Plus Size Friendly Care? What do we mean by it? If you’re a healthcare professional, how do you ensure you’re delivering it?
What is Plus Size Friendly Care?
I was lucky enough to attend the Primary Care and Public Health conference (PCPH) in Birmingham recently. (Thank you Parenting Science Gang and Wellcome for making that happen!) There I had the opportunity to speak to many midwives and other health professionals about the issues we face in the maternity system.
I took with me two big banners displaying the quotes we had gathered from our Parenting Science Gang Research. The white banner displayed what women wanted and expected from their care – i.e. plus size friendly care; the blue banner showed their real life experiences… which were less friendly. (Click here to read about our research)
Common themes arose in our study. Bigger women, (much like anyone attending maternity services!) are looking for choice being offered and having options available, feeling supported and heard, feeling respected, and for information to be presented clearly and sensitively.
Sounds sensible! Was this not the case?
And this was reflected in the conversations I had at PCPH. Most Health Care Professionals I met are clearly are doing great work providing holistic, supportive, sensitive care, and continually reflecting on their practice in order to improve. A few think they’re doing a great job, but after a few moments conversation, the terminology and phraseology they use, and particularly the way they feel about maternal choice, betrayed subconscious biases and less than helpful attitudes.
As soon as a see a woman come in with a long birth plan of things she wants, I know she’s going to be a problem. Worse still if it’s laminated! Half the time, birth plans might as well go straight in the bin, I don’t know why people bother with them…
Comments of a midwife attending PCPH Conference
When having those sorts of conversations (while internally wincing!) I will try to subtly encourage reflection on words used and opinons held. Comments like “But don’t you find that women…?” or “Maybe people do X because they feel…?”, or “Perhaps that’s because they want…?” are ways to introduce a conflicting perspective, without outright challenging the position the HCP holds.
Changing people’s atitudes
In all honesty, I know that those who are most likely to have problematic attitudes are also likely to be the most convinced that their way is the right way – because that’s part of the problem! But you catch more flies with honey than with vinegar, as the proverb goes; telling someone with strongly held views they are wrong is just likely to make their views more entrenched. Making them consider the possibility of alternatives is the first step to changing their minds and showing them a better way.
Big Birtha’s Tips For Professionals Wanting To Deliver Plus Size Friendly Care
It’s easy to point out examples of bad practice, but how do we turn that around into a helpful guide for good practice?
I’m a big believer in solution-focused working. No point telling me there’s an issue, if you can’t think of a way of doing it better! So, I’ve written a page for professionals to help give some pointers on how to deliver plus size friendly care. Have a read. Share it, please, if you agree. If you don’t, or I’ve missed anything out, feel free to comment – it’s a work in progress!
But which came first, the chicken, or the egg? Did generations of children growing up being marketed the implausibly proportioned Barbie learn to love the lean, or is Barbie merely holding up a mirror to the attitudes already prevalent in society, and giving consumers what they want?
There are other dolls!
Of course, while Mattel is the biggest player in this market, I knew other, more realistically proportioned dolls like Lammily and Lottie existed. They’ve always been very much on the sidelines, however.
Lammily is supposed to mirror the proportions of an ‘average’ 19 yer old. She’s chunkier than Barbie, for sure, but still seems to be the average proportions of a slim 19 year old, if you ask me. Lottie is modelled on the proportions of a 9 year old, but with a bigger head to enable more ‘hair play’.
I didn’t really imagine then that Mattel, makers of Barbie, would manufacture a curvier doll. Who would have!?
So what happened next?
Since that time, Lammily seems to have become somewhat a recluse. I couldn’t find a UK retailer for her, just a few ‘first edition’ dolls listed as collectors items on eBay. To be honest, she always seemed duller and less fun than Barbie, with fewer outfits and scenarios. Understandable since she was decades behind in terms of accessories and marketing etc. but there was never any chance of her catching up if she didn’t seem to be any fun! Who wants a dull doll to play with?
Lottie, however is definitely still going strong, and seems to be having plenty of fun, with a variety of skin and hair colour options, and lots of accessories and outfits available to facilitate imaginative play, from astronomy, to zoology. My personal favourite has to be ‘Activist Lottie‘ complete with placard and loudhailer!
So, whether Mattel heard the criticisms, or saw the rising success of Lottie who, let’s be clear is still a very small player in the market, who knows?
Rise of the Plus Size Barbie – the Fashionistas range!
In 2016, Mattel did the unthinkable. They introduced the ‘Fashionistas’ range of Barbies with different proportions. This seismic shift even got them a Time magazine cover!
‘At last!’ I thought. Some diversity emerging in the Barbie doll market – now young girls can play Barbie parties where all the attendees aren’t just identikit featureless Melania Trumps in different outfits, distinguished only by who’s had their toes bitten off, or who’s got regrettable marker-pen make up!
But I’d forgotten my earlier prediction. Do girls actually want to play with a new ‘curvier’ Barbie? Some researchers decided to find out.
Plus Size Barbie – what the researchers discovered
Their article is published in the September issue of Science Direct; yes, I know it’s only July! Science is the future, don’t forget! The title probably tells you everything you need to know at a glance:
They worked with 84 girls between the ages of 3 and 10, asking them to assign positive and negative traits to the various dolls. Their findings make sad, but not unexpected reading.
Results generally demonstrated greater negative attitudes towards the curvy Barbie doll and more positive attitudes towards dolls with a thinner body size/shape (i.e., original, tall, and petite dolls). Girls identified the curvy Barbie as the doll they least wanted to play with. Additionally, girls with higher levels of body dissatisfaction demonstrated less negative attitudes towards the original doll.
Overall, findings demonstrate a preference for thin bodies and aversion towards larger bodies among young girls. Further, findings suggest that the simple availability of body-diverse dolls may not be a powerful enough intervention to overcome harmful weight attitudes, and highlight the importance of continued efforts to encourage exposure to and acceptance of diverse body shapes and sizes in young children.
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.