It must be a New Year – all the gym car parks near me are full and every television programme seems to be focussed on weight loss, faddy ‘detox’ diets and quick ways to get fit. I daren’t even look at any of the January magazines and their plethora of celebrity dieting regimes. If ‘a dog is for life and not just for Christmas’ then my adage is: ‘healthy eating and fitness are for life and not just for New Year!’
What made me particularly squirm the other day was a television programme entitled ‘Britain’s biggest loser’ – the not so subtle title gives a bit of a clue to the fact that the contestants on this programme are going to be made to look like figures of fun and the embodiment of over-indulgence. Not only does the programme aim to get us all out of our armchairs it is undoubtedly designed to make us all feel somewhat superior to the victims on our screens – just a little smug and not so guilty about our own seasonal extra poundage.
At the beginning of the show about a dozen contestants, dressed in unflattering tight Lycra tops and shorts, meet with the show’s host, Davina McCall. Resplendent in designer clothes, immaculately made-up, not a hair or an eyelash out of place an undeniably trim Davina confidently addresses the nervous contestants. The first task of the anxious ‘weightwatchers-to-be’ is to run 5 km to the Stately Hall where they will be housed for the next few weeks for their televised fight for fitness. Viewers were then able to witness blood, sweat and ‘prime-time television’ tears as the contestants, who had already expressed that they rarely exercised at all, attempted to run over uneven terrain to their distant goal – weight loss boot camp. Unable to tolerate any more of this public display of humiliation I grabbed the remote control and changed channels. Later, checking out the ‘Biggest loser’ Website, I saw how I could, for a small price, achieve significant weight loss in six weeks or demand my money back. The site also generously told me how much weight I should expect to gain over the same period if I did not follow their programme of diet and exercise.
The New Year has also seen the ongoing news story about breast implants and their associated potential health risks. The health scare followed a report from French authorities who found a 5% rupture rate in implants and were recommending that they should be removed. The implants were manufactured by a French firm, Poly Implant Prothesis (PIP), and were banned in 2010 after it was discovered they contained industrial grade silicon gel rather than medical grade and have a propensity to rupture. About 95% of the PIP implants were done by private clinics for breast augmentation.
It may seem to us that an obsession with how we look and a desire to lose weight and have the perfect body – and perfect breasts – is a modern phenomenon. But the urge to reduce the figure and enlarge breast size can be traced back to the Minoans who around 1700 BC developed the first corset. This fashion accessory which was designed to alter the shape of women’s bodies then re-emerged during the Renaissance period around the 15th century. Louise Foxcroft, the author of the book ‘Calories and Corsets’, suggests that history shows men are not immune from the dieting imperative. Indeed, during the 18th Century the British writer Lord Byron maintained a diet of biscuits and soda water or potatoes drenched in vinegar in order to shed the pounds. As well as weighing himself obsessively, Lord Byron, apparently wore thick layers of clothes to lose further weight. His influence was such that he was accused of negatively influencing young people to follow unhealthy diets – presumably the young born into the privileged classes!
Nowadays, the term ‘manorexia’ has been coined to describe the increasing incidence of eating disorders among men and it appears to be gay men who are particularly vulnerable to these types of disorders. The other condition identified among men has been called ‘bigorexia’ where men suffer body dysmorphia and go in pursuit of increasingly more muscularity and strive for the perfect six pack.
The copy of December’s magazine ‘Attitude’, which is aimed at a mainly gay male readership, had semi-naked images of the winner of the 2011 ‘Strictly Come Dancing’ show, Harry Judd, on its front page. Judd, the drummer in boy band Mcfly, displays his naked torso – with a six pack, bulging veins and not an ounce of fat in sight. According to the Daily Mail it was not his dancing skills which caught the eye of the ‘Strictly’ judges but the ‘six pack which has seen the judges…awarding him high scores all season.’ We are left in no doubt that the body beautiful is equated with being sexually attractive and successful – a fit lean body is a sexy body.
Human behaviour and motivation are hugely complex issues as are the reasons why some eat too much and others eat too little. What influences some to strive for perfect bodies and others to become ‘couch potatoes’ (and some of us in-between) is multi-faceted and affected not only by individual choice but by the environmental, social, political, and economic context in which people live their lives; and all too often these factors are ignored in favour of judgemental, over-simplified and individualised solutions. Suggesting to an exhausted, single mother on a low income that she needs to go to the gym three times a week is unrealistic but there may be other ways of engaging with her in more healthy activities which take account of her personal circumstances and needs.
Body image and self esteem, which are undoubtedly interrelated, ultimately impact on sexual practices and sexual health and well-being. Over the years I have spoken to many people who feel they can only have sex in the dark because they are embarrassed by their body and fear they are too unattractive to be seen in the nude. Others have described how they will not adopt certain sexual positions because they fear they will look too fat and ungainly. Laying on one’s back in the missionary position, I have been assured, is the best way of concealing one’s spare tyre!
We know too that evidence suggests that young adults in the UK drink alcohol in the hope that it will improve their sex lives, presumably also give them greater confidence when having sex and offering them a temporary boost to their flagging self-esteem.
We need to shift away from striving for perfection when it comes to healthier bodies, healthier life-styles and healthier minds; acknowledging that a more balanced and pragmatic approach is more likely to have greater overall benefits. The individual pursuit of perfection is doomed to failure and by its very nature creates winners and losers. Health professionals and policy makers should challenge an idealised view of an ultimate goal, achievable by all, of peak health and fitness and sexual health. From an early age we need to be encouraging youngsters to better understand their bodies, value their bodies, build their self-esteem and challenge stereotypes of the perfect body; a learning process which needs to be encouraged to continue throughout all periods of life.
We should pursue health improvements, and be prepared to engage with people around ways in which they feel they might make more healthy decisions and are not made to feel demonised when they do make decisions which could ultimately negatively affect their health.
A recent recommendation by an independent panel of government advisors, The NHS Future Forum, has proposed that all health professionals should take every opportunity to discuss diet, exercise, smoking and drinking habits with any patient with whom they may come into contact. The report points out that in England GPs and practice nurses see over 800,000 patients each day, dentists see over 250,000 NHS patients and pharmacists are visited by over 1.6 million customers. Interestingly there is no suggestion that health professionals might engage in discussing topics such as sex and sexual health – presumably this is considered one step too far – and in my opinion is a missed opportunity.
There are critics of the initiative, entitled ‘making every contact count’, who feel that it could be counter-productive if some patients are made to feel defensive and judged about their health choices. Whatever the arguments it is clear that for such approaches to work health professionals have to engage and communicate effectively with patients and be sensitive to their needs. Furthermore, health professionals need to be continually mindful of the context in which people live their lives, they need to remain aware of health inequalities and see the person as a whole rather than a medical condition.
There are no quick fixes. We are not all going to achieve an exemplary healthy life style, develop a six pack – and we are not all going to consistently practice the safest sex. Instead of striving for perfection let’s aim for ‘good enough’ sexual health and ‘good enough’ general health and well-being. Let’s not ignore the multiple external as well as individual factors which impinge on healthy decision making. Maybe then at least we might be moving in the right direction and won’t make people feel even more helpless, demoralised and unhealthy. After all you wouldn’t ask someone who has never exercised before to suddenly undertake a 5km run. Would you?
