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When Maria began feeling unwell during the fall of 2020, she immediately went to a COVID-19 test centre for what she assumed would be a confirmation that she had contracted the virus.

Though her COVID test came back negative, Maria (not her real name) did get a positive result as well—she was pregnant. A few days later, she phoned her family physician’s office to discuss her options. During the call, her doctor told her she would not provide the necessary medications to end her pregnancy. The nearest hospital providing surgical abortions was nearly three hours’ drive away.

“It was a really hard knock,” she says. “I had thought, ‘I have a female doctor, this will be no problem.’ She told me that while she supported my choice, she didn’t feel ‘ethically good’ about prescribing it. I was panicking and scared, and I didn’t know what to do.”

While her doctor was willing to provide a referral, she “didn’t know who to send it to,” says Maria.

Although abortion care is available in every Canadian province, the distribution of centres providing medical and surgical terminations of pregnancy are not evenly spread, with clustering of access in city centres. At the onset of the pandemic, leaders across the country quickly affirmed abortion as an essential service. However, ongoing travel restrictions, increased vulnerability of marginalized populations and rising domestic violence raised concerns that seeking care may be more difficult than ever, even with commitments by providers to remain open.

In response, the Society of Obstetricians and Gynecologists of Canada mobilized to produce the Canadian Protocol for the Provision of Medical Abortion via Telemedicine, laying out instructions for “no-touch” or “low-touch” medical abortions, in which as much care as possible is offered without patient and provider meeting face-to-face. For an ideal patient with an early pregnancy, this could eliminate the need for ultrasounds or laboratory testing, requiring only confirmation with two urine pregnancy tests. Patients could pick up their abortive medication, Mifegymiso, from their pharmacy of choice, without ever setting foot in a hospital.

For Julie Thorne, staff physician at Mount Sinai and Women’s College Hospitals in Toronto and co-author of the protocol, that represented an acceleration in the direction her field was already taking.

“The COVID pandemic allowed an interesting opportunity for us to take existing evidence on safety and efficacy (of no-touch abortions) and say, now we have an urgent reason to put this into practice,” says Thorne.

Women’s College Hospital was at the forefront of this movement, integrating telemedicine in abortion care within a few months of the first wave.

“We were all very cautious in the beginning, but as time went on, people began to see that the success of this approach is similar to the success of seeing (patients) in person,” she says. “We saw that patients can give reliable histories if you take the time to ask the questions, and that we can reliably use their answers to determine whether someone might need an ultrasound, further lab tests or a visit to a clinic. And we became more confident.”

Thorne’s stance is supported by global evidence as abortion providers have doubled down on telemedicine as a solution to pandemic-related barriers to access. A recently published cohort study of more than 50,000 women in the United Kingdom found no difference in treatment success or serious adverse events between those seen through a traditional, in-person approach with ultrasounds and those seen via telemedicine. Mean time from referral to treatment was 4.2 days shorter in the telemedicine group. Indeed, over the past several decades, advocacy organizations like Women on Web have provided international access to abortive pills through the mail using only virtual consultations, an approach deemed to be safe and effective by the World Health Organization.

As restrictions placed on clinical medicine across Canada ease, we are now faced with a new question in the abortion debate: Should we take a step backward and restrict abortion care once more to our tried-and-true, in-person assessments, or embrace telemedicine and contactless care as a new normal?

For Sarah Warden, lead physician for the medical abortion program at the Bay Centre for Birth Control at Women’s College Hospital in Toronto, the answer is clear. “We have always felt that (no-touch abortion) had applications beyond the pandemic,” she says. “And at this point, more of our patients are accessing it due to geographical concerns than concerns over the pandemic.”

In reviewing the data from the past 12 months, Warden says she is confident of the safety and efficacy of the treatment, sharing that they have had only one failed abortion (a patient for whom medical management was insufficient and who ultimately required a surgical abortion), and no serious adverse events in more than a year of providing no-touch abortions.

Erika Feuerstein, a family physician and abortion provider in Toronto, agrees. Although her clinic does not offer telemedicine for abortion at this time, she says telemedicine would offer enhanced access to care for many patients.

“I think the biggest benefit is to be able to expand to provide service where it’s not readily available,” she says. “Virtual care is a whole new realm to provide equity in access to abortion.”

However, she says that no-touch abortion should not entirely replace in-person protocols. “Telemedicine is an amazing add-on, but abortion is a very personal experience and for some people, virtual won’t work,” Feuerstein. “What might be safe for one person might not be safe for another, and many of our patients do want to come into the clinic to be seen.”

For patients outside of urban centres, or whose social or financial circumstances make attending clinic appointments challenging, contactless care can make all the difference. However, the novelty of the no-touch approach means not many providers – much less patients – know this is an option. Several weeks after her initial visit with her family physician, Maria was able to access a surgical abortion at a hospital. She was not offered a no-touch option.

“If someone had been able to just prescribe me the pills over the phone, I would definitely have chosen that,” she says. “I would have been able to be at home and have my partner there. And I wouldn’t have had to go through weeks of knowing that I was pregnant and having to struggle with the decision over and over again.”

Maria was able to make the six-hour round trip to the hospital in the same day for her initial assessment, but when it came time for her procedure a week later, she arrived the night before and stayed in a hotel nearby. Her partner made the trip with her for support, but also because she was too ill with morning sickness to safely drive on her own. Both were able to secure time off and follow the hospital’s pre-operative quarantine and COVID test policies prior to arrival.

“I think of a teenager, or someone who couldn’t take time off work, or pay for the trip, or have support from a partner or family, what would you do? What would you do? I’m so lucky,” says Maria.

With ample support from providers and patients, the case for telemedicine’s role in termination of pregnancy seems strong. Yet there are still challenges to be overcome in establishing the protocol as an option outside of the pandemic.

Mifegymiso is not readily available at all pharmacies, and physicians may have difficulty prescribing medication for out-of-province patients. Smaller abortion centres may face an up-front cost in establishing the internal infrastructure required to confidentially share consent forms and other medical documentation between patients and their EMR. In Ontario, there is no equivalent virtual billing code for in-person abortion counselling, meaning primary care physicians may not be adequately remunerated for the comprehensive care they are providing.

Still, Thorne says that the temporary provisions in place can not only be made permanent but built upon. She calls for national data reporting from sites offering no-touch abortions to confirm safety and effectiveness, and for continued advocacy to support the use of telemedicine in abortion care at provincial and federal government levels.

“Virtual care is going to change the landscape of mainstream care and improve equity everywhere,” she says. “Ultimately, we need to move away from thinking of telemedicine as a pandemic-centred measure and start thinking of it as a patient-centred measure.”

This story originally appeared on Healthy Debate.

Next: The Forces That Shape Health Care for Black Women

(Also, learn the many health benefits of rutabaga.)

The depths of winter don’t exactly bring cooking enthusiasm. Juicy stone fruits and perfectly ripe tomatoes disappeared once the days grew shorter, and the turkey-packed excitement of the holidays has come and gone. It’s times like these when you need to dig deeper for cooking inspiration. Luckily, there are delicious foods just below the surface of the earth. This winter, try rutabagas, a versatile and overlooked vegetable.

First discovered in Scandinavia, rutabagas are hardy root vegetables that are likely a hybrid between a turnip and a cabbage. They’re sometimes called Swedish turnips, or Swedes for short, a nod to their Scandi origin. Although related to the turnip, rutabagas have a different flavour profile: They’re sweeter and lack the same bitter, peppery bite. Rutabagas also have golden yellow flesh instead of a white interior.

Rutabagas like cool weather, as their sweet flavour is enhanced by exposure to frosts. The vegetable also takes well to storage in cool cellar temperatures, which made them a reliable food source during the winter months before the invention of refrigeration. You’ll find the root veg in season from as early as November, when they’re harvested, through March.

Rutabaga nutrition facts

Rutabagas are lower in carbohydrates than other starchy vegetables like potatoes or squash. In fact, they have about half as many carbs per serving as potatoes and are a good source of fibre. Fibrous foods allow for a slower release of sugars. This reduces large spikes in blood sugar levels, which helps control hunger hormones and prevents the development of chronic diseases like type 2 diabetes and cardiovascular disease over time. Plus, they’re high in important nutrients like vitamin C, potassium and magnesium, which play roles in immune function and nerve transmission.

Like other members of the brassica family, such as Brussels sprouts, cauliflower and cabbage, rutabagas contain bioactive compounds called glucosinolates. As antioxidants, glucosinolates shut down the action of carcinogens and clear out pesky free radicals that can cause damage to cells. Glucosinolates also fight inflammation in the body by setting off a cascade of activity, including activating detoxification enzymes in the liver and triggering immune functions, all of which decreases the risk of developing cancer and other chronic diseases. Some glucosinolates are even capable of limiting and preventing tumour growth. Long story short, eat your brassicas! They’re good for you.

What to look for when buying rutabaga

Rutabagas have a craggy surface, but when you’re shopping, look for ones that have an undamaged peel and feel firm. Avoid any that are woody or dull-looking. Rutabaga peels are often given a waxy coating (which is removed when you peel the veggie) to help them keep longer, so don’t be alarmed if they feel a bit sticky at the grocery store. They’ll keep for up to three months when stored in a cool, dry place or in the refrigerator.

How to cook rutabaga

An easy sub for other starches, rutabagas can be used anywhere you would a potato. Slice them into sticks or wedges and roast them until crisp. Boil them and “mix and mash” with other root vegetables like squash and sweet potatoes to create a delicious and healthy alternative to mashed potatoes. Peel and grate rutabagas to create a lower-carbohydrate version of latkes or fritters. If you’re craving something sweet, stir grated rutabagas into muffins to add fibre and moistness. Serve rutabagas as a side dish with steak, pork or lamb—the vitamin C in rutabagas will help you absorb the meat’s iron more effectively.

Try using them in puréed soups to bring silkiness and body without the milk or cream. And rutabagas can go beyond your standard root vegetable: They also perform exceptionally well as veggie noodles made with a spiralizer, where their texture is perfect for creating tender, al dente strands that don’t turn to mush like other vegetables (ahem, zucchini). With a little creativity, rutabagas quickly become a kitchen workhorse. This winter, branch out from potatoes and carrots and delve into some of the more rugged-looking tubers and roots—they deserve the love and a spot on your table too.

Laura Jeha is a registered dietitian, nutrition counsellor and recipe developer. Find out more at ahealthyappetite.ca.

Next: Get the recipe for skillet shepherd’s pie with rutabaga mash.

Passports usually evoke images of world travel, opening the door to new and exciting adventures. These days, during the ongoing COVID-19 pandemic, passports have taken on a new meaning.

With more than 83 percent of Canadians fully vaccinated, individual provinces and the federal government have implemented proof of vaccination policies, also being called vaccine passports, to enable Canadians to return to some semblance of normal life. Across the country, verified vaccine passports allow fully vaccinated Canadians to reenter non-essential spaces, such as movie theatres, sports arenas and restaurants. As a result, vaccine passports are now as essential as grabbing your wallet, jacket and mask before heading out the door.

To make sure you always have your verifiable COVID-19 vaccination information at the ready, here’s how to save your vaccine passport on an iPhone—and how to keep it easily accessible.

Does the new federal COVID passport work for iPhones users?

Proof of vaccination has varied from showing the printed or emailed records received after a vaccine appointment to physical vaccine cards and more recently QR codes. In late October, the federal government announced new standardized proof of vaccination in the form of a downloadable QR code.

All Canadian provinces and territories are now following the SMART Health Cards Standards, a digital method of presenting verified health records created in response to COVID-19. It can be downloaded on a mobile device, computer or mobile wallet for iPhone users, and it’s designed to be globally accessible. Individuals outside of Canada, or who were vaccinated outside of Canada, can download and access their health records on the Apple’s Health and Wallet apps as long as their vaccine provider supports the SMART Health Cards standard.

How to add COVID-19 vaccine records to the Apple Health app

These steps are only applicable for devices using iOS 15 or later so before starting, make sure your software has been updated.

Access your vaccine records online. With the Canadian COVID-19 proof of vaccination plan, Canadians can access their vaccine history via the Government of Canada’s website. This will require your provincial health card and some personal information, such as your date of birth.
Print your QR code or download it to your desktop. At this stage, your vaccination records can also be stored in your iPhone files as a PDF.
On your iPhone, open the photo app and point the camera at the QR code. The phone should scan the code prompting a link to appear.
Click the link and follow the prompts to save the records to Apple Health. These records will be stored in the “health records” section of the Health app under “Immunizations.”

These records are now stored and ready to present at restaurants, gyms and other venues, along with personal identification.

How to add COVID-19 vaccine records to Apple Wallet

In order to add a vaccine passport to Apple Wallet on iPhone or iPod touch, devices must be updated to iOS 15.1. The vaccination card will detail your full name, type of COVID-19 vaccines received, the date of each dose, where it was issued and a QR code. None of these details will be accessible without the use of Face ID, Touch ID or a passcode and the vaccination card cannot be shared with other devices. When presented at a public venue, the QR code can be scanned to verify vaccination status.

If you have previously added your vaccination record to the Health app, open the Health app, tap “summary” and there will be a prompt under the vaccination record to add this record to your Apple Wallet. One tap is all it takes.
If you are downloading your QR code for the first time, access your vaccine records via the Government of Canada’s website.
Open the photo app and position the camera as if to take a photo of your QR code. Your iPhone will recognize the QR code and show a Health app notification, offering an option to add these records to Wallet and Health apps. Follow the prompts to add the record to both apps.

All vaccination cards will be grouped together in Wallet and there is no limit to how many vaccine passports can be stored in the app. These vaccination records can be deleted out of Wallet at any time, but if deleted, will still exist in the Health app. Both records need to be deleted separately.

In the event that vaccination records need to be updated or changed, for instance after receiving a booster shot, download the new updated vaccination records to the Heath and Wallet apps. Records will not update automatically.

For more detailed info on storing health records and troubleshooting, see Apple’s COVID vaccine passport support page.

Next: Could Protection from COVID Soon Be Available Through a Nasal Spray?

Pimples are like low-rise jeans—you think you left them in the past, but they make a sudden and unpleasant comeback 15 years later. Unlike low-rise jeans, however, I’ve found a way to make pimples a little more tolerable.

When a super red pimple emerges, I don’t squeeze, pop or poke it anymore. Impressed? Me too. It’s because I’ve learned a much more effective method for handling it, involving a special tool in my freezer—a shot glass full of ice.

My pimple-fighting journey began the first week of the pandemic. Stress had caused my skin to resemble a pizza pie, so I frantically hopped on a video call with New York-based aesthetician Sofie Pavitt to figure out what to do. She gave me a strict new skin care routine that included both acne- and acne-scar-fighting ingredients, as well as the instruction to apply ice to my blemishes for a few seconds in the morning and again at night. Pavitt says ice can be a fast way to soothe inflammation, reducing the size and redness of pimples, and making it an integral (and cost-effective) part of a pimple-fighting regimen. Since then, ice has become my low-tech version of a new beauty trend based on cryotherapy.

You might’ve heard of cryotherapy, a super cold body treatment offered in professional settings, where you stand naked in a “chamber” of liquid nitrogen (also known as dry ice) that produces a torturously frosty temperature for about three minutes—or until you can no longer bear it. The supposed reward is reduced inflammation, increased mind clarity and pain relief. The benefits don’t stop there: Cryotherapy can even help treat anxiety and depression in the short term, as it can activate the part of the brain that plays a role in motivation, emotion, and stress and pain responses by triggering the release of beta-endorphin hormones that offer a sense of elation.

Although cryotherapy has been Instagrammed by celebs lately, it’s not new. It was first used in a clinical setting in 1970s Japan, where a professor successfully treated rheumatism with extreme cold-water body immersion. And Danes have long been fond of winter swimming followed by a sauna for a reputed boost in energy and feel-good endorphins.

In Canada and the United States, cryotherapy is commonly used in sports medicine. Studies show cold immersion therapy aids in injury recovery and the prevention of exercise-induced soreness. And the cold smoke dermatologists use to freeze off warts and cancerous cells? That’s cryotherapy too. Now, it has a whole new purpose in a beauty treatment, even being dubbed “frotox” for its skin-tightening benefits.

Fans tout cryotherapy’s anti-aging, soothing and de-puffing abilities. Often added on to a conventional facial, the treatment involves blowing ice-cold air across the face to penetrate the pores and trigger a skin-tightening sensation. While more studies need to be done on its anti-aging benefits (there are claims cryotherapy can aid cellular renewal and collagen production), one study showed it can reduce dermatitis symptoms.

Today, many brands are taking advantage of the skin-improving benefits of cold therapy, launching cryotherapy-inspired beauty products for home use. There are iced glass sticks, eye creams with cooling stainless steel applicators, cooling masks, cooling cleansers and chilled gua sha wands, all promising to soothe and regenerate the face.

Do they actually work? “Any form of cryotherapy will provide some benefit,” says Dr. Dendy Engelman, celebrity dermatologist and cosmetic surgeon in New York City who partnered with Charlotte Tilbury for the release of the brand’s new cryotherapy products. While results can be more dramatic after a professional treatment, DIY alternatives still do the trick. With cryotherapy, results are immediate, says Engelman, as skin becomes instantly tighter, de-puffed and less red.

The main allure of these cryo-inspired beauty tools might just be their convenience. “Anyone can quickly reap the benefits of simple cryotherapy at home,” says Engelman. “Holding a frozen spoon to your undereye area will help with de-puffing, and a beauty tool that’s designed for cryotherapy can be used all over the face to not only deliver cold to the skin, but also to massage, contour and stimulate blood flow.” The process can also boost the efficacy of your skin care products by drawing them deeper into the skin as blood vessels contract, she says.

While such chilly beauty tools can be incorporated into an everyday beauty routine, one of the best times to consider using them is after a skin procedure (such as a laser treatment) to soothe swelling and redness, says Dr. Marni Wiseman, a dermatologist at Winnipeg’s Skinwise Dermatology clinic. Plus, the cold can help alleviate any discomfort caused by the procedure.

But icer beware: Wiseman cautions against using an ice cube and suggests reaching for a chilled product, like a stainless-steel applicator, as they’re safer to use. “Applying ice directly to the skin can actually cause freezing of the skin that’s equated to frostbite,” she says. If you choose to use ice or an ice-focused product, like ice globes, Wiseman says to check in with your body’s warning signs. If it hurts, stop—don’t overdo it.

I have overdone it. Turns out, pressing a shot glass full of ice on a blemish for more than 10 seconds gave me a red bump that took days to resolve. My self-cryo treatment now lasts just five to 10 seconds per blemish, with the occasional midday sesh for exceptionally bad pimples. Now excuse me, I have an appointment at my freezer.

what is cryotherapy | Iam Cryotherapy Products

Ice, Ice Baby: Try Cryotherapy with These Picks

Have 10 minutes? Apply this cryo- and acupressure-inspired reusable mask, that purports to de-puff and sculpt the face, shrink the appearance of pores, tighten and smooth the skin, and offer an all-around reinvigorated look.
Charlotte Tilbury Cryo Recovery Mask, $76, charlottetilbury.com

This eye serum boasts a light caffeine-infused formula, making it the perfect wake-up call for tired eyes. Similar to the Estée Lauder product, it comes with a cooling metal applicator that can be used to massage and de-puff the eye area.
Charlotte Tilbury Cryo-Recovery Eye Serum, $78, charlottetilbury.com

This super nourishing product is called a nighttime eye cream, but it’s so much more. Apply the formula with the stainless steel applicator all around the eyes to reduce the look of fine lines, de-puff the eye area and deliver a refreshing, cooling effect.
Estée Lauder Advanced Night Repair Eye Concentrate Matrix, $98, esteelauder.ca

These sticks offer similar benefits as a gua sha tool—they aid in lymphatic drainage and sculpt the face—while also cooling, soothing and de-puffing your skin.
Skinbyvee Gua Sha Cryo Sticks, $150, skinbyvee.com

Start your day with this ice-cold cleanser that’ll make you look and feel bright-eyed and bushy-tailed. It’ll wash away grime and cleanse your pores, and the addition of alpha hydroxy acid will help minimize the look of fine lines and wrinkles.
Boscia Cryosea Firming Icy-Cold Cleanser, $42, shoppersdrugmart.ca

Move over, ice cream: Slip these globes in the freezer and once the blue liquid freezes, swipe them across your face to decrease puffiness, increase blood circulation, provide lymphatic drainage, improve skin texture and calm redness.
Skin Gear Ice Globes, $42 USD, shopskingear.com

Next: Layering Skin Care Products—Am I Doing It Right?

On my quest to be more environmentally friendly, I’ve cut out plastic water bottles, adjusted what I eat to include more plant-based foods and avoided driving around the city. But I haven’t yet found eco-friendly swaps in the bedroom. Turns out, disposing of a sex toy might actually be more difficult than kicking an ex to the curb.

Sex toys are typically made up of a mixture of a few different plastics (some recyclable, some not), and a lot of them have electronic components and batteries that count as e-waste. Most municipal waste facilities in North America won’t even accept used sex toys, on account of them being a potential biohazard. So our discarded sex toys go to the place where all toxic exes belong: the dump. There, they leak chemicals into the soil and water.

On top of the environmental harm, sex toys can negatively affect human health: There are no rules when it comes to health regulations. “It’s hard to regulate the kind of materials sex toy manufacturers use, and they don’t really explain what they put in the toys,” says Isabelle Deslauriers, founder and CEO of Désirables, a Montreal-based brand that creates safe and eco-friendly sex toys made of porcelain. The lack of rules means manufacturers aren’t transparent about what their products are made from and whether they’re body safe.

The materials in some sex toys contain chemicals that can enter your bloodstream—especially if you’re using them internally. Exposure to phthalates, a group of chemicals commonly used in sex toys that make plastics flexible, has been linked to changes in sex hormone levels, reduced fertility, preterm birth and worsening allergy and asthma symptoms. One type of phthalate, DEHP, was banned in the use of cosmetics, medical devices and children’s toys in Canada in 1994, but Health Canada hasn’t banned DEHP or any phthalates in sex toys.

Thanks to the stigma attached, consumers might be buying sex toys that are bad for their bodies and for the environment, Deslauriers says. Because the topic is still somewhat taboo, people don’t want to think about it deeply, she says. They may avoid doing thorough research and asking questions, which leads to another source of confusion: the fact that harmful products are available in stores. “Low-quality sex toys are sold over the counter, and nothing is checked, even in drugstores,” says Deslauriers. People wrongly assume that if it’s on the shelf in your pharmacy, then it must be regulated and safe, she says.

Luckily, Deslauriers says, things are changing for the better. As consumers become more empowered and the stigma associated with sexuality and sex toys is challenged, more people are doing research into what’s good for their health. Sex toy manufacturers have taken note, and more and more of them are ditching toxic ingredients. “In the past 10 or so years we’ve been on the market, we’ve seen a lot more companies doing better,” she says.

All that considered, I tried the Gaia Eco, an affordable, body-safe, sustainable vibrator. Branded as the world’s first biodegradable bullet sex toy, Gaia is made of a plant-based bioplastic called BioFeel. According to Blush, the brand that produces Gaia, BioFeel will break down within 90 days at a commercial compost factory. It’s also recyclable in select facilities.

I enjoyed using Gaia—it’s tiny but still delivers a strong vibration. I also appreciated how discreet it is (about the same size as a tube of lipstick) and how easy it is to clean (in the sink with some soap; you shouldn’t boil it since it’s got electronic parts). Gaia is also super easy to use: Hold down the button to start the good vibes, and click to switch speeds (there are 10 modes in total, including some that pulsate). For something so tiny, I found it created a big sensation. Though our relationship has only just begun, I’m hoping Gaia and I will go steady and I can bid adieu to unsustainable and potentially unhealthy toys.

Another option is LoveHoney’s Womanizer Premium Eco Smart Silence Clitoral Stimulator, which is completely recyclable and has not been tested on animals.

Next: Sex Toys Don’t Need Genders

“Fat doesn’t fly.”

Tara McDougall, a former competitive figure skater who has been coaching young skaters since 1992, remembers hearing a high-level American skating coach casually drop this statement. It was during his presentation at a seminar for competitive skaters about 12 years ago and he clearly thought nothing of making this sort of body-shaming comment to a “packed room of skaters, coaches and parents,” she says. Worse, “some parents and skaters accepted that as something that needed to be addressed.”

It was a startling throwback to her own days as a competitive skater in the ’80s. She didn’t experience the overt body shaming that many young skaters did, but the attitude that thinner was better was hard to avoid.

“I had more of an athletic physique, so while there was no direct pressure to be thinner, you felt it,” she says. “What surrounded me was subtle. I often competed against very slim, petite teenage girls. Now I appreciate and love having a fit body, but back then it felt like they had the advantage, as they were ‘pretty’ and had nice lines on the ice. You felt that those with slimmer bodies were rewarded by the slimmest of margins.”

That’s entirely possible. Figure skating is an aesthetic sport; as in gymnastics and diving, judges for these types of sports evaluate an athlete’s performance based on their appearance and artistry as well as their technical skill, which means preconceived notions of what is “pretty” can skew the results. According to a 2020 study published in the Journal of Eating Disorders, “these sports are [also] considered lean sports due to the pervasive belief that a lower body weight results in more favorable judging.”

That’s why it’s common for coaches to tell their athletes they’re “too heavy” to perform the jumps that yield the highest scores during competitions, or to demand they follow restrictive diets. Rinkside conversations between parents might revolve around skaters’ body measurements, and skaters themselves regularly compare their bodies to their peers’.McDougall remembers her competitive program instituting weigh-ins, though the parents soon put a stop to that. In fact, she considers herself lucky to have been surrounded by supportive coaches, friends and family who encouraged her to use her strengths to her advantage. “I skated in more of a dramatic fashion and got really into the music, which I learned was also appreciated,” she says. “I was a shyer skater, but my choreographer Kevin Cottam saw my potential. [And my] scores, friends, other skaters’ parents and strangers also expressed this.Even when the jumps didn’t work, they still enjoyed watching me skate.”

She aims to be just as supportive in her own coaching. Now a national-level skating coach at Minto Skating Club and personal fitness trainer at Rideau Sports Centre in Ottawa, she believes it’s important to treat skaters sensitively—especially as they enter puberty.

“Body image always comes into play. Young girls experience a lot of changes in their bodies and often that can bring struggles with skating. It is important to have patience and help them to understand what is happening and that they will adapt,” she says. “I never talk about body weight. It is important to simply be fit for one’s natural design.”

Unfortunately, McDougall’s experience as a skater was all too rare—and her style of coaching, while far more common now, hasn’t totally replaced the previous approaches. In fact, when it comes to body image, not enough has changed in organized sports in general. This is particularly true in the aesthetic sports, like figure skating, which require technical skill and artistry as much as power, speed, endurance and flexibility. Coaches, members of an athlete’s team, judges, parents and other adults often still focus on weight and appearance, creating a body shaming culture in the name of elite performance. This focus has serious, long-term effects on female athletes’ mental and physical health—and it creates a system that is long overdue for change.

According to a study of 850 female high school athletes, which was published in the Journal of Orthopaedic & Sports Physical Therapy in 2011, disordered eating was more prevalent among aesthetic athletes than those who played other types of sports. What’s more, young female athletes who reported disordered eating were more likely to experience injuries than those who reported healthy eating behaviours—and aesthetic athletes in particular had the highest percentage of self-reported injuries, at 78 percent. A 2021 study by University of Toronto researchers in the faculty of kinesiology and physical education concluded that female athletes in aesthetic sports experience degrading comments and other forms of body shaming that are equal to emotional abuse and can cause long-lasting harm.

“It seems like it doesn’t matter which particular aesthetic sport and which era, there always seems to be a focus on your body. It’s [not just] how well you can perform but how good it looks,” says lead author Erin Willson, a PhD candidate at U of T and a former Olympic synchronized swimmer.

Willson’s study focused on the experiences of eight retired athletes, five of them former Olympians. All eight reported experiencing negative comments, body monitoring and extreme food and water restrictions throughout their careers, which led to eating disorders, poor performance and decreased enjoyment in their sport. One athlete said her coach put her on “ridiculous” diets, including instructing her to eat only watermelon on the weekends. Most talked about constant surveillance, whether that was “being weighed all the time, having your weight called out, or even seeing your teammates having their bodies picked apart or their weight determining their spot on the team,” Willson says. All of the athletes in the study reported experiencing symptoms that resembled those of post-traumatic stress disorder; they all had to seek out counselling or other mental health care.

This sounds very familiar to former Olympian Elizabeth Manley. Once considered “Canada’s sweetheart,” Manley won more than 50 national and international medals, including a silver at the 1988 World Figure Skating Championships in Budapest and a silver medal at the 1988 Olympic Winter Games in Calgary. She was also one of the first Canadian athletes to publicly address her mental health—in 1983, when she was just 18, she was dealing with severe anxiety and depression. She lost all her hair, gained 50 pounds of water weight and began experiencing suicidal ideation. She had to withdraw from training, and she thought her life was over. Looking back, she says that her mental health struggles weren’t only about body image, but they did play a role.

“I’m only four foot, 11 and a half inches, and I’m very muscular,” she says. “I was constantly criticized and harassed about my weight.”

She was eventually able to compete again thanks to the help of Terry Orlick, a world-renowned sports psychologist. But the comments about her weight never stopped.

“I would go to a competition, and I would be in really good shape. And commentators or media would make a point of saying, ‘She’s lost a tremendous amount of weight. She looks great.’ And as an athlete, you go, ‘Why can’t you just focus on my triple lutz? Why can’t you focus on the great skate?’”

Even after she retired from competing and embarked on a pro career, she was haunted by questions about her body.

“[Thinking about my] weight is a forever thing. I think it was embedded in my mind as an athlete,” she says, explaining that when she signed a contract to join the Ice Capades, the now-defunct touring theatrical ice skating show, she had to commit to maintaining a particular weight—and there were weekly weigh-ins to ensure she, and all the other athletes on the roster, did. Even later on, “there have been situations in my pro career where I was terrified to go into an event because I had an extra five pounds on me,” she says. “I had people who wanted to hire me for something, but through the grapevine would contact someone else and say, ‘How’s her weight?’ You start to feel afraid to be seen and you wonder what people were going to say.”

Though their careers were separated by decades, former competitive skater Meagan Duhamel’s experiences echo Manley’s. During Duhamel’s competitive career, she won seven Canadian national titles (every year between 2012 and 2018), two world titles (in 2015 and 2016) and three Olympic medals (silver in 2014 and gold and bronze in 2018). But even in the face of these massive accomplishments, she was the target of body shaming.

“I was a very athletic skater and had a stocky muscular body. I was always aware that I didn’t look like other figure skaters,” she says. “I remember my coach taking me to the gym with him when I was 14 years old. He never said I was fat or needed to lose weight, but he’d take me with him and I’d run on the treadmill.”

It got worse from there. At 21, she had moved to Montreal for training and needed new competition dresses, which at the time ran about $1,000 each. After using them once, she says officials from Skate Canada, the governing body for figuring skating in Canada, told her they made her look “too big” and that she needed new dresses.

“I was working full-time to pay for my skating and had borrowed money from my sister to buy those costumes, so that was pretty heartbreaking and devastating to deal with,” she says. “In the end, my skating club paid for me to get one new dress that ‘fit my body better,’ they told me. But I was by no means too large. I weighed 115 pounds.”

Olympics

Since then, Skate Canada has started working to change its culture, likely due to a confluence of factors, says mental performance consultant Judy Goss. These include coaches’ increasing awareness of body image-related issues among their skaters and better education around Relative Energy Deficiency in Sport (RED-S), a condition that encompasses disordered eating, missed periods and decreased bone density. Goss also cites the impact of larger cultural conversations around the #MeToo and body positivity movements, as well as celebrity athletes who have spoken out about their experiences around body image, mental health and exploitation in sports (like Serena Williams, Simone Biles and Naomi Osaka).

“Figure skating was primed and ready for a shift,” says Goss.

In 2019, Skate Canada hosted a high-performance camp, where it came to leadership’s attention that an off-ice trainer was weighing skaters. “All of us were like, ‘You’re not supposed to do this!’’ Goss says. “We went a little berserk.”

That led to conversations about what kind of information the organization could provide to coaches and other ancillary members of skaters’ teams—including off-ice trainers, who are employed by individual skaters or skate clubs rather than Skate Canada itself—and how the organization could ensure that they were using the right language. At the time, there weren’t many sports organizations that had guidelines around body image; Goss reviewed Gymnastics Australia’s policy, instituted in July 2019, and U.S. Figure Skating’s policy, and then worked with Skate Canada to write their own body positive guidelines in an attempt to “set boundaries on what is acceptable practice, language and behaviour for coaches, parents, officials, volunteers and staff when working with athletes of all ages, genders and skating abilities.”

Goss helped develop the guidelines using insights from several academics, including Catherine Sabiston, University of Toronto professor, Canada research chair in physical activity and mental health and director of the Mental Health and Physical Activity Research Centre. Sabiston’s research has found that addressing female athletes’ body image will require a collaborative effort between coaches, officials, parents and role models (like celebrity athletes or club alumni), as well as athletes themselves. It also suggests sports organizations should offer public education and casual, voluntary support, and that revealing uniforms need to be reconsidered. As a result, Skate Canada recommends avoiding body shaming language, including words like fat, overweight, large, heavy, skinny or stick-thin, as well as words like toned and lean, which “can also perpetuate body preoccupation and should be avoided.” They ask coaches to praise skill, execution, power, strength, effort, persistence or other attributes that are not appearance-based and “emphasize factors that contribute to personal success, such as motivation and effort rather than body weight or shape.” They also include links to additional resources on eating disorders and mental health in sports, and provide scripts to help coaches give performance-based feedback that doesn’t touch on physical appearance.

Part of the organization’s goal is to protect athletes as they continued to compete, but the guidelines are also intended to keep skaters from leaving the sport entirely. According to a 2020 report from Canadian Women & Sport, one in three Canadian girls leave sports by late adolescence, compared to a drop-out rate of just one in 10 for boys.

“One of the reasons we lose them is because their bodies change and develop,” Goss says. “When skaters start, they’re usually younger and smaller, because skating, like gymnastics, is an early specialization sport. [When they go through puberty] there certainly is physiological impact in terms of your ability—your centre of gravity shifts, so I wouldn’t say it becomes more difficult to do the jumps or the tricks, but it takes some time to adapt.”

Good coaches who understand that shape or size does not dictate performance can be integral to helping skaters adjust—and therefore stay in sports.

McDougall agrees. “Skating has changed. It has become very athletic with women doing triple axels and quad jumps. It isn’t simply about how you look. It is also about speed, edges, skills—the entire package,” she says. “Support has to be there by associations and clubs to make sure all members train in a safe and inclusive environment. Coaches have a unique role in their skaters’ lives. Ultimately it comes down to us on a day-to-day basis to create that environment and help create changes if we see situations that do not support or are detrimental to our young athletes.”

Coaches are only one piece of this puzzle, though. Adults who surround the skaters must stand against all forms of body shaming. That means parents, mentors and even teammates are all part of the cultural shift away from prioritizing appearance over performance. Perhaps even more urgently, so must officials and judges.

But change has been slow-going. “I’m not sure how much we’ve improved,” Duhamel says. “Skaters are still being told to use certain dress designs to make their body look a certain way.”

Goss agrees, noting that figure skating has historically been slow to respond to the growing body of research into higher incidences of eating disorders, injuries and menstrual dysfunction in aesthetic sports. “They have been successful for a long time, so it’s kind of like, ‘Why would we change what we’re doing?’” she says. She points out that some coaches have been working for years and years and have huge value to the system, but it’s hard for them to change their ways. “So, we have some factors that make it a little more challenging, but that’s okay. I’m up for the challenge.”

This feature is part of Best Health’s Body Talk package, exploring the issue of body image in elite sports. Read more about the experiences of current and former Winter Olympians and Paralympians here:

Olympic Legend Catriona Le May Doan: “I Worried About How People Viewed Me My Whole Career”

Bobsledder Cynthia Appiah: “I Looked Phenomenal, but I Felt Absolutely Terrible”

Speed Skater Alyson Charles: “I Consider Myself Lucky”

Alpine Skier Erin Mielzynski: “I Was Just Trying To Be Perfect”

Paralympian Brittany Hudak: “I Didn’t Think About Body Image Until I Became an Elite Athlete”

Get more great stories delivered straight to your inbox by signing up for the Best Health Must-Reads newsletter. Subscribe here.

We used to get weighed in front of the entire team. That was an issue. When I first started competing as part of the national senior team in 2018, I had to get on a scale every day prior to a competition and write down my weight. We all did. That sheet of paper was visible to the whole team. It was a very uncomfortable practice. I remember at one point, I realized I was heavier than two of the men.

Body image, and the pressure to look a certain way, isn’t talked about in speed skating. I’ve never been asked about it in an interview before, but it’s something that affects many athletes.

Speed skaters tend to have huge thighs and a small upper body. I started speed skating at age five, and at times, because of the way my body developed because of my sport, I felt like I wasn’t feminine enough or I was too muscular. As a teenager, I saw girls at school and my teammates developing breasts and hips. I had none of that. It made me feel self-conscious, almost like less of a woman—especially because in skating, there’s no way to cover up. Our skin-tight suits show everything.

For a long time, the South Korean short track speed skaters were absolutely dominant. Most of their athletes were really slim, and that became the unofficial goal. When I got to higher levels of competition, the pressure to be lean intensified. If it was getting close to competition and I saw that I had gained weight, I would feel anxious. It could’ve just been that I drank more water that morning or didn’t go to the bathroom right before testing. But in my mind, I worried that a few added kilos might slow me down. Or maybe that extra weight would let my team down because in relays we physically push each other.

Looking back, it’s easy to see how practices like seeing the weights of all your teammates can make you self-conscious. I’ve had moments where I compare myself to other skaters, thinking, if I had less body fat or if I had a six-pack like hers, maybe I would be stronger. I consider myself lucky to have always been surrounded by a good group of professionals and teammates. I never got offhand remarks from them about my weight or my physical appearance.

In fact, talking to other athletes, either from my sport or in other sports, helped me feel less alone. They struggled with the same pressures and self-consciousness that I did. Other speed skaters have told me about coaches that really focused on their weight, even though they ate well.

A former figure skater, who is also Black, told me about the discrimination she faced from judges. She had to work harder and be better to make it. Thankfully, I didn’t feel like that in my sport. Everything’s objective, you either finish first or you don’t.

When I made the national team, I started to realize that different body types can be successful in speed skating. I saw other girls who were tall like me, and had figures like mine, in my sport—and it helped me feel normal. With athletes from Europe, the U.S. and Canada excelling in short track, the podium at the world championships and even the Olympics is much more diverse now in terms of body shape and weight. We are starting to see that athletes don’t have to be small and skinny to win.

There have also been changes with how we train. Women on the speed skating team spoke up about how uncomfortable being weighed, and the public recording, made them feel. Now, we still get weighed, but our numbers are kept private. And the coaches are not allowed to comment on the numbers anymore. That input is reserved for the dietitians and nutritionists we work with.

It’s heavy to carry around these insecurities and I feel that a lot of young girls that are in elite sports are going through that. For myself, as I grew older, I understood that I am perfect the way I am. My physical appearance doesn’t define me because I know what I am capable of. I am strong.

This essay is part of Best Health’s Body Talk package exploring the issue of body image in elite sports. Read more about the experiences of current and former Winter Olympians and Paralympians, and what is being done to make sports a safer space for all athletes, here:

“Fat Doesn’t Fly”: Inside the Culture of Body Shaming in Figure Skating

Paralympian Brittany Hudak: “I Didn’t Think About Body Image Until I Became an Elite Athlete”

Bobsledder Cynthia Appiah: “I Looked Phenomenal, but I Felt Absolutely Terrible”

Alpine Skier Erin Mielzynski: “I Was Just Trying To Be Perfect”

Olympic Legend Catriona Le May Doan: “I Worried About How People Viewed Me My Whole Career”

Get more great stories delivered straight to your inbox by signing up for the Best Health Must-Reads newsletter. Subscribe here.

I’ve always been fairly lean, but not muscular. I did jazz dancing growing up, and I felt like I had the preferred body type. Like any kid, I was self-conscious, but that was more in relation to my physical disability, which I was born with. I avoided asking for help at school or with activities because I just wanted to be like my peers and prove that I could do the same activities as them. I didn’t think much about body image—until I became an elite athlete.

I was 19 and working at Canadian Tire when I was approached by Colette Bourgonje. The 10-time Paralympian skier, who now mentors Para athletes and encourages athletes with disabilities to get into snow sports, asked if I had ever considered training for cross-country skiing (I hadn’t until that moment). I decided to give it a try, and within two years, I was competing at my first international competition, hoping to earn a spot for the 2014 Paralympic Games in Sochi, Russia.

As I progressed to an elite level of skiing, I started undergoing testing that would demonstrate the progressions of my physical fitness. Every spring and fall, I’d get different parts of my body—from height and weight to the circumference of my thighs and forearm—measured. These measurements provided a snapshot of things like fat percentage, muscle percentage, power to weight ratio.

To be honest, there’s definitely some stress on the day you’re going to be weighed and have skinfolds measured. I found myself wondering what people might think when they saw my data and how these numbers played a role in performance.

Cross-country skiing is endurance based, and there’s this perception that if you have a higher fat percentage, you’re carrying that around the ski course. In high-performance sports, podiums can be won by a matter of seconds. So it can feel like being lean or having less body fat is one way to ski faster, even though that’s not always the case.

This perception, combined with body composition testing, makes it easy for athletes to go down a rabbit hole of self-assessing, thinking, Oh I’m getting bigger, this isn’t good. When we race, we wear skin-tight spandex suits, which can add to the heightened awareness of any aspects of your body that you might be self-conscious about.

But body image isn’t something that we really talk about.

I’m one of those athletes that likes to be self-informed. Why is this in my training plan? What purpose does this workout serve? Over the years, I’ve figured out what works best for me so that I can be my fastest. Sometimes that is being a bit leaner, other times it’s fuelling more in order to maximize how much I can train.

Even though the team measures every part of me, things like menstruation or normal weight fluctuations don’t get discussed. A few years ago, I told my male coach I hadn’t had my period for six months. That conversation was uncomfortable, but it helped us build trust.

The past couple of years, I started talking more openly to my coach about how my numbers will fluctuate slightly throughout the year. We discussed that I might be a few kilos heavier in the summer, but that’s what I need to maintain my energy. Having his feedback that it’s not sustainable for me to be at race weight all the time was critical for me to understand.

These conversations can be awkward at first, but talking about my metrics has really helped me. Being more informed, and talking openly with my coach, has helped me have a healthier mentality towards my body and performance.

Living and training out of Canmore, Alberta, which is a huge skiing hub, I’ve met national athletes from across Canada with so many different body types. It’s helped me recognize that an athlete’s body type alone does not lead to success. We need to balance body composition with individual needs and performance goals.

I once heard someone say, “an athlete is an athlete.” I’ve learned that’s not true. Every athlete is different.

“Fat Doesn’t Fly”: Inside the Culture of Body Shaming in Figure Skating

Speed Skater Alyson Charles: “I Consider Myself Lucky”

Bobsledder Cynthia Appiah: “I Looked Phenomenal, but I Felt Absolutely Terrible”

Alpine Skier Erin Mielzynski: “I Was Just Trying To Be Perfect”

Olympic Legend Catriona Le May Doan: “I Worried About How People Viewed Me My Whole Career”

Get more great stories delivered straight to your inbox by signing up for the Best Health Must-Reads newsletter. Subscribe here.

I remember taking my braids out. They had just been freshly done a few days prior, but I needed to remove any extra weight before stepping onto the scale. When I saw that I had only lost two kilograms, I was on the brink of tears. I felt defeated.

It was December 2015 and I had been diligently watching my eating for months in order to compete in bobsleigh.

I came to the sport after leaving the world of track and field in 2013, where I competed in shot put and hammer throw. I was a thrower for nearly a decade, but it became clear that the Olympic Summer Games weren’t going to happen for me. After watching brakewoman Shelley-Ann Brown medal at the Vancouver 2010 Olympics, I decided to move to bobsleigh. I soon learned that to slide without getting my team disqualified, I had to lose at least 13 kilograms.

During my time as a track and field athlete at York University, I had put on 18 kilograms of mostly muscle as a result of my training. There was no pressure to be a certain weight, but in throwing, the bigger you are, the farther and faster you’ll throw, so it aided in my performance. At the same time, there is this pressure, particularly on women, to avoid looking too muscular or masculine. That always played in the back of my mind. I had this internalized fear of looking too big or being seen as “fat.” When I learned I had to lose weight to become a bobsledder, my first instinct was, OK, I get to be skinny again.

I worked with a nutritionist, cut back on snacking and made sure that I balanced the rice, meat and vegetable portions when enjoying my family’s Ghanaian meals. As I transitioned into bobsleigh, people noticed the weight coming off and I got a lot of compliments. It was positive reinforcement that thinner was somehow better.

But in August 2015, the International Bobsleigh and Skeleton Federation (IBSF) cut the women’s weight limit by 15 kilograms, apparently to encourage a wider range of body types to enter the sport. But my body was perfect for the old weight limit. These new measures meant I had to lose even more weight. I was shredded, had washboard abs, my speed suit fit me in all the right places. I looked phenomenal, but after months of trying to lose more weight, I felt absolutely terrible. I was eating the bare minimum of what I needed to sustain my body, nearly half the calories that I average today. I did not have more weight to lose.

I ended up being paired with a pilot whose weight, combined with mine, allowed us to meet the new regulations. I made the team, but that moment on the scale stuck with me. I vowed never again to let myself get to the point where I was missing out on team dinners or declining offers to go for ice cream—where food was the only thing I focused on. I’m not yo-yo dieting to get competition-ready. I’m a big foodie, and I love sweets, so I work at eating balanced meals so I can maintain my body throughout the year.

Even so, as a high-performance athlete, you constantly compare yourself to competitors and fellow teammates. So naturally, I ask myself questions like: “How do I look compared to the rest of the team?” “Am I too big? Too small?” These questions come up for both men and women, and for me, they were amplified during the pandemic, when access to gyms was restricted, limiting my workouts to one-hour blocks instead of my typical two- to three-hour sessions. I wondered if my body would be ready for the Games, if I’d be fast enough, strong enough. Am I going to be pudgy? These thoughts invaded my mental space.

But body image isn’t something that gets talked about in elite sports. I don’t remember ever having a conversation about insecurities or the pressure to look a certain way with other athletes or coaching staff. Even when I felt my worst in 2015, I was still performing well, so there weren’t any warning signs for anyone to step in and check on me. If they had, it might’ve led to a healthier relationship with myself and the team at the time, because it felt like I had no resources and I had to figure things out on my own. It shouldn’t require athletes talking about their struggles or experiences with disordered eating for teams to work with health professionals and start open conversations. Those types of support should be available at all times and athletes need to seek the help they need.

It took a lot of time and internal work for me to accept my body. I realized my body helped me propel my career and I can’t use societal beauty standards to knock myself down. And now my body is taking me to the Olympics in Beijing.

The Olympics bring together a wide variety of athletes. I hope these Games and conversations can help cast a wider net on what an athlete can look like. You can be skinny, short, tall, big, small, whatever—and still be great.

This essay is part of Best Health’s Body Talk package exploring the issue of body image within elite sports. Read more about the experiences of current and former Winter Olympians and Paralympians, and what is being done to make sports a safer space for all athletes, here: