woman with blonde hair wearing a black active wear set, laying on the ground and smiling while looking to the side
  • May 20, 2024

Osteoporosis and Eating Disorders with Imogen Nicholson: Episode 55

Welcome back to another episode of the Imbodi Health Podcast! Today I’m joined by the lovely Imogen Nicholson. Imogen is […]

Welcome back to another episode of the Imbodi Health Podcast! Today I’m joined by the lovely Imogen Nicholson. Imogen is an exercise physiologist and pilates instructor, and has a special interest in women’s health, musculoskeletal, pregnancy and postpartum. Imogen is also a model on the side!

We will be chatting all things bone health – with a big focus on osteoporosis and osteopenia, and the relationship between osteoporosis and eating disorders. We will also chat a little bit about the modeling industry. So, let’s get into it!

 

 

Q1. As someone who works in that industry, can you tell me a bit about your experience in that industry? If you feel comfortable sharing, what’s it been like for you – with body image and your relationship with food? 

There’s a lot of topics and a lot of tangents that I can go on. I have some a lot of friends who are also in the modelling industry. You would think that by now, we would have all the dark information that we need, telling us how bad it is for our longevity, and for our health, to eat a certain way or to restrict your diet, and how detrimental it is to your body. 

I am super lucky in a few different ways. One, my agency has never put pressure on me to look a certain way. I’m with Busy Models, and they’ve always accepted me for who I am, and whatever body size that I am. 

I wasn’t scouted as a standard model – as a size six model. And I wasn’t scouted when I was in my teenage body and then felt pressure to maintain that teenage body as I grew into a woman. 

I was scouted as even this word a plus size model – which is wild. So as a plus size model, or on my agency’s page, I’m considered curvy. I know that I’m not plus size. I know I’m not overweight, I just know that I’m not a typical size six, and I never will be. 

I was lucky that I never felt any pressure to try to restrict myself. On the same note, I didn’t get as many jobs, which is okay, which I think long-term looking at it, I’m glad that I didn’t. I’ve never had to rely on modelling as my main source of income. Thankfully, that has never been a stressor of mine. 

And I’ve always been interested in my study in things outside my body image and how I perceive myself. But in saying that even, though I found myself in this fortunate position, it definitely affected how I viewed my body. 

I remember the first year of modelling, I had a lot of castings and went to a lot of meetings, and had no jobs that entire year. And again, that wasn’t my main source of income – so it was fine. But, when you walk away from those castings, or when you walk away from not getting a job opportunity, and it’s based purely on how you look, the only thing that you can control is your exercise and your diet. 

From that standpoint, you’re obsessed with how you look. And to an extent you can’t change how you look physically other than your body. And so I definitely went downa bit of a spiral, I struggled with my body image and developed an eating disorder. Sadly I think that it’s quite frequent in the modelling industry as a woman, based on a lot of societal pressures.

No one has ever made any comment or has ever said anything about how I look. But I definitely put this pressure on myself as a pilates instructor. I definitely doubted myself in the first six months and even before doing my course of deciding to be a pilates instructor. I’m not small, I have a more athletic build. And I’m more than okay with that. 

I think that the modelling industry made me feel quite neutral about how I look. This is my body, I’m blessed with what it can do. I would rather be healthy than not healthy to look a certain way. So even before going into pilates, people look at you in a certain way of “I want my body to look a certain way” if they’re going for that reason. And then if your instructor doesn’t align with what you want to look like, they want to be your client, would they want to continue seeing you? 

 


Kiah: People are visual creatures. For example, when influencers on social media lose huge amounts of weight, people will go to them for weight loss advice and tips when they have no qualifications. Of course it depends on the person, right. But it’s like because they’ve done it, it’s proof. 

I get that as well, as a dietitian. I feel privileged that I reside in a smaller body, and I haven’t had those comments made on me – people questioning the advice that I give based on my body type. But I know colleagues that have, who reside in a different body, as well as comments from other health professionals, saying things like “why would I want to work with them?”. I probably used to feel that pressure a lot more when I started my career, especially working in the vegan and vegetarian nutrition space as well. 

But going back to the modelling part, I think that’s really interesting. I haven’t looked at the stats with modelling and eating disorders, but I’m sure there’s a huge percentage of models that experience eating disorders. And I always find it really interesting, because if we think about this group of population models that, say, for example, there’s a large percentage of them with eating disorders. Then that population is on all the media and magazines, that just pushes that thin ideal. So that just really creates this completely unrealistic standard that to get this standard of body types, we have to be experiencing an eating disorder.

 

Imogen: Yeah, it’s hard to create a paradigm shift of what healthy looks like when you’re not seeing it represented. It’s also really hard to visually show that, which might be a segue to what we want to talk about, because a lot of the discussion that we’re planning to talk about today is about bone health – which is silent. 

 

Kiah: I’ll talk about my story first as I don’t think I’ve talked about this on the podcast before. 

Last year, I was diagnosed with osteopenia, which is essentially brittle bones. That would be a result of having an eating disorder when I was younger, and losing my period for quite a while, as one of the things that helps maintain our bone health is having a menstrual cycle. 

In addition to that, when I was younger, experiencing an eating disorder, I didn’t have enough calcium, and I didn’t have enough calories – all the things that are really important to bones. I didn’t know I had poor bone health until I got a symptomatic fracture. I literally was walking on the pavement and literally the step between the road and the pavement,my ankle rolled. Turns out I fractured my ankle. 

I ended up in a moonboot and all that sort of stuff. Then later on post-pregnancy, I realised all these weird things happening in my body, got some more tests and a DEXA scan, and got diagnosed with osteopenia. 

This is your reminder that I’ve not had an eating disorder for many years. Now I’m very good with my calcium intake and my calories and all this sort of stuff. But I still now have to deal with the long-term impacts of having an eating disorder when I was younger. But it’s also one of the reasons I see Imogen so she can improve my bone health. So let’s talk about that!

 

BOOK IN A FREE DISCOVERY CALL WITH OUR DIETITIANS
 

 

Q2. Do you want to talk a little bit about what osteoporosis is?

Osteoporosis is the deterioration of bone tissue, and low bone mineral density, leading to a reduced bone strength and increased fragility, and therefore an increased risk of skeletal fracture. 

So keeping that in mind, as you said before, to be diagnosed with osteoporosis, you have a DEXA scan. It’s the gold standard for testing your bone density. Once you have that test, you’ll be given a T-score, and that’s your standard deviation between your normal ranges of bone density for healthy and optimal bone density. 

Now the standard deviations away depend on how severe your osteoporosis is. It’s good to have a symptomatic fracture and find out that you’ve got osteopenia, because you haven’t been diagnosed with osteoporosis yet. You’re still your standard deviation away from what’s considered optimal – but you’re not categorised as osteoporotic yet. 

A few things to touch on when you’re in your formative years, or when you’re coming up to your mid 20s to esrly 30s. Early 30s is when you have the optimal time to create your peak bone mass. So that’s when if you have a period, and you have the energy intake that matches your energy, energy expenditure, then all of those factors support increasing your bone density. 

And so up until mid 20s, to late 30s, the idea is to create as much bone mass as you can, and then maintain it as past mid 30s. Having that natural decline, the goal is to maintain it as much as you can. So, having a history of losing your period, and having a history of low oestrogen as a female, that makes you a little bit more susceptible to having bone resorption. 

Bone resorption is where if you’re not the hormones to support that bone production, and if you’re having a lifestyle where your energy expenditure is greater than your energy intake, then your body will leech from the bone. 

It also doesn’t support the bone formation. So you have decreased bone formation, and you have increased bone resorption of losing it. Both these things happening at the same time, and can be really severe for your bone health. 

Similar with males. So females, it’s the hormone oestrogen. And for males, testosterone is similar in the way that if your energy intake doesn’t meet your energy expenditure, then your testosterone levels drop and we see similar bone resorption and decreased bone formation.

 

Q3. I think it’s interesting because with females, a telltale sign is not having a period. But with males not having a period, it can be a lot more difficult to identify. Is there an issue with hormones going on? 

That’s where things like having low energy levels, even low mood low libido, if you’re a male assigned male at birth, those can be kind of signs that maybe your testosterone is not where it should be. 

You don’t know until you have that fracture. A statistic that is really scary, but really important, is that by the time you’re over the age of 65, and you have a full and have a hip fracture, one in four people die in that following year. 

That could be their first fracture, that could be the first time that they find out that they have osteoporosis. It might not be but if you don’t even know about it, and you have a fall over the age of 65, your risk of death is from the studies, one in four currently.

When you’re a teenager, you’re not really thinking about the long-term or when we’re in our 60s. If I had known that as a teenager I wonder if that would have influenced me to think about my body in a different way.

 

 

Q4. Do you want to chat about some of the exercise related things you want to keep in mind to improve bone health?

There’s a few principles that you do want to think about when considering your bone health. Essentially, you want to create muscle stimulation, create muscle adaptation, so that you strengthen your muscles. This then strengthens or has a pooling effect on your tendons, which has an effect on your bones. 

A second principle that we want to think about is ground force reaction. This means putting force through your skeleton, putting forces through your load, and specifically, the sites (if you’ve had a DEXA scan) that have been affected. So typically, sites that are affected most commonly are: wrist, lumbar spine and femoral neck, so around your hip. 

When we first get started, we start with testing. Testing gives you a great starting point to know where you’re where you’re at with your exercise tolerance. Baseline testing is super important, because it’s specific to you, everyone has a different baseline. 

Then from there, ideally with our exercise prescription, the current research around bone health is you ideally doing resistance sessions twice per week, approximately eight exercises that cross over those affected joints. It’s recommended two sets, ideally more, but two sets is enough. 

The intensity that is prescribed is about 8 to 10 reps at about 75 to 80% of what’s considered your one repetition maximum. So that’s if you’re training to failure, your one rep, that’s the hardest that you can do and you can’t do any more. Overtime, you will be able to increase the weight. This is called progressive overload, which is what leads to muscle adaptations, and bone adaptations. 

The other thing that I was going to talk about, about what we do and why it might be helpful to see a health professional is talking about those ground force reactions. On top of building those muscle adaptations, you also want to put force through your joints. 

We know that with joints, you do want to put force through your joints because it actually creates a synovial fluid in that joint, which lubricates the knee. So, by putting weight on the knee as an example, if you have sore knees, depending on your condition, ideally, you want to load it to create that synovial fluid for it to feel lubricated. 

Going back to what we do with that impact through your joints – we want to make sure we are doing it in a way that is safe. So an example of something that we do is before we do the session is doing some proprioceptive work. Then, during the session we do something like a box step up where you’re moving in the same plane, you know the movement or you know the position and it’s controlled. 

Overtime, we can add weight to that, and you’re still getting that force through your joint without risk of injury. That’s the benefit of seeing health professionals, so that you’re able to do these exercises safely, and not be avoidant of a movement that is beneficial for your bones.

 

break up with diets ebook

 

Kiah: And it’s not just some random gym plan off the internet. Just like with nutrition – don’t get random diet advice on the internet. 

 

Imogen: On that note, another principle that should be considered for your bone health is the principle of irreversibility. That means that if you’re not consistent in doing the same exercises over time, and you’re not building on that progressive overload, then with bone health, you can lose that bone formation.

 

Kiah: So does that mean if you’re doing, for example, the exact the same workout every single time to the same weights, you never do heavier weights, your bones aren’t getting that extra force within them to grow?

 

Imogen: Your bones have adapted, which is a wonderful thing that your body has the ability to adapt. It means that your bones have become strong, and we want to create even stronger bones. Movement is good. And movement should be encouraged in every form. But for specific conditions, or specifically bone health, you want that consistency so that you can build on it. If you’re doing a different workout every time, it’s probably not going to be as effective as if you stick to a plan.

On that note, also find something that you enjoy, and don’t be afraid to share that with whoever is designing your program. 

 

Kiah: Definitely. And like that’s the kind of one of the principles we’ve talked about – having a healthy relationship with movement as well. They’ve re named it recently, from joyful movement to life enhancing movement. Because, we have to recognise that movement might not always be super pain-free for everyone. But, if we can get to a place with our movement that enhances our life, and then works towards that goal that we have and is enjoyable – that’s great.

 

dietitian and exercise physiologist sitting next to each other and smiling

 

Q4. So wrapping it all up now – what’s one key message that you want listeners to take home from this episode?

I think that my biggest takeaway is that exercise shouldn’t be confusing. There’s a lot of information out there, and it can be overwhelming. But with exercise, we’re not reinventing the wheel, so try not to be overwhelmed. Any movement is better than no movement. 

It’s finding exercise that is specific to you, and that works well for you. It doesn’t have to be overwhelming or have to be super complex. 

 

You can find Imogen at:

 

BOOK IN A FREE DISCOVERY CALL WITH OUR DIETITIANS
 

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Osteoporosis and Eating Disorders with Imogen Nicholson: Episode 55

woman with blonde hair wearing a black active wear set, laying on the ground and smiling while looking to the side

Welcome back to another episode of the Imbodi Health Podcast! Today I’m joined