Men's Health

Australian Nutrition Foundation Inc, c/- Women’s and Children’s Hospital, 72 King William Road, North Adelaide SA 5006 Tel: (08) 8204 7162

The state of play

What can we do to enable men to be better informed about their own health, wellbeing and the role of nutrition, instead of just providing information? This presentation is aimed at providing some insights into the availability of information and the activities which might enhance the provision of information and encourage men in Australia to take an active role in improving their own health and wellbeing.

Men do get sick. Many practising GPs would say that a large number of men won’t admit to feeling sick or being concerned about some aspect of health and their bodily functions. The mindset of many men, particularly older men, is to ‘soldier on’ in spite of the presence of worrying symptoms. Quite often the assistance which is finally sought comes too late and the prognosis is already poor. Even many younger men put themselves at risk of a range of diseases by consuming too many high-fat foods and having an excess alcohol intake.

So how much personal health and nutrition knowledge do men generally have in Australia?¹

In the case of heart disease, many men may not find out they are at risk until they actually have a heart attack. This is in spite of the fact that information about the risk of heart disease is readily available and men would be more familiar with seeing and hearing about heart problems than other problems such as bowel cancer. Some of these men may laugh about their so-called beer gut without realising that it is an indication of being at risk of diseases such as heart disease and bowel cancer. Indeed, many men are very proud of their size, and use it to increase their presence and power - when you are big you feel powerful.

Action stations - producing a range of information on Men’s Health

During 1996 the Australian Nutrition Foundation (ANF) decided that material needed to be produced about men’s health and that some action was needed in informing the community about specific men’s health concerns. During national Nutrition Week in October this year the focus was on men’s health with the release of the new booklet called ‘Food & Fitness for Men’². Also available was a set of informative factsheets covering cardiovascular disease; body shape; diet and cancer; exercise and weight control; and nutrition tips for preparing and cooking healthy meals.

To get the message out to a wide audience, a series of ANF seminars was conducted throughout Australia targeted at key men’s groups, including sporting bodies. In fact, one of these seminars was held last night as part of this conference, and it emphasised the importance of specific issues men should consider with regard to nutrition and their health. In particular, practical advice was given on how to change eating behaviours, which is really at the heart of this issue. We can be given plenty of information about why good nutrition is important, but without knowing how to put it in practice the information is virtually meaningless.

Eating habits may lead to a shorter life-span

Poor eating habits are to blame for many differences between the health of men and women. It seems that men attach less importance to health when selecting their diet compared with women for various reasons - partly due to less pressure placed on men to conform to social standards of thinness, and also to a "she’ll be right" attitude that prevails particularly in Australian men. A recent dietary survey of Australians found that many men still have a higher than recommended fat intake and lower than recommended fibre intake. All of this adds up to men living on average six years less than women. This gap has actually increased over the decades - at the turn of the century the figure was three years.

Men’s size, shape and weight - are these indications of wellbeing? Have men heard about the ‘healthy weight range’? Is their weight level OK?

Questions like these are fairly basic ones, however many men do not know what their ‘healthy weight range’³ really is. Often they don’t understand how the shape of their body in regard to their weight affects their risk of disease. A male body, slightly overweight, but shaped like an apple indicates a potential and very real increased risk of heart disease.⁴ This is because an ‘apple shape’ indicates that the spread of excess fat is around the middle of the body where the heart and other internal organs are located.

Australian research has shown that men and women have different responses to fats, oils and cholesterol in the diet. Some people can effectively lower their cholesterol levels, and hence risk of heart disease, by changing the types of foods in their diet and making healthier low-fat choices. Studies conducted in 1994 at the CSIRO Division of Human Nutrition⁵ showed that body shape can be an indicator of disease risk. In a dietary trial, volunteers consumed supplements of fat and cholesterol over a six week period. Although the change in total cholesterol was the same in men and women, women seemed better able to cope with the ‘high fat/high cholesterol’ diet than men, as they have a higher level of protection in the way their bodies deal with cholesterol.

The ANF has a range of resources which help people to work out their ‘healthy weight range’. These resources include posters, pamphlets and of course the weight chart appears in many ANF publications as weight may be a factor in the risk of heart disease, diabetes, cancer and has an effect on fitness levels.

As mentioned before, heart disease and cancer, especially bowel cancer and prostate cancer, are just a few diseases which men may have to contend with in their life and many studies have shown that 50% of Australian men are overweight, compared with 30% of women. These figures are in direct contradiction to the plethora of information directed at women to lose weight.

Being overweight is not only a disease risk but is also uncomfortable. Clothes don’t fit very well, back aches occur for no reason, and sudden physical exertion (such as rushing fast up a flight of stairs or dashing up the street to catch a bus) causes puffing and breathlessness.

Weight matters

There is no such thing as a single ideal weight for any height, but rather there is a healthy weight range which is based on a Body Mass Index⁶ (BMI). The BMI is a measure of body fat in adults. Studies have shown that men and women over the age of 18 years, with a BMI measure between 20 and 25, have the least risk of disease and a longer healthier life. The BMI is calculated by dividing your weight (in kilograms) by your height (in metres) squared. The aim of a weight control program is to reduce the stores of body fat and any weight loss should be slow and regular.

Various ANF publications recommend that a weight loss of 0.5kg to 1kg per week should be the goal. This can equal 6-12 kg over three months. Exercising and eating the best foods⁷ (and lots of them, such as breads and cereals, fruits and vegetables) actually enhances the body’s ability to shed fat and add muscle.

So far we have dealt with men’s heart health, the risk of disease due to being an ‘apple-shaped’ person, their weight, and tips for having a healthier variety of foods in order to reduce weight. But these are only a few of the concerns in relation to overall good health. Lifestyle is important as is choosing the best foods - those that may offer the best protection against cancer and other diseases. In most diseases mentioned previously, fat in the diet is a major concern.

Many books and brochures are available which may help men choose and manage a change of diet (such as the ANF’s ‘Food for a Healthy Heart’⁸ and ‘Eat less Fat’⁹ books). The benefits to men in eating a low saturated fat diet is at least twice as great as in women.

An all-round protective effect

Cancer may be defined as "any group of diseases in which cells grow in an uncontrolled manner." There is no proof that any one food can cause or prevent cancer. There are so many types of cancer that eating a varied diet may be the best way of reducing the risk^10,11,12,13. Cancer may occur in many parts of the body - we hear about lung cancer, breast and skin cancer, bowel cancer and, in men, prostate cancer. The cause of this latter one is unknown although there is some speculative evidence that viruses and dietary factors may be important. For many men, cancer of the prostate is an incidental finding and not the main reason medical tests may be conducted, other urinary problems may be the initiating reason for a visit to a doctor. Statistics¹⁴ so far, indicate that among men whose cancer is diagnosed during their lifetime, up to 80% will not die from the disease.

All anti-cancer organisations have guidelines¹⁵ for reducing the risk of cancer. Once again, fat in the diet is highlighted as the main item to be reduced. Breads and cereals (such as wholegrain breads, pasta and rice), fruits, and vegetables (especially the Brassica family - broccoli and cabbage) should form the bulk of the diet¹⁶. These food types (and green and black tea) provide a range of antioxidants which are suggested to have beneficial and protective effects against the development of many diseases including cancer.

How to eat for good health

Being male is now regarded as a risk to health. One of the reasons for this is that studies show that men don’t consider their health enough when selecting their diet. It may be that men’s poor food selection may be related to men feeling that nutrition is a feminine issue and that adopting healthy eating habits is not masculine. Also, perhaps traditional masculinity has trapped men into a very narrow definition of what it means to be male and unfortunately good nutrition does not appear to be a part of this. This attitude may lead to serious consequences for their health¹⁷.

In fact, an average Australian male lives for 6 years less than their female counterpart and is much more likely to suffer from serious health problems. Men eat too much fat^18,19. One third still do not trim the fat off their meat or remove the skin from their chicken and many are not eating enough fruit and vegetables. In addition, their rates of obesity continue to rise with almost 50% of men being overweight or obese.

Men need to think more about their health when selecting their diet⁷. They must realise that it is not unmanly to look after their health but actually a responsible thing to do. They need to challenge the stereotypical norms and start caring about their food intake in order to achieve better health.

Actively making food choices

Most men probably do want to look good, feel good and enjoy life as well. Being healthy and making sensible food choices could be a start to weight loss, an increase in energy for general living, doing more exercise and an all-round feeling of wellbeing⁷.

Eating the best foods, and lots of them, actually enhances the body’s ability to shed fat and add muscle. Eating a variety of foods provides necessary nutrients, including protective antioxidants^20,21, and can be nutritious and delicious at the same time. Men should eat more breads, cereals, fruits and vegetables, and supplement these with a small quantity of dairy products and lean meat.

Cooking the goose - some laid-back ideas for men’s culinary expertise

In some areas of Australia, "men-only cooking and nutrition" courses²² have begun which emphasise the importance to men of choosing what they want to eat rather than accepting food that is placed in front of them at home, or relying on greasy take-away foods. These men then band together to do some cooking or preparing of the chosen foods, such as casseroles, lean meat and fish grills, salads, and vegetable concoctions.

To obtain the best benefits of eating good food, it must also be prepared, cooked and served in the most nutritious way. To encourage men to have a bash at doing their own cooking, the ANF has compiled a range of nutritious and delicious recipes called ‘Laid-back recipes for blokes’²³.

This brings us to the heart of the issue. The facts and statistics that have just been mentioned are well known to everyone, but providing this information is not enough. To make any difference the information needs to be transferred into action. So lets draw a picture of the difference between a person obtaining information and a person actually being informed.

Information by the armful

For example, a chap (let’s name him Frank) may decide to build a little sheltered outdoor entertainment area for using during summer. Frank goes to home shows, hardware stores and bookshops to collect brochures or books about making this type of structure. Bob, his neighbour, watching a healthy living show on TV one night, suddenly decides he should have a healthier diet, so he contacts some health and nutrition organisations²⁴ which offer brochures and books about men’s health and nutrition.

Frank has moved onto to the next step - he decides to go and buy all the materials for a pergola. Wood, nails and roofing. He now has a wonderful image of the completed structure in his mind. Similarly, Bob has decided that he will make changes to the types of food he eats and goes and stocks up on all these healthy foods he’s been reading about. Perhaps he has a wonderful vision of the new fit and terrific person he will magically become after he has gone to all the effort of buying these foods.

Taking the information to heart

Now, these two stories illustrate that it is very easy to collect a lot of information, but are the men actually making informed decisions? Take Frank’s case. He should be aware of council regulations about building, the angle of the sun in summer for designing the roof, and the location of power lines and water and gas pipes near his house. Ooopps! He just hit the water pipe! And if he had checked with the Council he would have found that a slightly narrower structure would not have needed approval and the work would not have been delayed.

In Bob’s case, he should consult his doctor and perhaps a dietitian for advice in finding a diet plan which suits his medical and physical needs. He should also analyse his eating habits and only change a small number of foods in his diet at first, as well as learning that exercise is an important component of making an effort in changing to a healthy lifestyle. He might best have made healthy changes by joining a group such as GutBusters²⁵, or learning to cook in the most effective and healthy way at one of the men’s cooking and education groups that have started in some parts of Australia. In this way he would receive support from fellow members of the group, advice on the best way to start a new diet and monitor the changes, especially for weight loss, and would not make mistakes like still frying foods instead of grilling or steaming food.

The information helps, but being informed is better

So, Frank and Bob initially went to ‘shopfront counters’ for information. Then they should have supplemented this information by seeking further advice from appropriate agencies so that they would be fully informed about the task they were undertaking. In the end, Frank should have a completed pergola and a very pleasant area to entertain friends and relax during summer, and Bob should have reduced his risk of various diseases, perhaps become fitter and improved his overall wellbeing. They planned their tasks and became fully informed!

As you can see, converting the plethora of information about nutrition and health in general into a series of goals which men might take on board and actually act upon is no easy task.

Just simply handing out information, advice or preaching about health, fitness and reducing disease risk will not work in the long term. Messages and goals must be taken to heart and acted upon. They must become a part of each man’s lifestyle before changes will occur in the overall improvement of men’s health in Australia. Information on its own without a practical base will not achieve change. The ANF has started to act in this important and long-neglected area by developing resources and programmes that specifically target men. Will men take up the challenge to change?

INFORMATION or BEING INFORMED

Frank’s Activities

Getting information about building:

factsheets
home shows
books
hardware stores

Bob’s Activities

Getting information about nutrition:

factsheets
books
food shows
television, radio

To be fully informed:

council building laws and guidelines
location of power lines
check water and gas pipes
sun/shade angles for roof