intent.
- 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
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
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 waist-hip ratio: Report of a WHO expert consultation. https://www.who.int/publications/i/item/9789241501491
Wong, M., Gudzune, K., & Beich, S. (2015). Provider communication quality: Influence of patients’ weight and race. Patient Education and Counseling, 98(4), 492-498. https://doi.org/10.1016/j.pec.2014.12.007
