The skinny on “women’s health issues”
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Trigger Warning: The article on women’s health issues mentions assault and eating disorders.
Disclaimer: “*Women’s Health” in this article will mostly refer to the health and bodies of cis-women. For transwomen and transmen’s health, please see: Help! I’m a lesbian—scan my cervix! (& other rainbow health concerns). Cis women are also an oppressed group; especially POC and low-income cis-women; and their healthcare has been molded under decades of misogynistic practice. This space will be for discussing those realities in specific, not to ignore the realities of other bodies. There is, of course, no one way to be a woman and no one version of a female body. Much of the information here within will naturally apply to transwomen as well, to transmen, and even to a degree, to cis men. But for the duration of the article, “Women’s Health” will refer to that of cis-women.
What are women’s health issues?
Women’s health: you’d think with women needing their own terminology for healthcare (women’s healthcare is not to be confused with men’s healthcare, after all, which is given the simpler moniker: “healthcare”), there might be a whole subset of science explicitly devoted to women and their medical needs. However, the actual science behind the term “women’s health” is woefully lacking—and it is precisely in that cavernous lack we ignore the growing root causes of health concerns facing women and girls.
When we look at women’s health in the mainstream, it’s a hodgepodge of bewilderment and pearl-clutching, mostly. It ranges from the ancient (the 1825 speculum: no iSO update available), to the unknown (the vast viral mystification of the female anatomy), to the downright ignorant (US Representatives saying women’s bodies prevent pregnancy in the event of rape). Often, women’s health is just shorthand to mean “reproductive and maternal health”: boiling down the medical issues and the worth of a person’s wellness to her viability to carry children. This gross over-simplification further muddies access for non-cis women, as well as women who plan to be childless, or who cannot bear children.
Women’s health issues have been under-represented for decades
Women’s health outside of the maternal has been woefully under-represented and under-examined in general medical studies—and this includes the parts of a woman that might be responsible for one day nurturing a child. From the under-diagnosis of endomitosis to the over-diagnosis in false positives of breast cancer, hospitals and clinics are puzzled by women. And that ignorance begins at the research level—which echoes dangerously into everyday lives.
According to Londa Schiebinger’ Women’s Health and Clinical Trials (2003), women of “childbearing ages” have purposefully been left out of clinical trials starting in the 1940s, and then en masse in the 1970s and beyond. This research geared towards women was seen as less important than the possible side-effects of that research to the unborn children they are meant to one day achieve.
In other words: the mere prospect of children has been more important to these studies than the reality of living human females. Studies that included zero women, yet were foundational in establishing modern medicine, include: the study of Longitudinal Aging (despite the majority of elderly populations being female), the study on effects of aspirin on cardiovascular disease, and the study on links between smoking, blood pressure, and coronary heart disease—to name a few.
“For much of documented history, women have been excluded from medical and science knowledge production, so essentially we’ve ended up with a healthcare system, among other things in society, that has been made by men for men.”
The office for the Research on Women’s Health within the NIH was only established in 1990. As Schienbinger points out in her investigation, one of the most shocking omissions of women was in the study of estrogen and its ability to treat heart disease as an injectable: a treatment posited for men only. Further, studies which did include women (such as The Nurse’s Health Study on Oral Contraceptives) have utilized predominantly white, upper-middle class women, and do not take into account what variables there might be for women of different ethnicities or with less access to expensive healthcare, healthy food, and cleaner environments
Women’s absence from drug trials
Despite women being the primary consumers of US pharmaceutical drugs (80%, in 1988), by the end of the 1980s, the FDA were rarely including women in new drug trials. The result?
“Average doses” for almost all medications today are based on male body size and metabolisms. And the way development of diagnosis, preventative treatments, and care are taught are based almost solely on how symptoms manifest in cis-male bodies. The opposite is never true. Drugs are never tested exclusively on women, and then those results applied wholesale to men. Drugs also rarely take into account and are adjusted for the stages of female cycles: pre-menstruation, during menstruation, and menopause.
The justification for this model? That men are “cheaper and easier” to study, and that diversifying studies racks up the cost despite the fact that pharmaceutical companies make over one trillion dollars per year (over half of which comes from the US and Canada—7% of the world’s population), and with spending on healthcare in the United States topping 3.5 trillion dollars per year. (Gee, only 3.5 trillion? How they can afford anything, much less making drugs and healthcare more viable for half the population is certainly beyond me.)
“When a mass culture is explaining to women that they have to be thin at the cost of their real health, naturally, women become less healthy.”
Why are drug studies only ‘concerned’ about women’s reproductive health?
Mysteriously, the excuse that the unborn child (pre-conception) could be effected by medical research and drug studies never comes up as a possible dilemma or deterrent in using males in studies. Generally speaking, with my tongue wedged far into my cheek, men provide half the DNA of any future-tense children. However, their ability to sire these children is rarely considered when posing the question of whether or not their dosages of aspirin, Vicodin, and Valium should be regulated by hard research or guesswork.
The result? That women are twice as likely to have adverse drug reactions. And in hospital settings, an “adverse reaction” can quickly become a complication leading to illness, additional surgeries, medical emergencies, and death. The only area of medicine where women are over-treated, according to Norsigian’s 1993 Google Scholar article (Women and national health care reform: a progressive feminist agenda) is, unsurprisingly, (drumroll, please) reproductive health. The number of hysterotomies, false-positives checks on breast cancer, and C-sections women are made to endure—often before the assurance that they actually need these operations or preventative screenings—can be staggering.
Yet, while discussions have been ramped up and ongoing since the 1990s about women’s health in the realms of pharmaceuticals and disease, one area where the discussion lacks most comes down to the dietary: and the link between modern beauty standards and female health—specifically, the crises in feminine bone health.
Get thin! Or diet trying
By now, unrealistic beauty standards have been making waves as a hot button topic across everyone’s newsfeeds and newspapers. In 2016, Women’s Health magazine decided to drop the term “bikini body” for good—only after women the world over began shouting from rooftops that every body is a bikini body if you just apply a bikini to it. Healthline started to talk about the destructive effects of “fat shaming”—but only after the body-positivity movement coined the term. But this pushback is against a tide. There is a global editorial fondness for the ultra-thin. On the other end of the spectrum, mainstream TV shows like The Biggest Loser and Britain’s Fattest Families make a public spectacle out of poking fun at the obese and turn weight loss (fast) into a smug, cruel and sadistic form of circus.
The modern backlash was born of women’s frustration against modern beauty’s ever-shrinking, face-tuned, photoshopped waistline. And like the four horsemen of the apocalypse, riding beside these size-0 beauty standers were: dieting, supplements, cleanses, and weight loss pharmaceuticals.
Some of the most popular diets in the last few years have been: Diet Pills, SlimFast Drinks, Anti-Carb, Liquid Diets, Keto, the Macrobiotic Diet, the South Beach diet, the Master Cleanse, Alli drugs, HCG, and Weight Watchers.
Read more: Medical gaslighting: what is it?
Each diet comes with nearly a superhero moniker, as it if were able to move tectonic plates—and curb your own dishes in the meanwhile. But what all these diets and supplements have in common is, in one way or another, they are limiting certain food intakes, or else blocking absorption of foods, or replacing vital foods with the synthetic. If they were a superhero, they might be a Trickster. And absolutely all of them want you to lose the weight fast and keep it off by staying on that diet or supplement.
While of course these diets have touched down upon and resonated with men as well as women, the unfair and unrealistic body standards that exist for women; and the harsher judgements that come with them; mean that women spend, on average, 17 years of their lives on diets, and are shelling out the majority of the $60 billion-a-year profit that the weight loss industry makes. In general, women spend more than 5-10% of their monthly budget on beauty and wellness, and the numbers often climb much higher. Men do not spend a comparable amount, which means that it is the goal of diets and supplements to continue to target women—and it’s working.
Commercial weight loss’s financial forecasts are expected to grow nearly 10% by 2019, according to Market Research. Yet in the USA, 75% of men are considered overweight—versus only 60% of women. But often, being overweight—or healthy/unhealthy—has absolutely no bearing on who the weight loss industry targets: women of all ages, shapes, and sizes. Ad budgets reflect this, and so does ad placement: according to adbeat, for example, 70% of Nutrisystem’s customers are female. So the majority of its ad budget goes into pushing ‘lose weight fast’ ads onto sites like Cosmopolitan Magazine, Women’s Day, and Good Housekeeping. Similarly, celebrity “blink and it’s gone” post-baby weight loss culture helps to add fuel to the flame that even when women are naturally and healthily carrying any extra weight, it still must be eliminated at superhuman speeds.
Ethan et. al.’s 2016 study on weight loss and mainstream media in Health Promotion Perspectives found that 14% of all articles in US-based women’s magazines were focused on weight loss—but very few of those articles had a scientific perspective, and most were attempting to push or sell a product. Diets were the second most popular article type (after exercise), and the most popular category of dieting article were those selling pills to women to ‘lose weight fast’. Fat burners and blockers; also usually pills; were also popular topics.
Women are spending well over 40 billion dollars in the US alone on weight loss per year. This makes it big business. Competition for dollars is fierce. “Diet” foods (like low-fat yoghurt or sugar-free sodas), weight loss programs, pills, and books on how to lose weight all cut a decent profit margin in this fat-hysterical climate. Yet, the FTC has found that over 40% of weight loss claimants on the market are patently false: they are selling snake oil. But the FDA is a slow giant to respond to the critics, even as lawsuits against these peddlers top $100 million a year.
The FDA only banned diet pills using ephedra (linked to heart attacks), for example, in 2004. Its main victims were women. Also banned, though once widely used as or in dietary supplements are: Fenfluramine (for causing heart and lung damage), Hydroxycut (which caused jaundice, hepatitis, and liver failure), and Meridia (for causing cardiovascular damage and strokes.) The FDA keeps a list 209 strong (I know, because I counted) of weight loss supplements that are currently on-market and over-the-counter that are legally allowed not to list their inclusion of ingredients which can cause cancer, seizures, heart attacks, or a cornucopia of other; and often unstudied; side-effects.
Names as innocuous as ‘Green Coffee: Brazilian Slimming’ or ‘Strawberry Balance’ or ‘Toxin Discharged Tea’ command the list, tucked away onto a part of the web I doubt most people have glanced at. Other common ingredients in weight loss pills are known to cause liver damage, kidney damage, high blood pressure, and numerous lesser symptoms. Ingredients common to weight loss shakes, on the other hand, include: artificial sweeteners that damage healthy gut bacteria, synthetic vitamins, added sugars, very little fiber (leading to shortages in the body on shake or juice-heavy diets), and according to the Clean Label Project, even significant amounts of BPA, lead, arsenic, and mercury.
But to a degree, everybody knows at least some of this already. This isn’t new, or shocking.
Interestingly, it is health magazines and publications; which are often the gateway to diets; that are noted by researches as one of the most pressuring influences over women’s decision to diet to be thin. Typically, fashion magazines took the majority of the blame. Editorials of slim, cellulite-free, airbrushed models have been proven to alter women’s psyche, changing their body image for the worse, and prompting them to go full-tilt into weight loss and beautification. So these are prime environments for fad diets to lurk.
Weight loss is always linked in ads; and in people’s minds; to ideals of achievement, better happiness, success, better sex, and good health, regardless of how that weight loss is actually realized. Many women resort to purging and binging, or abstaining from food altogether (eating disorders bulimia nervosa and anorexia nervosa—which effect 10 million female versus 1 million males in the US). And these “ideals” are targeting all women: the majority of articles tend to be aimed at thin women rather than “overweight” women, unlike weight loss adds. Weight loss articles remind women not to be ‘flabby,’ telling them how to get rid of ‘baby fat,’ how to denounce ‘love handles,’ and ‘keep weight off.’ They promote women to hate any sign of too much skin, a roll, a wobbly bit of arm or leg or jaw.
In Fayat et. al.’s 2012 article in the Journal of Women’s Health, it was found that regardless of ethnicity, age, or background, women from the ages of 18-35 were precisely as likely as one another to diet. Which means that these publications and ads are tapping into; by creating; a mania for thinness that pervades every cultural boundary, defining that all womanhood equates to thinness. In Fayat’s study, over half of female college students felt they were overweight-obese, despite most being in the normal BMI range (78%). 75% of college-age women were either actively dieting or avoiding weight gain, with 27% being classified as “high restraint” eaters.
These collegiate diets start young, beginning for women in high school and becoming an engrained norm for these women by college, with no real foundation in ideas of true health, BMI, or nutritional value—only numbers on a scale. Yet the study also found that women who ate regularly were the most likely to be healthy, and those that dieted were more likely to have poor mental and physical health, higher incidence of gaining an eating disorder, and worse body image. The drilling starts young—and this is important.
When a mass culture is explaining to women that they have to be thin at the cost of their real health, naturally, women become less healthy. And what these diets and diet pills often have in common; whether they are restricting food groups, liquifying calories, or blocking absorption; is sapping of nutrients. The younger these diets happen, the fewer nutrients and energy a body has to bolster itself with. Should women be shedding pounds religiously, and at the rates at which they are often encouraged? Generally, absolutely not.
And this especially impacts the bone health of women.
A bone to pick with dieting…
It is estimated that 80% of Americans with osteoporosis are women. 80%! According to the International Osteoporosis Foundation and the National Osteoporosis Foundation, 3.5 million women in the UK and 8 million women in the USA now have osteoporosis. On average, more than 30% of women, in general, have “low bone mass” over the age of 50, even if they have not been diagnosed with the bone disease.
Historically, milk (and more specifically, the calcium in it) has been seen as the way to battle the onset of osteoporosis—yet 90% of Asian American women are lactose intolerant, as opposed to 15% of Caucasian-American women—yet more than 50% of Caucasian women have low bone mass, whereas only 20% of Asian-American women do. So it does not seem like dairy is the be-all, end-all answer.
A clue to where we might look for a better answer is in the at-risk list itself: being thin can make you more at risk for osteoporosis. Especially if that thinness came on quickly, or is due to a nutrient deficiency.
Yes, being thin—ultra thin! The thinner the better!!— has been mega-marketed as cure-all for women’s happiness. ‘Just be smaller!’ So repeat dieting, low-calorie foods, and frequent cardio—the full package promoted towards women, mostly—helps to contribute to loss of bone health over time. Eating disorders like bulimia and anorexia, often driven by the insane focus on thinness equating to happiness for women and preying upon the body dysmorphia and depression of women and girls, puts one so much at-risk for loss of bone mass that eating disorders are listed as a possible early cause on official osteoporosis sites. Dieting and abstaining from food are keys to bad bone health.
To really fight those odds? A good balance of Calcium and Vitamin D before menopause is the best blocker for future osteoporosis. And the foods highest in calcium might be the ones your diet tells you to restrict.
Full-fat cheese, breads, almonds, some fruit juices and breakfast cereals, and of course, leafy greens.
Vitamin D, which you can actually get from sunlight (and we aren’t going to use this article to delve into the pressure on women to pay heed to skincare such that umbrellas, hats, sunglasses, and visors are common outdoor items for even a quick stroll), you can also get from— you guessed it—foods most diets would find an anathema.
Fatty fish, eggs, cheese, and some fortified cereals and fruit juices (plus more generally “accepted” options like mushrooms.)
The best forms of exercise to prevent osteoporosis are often those least marketed to women, and instead aimed at men: weight-lifting and bearing and muscle-building movements. Many women, focused on being ‘thin’ above all, are fearful of putting on muscle—as it adds ‘mass,’ and doesn’t show a net loss of weight, but tends to even show a gain in weight (especially at first). Yet, muscle weight is healthy weight. But as we’ve already said—diets aren’t generally too concerned with health, only inches and pounds.
And just as diets are on the rise, so are elderly bone fractures. Bone fractures due to low-density bone mass are expected to rise by 240% by 2050 in the US alone, and osteoporosis has been on a meteoric rise in recent decades. And while the argument could be made that that’s because people will be living longer by 2050, we have some other interesting statics to look at that give us a different view. The rate of osteoporosis is meant to more than quadruple in Asia by that same 2050—yet looking as Asian-American populations, with their lower-than-average incidences of American with osteoporosis, we cannot conclude this is in any way genetic.
Instead, if we look at weight loss trends, the 2017 Obesity Review article Prevalence of personal weight control attempts in adults: a systematic review and meta‐analysis (Santos, et. al.), we can notice that there is a higher percentage of weight loss attempts in the last decade than in any other. In Asia, those numbers hit a staggering 61.3% as of 2009, the highest on any continent—and many of these women who are dieting fast and hard now will be aging past 50 (when the likelihood of osteoporosis rises) by 2050. So Asia’s trend towards more dieting is matching their quick climb to worse bone health, despite the introduction of more dairy dishes to many of the countries in Asia over the last few decades of globalization and increased trade. And the biggest motive for these dieters in Asia, above health, fitness, or to decrease likelihood of disease? “Improved appearance.”
Weight loss vendettas are literally cannibalizing women and spitting out the bones.
Women’s health issues: it is time to take our health into our own hands
Women are often made out to be their own category: there’s women’s health and women’s wellness. This separation often means that women are getting the shorter end of the stethoscope. One thing we can do, however, is take our health and our images into our own hands and talk more openly about good ways to tackle a bone-healthy diet and exercise plan that have nothing to do with getting thin, fast, and everything to do with staying strong, long.
Madison Salters, an award-winning writer, essayist, and documentarian, was selected as a 2018 U Revolution Media Fellow in the writing category.