Dangerous Curves Ahead

Barbie now comes in three different shapes: tall, petite and curvy – and her new incarnations have sparked some debate. There have been complaints that curvy Barbie is still thinner than the average woman in the UK and the US. But is this a bad thing?

Scaled up, curvy Barbie would be 167.6cm or 5’6” (slightly taller than average) with a waist measurement of 63cm (24.8in) and hips 91.2cm (35.9in) whereas the average British woman measures 79.5cm (31.3in) and 105cm (41.3in) according to the 2012 Health Survey of England.

In that year, 67% of men and 57% of women were overweight or obese. Overweight and obesity are defined as ‘abnormal or excessive fat accumulation that may impair health’. Being overweight/obese is associated with an increased risk for some common causes of disease and death including diabetes, cardiovascular disease and some cancers.

The cost to the NHS of obesity and obesity-related disease was £2.3 billion in 2007 and is projected to be £7.1 billion by 2050 (assuming we still have an NHS by then). Costs attributed to overweight and obesity taken together are £4.2bn in 2007, projected to be £9.7bn in 2050. This compares with the current cost of smoking-related disease at approximately £2bn (and smokers are heavily taxed).

For some time, Body Mass Index (BMI) has been used as an indicator of obesity but it’s a pretty blunt instrument as it doesn’t distinguish between fat and muscle or take account of how the fat is distributed (fat in the core area or around the organs is worse for health than fat lower down the body, for example). Waist to hip ratio or waist measurement are now considered more accurate with a waist measurement over 102cm (40.2in) in men and 88cm (34.6in) in women taken as the threshold for health concerns. This metric still works best for people of average height and Western ethnicity though.

By these measurements, Curvy Barbie is clearly thinner than the average UK woman. This may not be a bad thing.

Original skinny Barbie has taken a lot of flak over the years for causing girls and young women to be unhappy with their body shape. For example, research done in 2006 found that girls aged between 5.5 years and 7.5 years old were less satisfied with their own body shape after reading a book with pictures of original Barbie. The research was done by Helga Dittmar of Sussex University who found that "The girls said they wanted a thinner body shape than they had. They had lower body-esteems after seeing pictures of Barbie. If we show an effect with a single exposure study it stands to reason that the impact increases as time moves on."

The media is full of images of very thin people that cause a lot of pressure, misery and body dysmorphia in women (and of course, men too). Diet books and products are huge earners. Barbie is just a tiny contributor but even with falling sales, she is a presence in the lives of many young people.

Fat shaming is hateful behaviour. There was a recent case of people handing cards to overweight women on the Tube in London to humiliate them, reducing women (yet again) to just a body to be judged.

Women are of course used to being judged by their appearance – and found wanting both by companies trying to sell products and by society in general. But should Barbie reflect the average woman? If she had a scaled-down version of the average waist and hip size would this make young women feel better about themselves or would it normalise obesity? Even while acknowledging the flaws of BMI, the Health Survey of England found that ‘there was a significant discrepancy between participants’ own assessment and their BMI category, which was greater among men than women. This lends support to the idea that a high prevalence of overweight and obesity in the population has led to a greater bodyweight/size becoming the norm’.

There’s a fine line to be walked here. While it is in no way acceptable to judge anyone by their size, promoting healthy body shape through a balanced diet and exercise can only be a good thing. The message is too complex for some: obesity is not good for health but if fat is bad, it’s too easy to jump to the assumption that fat people are bad/weak/stupid. It’s important that children understand the distinction. There’s also a class/income element to obesity as people in lower income groups are more prevalent in overweight groups.

Children have little or no control over what they eat so education is essential to ensure that, as soon as they have a choice, they make it a healthy one. The recent proposal to tax sugary drinks has its heart in the right place but even if campaigners succeed in getting it done, it won’t work without education and healthy bodies as role models.

Prevention is easier than cure. It’s hard to lose weight and exercise regularly. Evolution has geared us to seek out fats and sugars as they were once in short supply. Now they’re everywhere. The time of food scarcity when a fat baby was thought to be a healthy baby is long gone.

Children don’t know what dress size Curvy Barbie takes, they don’t know that it’s less than the average, they just see that she’s not skinny as a stick. Yes, she is just a doll and is only a tiny part of the way children are influenced. But if Curvy Barbie helps just a little bit to stop children feeling as bad about themselves while at the same time it normalises a healthier shape, that could be a step in the right direction.

Perhaps toy maker Mattel is being more realistic about the shape we’re in or perhaps this is an attempt to boost profits, which are reported to have fallen by 59% with a 14% drop in sales of Barbie.

It seems unlikely that Mattel is being altruistic. The tall and petite versions only look different heights compared with standard Barbie. In isolation, they just look like any other doll – and are still unnaturally thin. Tall Barbie would be 180cm (5ft 11in tall) with a waist measurement of 56.4cm (22.2in) and 78cm (30.7in) hips. Just for comparison with Lanky Barbie, I am 185cm (73in) with a waist of 76cm (30”) and hips 99cm (39”). I weigh 66.5kg (146lb) with more muscle than average. If I were any thinner, I’d be ill.

Doctor Jesus - Government Approved

Two linked stories about religion and health this time.


Dr Richard Scott has been disciplined by the General Medical Council (GMC) for bringing Jesus into the surgery after the mother of a patient complained that Scott preached at her son during a consultation. Scott believes that where Western medicine ends, Jesus can step in. He claims he has seen Jesus curing people and that 'there is a place for Jesus in the surgery'. He also believes that homeopathy works - there is about the same amount of evidence for both of these practices. None.

He describes the 'faith approach' as 'an optional extra' but it's one patients have to actively opt out of.

The Bethesda Medical Centre in Margate where he practices is run by six Christian GPs. The website states: The 6 Partners are all practising Christians from a variety of Churches and their faith guides the way in which they view their work and responsibilities to the patients and employees. The Partners feel that the offer of talking to you on spiritual matters is of great benefit. If you do not wish this, that is your right and will not affect your medical care. Please tell the doctor (or drop a note to the Practice Manager) if you do not wish to speak on matters of faith.

NHS patients should not have to opt out of being preached at. Many people go to the doctor in a vulnerable state and may not feel confident enough to challenge him or her as the balance of power is very much with the doctor in that situation. There is a very big difference between practising medicine and practising Christianity.

Not only did he prescribe a dose of Jesus, he tried to convert the patient whose mother complained, telling him that 'he might find Christianity offers more than his current faith', suggesting the patient went to Scott's church or its Alpha courses. Presumably he's done a randomised, placebo-controlled, peer-reviewed experiment to prove this. He is supposed to be a scientist, after all.

The GMC is very clear that doctors 'must not impose their beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views.' If the patient wants to lead a conversation about faith then that's a different matter but even then, the doctor should keep his or her views in the background. Even the UK College of Healthcare Chaplaincy, an entirely religious body, describes proselytising as 'spiritual abuse' in its 2005 guidelines.

Scott is not deterred. He believes that the GMC's ruling is further evidence of 'Christians being hammered at work' and is appealing the decision, backed by the Christian Legal Centre who are always quick to jump on any case where they think that Christianity should take precedence over all other rights. You can see a clip of him talking here.

Scott also spoke about referring women to a local Christian abortion counselling centre. It's not surprising that he and an increasing number of others think it is their right to force their beliefs onto people in the workplace and in therapeutic settings. There is an increasingly foetid climate of religion demanding exemption from laws and guidelines. The Government is fuelling this state of affairs by welcoming hard-core believers into health care services with open arms - despite the fact that over 70% of people in the UK (Including reasonable, rational believers) support abortion and contraception.

The new sexual health forum set up to replace the Independent Advisory Group on Sexual Health and HIV will include the Life organisation - but not the British Pregnancy Advisory Service. Life is also a member of the new Sex and Relationships Council recently launched in parliament and endorsed by education secretary Michael Gove - all nine members of this group are either pro-abstinence, anti-abortion or both, including the Silver Ring Thing.

Life said that all members of the forum want to reduce the number of abortions and their motives are secondary. This is disingenuous at best. Life's mission, according to its website 'is to uphold the utmost respect for human life from fertilisation (conception) until natural death' and that it fulfills this mission by 'Offering non-directive counselling and information on pregnancy, pregnancy loss and abortion.' It's hard to see how it can be both pro-life and non-directive.

One of its aims is 'challenging governments and policy makers to adopt policies which reflect and uphold the utmost respect for human life from fertilisation until natural death'. They are opposed to abortion even after rape. The apparent reason for having them on the forum is to bring 'balance' but presumably this means balancing scientific evidence with a position that is neither scientific nor evidence-based.

As if this weren't enough, MP Nadine Dorries thinks that teaching abstinence - but just to girls - will solve everything, including child abuse. And in Richmond, the Catholic Children's Society has been given a contract to advise schoolchildren on contraception and pregnancy.

The abortion rate for under 18s has fallen so this is no time to revisit the Dark Ages of ignorance, judgement and prudery. Virginity is not a precious gift from God. Some of us are getting very weary indeed of saying that abstinence has been proven over and over not to work. These hard-core religious groups claim to be pro-life but it's not the life of women and young people they care about.


More of the Doctor Jesus series here, here, here and here.

Spirituality - The Emperor's New Clothes

The word 'spirituality' is very much in fashion but is used in such a nebulous way to mean so many things that it has become virtually emptied of meaning. It has also become something of a sacred cow, not to be questioned.

A Pew Survey in 2008 and a Newsweek survey in 2009 both found that Americans are increasingly identifying as spiritual rather than religious. Newsweek states that, of the people surveyed: Nearly half (48 percent) described themselves as both 'religious and spiritual' while another 30 per cent said they were 'spiritual but not religious'. A Mori poll in the UK in 2003 found that 24% of people considered themselves spiritual but did not belong to a religion.


There seem to be four main flavours of spirituality:


The first is used by religious people almost interchangeably with 'religion' and 'belief'.


The second covers people who have a faith but a more personal relationship with their deity, away from hierarchical, structured religion, formal worship and dogma. Some people's faith, whether they use the word 'spiritual' or not, is so loosely defined that it would barely be recognised as faith at all by the orthodox. One such believer writes in the Guardian that 'what I believe is that God is the ultimate aesthetic object, ultimate beauty, glory and power, and that the vision of God embodies the quintessence of every aesthetic experience and every sensual pleasure'. Hers is a very rarified conception and it's not clear why anyone would put themselves in a category and then go to great lengths to explain how different they are from everyone else in that category. Safety in numbers, perhaps.


The third is a secular, mostly New Age flavour that is personalized, pluralistic, mystical. This can take a particular form - for example, Native American spirituality - or it can be just be a sense of connection with the universe, that there is 'something out there', a belief in the supernatural in the broadest sense. Words like 'energy', 'quantum' and 'natural' crop up a lot. For example, the all-embracing pick and mix nature of this spirituality is illustrated by the Spiritual Forums, which welcome discussion on the Spiritual, Paranormal, Metaphysical, Philosophical, Supernatural, Complementary Therapies and Esoteric subjects from Astral Projection to Zen, Angels and Yoga.


Although this alternative spirituality is New Agey, it is not new. Followers of Swedenborg and his brand of spirituality have been around since the 18th century and, although less fashionable now, they still exist. Madame Blavatsky was another precursor of New Age spirituality.


Finally, there is spirituality-lite, a kind of life-style accessory involving scented candles, pictures of sunsets, having once read a book by Deepak Chopra and the buying of alternative medicine by people who probably went to India at some point or would like to.


What they all have in common is that they focus on something other than the purely physical. They often take a critical view of materialism although the last two flavours involve buying a lot of accessories.





Maslow's hierarchy of needs identifies five layers of human requirement. The first is the most basic, satisfying physical survival needs for food, water, sex, sleep and so on. The second is for safety, the third for relationships. The top two needs, once these basics have been achieved, are for esteem/self-esteem and self-actualisation. Spirituality seems to fall into these two categories, particularly the last (although deeply religious people might possibly put it into the relationship category). Anyone struggling to survive is not going to be pondering the meaning of life and their connection with the universe or admiring a dream catcher they picked up in the local garden centre while listening to whale music.


Is spirituality just an indulgence, a modern fad, or does it have benefits?


The Royal College of Psychiatrists (RCP) have a leaflet called Spirituality and Mental Health which looks at the potential benefits. It states that: In healthcare, spirituality is identified with experiencing a deep-seated sense of meaning and purpose in life, together with a sense of belonging. It is about acceptance, integration and wholeness. It also says that Evidence for the benefits for mental health of belonging to a faith community, holding religious or spiritual beliefs, and engaging in associated practices, is now substantial. The Spirituality and Psychiatry Special Interest Group (SIG) has over 2000 members.


The leaflet has a long list of spiritual practices, including belonging to a faith tradition, acts of compassion, reading scripture, yoga, meditation, appreciation of the arts and engaging in creative activities, including artistic pursuits, cookery, gardening etc, group or team sports.


Spiritual practices, they say, include being self-reflective and honest, developing greater empathy for others, achieving a peaceful state of mind, wisdom, equanimity, patience and joy.


While a lot of the things on the lists are desirable both in life and in therapy, many of them are not what most people would consider spiritual. Is sport a spiritual activity? It appears that the RCP are using this catch-all term to cover pretty much anything that improves quality of life.


Their claim that there is substantial evidence for the benefits of faith and belonging to a faith community is undoubtedly true for some people. But faith can also bring a whole lot of unwanted baggage such as guilt, prejudice, pressure to conform and conflict, especially for people whose lifestyle or identity is not mainstream. Faith communities can be supportive, a vital social safety net but some communities are very focussed on ritual, dogma, formal worship and other distinctly non-spiritual elements. So it seems that this leaflet is being over-general and optimistic, the word 'spiritual' bland to the point of uselessness.


The NHS has also recognised the need for using spirituality as part of 'holistic' and 'humane' treatment. Its guidelines for staff state that Recognising a person's spiritual dimension is one of the most vital aspects of care and recovery in mental health. While treating the whole person rather than regarding them as a set of symptoms is laudable, the guidelines are over-stating the case for spirituality and potentially putting a burden onto already over-loaded and under-funded medical staff.

The guide defines spirituality as (among other things), a life-force, what makes us unique, a sense of connectedness with other people, nature, animals, sport, our life-pilgrimage and quest, what gives our life meaning. Again, the vague, hippyish, touchy-feely catch-all. And, again, sport features on the list.

Although the guide gives an unsurprisingly prominent place to religion as an aspect of spirituality, its aim is to include everyone. However, there is no recognition that some people may not want to use that term to define the part of their lives concerned with relationships, enjoying nature, art and so on, perhaps because it has religious or New Age connotations or perhaps because it is just inappropriate. Human spirituality is, for the NHS, a given. The Scottish version of the NHS guide begins with the quotation: we are not human beings seeking spiritual experience. We are spiritual beings seeking what it means to be human.

The promotion of spirituality either by people who claim to have it or by organisations that think everyone should want it, is not entirely benign.

It is sometimes a way for an individual to make themselves feel a bit 'special', a self-aggrandizing term that they cannot define or explain but which must not be challenged or even questioned. There is potential for misunderstanding between the different interpretations of the word and, although the 'right' to spirituality is assumed, different groups could well see their version as superior. A deeply religious person is unlikely to value Native American spirituality even if they pay lip service to tolerance. It is potentially yet another way of creating the Us and Them divide so well exploited by religions. My spirituality is more spiritual than yours.

Moreover, on the basis of the NHS and BPS definitions, if you are not spiritual at all, you are lacking. Anyone rejecting the need for this vapid labelling could be seen as somehow less than fully human, lacking in 'wholeness' - and this is the worrying element (that and the fact that tax-payers' money is being spent).

One survey contradicts the findings that spirituality is essential for wholeness and a healthy emotional or mental life. Profiles of the Godless questioned nearly 6000 individuals and looks in depth at atheists, agnostics and spiritual people, comparing them with believers. The distinctive element of this research is that it breaks down the category that many surveys use to lump all non-religious people together.

It found that more women than men described themselves as spiritual (which touches on something I blogged about here). Interestingly, it also found that 'spirituals' (as the survey describes them) reported lower satisfaction with their lives than those with other belief labels. It reports: Those non-believers most confident in their non-belief tended to be the most emotionally healthy, relative to the 'fence sitters' (...) Therefore, having uncertainty regarding one's religious views appears to be associated with relatively greater emotional instability.


One conclusion of the survey was that being sure about what you think and believe, whether that manifests as being actively religious or atheist, is better for your mental health than being agnostic or spiritual.

While it would be satisfying to have a term to apply to that part of our lives in which we enjoy things other than meeting survival needs or satisfying material desires, spirituality is not a good candidate. A word that means too many things means nothing and, in trying to be inclusive becomes exclusive.


Why choose a term that has religious overtones and then stress that religion is not the only form of spirituality? The word also has the taint of dualism, separating body and spirit. This is an old view of the Self with wholly religious roots. There is also the marketing triad of Mind-Body-Spirit used in bookshops and places that sell spirituality accessories, which further splits the Self.


There is a difference between being a materialist (not believing in unseen powers or a separate spirit or life-force) and being materialistic (placing too much value in, or reliance on, material things). I am a materialist but not materialistic and I reject the use of spirituality, in any of its meanings, to apply to my life. Does that mean there is something a bit wrong with me? I have a hole where my spirituality should be.