My being denied access with my first-born is one of the reasons this blog even exists! I’d discussed it at every appointment, was promised a pool birth in the hospital (so long as the pool in the delivery suite wasn’t occupied when I needed it), taken on a tour of the pool room, but then repeatedly denied access to the pool while I was in labour until someone finally told me at 8cm dilated that I would not be allowed to use it after all. It’s also the reason I chose to have my second baby at home!
My second labour and birth, where I did have access to a pool, confirmed everything I had suspected. The warm water was incredible at helping me manage the pain of contractions! Coupled with that, the buoyancy provided by the water meant that I could move around with ease. I was so much more comfortable and relaxed – even during contractions!
The frustrating thing is there’s no evidence to support restricting access!!
To be honest, there’s not a lot of good-quality evidence about the use of birth pools full stop. But because so few women get access to water birth there’s no data to show it’s safe for larger mums. But because there’s no data to show it’s safe, we’re denied access! Anyone see a problem here?
I’m not alone in thinking this!
It turns out that Health Care Professionals are beginning to notice this. So I’m delighted to report that the Association for Improvements in the Maternity Services asked me to write an article for their journal, complete with oodles of references for you to wave in the faces of healthcare naysayers you may meet. Enjoy!
Well, this probably seems uncharitable, but here are my reasons why I will never again be donating to Cancer Research UK (CRUK).
Don’t get me wrong, if you’re a friend of mine, and you’re planning on running, swimming, knitting in a bath of custard etc in future and need sponsorship, I will happily donate to a charity in recognition of your efforts. But not to CRUK. You can pick another charity. You can choose one doing great work in cancer treatment or care or awareness or research; Macmillan, Marie Curie, Breast Cancer Now, there are hundreds! Just not Cancer Research UK/Race For Life/Stand Up To Cancer, which are many faces of the same charity.
Why? What’s wrong with Cancer Research UK?
Maybe it’s just me, but I’d hope that a charity which puts research at the forefront of its identity (it’s in the name, for heavens’ sake!) would understand the need to not make wild claims. I’d hope they understood the difference between causation and correlation – it’s usually taught in secondary schools! Here’s a really useful TED talk explaining the danger of mixing correlation with causation:
So we can see from the example given in the video (if you’re reading this on mobile data and don’t want to watch it!) is that just because the incidence of drownings increases when the sales of ice creams increase (a correlation), does not mean that we can infer ice creams are responsible for drownings (causation). Or conversely, decide that drownings are responsible for ice-cream sales!
We can suspect one leads to the other. We can theorise what might cause this, but without further evidence it is merely a theory. It may be difficult to prove. That doesn’t mean you can ignore the lack of proof and state it as fact for the sake of convenience. Furthermore we must not forget to look for other influencing factors which might explain both results, like the weather, in the TED example.
No one (and there’s been plenty of research!) has yet proven that obesity causes cancer. It is possible that there is a causal link, of course. The theories may be spot on. I don’t deny that. But you’d hope a charity spending hard-won donations, and with ‘research’ in their name, would be a bit more responsible and careful not to overstate a theory as fact? It’s an important distinction.
As with the TED analogy, research has suggested that common factors could be responsible for the connection. Genetics are particularly suspect. Did you know tall people are more likely to get cancer than short people? Don’t see them putting that on a bus shelter, or claiming that height causes cancer. It’s an accepted correlation. Strangely CRUK don’t feel the need to make anyone feel crap about being tall…
But being fat’s not the same as being tall!
“But people can’t help their height!” I hear the virtue-signallers cry! “It’s not the same! Fat people can lose weight!” (with a in implied side-order of “they’re just lazy/stupid/lack willpower!”).
Except if you’re overweight, and have always been overweight, come from a line of people who are and have always been overweight, and have repeatedly watch them try and fail to lose weight, you know that while the maxims of ‘just lose weight’, ‘just eat less’, ‘just exercise more’ sound so deceptively simple in theory, they’re incredibly difficult in practice.
Of course, there’s always surgery, the one reliable intervention to lose weight – but if that’s so desirable, why wouldn’t we suggest tall people lop off a couple of inches to reduce their cancer risk? (I’m not suggesting that either!) There are significant risks associated with surgery, and significant downsides. It is not a one-size-fits-all solution. Yes. Pun intended. Let’s not lose sight of the fact that there’s a lot more to being healthy than merely a BMI.
But obesity IS preventable! You just don’t want to hear the truth!
Many overweight people struggle with their weight their entire life. Many lose weight, only to put it all back on again and more, often over and over, getting bigger with every cycle. We know this, and we don’t fully understand why. But we’re beginning to understand that willpower and behaviour are probably only a small part of the puzzle, maybe as little as 5%, with many other factors coming into play .
If it was so easy, Slimming World and Weight Watchers would have gone out of business years ago. The fact of the matter is that their business model works precisely because most people don’t and can’t lose the weight and keep it off long term in our modern society. We know this. It’s a problem we’ve been trying to solve for years, and CRUK campaigning that obesity is a ‘preventable’ cause of cancer completely ignores this.
Every time I drove past one of the CRUK adverts last year it irritated me. I knew it was inaccurate, felt it was irresponsible, and I was frustrated that they were choosing to oversimplify a complex problem as a personal failing. I, and many others felt it insidiously feeds the narrative of blame and shame that is so common with obesity.
It allows those who don’t have a high BMI to feel just that bit more smug, just that bit more superior; safe in the knowledge that their predominantly genetic disposition to not be overweight is saving them from cancer, with the added implication that us fat people should really do something about it for the sake of our health…
Maybe they didn’t realise…?
Not everyone reacted as mildly as I did, of course…
Right, is anyone currently working on getting this piece of shit CancerResearchUK advert removed from everywhere? Is there something I can sign? How the fucking fuck is this okay? pic.twitter.com/b7eU7lulms
But those ads didn’t quite push me to the point of saying never again will I be donating to Cancer Research UK. That only happened this week…
I decided to give them the benefit of the doubt last year. Maybe they didn’t realise? Perhaps they felt the shock factor they wanted to use outweighed the risks of that approach and misjudged it? Maybe in wanting to keep the message simple they went further than they should have in overstating the point, but have learned from it?
So, what happened next?
Firstly, don’t be tempted to read the responses Sofie Hagen received on Twitter. Let’s just say plenty of people decided to tell her she was wrong. Haters gonna hate and all that… We don’t need that kind of negativity!
The campaign garnered lots of attention, was widely accused of fat-shaming and stigmatising obesity, and lauded by others for ‘telling it like it is’ (or as we know, isn’t, but hey-ho). These comments mainly came from smug-thins who think it’s simple to solve the ‘obesity problem’; just regularly tell fat people how crap they are and they’re sure to take it on board…
It also prompted amusing but entirely predictable responses implying the only reason people are overweight is because they eat fast food… yawn. Never saw that one coming. Oh, wait. Yes we did. It’s exactly these kinds of lazy tropes and attitudes that such a campaign fuels and that we’re entirely sick of.
They told CRUK how the adverts were stigmatising and misleading. They explained how simply telling people with obesity that they’re at increased risk of cancer does nothing to help, but does everything to make people feel more marginalised. Experts met with CRUK to explain how a more useful and sensitive campaign could be launched in future…
So, what happened this week?
This week, CRUK went one further with this ad campaign.
Cigarette packets branded with “Obesity is a cause of cancer too”. Eyecatching and emotive, certainly. Accurate and helpful? Not so much.
Marvellous. They’ve taken on board precisely …erm… nothing at all from last year’s campaign feedback!?
Or perhaps they enjoyed the publicity last time?
Good grief, I feel sorry for the people who gave up smoking and gained weight as a result. They must feel like they can’t do right for doing wrong! They’re probably having their nicotine addiction triggered by the enormous images of cigarette packets, all while wanting a cigarette to deal with the stress of finding out that they’re doomed to get cancer…
Of course, the media reported the release like this:
With the word ’cause’ prominently repeated, with images of fast food and headless fat bodies galore – despite organisations such as the European Association for the Study of Obesity and The World Obesity Federation campaigning widely against such reporting and providing and free usable non-stigmatising images… Here we go again. Entirely predictable. Blame and shame. Emotive stuff.
There was a swift backlash. The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (what a title!) wrote this great article:
Only this time there’s no room for the benefit of doubt; CRUK know these campaigns are hurtful, and they clearly don’t care.
@OliWilliamsPhD@DrStuartFlint@BrocqSarah@zoetw and I met with CRUK last winter to talk about their previous campaign, and how it stigmatises against people with obesity. We talked at length about how they could create a better campaign. No change in focus. Agree this is worse.
What, are we just pointing out random statistics we observe now? No. Clearly CRUK has decided this is the hill they want to die on; might as well be hung for a sheep as a lamb. If you don’t like it, go chew some obesity gum or puff on your obesity inhaler… Oh, wait…
It’s a lot. A sizeable amount is spent on research. So far so good. But when £43 million pounds in 2017/18 was spent on ‘information and policy’ (admittedly, it’s only half of what they spend on raising the cash in the first place…), and when that information and policy is based around misrepresenting that research, enough is enough.
What does CRUKs CEO have to say?
Luckily not all media outlets have responded to CRUKs latest campaign by parroting it blindly… Sky News at least have responded by reporting some of the criticisms the new campaign has received:
Pregnancy is a time of information and advice overload. But is that information always delivered in the best and most helpful way? Are the messages consistent? Have you ever left a meeting with a health care professional feeling confused, or frustrated, or upset? Our voices and our experiences matter, so please, if you have a few minutes, follow the survey link and tell your story.
It’s great that we’re seeing so many researchers and surveys asking for our perspective lately; it’s the first step to making ourselves heard.
To take part, you need to be:
Living in the UK
Have been pregnant in the last 5 years (or are currently pregnant)
What The WRISK Project/Survey Hopes To Achieve
This survey hopes to learn more about women’s experiences of advice and information given before and during pregnancy. It’s open to anyone who has been pregnant in the last 5 years, irrespective of how that pregnancy ended.
Women who are planning a pregnancy or who are pregnant receive many public health messages that are intended to guide their decision making. For example, they receive advice about what to eat, drink, how much they should weigh, and what medications they should or shouldn’t take. These messages are intended to improve outcomes for babies and mothers.
However, there is growing concern that messages do not always fully reflect or explain the evidence base underpinning them, and that negotiating the risk landscape can sometimes feel confusing, overwhelming, and disempowering. This may negatively affect women’s experiences of pregnancy and motherhood, and be exacerbated by a wider culture of parenting that tends to blame mothers for all less-than-ideal outcomes in their children.
The survey is particularly keen to capture the experiences of women whose voices often go unheard; including BAME women, those receiving welfare benefits, and younger/older women.
The project will draw on your insights to understand and suggest improvements for the communication of risk messages in pregnancy.
Please share this survey amongst your networks and across all of your social media platforms. We want to reach as many people as possible!
Who Is/Are WRISK?
The WRISK Project is led by the British Pregnancy Advisory Service (BPAS), in conjunction with Cardiff University, funded by Wellcome. Membership of the project oversight group includes representation from many different organisations involved with pregnancy, which includes Big Birthas.
Well, that sure was an exhausting but very worthwhile couple of days!
As my first experience as a conference exhibitor it was possibly a bit of a baptism of fire doing two days @PrimaryCareShow, plus set-up and take down. Definitely a steep learning curve, but really excellent to have the opportunity to put our Parenting Science Gang Research findings before a wider (and very receptive) audience!
Met many, many lovely healthcare professionals across the two days, the vast majority of whom are totally sympathetic to the rough deal bigger mums often experience, and are all too aware of some of the hurtful and unnecessary things that can be said and done while navigating maternity services; some of whom knew from personal experience!
Some interesting discussions too with healthcare professionals who clearly thought their practice was empathetic, encouraging, and open, but whose use of language belied a weight bias, or a propensity to be dictatorial in their provision of care…
Did they notice my (hopefully subtle) efforts at positively reframing their words? Who knows, but I didn’t get into any heated debates, so my challenging of attitudes was at least successful in that I seemingly didn’t make any enemies or get anyone’s backs up, I just hope my words didn’t fly completely undetected under the radar!
We did raise some eyebrows with some of the quotes from the research, even from very experienced midwives, and hopefully prompted some thoughts and reflective practice. Also gained a few new followers on Twitter and some new sign-ups to the Facebook chat group, hi if you’re reading!
Although most of the time was spent in the exhibition hall speaking to delegates, I did manage to get along to 4 conference presentations across the two days – two in the Mother & Baby programme and two of the Obesity & Weight Management sessions, with mixed reaction!
I was shocked and frustrated to listen to Judith Stephenson, a Professor of Sexual and Reproductive Health, waxing lyrical about a 2018 study which promoted a ‘drink only semi-skimmed milk for 8 weeks’ diet in order to facilitate rapid weight loss and thus be in a better position to enter into pregnancy – when all studies I have ever encountered suggest that restrictive diets and rapid weight loss do more harm than good, and while seemingly effective in the short term, are rarely successful in the medium to long term.
I was also frustrated that she feels that obese women planning pregnancy need to be told that they would decrease risks by losing weight. “This isn’t about blaming women” (except it sounds a lot like it!!). In my experience women are VERY aware that we should lose weight, and it’s not that bloody simple; repeatedly telling us this fact does nothing to help us, and just increases blame, guilt, and disengagement. If you actually want to help us, just ask if we’d like to do something about weight management/fitness or like to hear about local options available to help, and if we say no, move on!
I was at least able to put these points in questions after the session, and several attendees came and sought me out afterwards to thank me/agree/discuss further, so definitely glad I attended that one!
On the plus side, I do agree with her that healthcare services are missing a trick when women attending a family planning clinic for removal of a long-term contraceptive device are not given basic information about preconception health, e.g. to take folic acid, and offering signposting to services available to help with weight loss, smoking cessation etc. given that pregnancy is a very pivotal moment in a woman’s life and the likelihood is that we are at our most receptive and motivated to change any perceived negative behaviours, for the benefit of the planned-for baby.
I later attended an excellent talk by Debra Bick of the University of Warwick on the Care of Women with Obesity in Pregnancy which was far more supportive in the use of language, remembered that there’s often a husband or partner in this equation, and a really useful review of recent studies and their results – which I now need to seek out and read!
The following day was more of the same – firstly a really aggravating talk on Weight Management During Pregnancy and the Post-Natal Period by Dr Amanda Avery… who was billed as the chair of the BDA Obesity Specialist Group and an Associate Professor in Nutrition and Dietetics, but just so happens to be on the payroll of Slimming World and who uses a LOT of ‘they’/’other’ and presumptive-generalisation-speak when talking about women with obesity. Very judgemental/dictatorial/patronising – pregnancy is a “teaching opportunity”. All right, we get it: you’re not and never have been a fatty, and those of us who are overweight just need you to swoop in and educate us! Grrrrrr. Haven’t we moved on AT ALL?!?
She then went on to minimise the risks to the unborn of weight loss while pregnant, recommend Slimming World (of course!), push for encouraging obese women to lose weight while pregnant, and advocate for a return to weighing women at every antenatal appointment to encourage this – “it’s a low-cost intervention – you only need a set of scales!” – yes, that was dropped because it was stigmatising, anxiety inducing, disengaging, and showed no benefit to fetal and neonatal health!?! Then she suggested that the reason that childhood obesity has increased since the 1990s is because that’s when we stopped doing regular antenatal weighing! For goodness’ sakes – oversimplification maybe!?! I think quite a few other things may have changed in those two decades!?!
So. Many. Issues… I was really struggling to work out which points I was going to challenge about her talk when it came to question time – would it one of the above concerns, the persistent conflation of pregnancy weight gain with obesity, or for failing to adjust macrosomia figures to account for gestational diabetes… but no need – there was no opportunity for questions unless you stayed to listen to the following talk too! Arrrgh!
Fortunately my confidence was later restored by a lovely talk by Karen Gaynor, a senior dietitian from Dublin, talking about The Impact of Stigma and Bias in Obesity Treatment, who totally gets it: You want to build an inclusive empowering dietician service? Then ask your patients what they want and involve them in designing it!
Don’t push for dramatic and unachievable weight loss goals – 10% is about the realistic limit! Remember that around 85% of obesity is due to genetic factors – only 15% down to environmental factors, with only a proportion of that down to personal willpower. Never forget we’re in an obesogenic environment and change is a massive uphill struggle and life-long commitment! Don’t use shaming imagery – there are plenty of online free-to-use gallery images featuring empowering pictures of overweight and obese people (try https://easo.org/media-portal/obesity-image-bank/ ) – and if you see stigmatising imagery or language used in practice or the media, call it out!! Honestly, the talk, and the questions/comments from delegates which followed were so uplifting! What a great session to end on!
Most special thanks go to (in order of appearance) the wonderful El, Serena, Mawgen, and Dani; who worked charmingly and tirelessly along with me (with the aid of sugar and caffeine) in talking to dozens? hundreds? (wish I’d had the foresight to bring a tally counter – lesson learnt) of healthcare professionals across the two days.
Lastly (this is starting to feel like an Oscar acceptance speech, I’m sure someone somewhere is frantically gesturing me to get a move on as the orchestra pipes up!) huge thanks have to go to The Parenting Science Gang for making this happen, and Wellcome for funding it!
Lots of contacts made, lots of thoughts provoked, lots of ideas forged, lots of avenues opened.