4 Things You DON’T Need to Start a Business (Part 1/2)

3e3556eEver wanted to go into business for yourself? Been tempted but the thought of it is way too daunting? For starters there’s the money involved in starting a business, then finding a place to work out of, paying staff, advertising and promotion, licensing, registration, insurance, and on and on it goes. How can anyone struggling to get by possibly start their own business?

It might just be more possible than you think.

It actually takes surprisingly little to start your own business. Of course, what you DO need to start is highly dependent on the type of business you want to create, and any business that wants to succeed in the long-term is eventually going to need all those things already mentioned, and a whole lot more. But getting started, actually getting your idea out of your mind, out of your dreams, and into reality need not be as onerous or restrictive as you might have been led to believe.

Here are four things that might be holding you back that you don’t really need to start your own business:

  1. Money (at least not very much)

Now you probably think that’s crazy, if not impossible, however bear with me. To build a long-term, successful business will require expenditure, which means you will need money – I admit there is no escaping that. However, to get started, to take that first step towards being an entrepreneur, requires very little to no money at all. Chances are much of what you need you already have, or have access to.

Keeping initial costs down is all about two things: taking the do-it-yourself approach, and utilising as much free stuff as possible. For example, my first attempt at owning my own physiotherapy practice was as an in-home service. I had a computer, a printer, a car, my hands, and my vision. It cost me around $25.00 to obtain an ABN, and I registered my trading name at the same time. My first step was to create a letter to send out to all the doctors and medical centres in my area informing them of my service and what I could do for patients. Using programs that came with my computer, I created my own log, letterhead, and information package. After printing and stationary it probably cost me around $60.00 to do that. I then created a small flyer to do a mailbox drop in areas I thought I might get a response from. Printing costs may have been around $15.00, and I did the mailbox drop myself. Once I started getting referrals, the cost of service immediately offset the expense of running my vehicle, and soon compensated me for my accumulated expenses.

Setting up a physiotherapy service for around $100.00 is no mean feat. Sure, it wasn’t an elaborate clinic, and if I had simply left it at that it would never have led to long-term success or sustainability. It was, however, a start. It gave me my first real taste of being an entrepreneur, and led me to the business I operate today. Unless you have major initial expenses related to your business idea – for example, the need to purchase equipment, storage space, or stock – there’s no reason money, or a lack thereof, should stop you from starting a business.

  1. An Office/Storefront

Almost every business venture I’ve started has been run from my desk and/or my laptop. In some cases this has been a pragmatic approach – I simply didn’t have the money or resource to lease and fit out an office or storefront – however for the most part the simple fact was that I didn’t need a physical location in order to do business. And unless your business idea requires a physical space that you cannot already provide, neither does yours.

The Digital Age give us the opportunity to revolutionise business like never before. Think about the average office environment – what does it contain? For an individual, it’s typically a desk, a chair, a computer, a file cabinet, and a phone. Some may have their own printer, many use a printer that is assigned to a work group. This will often be a multifunction device, enabling printing, copying, scanning and faxing. Look beyond the cubicle: every other person essentially has the same thing. Some – directors, managers, and so forth – will have their own office, but the contents of that office, the things that actually need to be able to work, are essentially the same. You’ll probably also see some kind of board- or meeting-room as well. Pretty standard, right?

Now consider this. You most likely have, or have access to, all those things right now. If you own a computer, a laptop, or one of the better tablets or smart phones, you already have your workstation. You might even already have a small personal multifunction device that lets you print, copy, scan and fax; but even if you don’t, you probably don’t need it anyway. Being able to store and share documents and information electronically has almost eliminated the need for hard copy. Why print when you can read and edit on-screen? Why fax when you can email? Why take up physical space filing hard copy when you can store things digitally on a device a fraction of the size of the average novel?

Thinking along those lines, it’s not difficult to see how this can revolutionise workgroups. If everyone can work and share electronically, what is the need to have an actual office? You might say what about face-to-face contact, interaction and collaboration? Well, that’s all possible too thanks to almost every device that connects to the internet having audio-visual capabilities. If you own a recent laptop, tablet or smart phone, you already have a device capable of video conferencing, which helps bring people face-to-face. There are plenty of apps and software available – much of it free of charge – that will allow to connect one-to-one and as a group: and you don’t need to be in the same area, the same town, not even the same country to be able to do it.

But what about presence? What about having that location that represents your business? What if you need to meet with clients or investors or other VIPs? Meeting at your kitchen table or the local coffee shop might not cut it, right? In that case, let me introduce you to the virtual office. Virtual offices have been around for sometime but remarkably not many first time or developing entrepreneurs know about them. In fact, there’s a good chance you’ve already done business with someone who used a virtual office and never even realised it. What is a virtual office?

You can think of a virtual office as the façade of your business. Virtual offices are a business in themselves: their business is presenting a public face for your business. A basic virtual office setup will often include, for a recurring fee, a physical location address, a mail service – whereby you can have mail sent and either pick it up or have it redirected – and a ‘receptionist’ who can redirect calls to you or take messages as required. You are generally provided with a business number to give out and calls received on your behalf are greeted with your company’s name as they would be if you had your own employed receptionist. For additional one-off or recurring fees additional services can also be provided, from having access to an office/cubicle and business equipment, to the provision of a board- or meeting-room to hold face-to-face meetings with clients. Many virtual office providers have services in different cities, even different countries, and can extend the same range of services in area they are based in. Suddenly, your business can give the appearance of being national or multi-national – something to consider when planning the scope of your business.

A virtual office can be an excellent short-to-mid-term solution for someone wanting establish a professional presence for a new business. Yes, all of this comes with a price, however when you consider the costs associated with leasing, or worse, purchasing, a business property, there really is no comparison when first starting out.

The next two tips will appear in Part 2 of this article – be sure to Subscribe so you don’t miss out!

Why Australian Health Insurers Should Cover Tai Chi

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Photo courtesy Gold Coast Tai Chi Academy

Regular readers will be well aware of my advocacy of Tai Chi as a means of maintaining optimal health for the lifespan. (For those who are new, click on the Tai Chi tag to read past articles about the benefits of Tai Chi). There are few forms of exercise that can boast the wide range of physical and mental health benefits, whilst being accessible to people of all ages and abilities, as Tai Chi does.

Health insurers around the world have increasingly recognised the benefits of enabling their members to engage in activities designed to promote healthy lifestyles, and thereby maximise health and well-being. The rationale is simple: engaging in preventative health practices minimises the risks of developing more serious, complicated, and/or debilitating conditions, and therefore reduces both the incidence and level (not to mention the expense) of future medical care required. For example, it is far better from an insurers point of view to support a member to engage in a weight management program, gym membership, and nicotine replacement therapy, than it is to support them through coronary artery bypass surgery and the follow-up care afterwards.

As a result, most, if not all, health insurers now offer some form of support for members to engage in activities designed to maintain or improve their health. The types of activities vary between insurers: in Australia, common activities covered include gym and personal training, yoga, Pilates, and weight management programs. Yet despite its known benefits to health, Tai Chi is not currently covered by any major Australian health insurer. Why?

It’s a good question. Considering that health insurers will, for the most part, only cover treatments or activities that are supported by clinical evidence to be effective in maintaining or improving health, Tai Chi is possibly one of the better examples of evidence-based interventions for good health. A good example of this can be found in a review published in the American Journal of Health Promotion (1.). In this article, Jahnke and colleagues examined the outcomes of randomised controlled trials investigating the outcomes of both Tai Chi and Qigong exercises, and found evidence of positive outcomes for numerous health factors, including bone health, cardiopulmonary health, physical function, falls prevention, immunity, psychological conditions such as anxiety, depression and self-efficacy, and general quality of life. This is by no means an exhaustive list: research since publication continues to identify more health conditions for which Tai Chi can be beneficial. In the face of such evidence, and considering that many insurers cover a range of complimentary or alternative health practices whose evidence based is equal to or less than that of Tai Chi, it seems odd that Tai Chi would not be covered alongside options such as yoga and Pilates.

It becomes even more confusing when you consider that Tai Chi has previously been covered by at least one insurer in Australia. In 2010 the Tai Chi Association of Australia (TCAA) reported that MBF (which has since merged and is now known as Bupa) had recognised Tai Chi for inclusion in its Lifestyle Bonus option, and as much as 70% of class fees could be covered under certain conditions. At the time of writing however, Tai Chi does not appear to be covered under Bupa’s Living Well programs, whereas other forms of exercise such as yoga and Pilates are, and the reasons for this remain unknown.

Another point of consideration is the fact that Tai Chi is gaining recognition and support from the broader health and medical industry for its health benefits. An increasing number of doctors, physiotherapists, exercise physiologists and other health professionals are recommending Tai Chi as a part of maintaining a healthy lifestyle. A number of hospitals and health services either conduct, or are connected to, Tai Chi classes, and promote this to their patients and the broader community. For example, the South West Hospital and Health Service in rural south-west Queensland offers free Tai Chi classes to the general public. This is similar to programs offered by local councils, such as the Gold Coast City Council’s Active and Health Program which includes Tai Chi amongst its variety of healthy activities. In addition, the benefits of Tai Chi have been formally recognised and endorsed by a number of peak representative bodies, including Arthritis Australia, Diabetes Australia and Osteoporosis Australia.

In the light of such evidence, recognition and support, it seems to only make sense that health insurers should be including Tai Chi alongside other already recognised activities such as yoga and Pilates. Indeed, health insurers in other countries, for example the United States, have already recognised the benefits of including Tai Chi in their own benefits packages. Surely the inclusion of Tai Chi within a healthy lifestyle package can only serve to benefit health insurer’s members, and in doing so, benefit the insurers themselves.

Do you practice Tai Chi? Do you have private health insurance? Do you think health insurance should cover Tai Chi, as it does other activities such as yoga and Pilates? Please share your comments below.

References

1. Jahnke, R., et al. (2010). A comprehensive review of health benefits of Qigong and Tai Chi. American Journal of Health Promotion, 24(6): e1-e25.

Words vs. Actions: Which is Greatest?

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When was the last time you heard someone say, “actions speak louder than words?” How about, “the pen is mightier than the sword?” Words and actions have been stuck in an endless grudge-match since both coexisted. Both have their merits and pitfalls, their strengths and weaknesses. Yet does one have an advantage over the other? Are words in fact stronger than actions? Or will actions always win out over words?

There’s no question that words can be very powerful, a topic I’ve touched on before. We’ve all felt their power at one time or another in our lives: “you’ve passed”, “you’ve failed”, “you’ve got the job”, “we’ve given the job to someone else”, “I love you”, “I hate you”, “I’m so proud of you”, “I’m so disappointed in you” are simple examples of phrases that have most likely had a profound effect on you when you’ve heard them. Even “yes” and “no” can be powerful within certain contexts; just think about the impact either word can have in answer to the question, “will you marry me?”

Words have proven their power through the evolution of language and communication. It’s important to realise that our use of words is not only for pragmatic reasons. Consider the difference between reading a book in order to obtain knowledge and information, and reading one purely for pleasure and enjoyment. Consider why we read poetry, or listen to songs. Greeting card companies exist because of the power of words. Words influence us. They are powerful enough to alter our thoughts and our emotions. If they can alter our thoughts and emotions, then they can also influence our actions and behaviour. If our can be determined by words, then perhaps they are more powerful than actions.

However, what are words without actions behind them? Consider a situation where someone says they can do something, but then demonstrates they really can’t. Or makes a promise, but fails to keep it. Or apologises for something they did, and then does exactly the same thing again. The words become meaningless, and words without meaning have no power. They lose their ability to influence, convince, or support anything. In this sense, words need actions; they are dependent on actions to reinforce them, to give them credence and credibility, to make them mean something. Actions reveal the level of truth behind the words, and that determines what influence the words have upon us.

For example, if someone says, “you can trust me”, and then demonstrates through their actions that you can in fact trust them, this will have a powerful effect on your perception of that person and relationship with them. However, an equally powerful effect will occur if that person’s actions demonstrates that you cannot trust them. The words themselves are unchanged – “you can trust me” – so they are not what determines the direction of influence. It is the actions the person undertakes after speaking them that determines their meaning (or lack thereof), and the ultimate outcome. If words can only derive their meaning from the actions behind them, then it surely it stands to reason that actions are stronger than words.

Consider what happens though when there are no actions, or to put another way, when someone undertakes the action of inaction. You’ve probably encountered this situation numerous times: ever sent an email or left a voice message and not had any response from the recipient? Ever scheduled an appointment with someone and they just haven’t shown up? Ever told someone something and their only answer was silence? Those who follow the concept of neuro-linguistic programming (NLP) tell us that a person cannot not communicate: that is, even when someone does not respond to us, that lack of response is in fact a response in itself. The problem is, how do you know what they’re trying to communicate to you? Are they ignoring you? Are they indifferent? Are they considering? Do they simply have nothing to say or contribute? Or perhaps they haven’t had time to respond? Maybe they didn’t get your message at all? How do you know what they’re telling you?

The fact is you cannot know what the lack of action means without some form of clarification, and this will almost always be through the use of words. Words can explain both action and inaction, and thereby give those actions context and meaning, which then helps our understanding and comprehension. In fact, sometimes words are all you’ve got to be able to convey something to someone else.

Consider a couple separated by distance – perhaps one is a soldier stationed overseas, or needs to travel for business, or for whatever reason just can’t be with the person they belong with. Under these circumstances, the physical presence that conveys the love, security, and support through the many non-verbal cues and actions that occur when they are together is absent. Does this mean all those things suddenly stop, or change, or become less important? Not at all. However, many couples struggle with this situation simply because while they detect this absence – that something is ‘missing’ – they are unable to resolve it, or at least accommodate it, through other means. In this instance, words can be vital, because they might be all you have. We know that words influence feelings, emotions, and behaviours, and if it’s all you’ve got, then doesn’t that make them a great asset in terms of maintaining what you share as a couple?

This is not to suggest words can substitute for actions, nor that one needs to become a poet or bard in order to use words effectively in this type of situation. But saying something – saying anything – about how you feel about someone, what they mean to you, how important they are to you, or your relationship together is to you, can help ensure that you don’t ‘lose’ anything during your time apart.

Now here’s the real kicker. Ask a couple that’s been through this: was it the words themselves, or the action of expressing them, that made the difference? What do you think they will say?

It’s easy to keep going around in circles with this discussion, and therefore why words and actions have been squaring off for so long. Is one stronger than the other? Sometimes, yes, one does appear to be stronger, or have more meaning, or more power, than the other. Ultimately though, both words and actions are equally powerful; it is the context that determines the balance between the two. What does this mean in practical terms? My advice would be: don’t choose a side, or better yet, choose both sides. Just say what you mean, and mean what you say, and you will have the power of both.

Where do you stand? Are actions more important than words? Are words more powerful than actions? Are both equally important to you? Please share your thoughts in the comments below.

Walk the Talk: Why Your Word is One of Your Greatest Assets

3407902250_0ee64a18f7_bEver made a promise but didn’t keep it? What about one that you knew you couldn’t keep at the time you were making it? Chances are, if you’ve ever promised anyone anything, you’ve encountered a time where you just couldn’t keep your word. There may have been legitimate reasons for this, or maybe you just didn’t want to or think it was important. The reactions of those you made the promise to were most likely also determined by the nature of the promise, how much it meant to them, and whether they expected you would keep it. But does it really matter if we break our promises? Should we really be beholden to things we may have said on the spur of the moment, or under certain pressures or emotional conditions?

I’ve always tried to live by the adage, “don’t make promises you cannot keep.” The reason for this is because a person’s word does have value, whether it be in your personal or professional life. The value of our word is reflected in others perceptions of our credibility, our reliability, and our trustworthiness. It influences their desire to want to interact with us, both currently and into the future. Evidence of this is everywhere: the couple that breaks up after a broken promise, the customer who never returns to a store that did not honour an agreement or guarantee, or the politician who is voted out of office for failing to deliver on the claims that got them elected. But why is this so important? Why do we hold promises in such high regard?

A promise is a binding agreement; a vow, a guarantee, a covenant, a bond, or a commitment.It is more than a statement of intention, in that by making a promise you are pledging to ensure that you will do whatever it is you are promising to do.You could think of it as entering into a contract with someone, where you declare that a certain action or undertaking to be performed, under whatever conditions are agreed upon. Failure to keep your promise could be considered to be a ‘breach of contract’, with resultant penalties. In some cases, promises made ‘innocently’ can be enforced by legal means, as the law often does not differentiate between a spoken promise and a promise made through a formal agreement, such as a contract.

This is where a person’s word can gain or lose its value. You may have heard the phrase, “my word is gold”, and it can be useful to think of the value of a person’s word in such financial terms. Because a promise is not just a statement, but a guarantee, it holds a certain value. You could think of making a promise as making an investment in your word – your credibility, reliability, and trustworthiness – and giving it value. Keep your promise, and the value of your word ‘appreciates’. It increases its net worth, so the next time you make a promise, it is already at this new, higher value. To the promisee, this means your credibility, reliability and trustworthiness are already at a higher level, which means they will be more likely to ‘invest’ in your word, and subsequently in you.

What’s important to realise is that this is not just a one-to-one phenomenon. As your word increase in value with one person, that person then becomes your advocate, your ‘broker’ if you will. They share the value of your word with other people, and may even convince people to ‘invest’ in your word for themselves. In this way, the value of your word grows both actively – through direct interaction with individuals – and passively – through an on-flow effect to others. This is why we see marketing slogans such as, “1 million satisfied customers” – we think to ourselves, “if they were all satisfied, perhaps I will be too.”

Conversely, your word can just as easily ‘depreciate’ in value if you break your promises. Fail to deliver, or follow through, or do the complete opposite of what you guaranteed, and you can be sure that without extenuating circumstances to explain it, your word will suffer. This can have a compound effect if you tend to make and break the same promise over and over again. In fact, breaking the same promise multiple times can result in an exponential reduction in the value of your word. For an example of this, visit any court of law hearing divorce cases: you will likely hear many references to promises broken again and again.

This is also not confined to a one-to-one situation. If your word loses value with one person, you can almost be sure it will lose value to some extent with every person that one comes into contact with. This can have a disastrous effect on your credibility, reliability and trustworthiness, and can make future interactions with others very difficult, if not impossible. It is the reason why many businesses adopt the customer service policy of, “the customer is always right”.

So how do you give your word value? Or more importantly, how do you increase it’s value? Here’s four tips on how you can ensure your word is a worthwhile investment for others:

1. Only make promises you know you can keep – or at least that you know you have every intention to keep. If you know from the start that you cannot, or most likely will not, keep a promise, don’t make it in the first place. You are only setting yourself up for failure, and the fallout can be difficult to recover from. In fact, in many instances people may appreciate that you cannot promise something more than they will a broken promise.

2. Only promise what you can deliver – similar to the point above, this is about being able to ‘walk the talk’, that is, not overestimating or overstating what you can really do. Equally true for business as well as personal relationships, it can be easy to make a grandiose promise, yet fall short in being able to deliver on it. This is not always as bad as failing to keep a promise at all, however it can still damage the value of your word. For example, as a physiotherapist, I never promise my patients that I can cure them, because there are so many variables outside of my influence or control that could affect their final outcome – not the least of which being what they themselves do outside of treatment sessions. What I do promise them is that I will give them my very best level of care, because that is completely within my control and ability to deliver on.

3. No promise is too small – we always remember the big promises that people make or break, but there is great value in all the little ones that are made as well. It’s the little things that attribute to our consistency, our ability to deliver on something over and over and over again, and this can have a much higher net value than one large promise. All promises have value, and the smaller ones are every bit as valuable as the big ones. Think of it like building a wall: you can use the biggest bricks you can find, but it’s the mortar in between that holds it all together.

4. If you must break a promise, show good reason – in a given lifetime, very few people, if any, will be able to keep every promise they make. There are only so many things we can control, and even when we get all of these right, sometimes extenuating circumstances stop us from being able to deliver what we promised. If the reason for not keeping a promise can be seen as plausible, then you can minimise, even eliminate, any detrimental effect this might have on the value of your word. For example, a delivery company promises to deliver, “on time, every time.” But what if there is unusually heavy traffic? Or their vehicle breaks down? Or worse, they have an accident? Would it be fair to devalue their word under these circumstances? Ultimately, that is in the hands of the promisee. However, it is far more likely that someone will forgive a broken promise when it can be shown that it was beyond your control to keep it, than they will if they believe you could have done something to prevent it.

Whether it’s in business, in personal relationships, or even to yourself, invest in the value of your word, make it one of your greatest assets, and it will reward you accordingly.

Are promises important to you? How does a kept promise influence your interactions with others? What about a broken one? Please feel free to share your thoughts in the comments section below.

3 of Tai Chi’s Lesser Known Health Benefits

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Reproduced with permission from Gold Coast Tai Chi Academy

Tai Chi (T’ai Chi Ch’uan) is well-known and widely practiced for its health benefits. It’s particularly regarded for its ability to improve balance, range of motion, and lower limb strength, and has been highly researched to establish its effectiveness as a form of exercise for the elderly. In fact, there has been a great deal of research conducted on Tai Chi and Qigong exercises, and both the scientific evidence and the range of health conditions Tai Chi can prove beneficial for is constantly growing.

As a physiotherapist who practices and has been involved in teaching Tai Chi, I keep an eye on the evidence-based research coming out about Tai Chi and its benefits to people, so I can use this to advocate for Tai Chi as a form of therapeutic exercise. What has been interesting is seeing the breadth of research that is being undertaken, and the health conditions that Tai Chi is being shown to produce positive outcomes in beyond the classic falls prevention, various forms of arthritis, and age-related deconditioning. Conditions that I don’t believe most people would normally associate Tai Chi as being able to influence, much less produce positive outcomes. I’d like to illustrate this by bringing three such conditions to your attention, which you may not have been aware of.

Tai Chi and Breast Cancer

g32025800000000000058a37129c5f09d9942b164d878e1e23852dd1738This has been of particular interest to me having had someone I care about recently undertake their own battle with breast cancer, as well as a number of past patients. Over the last several years researchers have been examining the effectiveness of Tai Chi as an intervention to prevent or improve secondary health conditions experienced by breast cancer survivors.

For example, a recent study by Galantino and colleagues (1.) has shown the feasibility of Tai Chi in improving the well-being of postmenopausal breast cancer survivors who have developed arthralgias (joint pain) as a side effect of being prescribed aromatase inhibitors (eg: Aromasin, Arimidex and Femara) to reduce estrogen production. Their study demonstrated statistically significant improvements amongst their test subjects for anxiety, depression, emotional well-being and fatigue, as well as the Sit-and-Reach test, and near statistical significance for pain severity, physical well-being, the Berg Balance Scale and Timed-Up-and-Go Test. This is important because, as the authors state, there are very few interventions that have been developed to counteract the side effects associated with this form of post-breast cancer therapy, and consequently many breast cancer survivors stop using their medication. If Tai Chi can limit the negative side effects of this type of therapy, not only can it improve people’s physical and emotional well-being, it can potentially increase adherence to medication regimes, and thereby reduce the risk of these survivors developing future complications.

The benefits Tai Chi can have on post-cancer symptoms experienced by many breast cancer survivors have also been demonstrated by other researchers. Huang and colleagues (2.) found that breast cancer survivors who engaged in physical activities like Tai Chi and Qigong demonstrated a proportional decrease in cancer-related fatigue compared to those who did not, while Sprod and colleagues (3.) demonstrated changes in biomarkers including insulin, glucose, and cortisol levels which correlated with improvements in health-related quality of life, physical functioning, social functioning and general mental health. Overall, the evidence is growing that breast cancer survivors – particularly those who are post-menopausal – would gain significant benefit from regular Tai Chi practice.

Tai Chi and Depression

Depression is an all-too-common, and in many ways still poorly managed, mental health condition in many societies, and one I encounter frequently amongst patients, particularly those suffering from chronic pain. While it is difficult to locate studies that have solely examined the relationship Tai Chi can have on depression, many studies exist where depression has been one of the variables measured as part of using Tai Chi as a form of therapeutic intervention.

One chronic pain condition that has been well-researched in terms of the effects of Tai Chi is fibromyalgia. An example of this is the research from Wang and colleagues (4.), who measured a number of physical, mental and emotional well-being indicators, including depression, amongst their participants who were engaged twelve weeks of Tai Chi training. Not only did they demonstrate improvements in measures of depression at the end of the twelve weeks of training, but these improvements persisted 12 weeks after the cessation of the training. Similar improvements in mental health measures, including depression, were reported the studies described for breast cancer suffers above.

Results such as these have led researchers and clinicians to call on health professionals to support patients wanting to explore Tai Chi as a form of complimentary therapy to treat issues such as depression. In their editorial in The New England Journal of Medicine, Yeh and colleagues (5.) called on physicians to ‘prescribe’ Tai Chi for patients with fibromyalgia, while psychotherapist Mary Ann La Torre (6.) advocates the use of body movement – in particular, Tai Chi, as a means of creating change and enhancing healing in psychotherapeutic treatment.

On a personal level, not only am I aware of the impact Tai Chi has on my own mental health, I have had patients with a variety of conditions where depression has been a component (for example, chronic pain, cancer, and HIV-positive status) who have all anecdotally reported improvements in their mental health and well-being having commenced Tai Chi training. It would be interesting to see future research specifically investigating the effects of Tai Chi on individual mental health conditions, such as depression, as these results would likely be transferable across a wide range of health conditions where depression is a factor.

Tai Chi and Diabetes

Another condition of close personal interest to me, not only because of its disproportionately high incidence amongst Aboriginal and Torres Strait peoples, but also because several people dear to me have either Type I or Type II diabetes. It is well-known that exercise is beneficial for the management of both types of diabetes, so it would be reasonable to expect that Tai Chi would produce similar benefits. However, what is interesting in the research being undertaken is that Tai Chi is not only beneficial for the secondary conditions associated with diabetes, for example, impaired mobility due to peripheral vascular complications (7.), it also has a direct effect on cellular physiology. For example, several studies have demonstrated that Tai Chi practice can increase insulin sensitivity and thereby reduce A1C levels (a better indicator of blood glucose levels over time, as opposed to the immediate result from a blood glucose monitor) (8.), and increase the levels and enhance the activity of regulatory T-cell levels (9.) which improves immune system functioning.

This is critical for those with diabetes, as being able to effect changes at the cellular level means better management of the primary complications associated with diabetes, which can then result in reduced risk of developing, or progression of, secondary complications, such as peripheral vascular disease and neuropathies.

IMG_9858These are only three examples of the wide range of health conditions that Tai Chi is proving itself to be able to make positive changes to. As quality of studies improve and researchers start to identify the specific ways in which Tai Chi can make changes to our health, it is my hope that we will see Tai Chi become a ‘treatment of choice’ in both managing and preventing ill-health.

Do you do Tai Chi? What ways has Tai Chi improved your health and well-being? Please feel free to share your answers in the comments section below.


 

References

1. Galantino, M. L., et al. (2013). Tai Chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: a feasibility study. Alternative Therapies in Health and Medicine, 19(6): 38-44.

2. Huang, X., et al. (2010). Factors associated with cancer related fatigue in breast cancer patients undergoing endocrine therapy in an urban setting: a cross-sectional study. BMC Cancer, 10: 453-459

3. Sprod, L. K., et al. (2012). Health related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan. Journal of Cancer Survivorship: Research and Practice, 6(2): 146-154.

4. Wang, C., et al. (2010). A randomized trial of tai chi for fibromyalgia. The New England Journal of Medicine, 363(8): 743-754.

5. Yeh, G. Y., et al. (2010). Prescribing tai chi for fibromyalgia – are we there yet? The New England Journal of Medicine, 363(8): 783-784.

6. La Torre, M. A. (2008). The role of body movement in psychotherapy. Perspectives in Psychiatric Care, 44(2): 127-130.

7. Orr, R., et al. (2006). Mobility impairment in Type 2 diabetes: association of muscle power and effect of tai chi intervention. Diabetes Care, 29(9): 2120-2122.

8. Bronas, U. G., et al. (2009). Alternative forms of exercise training as complementary therapy in the prevention and management of Type 2 diabetes. Diabetes Spectrum, 22(4): 220-225.

9. Yeh, S., et. al. (2007). Tai chi chuan exercise decreases A1C levels along with increase of regulatory T-cells and decrease in cytotoxic T-cell population in Type 2 diabetic patients. Diabetes Care, 30(3): 716-718.

5 Tips for Surviving the NPTE

keep-calm-and-pass-the-npte-2After eighteen months of preparation, perspiration, and palpitations, I have finally passed the National Physical Therapy Exam (NPTE), administered by the United States of America’s Federation of State Boards of Physical Therapy (FSBPT). The NPTE is the means by which all candidates for physical therapy licensure, whether domestic graduates or foreign trained applicants, are assessed for basic entry-level competency for the profession. It is not the only requirement for licensure, however it is the one standarised requirement in all fifty States, and if you want to work as a physical therapist in the USA, you must sit and pass it.

You might think for someone like myself who has been a physical therapist for the past eleven years this would be little more than a formality. Think again. The NPTE is one of – if not THE – toughest exams I’ve ever taken. Unfortunately, those who have taken the exam are prohibited from disclosing any information about the exam itself, so I cannot reveal the anything about its content or structure. I can, however, give some more general advice based on my experience in preparing for and undertaking the exam – advice I would have found invaluable in my own lead-up to the exam date.

Here are my five tips for surviving the NPTE:

  1. Allow plenty of time to prepare

A five-hour 250 question exam requires ample preparation time. The exams generally run every three months, so depending on where you are in the schedule should guide you as to which exam you should take. Don’t be in a rush to sit the first available exam. It may be in your best interest to give yourself additional time to ensure you are able to cover all the required material, get a feel for the exam with some practice exams (see below), and build your confidence in your ability to do well.

  1. Study everything

The NPTE potentially covers the entire scope of practice of physical therapy, from musculoskeletal to neurology, cardiac and respiratory to lifespan, and principles of general practice and research. Chances are you don’t remember everything there is to know about physical therapy, even if you are a new graduate. If you are currently working as a physical therapist, you probably know the area you work in quite well, but haven’t even thought about other areas in a long time. You need to study everything about physical therapy, and feel confident that you can apply that knowledge. It is a big ask, and it is probably the last time you will ever need to know everything about the profession, however it is essential if you want to get through the NPTE.

Didn’t keep all your old textbooks? Fear not, there are some very useful resources to help you revise and prepare for the exam. Two that I used are BenchPrep, an online prepatory course for the NPTE, and PT Exam: The Complete Study Guide by Scott Giles, a reference text which is a thorough summary of all the areas of physical therapy, set out in a way that is specific to the content of the NPTE. BenchPrep is particularly useful as it gives you a study guide, which tells you how much material you need to cover in a given timeframe in order to be ready for the exam, and enables you to connect to other students preparing for the exam to ask questions or form study groups. The PT Exam text I used was a little dated (2011), however the material is still relevant and the practice exams that come with it are very useful indicators of how you’re doing. The resources available are not limited to these and you should search for some that you feel are most appropriate to your needs.

  1. Do the practice exams

Find and complete as many practice exams as you possibly can. Not only is it useful to familiarise yourself with the exam situation, it will give you clear feedback as to where your strengths and weaknesses are, and enable you to adjust your study plan accordingly. Both BenchPrep and the PT Exam book have quizzes and practice exams, and FSBPT provides (for a fee) an online practice and assessment tool (PEAT) which very closely mirrors what you can expect from the actual exam. Practice exams enable you to get a feel for how questions will be worded, and practice interpreting the possible answers. Often, the answer that’s required is not a matter of separating right from wrong, but understanding which answer is the MOST correct based on the information you’re presented with. It takes practice to be able to understand this, particularly if you’re a current practitioner, as chances are you have developed your own ways of addressing the needs of patients, and this may not match to what the examiner is expecting.

  1. Seek support

Having good support structures in place is invaluable, both in terms of supporting your study and maintaining your sanity. Having family members, friends, loved ones who can support you during this incredibly stressful time can make all the difference to your mental and emotional health. A little understanding goes a long way, and it’s likely you will need plenty in the lead in to the exam.

Support from other people undertaking the exam is very useful as well. Being able to find discussion forums or study groups can greatly assist your preparation. This gives you the chance to check your understanding about different things, develop your judgement and reasoning, and ensure you are covering everything you need to know. In most groups you will find someone who knows the answer you’re looking for, or who will ask a question you haven’t thought of. It can also be useful to be able to relate to others who are going through the same experience you are.

  1. Find ‘you’ time

It can be very easy to narrow your focus to preparing for the exam, and let all other aspects of your life fall by the wayside in the process. Do this, and not only do you risk severely over-stressing yourself, you may cause damage to your health, your relationships, and other things that are important to you. This is where allowing ample time (see 1. above) becomes critical. You need to be able to step away from your study and preparation, if only to give yourself a chance to recharge and recuperate. Take a walk, go to the gym, play with the kids or catch a movie you’ve been wanting to see. There are no bonus points for spending all your time on studying – in fact, chances are by taking some ‘you’ time, you will return to your studies with a clearer mind and sharper focus.

According to FSBPT, only about 88% of US graduates, and 30% of non-US graduates, pass the NPTE the first time. Incorporating these tips into your study plan might just give you the edge on ensuring you are one of those who pass.

If you are preparing to take the NPTE, I wish you the best of luck for a successful outcome, and for your future career as a physical therapist.

Got some other tips for taking the NPTE? Please feel free to share in the comments section below.

Should Non-Indigenous Australians Be Proud of Indigenous Culture?

984a1b0af5d47f5f81d26ace274913bdAll this month, I’ve had the pleasure of both contributing to, and reading, some of the great blogs that have made up the Deadly Bloggers Blogging Carnival as part of Australia’s Blak History Month. While the blog articles themselves have been diverse and interesting, what struck me was the interaction and involvement through the various social media platforms. Particularly during NAIDOC week, I noticed a tremendous support from Aboriginal, Torres Strait Islander, and non-Indigenous peoples, liking, favouriting, and sharing my articles and articles both other Deadly Bloggers.

What I found especially exciting was the amount of involvement from non-Indigenous people, who were obviously reading, sharing, and enjoying post from Aboriginal and Torres Strait Islander bloggers. More than that, people wanted to spread these messages, to share Australia’s Indigenous identity, if you will, to the point where – for me at least – there seemed to be definite evidence of pride in Aboriginal and Torres Strait Islander peoples and culture. It got me thinking: why not? Why shouldn’t non-Indigenous Australians be proud of Aboriginal and Torres Strait Islander peoples and culture? Surely, that can only be a positive thing, right?

So I decided to see what the people thought by creating a simple survey titled, “Should non-Indigenous Australians be proud of Indigenous culture?”, and sent it out amongst the digital masses. The response was very interesting.

Over about three weeks I managed to get 83 respondents, of which 76 completed all the questions. The majority of respondents were non-Indigenous (64.5%), female (62%), and aged between 40 and 60 years of age (60.5%).

The first section attempted to determine the current perception of non-Indigenous Australian’s opinions towards Aboriginal and Torres Strait Islander cultures. Specifically, whether non-Indigenous Australians know about and are proud of Indigenous Australian cultures, and whether they consider this an important part of Australia’s identity. It should be noted that these questions were about the respondents perceptions of the greater Australian community, not their own personal perception.

From the responses obtained, it seems that in general people believe that non-Indigenous Australians neither know about (64% No vs. 19% Yes), nor are proud of (59% No vs. 19% Yes) Aboriginal and Torres Strait Islander cultures. Further, the respondents’ perception was that non-Indigenous Australians generally do not consider Aboriginal and Torres Strait Islander cultures an important part of Australia’s identity (51% No vs. 34% Yes). While this may not surprise many given Australia’s sociopolitical history and track record in Indigenous affairs, it becomes very interesting when considered in the context of the next question.

The second section consisted of one simple question, and the opportunity for respondents to explain their answer. The question: in your opinion, should non-Indigenous Australians be proud of Indigenous Australian culture?

An overwhelming 95% of respondents answered, ‘Yes’, while the remaining 5% answered ‘Don’t Know’.

This is a remarkable contrast. It seems people are saying that non-Indigenous Australians should be proud of Aboriginal and Torres Strait Islander cultures, even though they might not currently be, or perhaps know enough to be, and that it is important for Australia’s identity. This is further supported in many of the additional comments respondents made in answering this question.

In explaining why they thought non-Indigenous Australian’s should be proud of Aboriginal and Torres Strait Islander cultures, several common themes emerged from the ideas put forward. These included:

  • the richness, diversity, and spirituality of Aboriginal and Torres Strait Islander cultures;
  • the long history of Aboriginal and Torres Strait Islander peoples as the original inhabitants of this land Australia;
  • the connection and relationship Aboriginal and Torres Strait Islander peoples have to the land, including understanding of land management; and
  • the social values inherent in Aboriginal and Torres Strait Islander cultures, and how these could enhance the broader Australian society.

This is reflected in statements such as:

“Because Indigenous Australian’s are the traditional owners of the land and bring with them a unique culture. We could learn more as non Indigenous people especially with regard to kinship values, the importance of the land and spirituality”

“Yes – it is what is unique to Australia, something that differentiates us from the rest of the world; we have one of the longest living cultures in the world and we should be proud of it and cherish it whether we are Indigenous or not.”

“Indigenous culture is a valuable resource for all Australians. It is rich and diverse, it is enduring and adaptable. It speaks with the voice of our ancient past. Indigenous culture advises us on how to care for the natural world and for each other. The language, art, music, learning,rituals, rules and ways of living cans inform all our ways of living.”

Some supported the idea in principle, however argued that ‘pride’ may not be as appropriate a term as ‘respect’ is. For example:

“I have difficulty with the word “proud”. … I think non-Indigenous Australians should be RESPECTFUL of the Indigenous culture. I feel we have a responsibility to help Indigenous people to feel proud of who they are. We have a responsibility to raise awareness of injustice that exists in our country against Indigenous people. We have a responsibility to recognize the past wrongs and rectify the situation (such as closing the gap in health and education). I feel honoured to know so many inspiring and wonderful indigenous people but I don’t feel that I have a right to say I am proud of a culture that isn’t mine. I haven’t earned the right to feel proud. What I wish I could say is that I am proud to live in a country that values and recognises its Indigenous population. …” (emphasis is respondent’s own)

While I can neither claim my little survey to be the model of empirical research, nor the responses received to be representative of the entire Australian population, I do feel a clear message comes through from this exercise: Non-Indigenous Australians should be proud – or at the very least, respectful – of Aboriginal and Torres Strait Islander cultures. More than that, non-Indigenous Australians want to be proud of Aboriginal and Torres Strait Islander cultures.

The next question must be: what’s stopping them? What are the obstacles and barriers to non-Indigenous pride in Aboriginal and Torres Strait Islander cultures? Is it that Australians are victims of history – that the historical beliefs and attitudes towards Aboriginal and Torres Strait Islander peoples still persists, perhaps subconsciously, in the Australian psyche? Is it that we have inadequate leadership guiding us towards a society that values Aboriginal and Torres Strait Islander cultures? Could it even be that Aboriginal and Torres Strait Islander peoples ourselves have become so used to protecting and defending our cultural rights, responsibilities, and beliefs, that we are unable or unwilling to allow non-Indigenous Australians to be proud of us?

Perhaps when we can examine and address these questions, we will find ourselves moving towards a truly Reconciled Australia that not only recognises, but takes pride, in its Aboriginal and Torres Strait Islander peoples.

I would like to thank all those who participated in the survey for your responses. Anyone interested in viewing the raw data from the survey can find it here.

Do you think non-Indigenous Australians should be proud of Aboriginal and Torres Strait Islander cultures? What do you think needs to change in order for this to happen? Please feel free to share your thoughts in the comments section below.

This post appears as part of the Deadly Bloggers Inaugural Blogging Carnival, held during Australia’s Blak History Month. To read other posts from Aboriginal and Torres Strait Islander Bloggers, visit the Deadly Bloggers website.

Reconciling Australia: It Starts With Our First Nations

Partnerships-Full-Image

“Partnerships”

In the mid-90’s I had the privilege of attending an advanced cultural awareness workshop for staff of the (then) Department of Human Services and Health in Canberra, at which Aboriginal Elder Aunty Mary Graham was one of the main facilitators. Aunty Mary shared many gems of information over those days, however one of the main statements she made that has always stuck in my mind was this:

“Aboriginal people will never have their Martin Luther King [Jr.]”

It was a statement made as part of a discussion on the diversity of Aboriginal peoples aimed at broadening the participants’ understanding of Aboriginal Australia as a ‘nation of nations’ – a land where each Clan/Language group was as separate and distinct from each other as other countries of the world are. The overarching message was that the Government must recognise that attempts to engage in consultation or partnerships with Aboriginal peoples needed to be done at local (community) levels; that there was not – and never will be – ‘one person’ who could speak for or claim to represent all Aboriginal peoples.

In that sense, Aunty Mary’s statement is very true, and I appreciate and agree with it from that perspective. However, to my way of thinking, it’s also a sad statement, because in a broader context, it also suggests that Aboriginal peoples will never achieve unity amongst ourselves. When you consider the achievements of Dr Martin Luther King Jr., one of the main things he did was unify people. In leading the American Civil Rights Movement, Dr King not only provided a voice for African-Americans, he gave them a common cause to rally to, and in doing so, brought African-Americans (and in a broader sense, all Americans who believed in racial equality) together in the spirit of unity. As a result, Dr King is credited with achieving, “more genuine progress toward racial equality in America than the previous 350 years …” (The King Center).

Australia’s Aboriginal peoples may never have our Dr King, however, we do need to create that unity amongst our First Nations. There have been attempts, the latest of which has been the formation of the National Congress of Australia’s First Peoples (Congress). Congress was established under the premise of being a representative body for all Aboriginal and Torres Strait Islander peoples that could act as our national voice, particularly when dealing with Government. Congress states that as of January 2014 it has over 7,500 individual members from all over Australia – a considerable figure given it was only formally established in 2010. However, whether this can be considered sufficiently ‘representative’ (about 1%) of the almost 670,000 Aboriginal and Torres Strait Islander peoples living in Australia is subject to debate, as is Congress’ continued existence, given the Australian Government’s recent decision to discontinue its funding.

What isn’t debatable is the need for a unified voice that led to the formation of Congress in the first place. Aboriginal and Torres Strait Islander peoples still only make up approximately 3% of the total Australian population, giving us a relatively small voice in Australian affairs. Divide that by the number of First Nations (estimated at about 600 prior to European settlement), and the voices of individual Nations becomes even smaller. This would not necessarily be a problem if Aboriginal and Torres Strait Islander peoples enjoyed an equitable status in areas such as health, education, employment, and social justice, with non-Indigenous Australians. The fact that we don’t, and that the scales are tipped so far away from Aboriginal and Torres Strait Islander Australians, should be reason enough for us to unify and seek solutions to common problems.

Ironically, in my observation at least, it is these very inequities that steer us away from unity. There is conflict between and within nations, communities, and sometimes even families, over what needs to be done and who has the ‘right’ to make those decisions. We fight over who should or shouldn’t have access to services, who should or shouldn’t be able to speak for our peoples, even who should or shouldn’t be identified as Aboriginal. This is not to say that there aren’t real issues within nations and communities that require resolution, however, when you consider that many of these issues only exist because of the effects of both historical and current policies and practices that have been imposed upon us, you have to question whether much of our internal conflict stems from a continued – perhaps now self-imposed – ‘divide-and-conquer’ strategy. As an Aboriginal person, I find this highly distressing, divisive, and confusing. I can only imagine how it must appear to non-Indigenous peoples. How can we possibly expect to achieve Reconciliation within Australia, when we’re unable to achieve it amongst ourselves?

It is crucial that all First Nations be able to retain their individuality in their identity, their Law, their cultural practices and beliefs, and their ability to determine their own futures. However, if we are going to make changes and improvements for the betterment of our peoples, we need to unify to address common issues. We need to reconcile both within and between communities and nations, and present a united front – a united voice – to combat the injustices we face. We need to adopt the old adage of “strength in numbers”, because as a minority within our own land, we need all the numbers we can get!

And if we can reconcile amongst ourselves, we give ourselves a greater chance of achieving Reconciliation amongst all of Australia. We can achieve a lot with 670,000. Imagine what we could achieve with 22 million.


I would like to acknowledge and thank the Making Two Worlds Work project for permission to use the image, Partnerships, in this article.


This post appear[ed] as part of the Deadly Bloggers Inaugural Blogging Carnival, held during Australian Blak History Month. To read other posts from Aboriginal and Torres Strait Islander Bloggers, visit the Deadly Bloggers website.

Why Identify?

20140126_142430-1Happy NAIDOC week to all of you who celebrate it! NAIDOC week is a great week of celebration of Aboriginal and Torres Strait Islander peoples, our culture, and our achievements. For me, it’s always a time to not only celebrate my Aboriginality, but to reflect on what it means to me, what I’ve done to celebrate it within myself, and what I want to do to recognise and celebrate it as my life moves forward. This year, inspired by NAIDOC and the Deadly Bloggers Inaugural Blogging Carnival, as well as some personal experiences I’ve had over the last couple of years, I’ve decided to share with you my thoughts on two questions that I have been asked on numerous occasions, and often together: “Why do you identify as Aboriginal?” and “What do you get out of it?”

The second question is particularly interesting, as it suggests that there is still a perception within certain parts of the Australian community that the only reason anyone would identify as Aboriginal is to gain some sort of tangible benefit from it. This disappoints me for two main reasons: first, because while I mostly get asked this by non-Aboriginal people, it’s not uncommon for some Aboriginal people to challenge me with it as well; and second, because it indicates to me that when it comes to Aboriginal identity, there is still confusion and concern over the difference between Aboriginal ‘identity’ and Aboriginal ‘identification’.

It seems that some people still harbor a fear or resentment that calling yourself ‘Aboriginal’ will grant you some form of entitlement that their own biases don’t believe you should have. While there is no doubt there will always be those who will look for ways to abuse any system for their own benefit, to my way of thinking, questioning whether someone who identifies as Aboriginal does so only for personal gain is equivalent of questioning whether someone with a serious physical or mental disability only identifies as such to gain disability benefits. Yes, there may be abusers, but to question the motivations of everyone who identifies with any group is quite ludicrous. As another Aboriginal man said to me years ago, “why would anyone who wants some sort of advantage over others choose to identify with the group that has the poorest health, the poorest education, the poorest employment, and the worst racism? If I wanted an advantage, I’d choose to be white!”

However, the truth is I do gain from identifying as Aboriginal. What I gain from it is a greater sense of self. I do not identify as Aboriginal, so much as my Aboriginality gives me my identity. It tells me who and where I came from, and who and where I’m connected to. It helps to form my world view, and my place within that world. It influences the person I want to be, through my morals, my ethics, and my approach to life. That is not to say that it is separate from the other things that make up me – it is one of many pieces of my personal puzzle, which together provide the full picture that is me. It is as important in defining who I am as is being a man, or a father, or a healthcare professional, or any one of a number of the hats I wear. It gives me ME, and I would be incomplete without it. I would not know myself, and that is a terrible way to live one’s life.

So, why do I identify as Aboriginal?

Simple. That’s who I am.

And if you know who you are, and what gives you that sense of self, I have no doubt you will understand exactly what I mean.

What more reason could anyone need?

Is it Time to Say “Bye” to BMI?

bmi_flawedBody Mass Index, or BMI, has become somewhat of a catchphrase in a world of ever-increasing obesity. Doctors, dietitians, and personal trainers are just some of those who use your BMI to determine whether you are obese, or at risk of becoming obese. Even the tools we use for fitness – electronic scales, heart rate monitors, and even our smart phone apps – use BMI as a primary indicator of whether you are at your ‘ideal weight’. However, while everyone is busy calculating their BMI and worrying whether they’re outside the ‘golden range’, few seem to be asking what this number actually represents, and fewer still whether it actually has any validity.

What are we actually talking about?

Before trying to answer those questions, it’s important to define a few terms:

‘Weight’ – contrary to popular belief, your weight is not a measure of how fat you are. Your weight is a measure of the effect of gravity on your mass – that is, the resultant force that gravity is having on the total mass of matter that makes up you. Weight doesn’t care what this matter represents – fat, bone, muscle, fluid – it just tells you what gravity is doing to you. Because gravity is pretty much the same all over Earth, the only way to change your weight is to change your physical mass. By that reasoning it could be said that to be ‘overweight’ or ‘underweight’ means you either have too much or too little physical mass compared to an ideal value. However, in practice we do not define these terms in this way.

‘Overweight’ and ‘obesity’ are defined by the World Health Organisation (WHO) as, “abnormal or excessive fat accumulation that presents a risk to health.” Note that the thing that is being measured or compared in this definition is the amount of fat that makes up an individuals body composition. Therefore, to determine whether a person has an abnormal or excessive accumulation of fat, it stands to reason you need to know the amount of fat that makes up a person’s mass. WHO further defines obesity as a percentage of body fat equivalent to 25% total body weight for men, and 35% for women.

‘Underweight’ interestingly enough, is most often defined by a person’s BMI, which is discussed below.

‘BMI’ – again, contrary to popular belief, BMI is a mathematical calculation, not a measurement. BMI is calculated by dividing your weight (in kg) by the square of your height (in meters). So for example, a person weighing 70kgs at a height of 1.75m would have a BMI of: 70kg / (1.75m x 1.75m) = 22.86 kg/m2.

So what’s the problem with BMI?

Well, there are several problems which continue to be debated within the literature today, including concerns around its validity in reference to specific populations and its use as a diagnostic tool (which, by the admittance of its inventor, Belgian mathematician Lambert Adolphe Jacques Quetelet, it was never intended for). However the most glaring one should be obvious from these definitions. BMI tells us about the relationship between the height and weight of an individual, however it does not – in fact, it cannot – tell us anything about the composition of that individual’s body. Specifically, it does not – cannot – tell us anything about the fat composition of that individual’s body.

This in itself would not be a concern, if not for the fact that BMI is frequently used to categorise people as being underweight, overweight, or obese. The fact is, BMI cannot make this categorisation because it does not measure fat composition. At worst, it runs the risk of generating false positives and false negatives when attempting to categorise people based on a comparison of height and weight. This can be illustrated with a simple example using a muscular athlete, such as a competitive body-builder.

Jay-Cutler-From-2009-IFBB-Olympia

Photo courtesy HealthyCeleb.com

Meet Jay (Jason) Cutler, a four-time Mr Olympia winner from the United States. Jay is 5’9″ (1.75m) and at competition weight approximately 274 pounds (124kg). Based on his height and weight, Jay’s BMI is 40.49 kg/m2, which accordingly to WHO classification, puts him in the morbidly obese category. Looking at Jay at the 2009 Mr Olympia competition, you would be hard pressed to call this man “morbidly obese.” Why is his BMI so high? Simply because muscle has a higher density (approximately 18% greater) than fat, so for the same volume of tissue, muscle weighs more than fat. As such, Jay’s BMI is clearly a false positive result. (For interest, Jay’s weight outside of competition has been recorded at 310 pounds (140kg), which would place him in the super obese category!)

The problem of density differences between muscle and fat can also give false negative results as well. Consider someone with a low proportion of muscle mass (eg: sedentary-lifestyle) or whose muscle mass is reducing over time (eg: elderly, or active person becoming inactive). It is quite possible that this person will record a BMI that would be considered ‘normal’, yet physiologically have a body fat percentage higher than that considered ‘healthy’ by the WHO. This has been demonstrated in a number of scientific studies by comparing BMI with more accurate body composition recording techniques, such as dual energy x-ray absorptiometry (DXA or DEXA), including one study where approximately 1 in 4 men and 1 in 2 women were incorrectly classified by BMI [1]. Can these error rates be considered acceptable when screening for risks to people’s health?

So why do we use it?

Despite its problems, BMI’s simplicity is the main reason why it continues to be used. It’s quick, cheap, and easy to do. If you have the ability to measure a person’s height and weight, and basic math skills, you can categorise someone as being within a ‘healthy’ weight range, or not. Apparent anomalies are often dismissed through subjective observation by the assessor. “No, Jay, of course you’re not obese,” is what we would expect Jay Cutler’s doctor to advise him, for example. Though in light of the incidence of false negatives BMI produces, it could be argued we should be questioning whether such subjective opinions are valid, or even putting individuals at risk of being miss- or undiagnosed.

Critics of BMI have cited more potentially malicious reasons why the use of BMI persists. For example, some health insurance companies adjust their customer’s premiums based on their BMI – the higher your BMI, the more you pay – because they are considered to be at higher risk for developing problems with their health. Is this fair for the professional athlete, a person considered to be at peak physical fitness, and therefore healthy compared to the rest of the population? What about the 29 million Americans who suddenly “became fat” in 1998 when the U.S. National Institutes of Health and the Center for Disease Control (CDC) lowered the U.S. cutoff for ‘normal’ BMI from 27.8 to 25 [2]?

What’s the alternative?

There are many different ways body composition can be measured. In relation to body fat, hydrostatic weighing (weighing underwater) and whole-body air displacement plethysmography (ADP) are considered the gold standards of getting an accurate value. DXA or DEXA is also highly regarded, though primarily used in research. However, these procedures require specialised equipment and operators, and in some cases can be quite expensive to undertake.

Bioelectrical impedance analysis (BIA) is a cheaper alternative which is gaining popularity, particularly as an ‘in-home’ means of determining body composition through the use of body composition analysis scales. BIA has been demonstrated to be useful for predicting the body fat composition of groups, however shows poorer accuracy for individuals, likely due to the fact that readings can vary depending on an individual’s level of hydration (or dehydration) [3].

Skinfold calipers are another inexpensive and time-honoured method of determining body fat percentage, and chances are if you’ve been involved in college/university level sports, or been part of a sports institute, you’ve felt the skinfold pinch. There has been much ongoing debate in the scientific literature about the accuracy and usefulness of skinfold measurements in determining body fat, with issues such as inter- and intra-tester reliability (ie: whether the same person or different people can produce the same results with each test), the sites used, the methods of calculation, and again, the hydration level of the subject, identified as potential problems. At best, it seems skinfold measurements are accurate at determining body fat percentage on lean athletes, but less so for those with excess body fat or loose connective tissue (ie: the elderly) [4].

In the last two decades, waist circumference measurement has been increasingly used as a screening tool for assessing individual’s risk of developing diseases associated with excess body fat, such as diabetes and cardiovascular disease. Like BMI it is quick, easy, and inexpensive to administer, requiring only a tape measure. Current Australian guidelines state that waist measurements above 94cm for adult males and 80cm for adult females are indicator of excessive internal fat deposits, and increase the risk of chronic disease. Waist circumference has been demonstrated to be a good predictor of visceral fat (fat around the organs) [5] and a better predictor of risk of cardiovascular disease [4,5,6], type II diabetes [4,5], and metabolic syndrome [5] than BMI.

Is it time to say “bye” to BMI?

It is apparent that BMI tells us nothing about the composition of the body, and that there are problems with its use as an indicator of diseases such as obesity, and with its accuracy at identifying individuals who may be at risk of further health complications based on their body composition. It’s also apparent that there are more accurate ways of determining body composition, and these may be better indicators for people’s risk of developing diseases related to unhealthy levels of body fat [4]. Is it therefore time we stopped using BMI?

It’s not a simple question to answer. BMI still has potential in screening people who are underweight compared to a normal population, and flag the need for further examination, to determine if they may be suffering from diseases such as malnutrition or anorexia. However, while BMI can determine whether an individual is ‘overweight’ compared to a normal population, it cannot give any indication as to why that is the case. Therefore it would seem justifiable that BMI should no longer be used as a means of categorising people as being ‘obese’, as it cannot indicate what the body composition of an individual is.

Further, given that other methods of body composition analysis are better predictors of the risk of disease and other complications associated with unhealthy levels of body fat, it seems justifiable to suggest that BMI should be the least favoured tool utilised by clinicians and individuals. This is particularly true where other methods, such as waist circumference measurement, have been demonstrated to be more reliable indicators of risk of associated health problems, such as cardiovascular disease, and are just as quick, easy and cost-effective to administer as BMI.

Why, then, should we continue to use BMI?

Do you know your BMI? Do you agree with the category it places you in? Would you rather know your BMI, or your Body Fat Percentage, in terms of making decisions about your own health? Please feel free to share your thoughts in the comments section below.

References

1. Shah, N. R. and Braverman, E. R. (2012). Measuring adiposity in patients: the utility of Body Mass Index (BMI), percent body fat, and leptin. PLoSOne. 7(4): e33308 1-8.
2. Cohen, E. and McDermott, A. (1998). Who’s fat? New definition adopted. CNN: 17 June 1998. Retrieved 26 June 2014 at: http://edition.cnn.com/HEALTH/9806/17/weight.guidelines/
3. Houtkooper, L. B. et al. (1996). Why bioelectrical impedence analysis should be used for estimating adiposity. American Journal of Clinical Nutrition. 64(suppl.): 436S-448S.
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