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Item Effect of New Zealand Greenshell™ mussel on osteoarthritis biomarkers and inflammation in healthy postmenopausal women : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science, School of Health Sciences, Massey University, Palmerston North, New Zealand(Massey University, 2023) Abshirini, MaryamNew Zealand GreenshellTM Mussel (GSM) showed chondroprotective effects in a pre-clinical study using a rat model of metabolic osteoarthritis, warranting further assessment in a human study. This PhD project aimed to assess the effect of GSM supplementation on cartilage degradation biomarkers in humans, and to develop novel biomarkers through a metabolomic approach. A double-blind, placebo-controlled, longitudinal clinical trial was carried out in overweight postmenopausal women who were given 3 g/day whole meat GSM powder or placebo (sunflower seed protein) for 12 weeks. Plasma samples from the pre-clinical rat trial were assessed through an untargeted metabolomic approach, followed by metabolomic analysis of plasma samples from the clinical trial. In participants with active knee pain, the cartilage turnover biomarker C-terminal telopeptide of type II collagen was significantly lower in GSM participants compared to placebo at weeks 6 and 12. GSM significantly reduced joint pain and improved knee-related symptoms. GSM but not placebo altered the faecal microbiota population and reduced the rate at which body fat accumulation increased. However, no changes in inflammatory cytokines were found. The metabolomic analysis of rat plasma samples revealed that GSM supplementation regulated the alteration in plasma triglyceride and other lipids caused by a high-fat diet. In the plasma of human participants, GSM supplementation increased long-chain polyunsaturated fatty acids (PUFA), ceramide, and some other lipids. In both rats and humans, GSM suppressed the sphingomyelin synthesis pathway. Polar metabolites including threonine, histidine and pipecolic acid were significantly impacted in both rat and human and are potential metabolic biomarkers for the impact of GSM powder supplementation in metabolic osteoarthritis. In conclusion, consumption of GMS powder may provide cartilage protection and reduce joint pain, particularly in women with symptomatic knees. However, no significant impact was observed on circulating inflammatory cytokines, suggesting that GSM may exert anti-inflammatory effects at the microenvironmental rather than systemic level. The bioactive compounds present in GSM powder such as omega-3 PUFA and chondroprotective glycosaminoglycans may be responsible for the beneficial effect through inhibiting the breakdown of type II collagen in cartilage, regulating gut microbe abundance, improving body composition, and the metabolite profile which needs to be investigated in future research.Item Finding the recipe for nutritious and delicious living : understanding the lived experience of weight loss from morbid obesity in New Zealand women : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Critical Health Psychology at Massey University, Albany, New Zealand(Massey University, 2019) Norman, KimberleyObesity is classed as a crisis in New Zealand and across the world. Despite obesity reduction efforts, the obesity rates and failed weight loss attempts continue to be high. Due to the limited research available on the successful obesity reduction experience, this research aimed to understand the lived experience of significant weight loss in New Zealand women from a social constructionist perspective. Using critical discourse analysis, five participants were interviewed using semistructured questions. Each participant had lost between 30 and 105 kilograms each and kept the weight off long term for over one year. Findings indicate that there are identity changes, social experience changes, and issues with disclosure of their ex-morbidly obese identity in new social contexts. Additionally, understanding their ‘why’ was demonstrated to be a significant aspect to their success at long-term significant weight loss. This research indicates that the psychological and social aspects of weight loss are more significant than the biomedical aspect of energy balancing for weight loss. These results highlight that potentially these psychological and social aspects are not addressed within mainstream weight management programmes. This research calls for evaluation of current weight management programmes to ensure comprehensive and appropriate healthcare is being provided for morbidly obese individuals. This would assist with reducing obesity rates and enable the term ‘crisis’ to be disassociated with obesity in New Zealand.Item Being big, becoming small : conversations with Māori women about weight loss surgery : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Social Anthropology at Massey University, Albany, Aotearoa, New Zealand(Massey University, 2019) Joensen, ClareWeight loss surgery is increasingly being used to combat obesity, resulting in recipients becoming more visible in society. This in turn facilitates the normalising of what once would have been considered a radical medical procedure and the proliferation of discourse that more often than not measures success against models of slimness and appearance and underplays the downsides of surgery. Through the use of a narrative phenomenological approach, this research explores the experiences of surgery recipients, specifically Māori women, and asks the question; ‘how does the embodiment of radical change impact on relationality, interiority, conviviality, and ‘being in the world’?’ Through learning from Māori women, this research also explores how being Māori shapes experience both before and after surgery and in doing so, contrasts to literature which frames experiences of indigenous women through a Foucauldian lens of colonialism. I argue that, as Māori, these women are supported by the collective – significantly so – but also have to grapple with and push back negative discourses that leak into their world. I also argue that life post-surgery is entangled with both liminality and potentialities; precarious, unsettled and unsettling, while being simultaneously imbued with hope and focused towards an extending future. Surgery does transform bodies through enabling tremendous weight loss but also transfigures far more than it is designed to do.Item Breakfast intake, habits and body composition in New Zealand European women : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2017) Cullen, Elizabeth MargaretBackground: The rise of obesity and related poor health outcomes is rampant in New Zealand. Dietary factors are key in the aetiology of obesity. One dietary factor with wide reaching implications on health and weight maintenance is breakfast consumption. Breakfast consumption has declined in New Zealand in recent years, and adverse health outcomes have risen concurrently. Breakfast consumption has been associated with lower BMI, improved appetite control, better diet quality, and more stable glycaemia. Objective: The aim of this study was to describe and compare reported and observed breakfast consumption between obese and normal weight New Zealand European women aged 18-45 years, living in Auckland, New Zealand. Methods: In a cross-sectional study, healthy women (n=75 normal BMI, n=82 obese BMI) completed a 5-day food record, an observed ad libitum buffet breakfast assessment and body composition measurements. Nutrient intake, food choices and behavioural aspects, including pace of eating and meal skipping data were obtained and analysed. Results: More normal BMI women (n=69; 84.1%) than obese BMI women (n=56; 74.6%) consumed breakfast daily. Obese BMI women consumed significantly more energy at the observed breakfast (1915 ± 868 kJ) than at the recorded breakfast (1431 ± 690kJ, p<0.001); however neither BMI group met one third of estimated energy requirements at either breakfast occasion. Carbohydrate consumption was lower than recommended (AMDR: 45-65%) in both groups in the recorded breakfast (40.7% and 42.6%; normal BMI and obese BMI respectively), whereas total fat consumption was higher than recommended (AMDR: 20-35%) (36.5% and 35.9% respectively). Protein consumption was within AMDR recommendations (15-25%) for both groups in the recorded breakfast (16.3% and 17.5%) but not in the observed breakfast, (13.0% and 14.0%), obese BMI and normal BMI respectively. Foods with the greatest contribution to energy at the observed breakfast for obese BMI women were discretionary items (fats, cake and biscuits), compared with sweetened cereals, nuts and seeds for normal BMI women. Having a faster pace of eating and consuming foods with a higher energy density significantly increased the likelihood of falling into the obese BMI category (b=3.11, p=0.016; b=1.35, p=0.042 respectively). Conclusions: Consuming a breakfast, particularly one that contains whole grains, fruits and low-fat dairy products, and minimising discretionary items could enable women to more closely meet dietary recommendations, and as a result, improve health outcomes. Key words: breakfast, obesity, energy intake, appetite, pace of eatingItem Exploring body composition and metabolic health amongst NZ European, Pacific Island and Māori women participating in the women's EXPLORE study : a thesis completed as part of the requirements for Master of Science in Nutrition and Dietetics at Massey University, Albany Campus, Auckland, New Zealand(Massey University, 2017) Whitford, AmandaBackground: In New Zealand, 31.6% of adults are obese. Significant ethnic health inequalities exist; Pacific Islanders and Māori have the highest rates. Objectives: To investigate the body composition and metabolic health profiles of healthy NZ European, Pacific and Māori women participating in the women’s EXPLORE study. Methods/Design: Cross sectional design investigating 233 European, 91 Pacific and 84 Māori women. Different body mass index (BMI) and body fat % (BF%) defined body composition profiles were analysed for anthropometric measurements, body fat location, and metabolic biomarkers. Results: Obese (BF%) Māori women had higher android fat mass than obese (BF%) Europeans (2.53kg vs 2.23kg) with no difference in waist circumference (WC). Non-obese (BMI) Māori had higher WC than non-obese (BMI) NZ Europeans (78cm vs 73.5cm) with android fat differences. Regardless of body composition grouping, no ethnic differences were found for BF%. Obese Pacific women had higher HOMA-IR (5.12-5.45) and insulin (24.28- 23.28mU/L) than obese Europeans (2.10-2.61 and 10.07-11.24mU/L respectively), as did obese Māori (3.64-4.35 and 16.76-19.41mU/L respectively). Body composition measures with highest sensitivity across all biomarkers assessed were BF% ≥30 for Europeans, both BF% ≥30 and BMI ≥25 for Pacific, and BMI ≥25 for Māori. Conclusion: Māori and Pacific women had significantly higher glucose metabolism markers than NZ Europeans despite no differences in BF%. When comparing Māori to NZ Europeans, a higher WC was not always related to a higher android fat mass or vice versa, suggesting that WC may not be an accurate representation of abdominal fat for Māori. In spite of ethnic differences, BF% ≥30 and BMI ≥25 appear most sensitive to detect high biomarkers compared to abdominal measurements.Item Bounded bodies : the everyday clothing practices of larger women : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Sociology, Massey University, Albany, New Zealand(Massey University, 2011) Cain, Trudie MelissaThe field of dress studies currently emphasises dress as an embodied practice, but surprisingly scant attention has been awarded to the fat fleshy clothed body. This thesis addresses this lacuna, and is concerned with the everyday clothing practices of larger women. Theoretically, I draw on and integrate literature from material culture studies, as well as from the politics of fatness, the latter serving as the socio-cultural foundation for the research. In doing so, my research contributes to and extends the current body of literature that considers dress as material culture. This thesis offers further extension of the field through the methodological focus of the research. Employing multiple inter-related methods allows the complex social processes of larger women?s clothing practices to be revealed. Often these processes are embedded within the seemingly habitual, mundane, everyday things that people do while operating within a particular social milieu. With this in mind, I employ an ethnographically-inspired, multiple-method research methodology to explore the everyday clothing practices of ten self-identified larger women in Auckland, New Zealand. The five research methods involve asking the participants to: keep a clothing journal; rummage through their wardrobe with me; go shopping for clothes with me; take photographs of their „clothed worlds?; and take part in a group discussion with other participants. Employing an integrative analytic process, I reveal the numerous ways that larger women enact their agency at the same time as being bound within structures of socio-cultural corporeal and clothing norms. My research shows that the boundaries between fleshy fat bodies, clothing and culturally-bound geographical spaces are experienced by my participants as tension-filled and ambiguous. Ultimately, they are perpetually provisional; the boundaries fixed yet potentially permeable. Using space as an organisational and analytic framework, my research explores the boundaries of four distinct spaces: spaces of consumption; public spaces beyond consumption; private spaces; and the spaces between fat bodies and clothes. I argue that, despite structural barriers that create „fat? bodies as „matter out of place? and, as such, beyond the bounds of possibility, larger women enact agency in creative and resourceful ways. In doing so, they challenge the boundaries of dominant Western constructions of fatness and ultimately, transform places of exclusion into spaces of inclusion.Item Living large : the experiences of large-bodied women when accessing general practice services : a thesis presented in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing) at Massey University, Palmerston North, New Zealand(Massey University, 2011) Russell, NicolaThe ‘obesity epidemic’ of the past two decades has resulted in numerous studies reporting higher levels of stigma and discrimination experienced by obese/overweight women, both within the health care system and society in the main. Despite general practice being the most utilised point of access for health care services, there has been very little international or national exploration of the experiences of large-bodied women accessing these services. Utilising a qualitative, descriptive research design, this post-structuralist feminist study has enabled a group of large-bodied women to express their stories of accessing general practice services. Eight self identified large-bodied women volunteered to participate in semi-structured face-to-face interviews. Thematic analysis identified seven themes: Early experiences of body perception, Confronting social stereotypes, Contending with feminine beauty ideals, Perceptions of health, Pursuing health, Respecting the whole person and Feeling safe to access care. The women in this study articulated broader interpretations of health and well-being than those teachings reproduced within dominant bio-medical and social discourses of obesity. When these women’s personal context, beliefs and values are silenced by the health care provider, the rhetoric of health care professional claims of patient-centred care has given way to these women experiencing stigmatisation and a sense of ambiguity about general practice services. However, when space is given for multiple interpretations of obesity to exist within the patient-health care provider relationship, these women feel respected, their health needs are satisfied and they are more comfortable to engage in health screening services. Resisting the powerful socio-cultural milieu which supports the superiority of a slim female body as a signifier of both health and beauty presents a challenge for health care professionals to negotiate. I contend however, that giving consideration to the perspectives of large-bodied women and critically reflecting upon one’s own personal beliefs and attitudes about the overweight/obese, presents an opportunity to ensure clinical practice for this population is truly patient-centred.Item A feminist appraisal of the experience of embodied largeness : a challenge for nursing : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, New Zealand(Massey University, 1997) Carryer, Jennifer B.; Carryer, Jennifer B.To be a fat woman is to experience a prolonged, personal battle with the body. The battle is enacted in a social context which is the site of remarkable consensus about the personal culpability of fat people for their bodily largeness; for women in particular the sanctions are especially powerful. In this research nine large women have engaged in a prolonged dialogue about the experience of being 'obese'. In the course of a feminist research endeavour, with a researcher who is similarly positioned, they have both contributed to and gained from a project which illuminates the experience of largeness alongside a critical examination of the discourses which shape body size. This dissertation critiques a dominant medical discourse which ignores conflicting research and supports a narrow view of health by simplistically linking increased body weight with poor health outcomes. Such is the hegemonic power of medicine that an examination of both nursing and popular literature in the area of study, reveals widespread acceptance of the notion that to be thin is to be healthy and virtuous, and to be fat is to be unhealthy and morally deficient. For nursing, the unquestioning obedience to medical teaching, raises serious questions about nursing's autonomy and separateness from medicine. Nurses have perpetuated an unhelpful and reductionist approach to their care of large women , in direct contradiction to nursing's supposed allegiance to a holistic approach to health care. Current strictures on women's body size and continued support for reduction dieting leave large women with the choice between two binary opposites; to diet or not to diet. Either choice has consequences which are traumatic and not health promoting. The experience of largeness emerges as a socially constructed disability in which many women are denied the opportunity to be fully healthy.Item (D)-graded female bodies and the emergence of weight-loss surgery : a discourse analysis of narratives relating a precarious moment in the medicalisation of women's weight : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Health Sciences at Massey University, Palmerston North, New Zealand(Massey University, 2010) Westwater-Hobbs, MargretWithin the last century, as large bodies came to be regarded as unattractive and deviant, the project of appearance has become entangled in projects of health. In the assumed legitimacy of discourses linking overweight with ill health, alternative understandings of large body size and the possibilities for large-body health have been effectively silenced. Within New Zealand’s gendered social order, women in particular experience and enact surveillance and criticism of their bodies from an early age. Those whose bodies do not fit within prescribed norms for health and beauty become (D)-graded large bodies, especially vulnerable to discriminatory practices within consultations and legitimate objects for practice, treatment and experimentation. In the failure of diets and pharmaceuticals to produce ‘normal’ weight over the long term, some women considered weight-loss surgery (WLS) options. This thesis traced the spread of WLS within New Zealand and the conspicuous creep of cultural prescription, morality and trade - including Direct-to-Consumer advertising - driving that proliferation. In this thesis, I attend to the problematics of surgeons trading in and promoting experimental and new procedures, especially where these were performed as early-on procedures in private medical arenas. A range of narratives in this account record some of the unexpected, unpredictable, and often adverse outcomes experienced by some WLS patients: Elective weight-loss surgeries were risky procedures and accompanied by significant iatrogenic injuries when surgeons had minimal experience, training and proctoring. WLS patients experienced technically induced eating disorders and multiple surgical and medical interventions, often for little or no long-term weight loss. Informed consent was a legalised ritual that did not protect patients. In this reflexive, qualitative research project, reports, case material, emails and interviews with 14 doctors and 22 patients were analysed with respect to the power/knowledge relations implicit in them. This critical-health analysis challenges any inevitability of benefits in the wider application of WLS. WLS consultation and practice requires attention to the cultural and trade insistences that limit the parameters of weight/health and, secondly, to the development of respectful practices of communication and consultation based within a relational ethics of care.