December 11, 2015
When my phone starts going nuts first thing it normally means one thing…an obesity story has hit the morning news and everyone wants my view on it.
So I am up and at my desk writing this in my PJs whilst eating a slice of gluten free toast with coconut oil as spread (just in case you were wondering) and trying to hydrate myself after my running clubs xmas social gathering last night.
The headline on the BBC news website goes like this….
Obesity ‘biggest threat to women’s health’ in England
This is in response to the chief medical officer Sally C Davies annual report, which in her 4th year is entitled “The Health of the 51%: Women”
Now I am not going to lie, I haven’t done a full literature review of this document, I had a late night, little sleep and one too many vodkas at a xmas do so some of the graphics in this report are making my brain hurt, but what follows below are just some initial thoughts on what strikes me at first glance
Isn’t it telling that the report has 11 different areas of focus, obesity not being one in its own right, yet obesity is the health issue that makes all the headlines. No, stress incontinence, the menopause, and perinatal mental health are not damning enough, won’t get people clicking onto websites to find out more. No, lets go with the thing the media most like to shame the nation (and particularly women) with or maybe I am missing the point?
As the chapters of this report came together, the issue of obesity came to the fore as a common theme. A healthy Body Mass Index (BMI) is 18.5–24.9, obesity is defined as a BMI >30. (oh here we go again with the BMI thing) The prevalence of obesity is over 25% in both women and men. It is associated with leading causes of morbidity and mortality, such as diabetes, cardiovascular disease and cancers.
This is not stuff we don’t know though, again we are talking about the What with very little about the Why or even the How.
This is a difficult message to convey, as it risks burdening women with guilt and onerous responsibility; I believe, however, that it can also empower women to take positive steps to healthy, stable nutrition and physical activity to benefit themselves and their families. Action is required for women and across society to prevent obesity and its associated morbidity and mortality from overwhelming our health and social care resources and reducing England’s productivity. We must redouble our efforts to address education and environmental factors, across government, healthcare and wider society, while encouraging a greater degree of personal responsibility.
I quite like this bit as it acknowledges just how damming these reports can feel for those they are talking about, but again I want to now how we can all help with this agenda when it doesn’t seem like the status quo is changing much.
Recommendation 1 in this report is that the Government includes obesity in its national risk planning. I for one would like to know what that looks like, because in my mind I have visions of a bunch of slim people with Tupperware boxes full of bean sprouts and tuna steaks for lunch in an underground bunker somewhere in central london carrying out covert operations to eliminate the obese population…or am I letting my imagination run wild again?
The document says that many women do not report eating disorders. I wonder if this needs to be rephrased somewhat, because in my experience women with binge like disorders do seek help, but doctors (like many others) simply believe that obesity is a straight forward case of “eat less, move more” “get some control woman”, dismissing the complex psychological issues many women have with food and body image. My medical notes will reveal that I have expressed concerns about my weight numerous times over the years and have only ever been handed a diet sheet or offered those fat binding tablets that make your poo oily…no thank you very much.
I think rather than talking about specific eating disorders I would say much of the population (large or small) have disordered eating. There is food overwhelm, we are time poor, food choice rich, with conflicting information about what is actually healthy for us to eat.
I spoke last week on the proposed sugar tax, and I made reference to the fact that the supermarkets are jammed packed with products that are made to look like food, but are in fact not actual food. When did this all become so complex?
This report has come at an interesting time too, as we sit here with the war of adverts going on between the top supermarkets in the lead up to xmas, and the countdown to a two week period where most of the country will be showing symptoms and behaviours of someone with an eating disorder…pass the celebrations someone?
Recommendation 7 is that Clinical Commissioning Groups ensure prompt access to evidence-based enhanced cognitive behaviour therapy (CBT-E) and family-based therapy for eating disorders. Which should be available in all areas, as in the NICE guidance, and not restricted to specific age groups. I will be interested to see how this pans out, in fact can I put myself on the list now to be front of the queue??
Now we may be getting somewhere, but sadly this section which is right at the end of the report, with no actionable recommendations, so will likely be dismissed rather than taken seriously as a driving force to see real change. Why wasn’t this the theme that supported the whole document, why are we not talking about health inequality and that fact that women play less sport than men, and experience disadvantage and pressure to conform at each and every stage of their life (Did you see this video about the 48 things women will hear in their lifetime that men won’t?)
The report says,
Women in England live longer than men, but with a greater proportion of their lives affected by disability, and have shorter life expectancies than women in some other EU countries, eg Greece, Slovenia and Portugal. Women as a group are paid less than men and experience specific human rights disadvantages evidenced by increased rates of rape, domestic violence, ‘honour-based’ violence and trafficking compared with men. Women access healthcare more often than men but may be denied access to basic services such as contraception. Considering the human rights applicable to women’s health may have relevance to the planning of medical services and provides an approach that promotes equity. A human rights approach can help to draw health issues experienced by women together and highlight areas where disadvantage is gendered.
It is no coincidence that women constitute around 70% of the world’s poor, or that 2 million fewer women than men play sport in England, or that fewer than 5% of CEOs at fortune 500 companies are women, or I could go on and on. We need to be talking about this gender inequality and address some of the reasons why so many women are unable to prioritise their health consistently throughout their life.
This report, and reports like it are of course needed. They provide much needed research evidence and a context to which we can launch discussions and debate about the next steps. But reports alone are not going to change anything, if we want to see change, we need to be the change ourselves. Each and every one of us can do something daily that overtime leads to improvements in our health, and we should be empowered to do that not only for ourselves, but for those around us.
We are role models. All of us.
Let me share something from a more personal perspective.
As you know I am a runner. I love to run. I would run every day of the week if I could. Earlier this year I was running 3-4 times a week as I prepared for the London Marathon. However recently my circumstances changed and I am no longer able to run in the evenings or weekends, so I miss parkrun on a Saturday morning, and I can’t enter Sunday races like I love to. My running club think I have abandoned them and its unlikely that I will meet the 30 miles in December target that I set for myself. So now I am a runner who struggles to run.
My desire to prioritise my health is always there, however the practical ability to get out and run like I have in the past is simply not there, while I deal with the inequality of having to raise a child and run a home and a business single handedly. I am having to adapt and ask for help, change my goals and expectations about what I can possibly achieve at present. But the intent is 100% still there in terms of living a healthy balanced life.
Health is more than just the weight you are or the size of your jeans. Health is about physical fitness and mental strength. It’s about balance, and seasonal cycles. Its about lifestyle, and relationships, and laughter, and resilience. Do we need to address obesity, without a doubt. Is it the ONLY issue this country has to worry about in terms of the health and wellbeing of the nation. NO.
In a recent 5 weeks to 5k programme I run, more than 70% of the cohort said they had depression or anxiety. At the start only 35% of the group were doing the recommended 3x30minutes of activity, and by the end almost 80% were meeting or exceeding that target, and were excited about continuing with running in their lives, with some women reporting that the programme had had a significant impact on their mental health and wellbeing.
I often ask,
Are we unhappy because we are fat, or are we fat because we are unhappy
Or is it neither of these?
Are we simply looking to stop the battle with our bodies and find peace instead?
On Monday I launch my new ebook, a book about health and happiness which has taken a lot of soul searching to write. I am sick of being shamed for the size of my body, yet I am not willing to endure any kind of extreme diet to simply conform to what is expected of me. Transformations are not just about weight loss, they are about a journey towards broader wellbeing, and most importantly happiness.
I have some pretty exciting plans for 2016 to help address some of this health inequality for women, but I can’t do it alone. The journey I have been on with my own health and understanding of womens health has been incredible, and I am more motivated than ever to scale up my efforts and really make a difference to the lives of women around the world.
You can preorder “New Year, Same Me” from Amazon for just £5.99, and if you are feeling particularly generous why not help me promote this book (via my thunderclap or simply word of mouth will do) and create a monumental change in mindset for all those women who want to make changes to their lives come January 1st.