What are body dissatisfaction, body shame and body surveillance?

Definitions for Personal Trainers - What are body dissatisfaction, body shame and body surveillance? 

by Kathleen Lisson

Certified Lymphedema Therapist

ACE Certified Personal Trainer

Self compassion is a good intervention to reduce the severity of body image concerns 

in women with body image issues. As Personal Trainers or other healthcare professionals helping clients with a lipedema diagnosis, body image issues are an inevitable result of living with lipedema adipose tissue in today's image-obsessed Western society. We must be empathetic and have an understanding of what our clients are experiencing. Simply put, what are we dealing with here?

Kristin Neff is a meditation expert and researcher in self-compassion. Neff defines self-compassion as three intertwined elements - "mindfulness, self-kindness, and common humanity"

• Mindfulness is important so the meditator can notice her suffering in a balanced way 

• Self-kindness involves "care and understanding" versus "harsh judgment or criticism" 

• Common humanity allows the meditator to understand that "imperfections are part of being human and that flaws and inadequacies make one more (rather than less) connected to others." 

Body image concerns include body dissatisfaction, body shame and body surveillance.

• Body dissatisfaction happens when we evaluate ourselves in a negative light.

• Body shame is when we judge ourselves as a person negatively because our body does not conform to society's standards.

• Body surveillance is when we are endlessly concerned with how our bodies appear to others. 

These definitions came from the study 'Brief self-compassion meditation training for body image distress in young adult women' by Aubrey M. Toole, Linda W. Craighead

 http://self-compassion.org/wp-content/uploads/2017/01/Toole2016.pdf

In this video, Dr. Karen Dill-Shackleford, Media & Social Psychologist from the Fielding Graduate Institute shares information on what body image interventions DON'T work:

In this video, a lady with lipedema speaks about how she feels versus what she sees in the mirror: 

Hypoxi for Lipedema?

Hypoxi for Lipedema?

by Kathleen Lisson

Certified Lymphedema Therapist

ACE Certified Personal Trainer

Hypoxi is a low impact exercise intervention using advanced vacuum and compression technology. It's more popular outside the United States, but there are a few Hypoxi centers in the United States.

The difficulty with recommending it as a lipedema treatment is similar to other treatments - there are such a low percentage of people with an actual lipedema diagnosis in the United States, it is hard to recruit participants for a controlled study. It is hard to know if the product works only on cellulite or if it is affecting lipedema fat.

The Personal Trainer-style job at this business is called a Hypoxi Coach. 

This link has information on a small, unpublished study involving lipedema patients. http://hypoxi-lipoedema.com/great-result-of-the-hypoxi-lipoedema-study. I AM interested in the effect that this type of exercise intervention has on pain levels.

Here's more information form ABC15 Arizona:

Why I am Interested in Lipedema

Why Learn About Lipedema?

by Kathleen Lisson
Certified Lymphedema Therapist
ACE Certified Personal Trainer

I was fresh out of massage school and had only been a certified massage therapist for a few months when she came in for her first appointment. She was tall, blonde and, at 16 years old, had booked her first massage ever with her mother’s permission at the day spa where I worked. She shyly told me she enjoyed playing several sports but had not been able to diet away a layer of tissue that had started to accumulate on her legs.

She’s not the first person to ask me if massage can either help with weight loss or reduce cellulite, but this was something different. I remember noticing something unusual at her ankles. Her calves ended abruptly at the top of her foot, almost like she was wearing a pair of thin leggings. I knew from my oncology massage class that there was a condition called lymphedema, but this was different. I made a mental note to look back into my textbooks and see if I could figure out what was going on. For weeks I hoped she would come back for another massage, but I never saw her again. It’s been a few years, and knowing what I know now, I wish I could have suggested she do an internet search for the word ‘lipedema.’

For many women, lipedema adipose tissue starts appearing at puberty and may increase with childbirth and menopause. It is not reduced by diet and exercise, but women can spend decades trying to lower their weight in vain, desperately wondering why no diet or exercise regime ever works for them. The average woman is in her forties when she is finally diagnosed.

I breaks my heart that I was unable to help that innocent, shy blonde girl that came to me for her first massage. I have spent time over the past months giving presentations around San Diego to raise awareness about the adipose tissue disorder called lipedema, in the hopes that the men and women I speak to will be able to see it in their friends or family and help the women they love avoid years of frustration and thousands of dollars trying diets and exercise programs that will not remove the lipedema tissue on their legs, thighs and buttocks.

Is Lipedema Genetic?

Is Lipedema / Lipoedema Genetic? 

by Kathleen Lisson

Certified Lymphedema Therapist

ACE Certified Personal Trainer

Scientists have not found a genetic link yet, but 74% of the women surveyed in the The Lipoedema UK Big Survey stated that they “suspect other members of their family have/had lipoedema without being diagnosed” (Fetzer & Fetzer, 2016).  There may be a hormonal component, because symptoms may worsen after puberty, birth control, childbearing and menopause.

It's worth asking the client with lipedema if anyone in her family has a similar body type. Old family photos can also provide clues.

Research:

Fetzer A. & Fetzer S. (2016). Lipoedema UK Big Survey 2014 Research Report Report. Lipoedema UK.

Retrieved from http://www.lipoedema.co.uk/wp-content/uploads/2016/04/UK-Big-Surey-version-web.pdf

My Client Has Lipedema! What Does this Mean for the Personal Trainer?

My Client Has Lipedema!
What Does this Mean for the Personal Trainer?

Kathleen Lisson

Certified Lymphedema Therapist

ACE Certified Personal Trainer

Lipedema is a chronic, progressive adipose tissue disorder thought to affect around ten percent of the female population in America. Lipedema was first described by Doctors Allen and Hines of the Mayo Clinic in 1940. Almost 80 years later, the condition is often mistaken for obesity and not well known in the medical community. For many women, lipedema tissue starts appearing on the butt, thighs and calves at puberty and is extremely hard to reduce via diet and exercise.

Lipedema may cause:  

• gait changes
• postural changes
• arthritis of knees
• valgus knee deformity / genu valgum / knock knees
• restricted ROM of knee
• flat feet / pes planus
• hypermobility
• pain
• bruising
• shortness of breath

In addition psychosocial issues surrounding body image and inability to find workout clothing may be barriers to working out.

How Can Personal Trainers Help Clients with Lipedema?

First things first, your workout is not going to magically melt the lipedema tissue off of their body. Though exercise may not reduce the lipedema adipose tissue, movement is valuable for overall health.

Warren Peled & Kappos (2016) state that "low levels of physical exercise are a risk factor for further deterioration of lipedema, especially in combination with an increase in body weight. The ultimate goal of therapeutic interventions is improving strength and fitness to enable an active lifestyle, which can help alleviate some symptoms, particularly in more mild cases” (Warren Peled & Kappos, 2016).

We may also need to modify goals. Instead of losing inches and pounds, we can focus on activities of daily living (ADL) like walking longer distances (perhaps charting progress with the 6MWT test) , getting in and out of the bed/chair/car, and other issues important to the client.

A Dutch study compared women with obesity to women with lipedema and found that those with lipedema had a slightly lower performance on the 6MWT and increased muscle weakness in the quadriceps. According to van Esch-Smeenge et al, (2017), “clinical examination of patients with lipoedema often reveals loss of muscle strength and exercise capacity compared to patients with obesity, posing a challenge to activity regimens” (van Esch-Smeenge et al, 2017).

Aerobic vs. Anaerobic: Exercise levels should not be too intense. According to the Fat Disorders Research Society, "intense exercise like running, spin class, or heavy weight training can deprive your muscles of oxygen which causes inflammation and can aggravate your lipedema. In general, if you can “feel the burn,” then that activity is too intense for you" (Exercise, n.d.).

Other posts on this blog cover specific exercise interventions that are suitable for the client with lipedema.

Resources:

Dayan, E., Kim, J.N., Smith M.L., Seo, C. A., Damstra, R.J., Schmeller, W. Frambach, Y., Carmody, M.A. Foldi, E., & Rockson, S. G., (2017). Lipedema - The disease they call FAT: An overview for clinicians. Boston MA: Lipedema Simplified Publications, The Friedman Center for Lymphedema Research and Treatment at The Center for Advanced Medicine at Northwell Health in collaboration with Lymphatic Education & Research Network (LE&RN).

Exercise. (n.d.). Retrieved from https://www.fatdisorders.org/excercise/

van Esch-Smeenge, J., Damstra, R., Hendrickx, A. (2017). Muscle strength and functional exercise capacity in patients with lipoedema and obesity: a comparative study.

Journal of Lymphoedema. 6/1/2017, Vol. 12 Issue 1, p27-31. 5p. Retrieved from http://lymphoedemaeducation.com.au/wp-content/uploads/2017/06/1.-jol_12-1_27-31_vanesch-1.pdf

Warren Peled, A., & Kappos, E. A. (2016). Lipedema: diagnostic and management challenges. International Journal of Women’s Health, 8, 389–395. http://doi.org/10.2147/IJWH.S106227 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986968/