Brock McLean says it was “almost destiny” that he would aspire to play in the Australian Football League, following in the footsteps of several family members.
“I was very much an all-or-nothing person – everything I did was absolutely flat out,” he says.
McLean’s AFL career lasted over a decade. From the beginning, he loved pushing his body to the limit, training up to 20 times a week. After several injuries, he went on a strict diet “just to lose a few kilos” in a bid to reduce injury risk.
“And it helped: my performance was really good. It reinforced to me that that was the right thing.”
Gradually, McLean became obsessed with food: weighing every item, and weighing himself before and after he ate. He believed this focus was giving him an edge as a footballer.
“Everything was tied up in that … without football, I felt completely worthless.”
Then a coach asked him to lose more weight to improve his leg speed, which his nutritionist warned against. But, worried over time lost to injuries, McLean wanted to do everything to ensure he could play.
He deprived himself of certain foods, entering a cycle of binge-eating, suffering terrible guilt, and frequently making himself vomit.
“I’d panic if I jumped on the scales and was [a certain weight], I’d think ‘oh God, I’m putting on weight, I’m not going to play’ … I was dealing with depression, and it was around then that suicidal ideation became a problem.”
He attempted suicide on 23 August 2017.
“I’m very lucky that I was found when I was, by my partner … I realised I needed to keep seeing a psychologist and keep working on my issues.”
Helen Bird, education services manager at the Butterfly foundation, an eating disorder charity, says there’s growing recognition of the prevalence of disordered eating in sports – which can affect players at any level – and an increasing number of sports groups are approaching them for support.
The AFL and AFLW dropped skinfold testing, which involves using calipers to measure the thickness of skin and underlying fat at specific places on the body, for draft prospects in 2021. Now experts are questioning the usefulness of measures such as weight and body composition as indicators of athletic performance – and health more broadly.
In 2022, the authors of a small study of 22 AFLW players called for practitioners to prioritise factors such as aerobic fitness and muscular power, after finding no significant relationship between pre-season body composition measures and match performance.
The Compeat Performance team, which provides nutrition support to the Matildas, stopped weighing players or monitoring body composition two years ago – saying the metrics often came at the cost of player performance, and didn’t have a clear purpose.
There remains a widespread emphasis on weight and performance in many areas of sport, Compeat co-CEO Alicia Edge says.
“When we’re looking at the research, the only real connection we’ve got is that there’s a relationship between lean mass and our ability to perform, but no clear connection when we’re looking at body fat,” says Edge, an advanced sports dietitian.
“So if we’re looking at that cultural [idea] of always aiming for ‘lighter is better’, we’re basing that on our own assumptions rather than what the research is telling us.”
Edge and Compeat co-CEO Dan Edge began questioning the role of these measures back in 2016.
“We started to fully appreciate that whenever we’re working with weight or body composition, that’s a lag measure, it’s a symptom. If the problem is perceived to be body fat, or whatever it may be, ‘eat less or train more’ is a really over-simplified solution that doesn’t appreciate the person behind the data.”
Weight and body composition can still be discussed, Edge says. But they have developed a new screening tool to track progress without those metrics, which also helps them understand clients’ relationships with food and other influences on their health behaviours.
“When we’re getting to know someone, we’re considering all those influences … mental, social, financial, and physical wellbeing – along with their occupation, culture, and environment.”
Focusing on controlling something uncontrollable can fuel anxiety, she adds, because body weight and composition aren’t predictable outcomes.
Prof Amanda Salis of the University of Western Australia says: “Body size is influenced by a combination of dozens, if not hundreds of things.”
“You’ve got major players like genetics, and the environment – the food, physical activity, the stress environment … We also have our past and emotions – if someone goes through adverse childhood experiences, that plays out in how much they eat, move, and their stress, and all have an impact on the size we exist in.”
She says that while many assume size comes down to “personal choice and willpower”, in reality “it’s much more complex than it’s often made out to be”.
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Salis has authored several books on weight management and is now running a clinical weight loss trial using total meal replacement products, an approach she stresses should not be adopted without medical supervision.
BMI – a calculation with roots in the development of eugenics – is only relevant at a population level. Salis says it won’t provide information on someone’s metabolic health, which should be the priority.
“Even someone who might have a very high BMI, a doctor might see no, they haven’t got the risk factors for heart disease, diabetes, etc. when looking at their blood sugar or glucose levels for example.
“There’s some good evidence that a waist circumference above a certain number is likely to be associated with metabolic diseases, compared to having a waist below a certain number, and it’s different according to age and sex and things, but it’s not an absolute indicator, nor is BMI … it’s all just probabilistic.”
The recent National Eating Disorders Strategy flags weight stigma as a risk to physical and mental health. However, experts have pointed to a disconnect between the research and ‘weight-centric’ resources available online (including from the federal government), many of which still include BMI calculators.
Feeling judged for any reason, including body size, can lead people to avoid seeking healthcare, says Canberra-based GP Dr Liz Sturgiss.
“We know women with larger bodies have lower rates of cervical screening, they have fewer presentations for breast screening. All these things mean that if you have a bigger body, you’ll have poorer health outcomes than someone in a smaller body,” says Sturgiss, who is also a primary care researcher at Monash University.
Advanced dietitian Dr Fiona Willer adds that weight stigma may also lead people to celebrate any weight loss, whereas the underlying causes may be sinister.
“The overlap between people who are intentionally losing weight and unintentionally losing weight can be quite significant. Somebody can be suffering from a form of cancer and losing weight because of that, but because they’re also trying to diet at the same time, they don’t realise it’s not the diet, it’s that they’re actually dying and no one’s picked it up yet.”
Sturgiss’ echoes that making assumptions about health based on body size comes with risks for any patient, and she warns against “cheering the scales”.
Many of her patients are from low-income groups and have food insecurity, so weight loss may prompt concerns of malnutrition.
“If someone is binging on laxatives, exercising in unhelpful ways, they have no money for food – none of those things are good,” Sturgiss says.
She only weighs patients if they are happy to be weighed, as one of several measures – with the focus on any changes over time, and understanding the driving forces. “I like to focus on, ‘what’s life like at the moment?’ … not just the numbers.”
“There are plenty of people who have very low body weights and really poor cardiovascular outcomes for all kinds of reasons. So any time we put out health messaging, either in an individual consultation or in public health messaging, that if your body’s not large you’re fine … that’s really unhelpful.”
If a patient has ‘adiposity’ or body fat causing health issues – the WHO definition for obesity or overweight that Sturgiss uses – and wants to address that, she says they should be supported.
“But we live in a society incredibly biased against people who have larger bodies … and you don’t want to be supporting any kind of industry that involves body shaming, so it’s a difficult line to walk.”
Willer, who runs a business training health professionals in size-inclusive approaches, says people with bigger bodies often anticipate their health professional will raise the topic of weight, and fear healthcare will be ‘gate-kept’ due to their size.
“Size inclusive practice understands that weight is not nothing – but usually the most relevant thing about somebody’s high body weight is how they’ve been treated because of it.
“Size inclusive practice supports someone in the body they have, at that time, and looks for treatments for whatever their presenting complaint is that don’t require starvation or weight change prior to addressing the health condition they’ve presented with.”
Dr Mark Morgan, chair of the Royal Australian College of General Practitioners quality care expert committee, is overseeing the new edition of the Red Book, which will include updated guidelines for GPs on screening for weight-related health issues.
He echoes that it’s crucial everyone feels respected when attending general practice, noting the words ‘overweight’ and ‘obesity’ have specific definitions in a medical context so clinicians, researchers and epidemiologists can use a common language. But, “for individuals, these definitions may not apply and may have little relationship to healthiness,” he says.
“In conversational English, the terms can be offensive and carry stigma. It’s therefore important for health professionals to use great sensitivity in discussions about a person’s weight and the relationship to their health.”
Brock McLean, now much healthier, says he’d emphasise that self-worth doesn’t come from external factors, including physical appearance.
“Kids are taught to have high self-esteem if they’re particularly good at something … whereas self-worth teaches you the concept that no matter what you’re good at, no matter what you’re bad at, you’re a human being and you’re worthy of love and compassion.”
* Dr Willis and Dr Sturgiss urge anyone struggling with how they feel about their body or eating habits to seek support through their GP, and to ask where they can receive size-inclusive care.
