The modern world has brought with it new but not novel problems. Are lifestyle and technological changes, pandemics and ideological divides, so drastic that they are affecting our health? A paper by the Institute of Health Equity remarks that working women, juggling their career, family, and children, tend to be twice as stressed as men. The alienation of wellness from the collective goals and experiences of community has resulted in a fracturing of the language around how we understand health. The individual experience of disease and disorder, divorced from our socio-political formations and economic realities, has effectively changed our imagination of fitness. It is under these conditions that the bodies of those already marginalised are further isolated by institutions of governance and society.

Khatri marks a rare breed of athletes and wellness educators that takes an approach of inclusivity by demystifying myths around wellness. Now a PhD candidate at the University of Huddersfield with a focus on women’s health, the menstrual cycle and endurance performance, she has worked with both professional and recreational athletes. While she specialises in improving sport performance and injury rehabilitation some of her most meaningful contributions to the conversation around health and nutrition are through her insights on living healthy and balanced urban lives. 

Her latest campaign focuses on Polycystic Ovary Syndrome (PCOS), a hormonal disorder causing enlarged ovaries with small cysts in individuals. For a disorder that affects around 22% of India’s women, research still reveals alarming gaps in the existing information on PCOS. The cause of PCOS remains unclear and its many symptoms continue to be uncategorised and varied. While the awareness around PCOS is rising, a vast number of myths blur the facts around the syndrome and exclude various body-types from both PCOS research and treatment. Surveys have revealed that stigma plays a huge sociological role in both the diagnosis and treatment of PCOS. Access to healthy conversations that purge shame associated with bodies, therefore, remains imperative to detection and management of the syndrome, especially within high-risk groups. 

In conversation with Mishti Khatri

1. What influenced you to design this particular wellness programme on tackling PCOS? Do you think a wellness approach is more helpful than a clinical approach?

A lot of women—especially young women—are diagnosed with PCOS but often don’t know that it is best approached holistically. I designed the Manage PCOS with Mishti programme to address this gap. The programme’s focus on wellness does not intend to replace clinical interventions. It simply recommends lifestyle changes like exercise, nutrition, mindfulness, and stress management that are also recommended by gynaecologists. Since PCOS is caused by an interplay of hormones, a holistic foundation of good sleep, healthy nutrition and stress management along with medical intervention is optimal for its management.

2. What are some common myths about PCOS? In your opinion, what sustains these myths?

Many people assume a relationship between PCOS and body weight. This is a myth that has fed a belief that losing weight can ‘cure’ PCOS. Another common myth is that only overweight women can have PCOS. However, PCOS can be diagnosed in lean women too and is known as ‘Lean PCOS’. In truth, there is no established relationship between weight and PCOS, and losing weight may not affect PCOS at all. In fact, over-exercising and lack of proper nutrition can worsen symptoms of PCOS. 

Another myth is the presumed correlation between PCOS and infertility; it is generally believed that all women with PCOS go through fertility issues. This is not true. I do not think that these myths are sustained by medical professionals. Sometimes medical professionals do prescribe oral contraceptives (or control pills) to mask the symptoms of PCOS but this is ineffective in the long run. It is important to realise that all stakeholders such as doctors, nutritionists, endocrinologists must work together and communicate effectively with their clients and colleagues for best results.

3. Would you say that the conversation around PCOS (or women’s reproductive health in general) is fertility oriented rather than wellness-oriented? How do you think this can be changed?

PCOS is largely viewed as a fertility problem and as mentioned before, this is a myth; a lot of women with PCOS do not face fertility issues. We need to remember that women with PCOS are also prone to mood disorders, mental health problems, hypertension, cardiovascular disorders and certain types of cancer.

Infertility is definitely an important symptom that needs to be monitored but more often than not, other problems related to PCOS are overshadowed by it. This can be changed by spreading awareness regarding the different types of PCOS and the different risks that come with it. It is also important to spread the message which helps people realise that PCOS cannot be eradicated or reversed but managed through a well balanced lifestyle.

4. Do you feel that the mental health aspect of PCOS is often neglected? How does your program address this?

I have seen a change in the conversation around PCOS and mental health. Many doctors, nutritionists and women’s health advocates talk about the mental health problems that come with PCOS. I also feel that since the pandemic the conversation around mental health, in general, has become more mainstream. It has been clinically proven that women with PCOS have a higher chance of being diagnosed with depression and mood disorders caused by hormonal imbalances. It is, therefore, important to not view mental health problems as independent of PCOS. Reaching out to mental health professionals in such cases is important especially since at times medication may also be required.

Managing stress is also an important component of managing PCOS because augmented cortisol levels can trigger certain bodily functions which can worsen PCOS and mood disorders. In my programme, we introduced holistic stress management through mindfulness, breathing techniques, and journaling. Having a sense of community in the programme has also helped in easing people’s anxieties about PCOS.

5. What has your journey been like in the field of fitness? What are some of the things that you unlearned in the process?

When I started my journey in this field, very few people were studying nutrition and sports but now so many are seriously pursuing these courses, which is exciting for the industry. Fitness training is something I have grown up with. I have always enjoyed sports and wanted to be in the paramedical or sports industry. Right after college I started working with a physiotherapy clinic as a personal trainer and have since been in this field. I completed my MSc in sport and exercise nutrition in 2020 and am heading back to the UK for a PhD in sports nutrition. I have realised that there is so much to learn in my field, which is an extremely dynamic space.

6. Do you think celebrity endorsements of ‘wellness’ products and practices (detox products or fat burners) harm the credibility of wellness programs? As a health/wellness proponent, how do you tackle such instances of misinformation?
   

When celebrities like the Kardashians and others promote the use of products such as detox teas, fat burners, and waist trainers, they create an aspiration for an unrealistic body and these unhealthy products are endorsed as a way of obtaining such a body. This is dangerous because it festers misinformation among end users. For instance, most people do not know that detox teas may contain laxatives that could have other effects on your body.

‘Wellness’ products such as these are not regulated or properly tested and are therefore hazardous to one’s health. I believe that there is a need for more stringent guidelines about what can be promoted on social media because some products can be potentially dangerous.

I don’t consider myself a wellness or health influencer; my content on Instagram is designed to educate people. I have a ‘Supplement Series’ where I break down supplements and harmful products marketed as wellness items. By doing so, I try to counter the influence of celebrities who irresponsibly promote products that have not been duly tested. 

7. What did you learn from your clients during the process of conducting this programme ?

I don’t have PCOS myself and the programme helped me understand the nuances of the syndrome. I discovered that PCOS doesn’t look the same on everyone, and is thus a different journey for each person. We planned the programme to accommodate everyone’s needs and did not want to create stress in relation to working out. The nutrition was not very stringent either. We primarily educated clients about their food habits and provided them with some guidelines that would help them build healthy habits at their own convenience. Most of the participants had their own doctors and everything in the programme was approved by them. We had such a great variety of activities in the program which ranged from mindfulness to strength training. And it was great to be reassured that you see results when you consistently do the right things. 

ALMA Staff

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