tag:theconversation.com,2011:/id/topics/normal-6924/articlesNormal – The Conversation2023-08-22T14:52:07Ztag:theconversation.com,2011:article/2077532023-08-22T14:52:07Z2023-08-22T14:52:07ZSix pregnancy terms you probably won’t hear again, including ‘high risk’ and ‘failed’<figure><img src="https://images.theconversation.com/files/542983/original/file-20230816-17-towf59.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C5152%2C3435&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The language midwives use is an important part of the care they provide.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-pregnant-woman-visit-gynecologist-doctor-1404770729">Blue Planet Studio/Shutterstock</a></span></figcaption></figure><p>Medical terminology evolves alongside our understanding of medicine. As time goes by, new terms are adopted while others are abandoned. In midwifery, there should always be a strong emphasis on the language we use, particularly in pregnancy.</p>
<p>In 2020, the Royal College of Midwives launched an initiative to discover the impact language has on women. The aim of the <a href="https://www.rcm.org.uk/rebirth-hub/">Re:Birth</a> project was to find language around pregnancy that could be understood both by people delivering maternity care and those receiving it. </p>
<p>It was the first project of its kind to consult the maternity community (including new mothers and healthcare professionals) directly on their preferred language to describe labour and birth. The findings of the project supported the fact that many women were less concerned about the way their baby was born but with whether they had a positive experience and felt safe and listened to.</p>
<p>Last year, the Royal College of Midwives published a <a href="https://www.rcm.org.uk/media/6234/re_birth_summary_.pdf">report</a> outlining their findings and a new pocket guide is being issued to midwives this year. </p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<p>Here are six maternity terms you are now unlikely to hear:</p>
<h2>1. Delivery</h2>
<p>The term “birth” has now been accepted, rather than the term “delivery”, which has commonly been used in the past. Women and health professionals also wanted accurate, specific descriptions as far as possible to describe what had happened in the labour and birth. For example, “birth with forceps” or “birth with ventouse”. This also includes “caesarean birth”.</p>
<h2>2. Low risk / high risk</h2>
<p>“Universal care needs” is being used rather than “low risk”. While “additional care needs” is now the preferred term for “high risk”. The word “risk” is associated with uncertainty and it is vital that women feel comfortable and confident during their pregnancy.</p>
<h2>3. Normal</h2>
<p>“Normal birth” is a term that has long been used by midwives and other healthcare professionals to describe a spontaneous, physiological vaginal delivery. But what counts as “normal”? Does this label someone as “abnormal” if they did not experience what we classify as “normal” birth?</p>
<p>The new preferred term, “spontaneous vaginal birth”, covers spontaneous labour without significant medical interventions such as induction and oxytocin. It also covers spontaneous vaginal birth without the need for instruments, such as forceps. </p>
<h2>4. Emergency caesarean</h2>
<p>The new overarching term for an operative caesarean section is “caesarean birth”. This replaces the word “emergency”, which is a term that may cause alarm. The term “unplanned caesarean birth” is now preferred over “emergency caesarean”. </p>
<h2>5. Incompetent cervix</h2>
<p>“Incompetent cervix” has connotations of personal failure. So, the preferred term is now “cervical insufficiency”. </p>
<h2>6. Failure / failed</h2>
<p>During the Re:Birth project, women were keen to share how terms such as “failure to progress” can contribute to feelings of failure and trauma. “Delayed progress in labour” or “slow labour” are now preferred terms.</p>
<p>We can apply the same logic to terms such as “failed induction” or “failed homebirth”. “Induction of labour, with delay and followed by operative birth” and “transfer in during planned homebirth” are favoured, respectively. </p>
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<img alt="A pregnant woman wearing a yellow top clutches her belly." src="https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Language matters.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-african-american-woman-doing-morning-1842709132">Prostock-studio/Shutterstock</a></span>
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<p>Language which infantalises pregnant women, such as “good girl” or “you are allowed/not allowed to” should also be avoided, as should language which has connotations of blame. Examples of this include “poor maternal effort” and “refused”. </p>
<p>During pregnancy and birth, which is a vulnerable time for many, the role of the midwife is to empower women and to value their autonomy over their care decisions. </p>
<p>The Nursing and Midwifery Council’s <a href="https://www.nmc.org.uk/globalassets/sitedocuments/standards/standards-of-proficiency-for-midwives.pdf">standards of proficiency for midwives</a> document states that midwives provide universal care for all women and new-born infants. Midwives support physical, psychological, social, cultural and spiritual safety. The emphasis on psychological care is clear, therefore, with language having a profound impact on wellbeing.</p>
<p>Healthcare professionals must acknowledge that the language we use is an important part of the care we provide. Improved psychological safety and wellbeing is closely linked to improved safety, positive outcomes and future experiences. Language matters.</p><img src="https://counter.theconversation.com/content/207753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Aubrey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Several familiar maternity terms have been abandoned after a consultation with pregnant women and healthcare professionals.Sarah Aubrey, Lead Midwife for Education, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/333512014-11-26T10:25:52Z2014-11-26T10:25:52ZMichael Jackson: Posthuman<figure><img src="https://images.theconversation.com/files/64164/original/wpntnrwb-1415653130.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C499%2C330&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mark Ryden's art for Michael Jackson's 1991 album Dangerous.</span> <span class="attribution"><a class="source" href="https://c1.staticflickr.com/1/128/344985533_f5315ae187.jpg">Augusto Podrido/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>The album cover for Michael Jackson’s album Dangerous was painted by American pop-surrealist artist <a href="http://www.markryden.com">Mark Ryden</a>. In it, he depicts a world in which the boundaries between human and animal, living and dead, whole and part, and celestial and terrestrial have been crossed and fused.</p>
<p>Surrealist painters like Ryden often aim to collapse such categories – to reconcile, in their art, what seems to be irreconcilable in life. But actually, this boundary-crossing <em>does</em> happen in life – increasingly so – and corresponds to what some have called posthumanism. </p>
<p>Cary Wolfe, an English Professor and author of the book “<a href="https://www.upress.umn.edu/book-division/books/what-is-posthumanism">What is Posthumanism?</a>,” writes that we are “fundamentally prosthetic creatures,” that we rely on entities outside the self – other humans, animals, technology – in order to function and thrive. </p>
<p>In other words: the boundaries of our bodies and intellect are not as firm and finite as we want to believe. </p>
<p>Posthumanism also argues for the dismantling of the hierarchy that puts humans – largely because of our ability to “reason” – above other forms of life and technology.</p>
<p>Both of these ideas were central to Michael Jackson’s life and art. </p>
<p>It’s somewhat surprising that so few have considered him through this lens; instead, many have simply <a href="http://www.telegraph.co.uk/news/picturegalleries/celebritynews/5648779/The-eccentric-antics-of-Michael-Jackson.html">labeled him</a> as weird or eccentric. </p>
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<a href="https://images.theconversation.com/files/64163/original/tw594ybs-1415652222.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/64163/original/tw594ybs-1415652222.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/64163/original/tw594ybs-1415652222.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=762&fit=crop&dpr=1 600w, https://images.theconversation.com/files/64163/original/tw594ybs-1415652222.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=762&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/64163/original/tw594ybs-1415652222.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=762&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/64163/original/tw594ybs-1415652222.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=958&fit=crop&dpr=1 754w, https://images.theconversation.com/files/64163/original/tw594ybs-1415652222.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=958&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/64163/original/tw594ybs-1415652222.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=958&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The media was quick to label Jackson without considering his artistic intentions.</span>
<span class="attribution"><a class="source" href="http://bnewmanx.wpengine.netdna-cdn.com/wp-content/uploads/2013/02/12-wacko_jacko_backo_rt_001-806x1024.jpg">http://www.robertnewman.com/bio/influences/</a></span>
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<p>Yet Jackson’s entire career was defined by his rejection of normal boundaries. This includes not only the most obvious of these (race and gender) but also generational barriers, the limits of his physical body, and divisions among real and fictional species – not to mention the seamless way he could fuse artistic genres. </p>
<p>Jackson celebrated the prosthetic idea of the human in a number of ways. For example, through plastic surgery, cosmetic procedures, make-up, hair styles and costumes, he asks us not only to reconsider gender binaries (that’s the relatively easy part), but to question prevailing ideas about aesthetic beauty and what can be called “normal.” Our appearances are all products of outside intervention (even face creams and nail files count); Jackson’s extreme modifications could be thought of as a commentary on this.</p>
<p>Fictional boundary-crossing was also a characteristic of his artistic practice – where, at various points, he presented himself as a <a href="http://images2.fanpop.com/images/photos/7800000/Werewolf-Jackson-micheal-jackson-7804230-461-345.jpg">werewolf</a>, a <a href="http://www.mjworld.net/wp-content/uploads/michael-jackson-thriller-zombie.jpg">zombie</a>, and a <a href="http://www.criticalcommons.org/Members/ironman28/clips/MichaelJacksonBlackWhitePanther.mp4/thumbnailImage">panther</a>. In the film Moonwalker he morphs into a spaceship; in Ghosts, he becomes a dancing skeleton, a grotesque monster, and a gigantic face that blocks a doorway. </p>
<p>Ghosts, in fact, is a film in which he addresses the perception that he is a “freak” and “abnormal” directly. It’s remarkable that so much of his morphing in this film is focused on his face – an object of constant scrutiny and derision in the media. </p>
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<figcaption><span class="caption">In Ghosts, Jackson directly confronts his critics. Who has the authority to declare what is normal, and what is not?</span></figcaption>
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<p>In both his life and his art, he held out his body as a work in progress, fully open to and trusting in limitless experimentation. There’s quite a long tradition of artists who have engaged in body modification as a means through which to test the limits of the flesh, like <a href="http://www.orlan.eu">Orlan</a> and <a href="http://stelarc.org/?catID=20247">Stelarc</a>. </p>
<p>Perhaps the most controversial aspect of Jackson’s physical changes was the lightening of his skin. We should keep in mind that this was the result of the skin disease vitiligo. It’s thought, erroneously, that his skin color simply got lighter, but it actually fluctuated – so much so that his intent was certainly far from wanting to “be” white, as many have concluded.</p>
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<a href="https://images.theconversation.com/files/64993/original/image-20141119-31600-1bplmme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/64993/original/image-20141119-31600-1bplmme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/64993/original/image-20141119-31600-1bplmme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=905&fit=crop&dpr=1 600w, https://images.theconversation.com/files/64993/original/image-20141119-31600-1bplmme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=905&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/64993/original/image-20141119-31600-1bplmme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=905&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/64993/original/image-20141119-31600-1bplmme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1137&fit=crop&dpr=1 754w, https://images.theconversation.com/files/64993/original/image-20141119-31600-1bplmme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1137&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/64993/original/image-20141119-31600-1bplmme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1137&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">There has been a long tradition of artists (like Stelarc, pictured here) who have engaged in body modification. None have received the amount of scrutiny – and criticism – that Jackson has.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Stelarc_Extra_Ear_Ear_on_Arm.jpg">Nina Sellers/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Instead, it’s possible that vitiligo – painful as it must have been for him – served as an opportunity to start a conversation about race and skin color. He wanted to challenge the idea of race as fixed or linked to biology, rather than socially constructed.</p>
<p>Jackson’s boundary-pushing extended to his notion of family, which can be described as a sort of “queer kinship.” This has nothing to do with sexual orientation, but with how he challenged normative ideas about what constitutes family. His family included animals (Bubbles the chimp, yes, but also <a href="http://www.thewrap.com/sites/default/files/snake_0.jpg">Muscles the snake</a> and <a href="https://pbs.twimg.com/profile_images/2519520685/image.jpg">Louis the llama</a>). It included children (Jackson could still play like a child, with children, when he was an adult, testing ideas about the normal, linear progression from childhood to adulthood). It included older Hollywood starlets, like Elizabeth Taylor and Liza Minnelli (again breaking the boundaries of normative generational affiliation); and it included <a href="http://www.amazon.com/My-Friend-Michael-Friendship-Extraordinary/dp/B00A1AABTE">Frank Cascio’s middle-class family</a> from New Jersey, which Jackson adopted as his own, regularly showing up and spending time at their home, where he vacuumed and made beds with Cascio’s mother. </p>
<p>Much of this has been viewed as pathological because it’s a way of building family that does not conform; it crosses boundaries not normally crossed. </p>
<p>This makes many people uncomfortable.</p>
<p>But Jackson’s vision of the body and of kinship were actually forward-looking, a kind of reaching beyond societal norms that is often celebrated in other artists and activists, but still viewed with great suspicion in Jackson’s case. Elsewhere, I have <a href="http://www.tandfonline.com/doi/abs/10.1080/03007761003640574#.VGoPCoeWRJE">argued</a> that this is because Jackson crossed so many boundaries simultaneously. It was the combination of social transgressions that caused people to fear – rather than celebrate – his difference. </p>
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<span class="caption">Jackson’s boundary-pushing extended to family, as well. Here he’s pictured with his chimp Bubbles.</span>
<span class="attribution"><a class="source" href="http://upload.wikimedia.org/wikipedia/commons/d/d6/Michael_Jackson_And_Bubbles_The_Chimp-Age_Dangerous-.jpg">Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>It was also that he truly <em>lived</em> these transgressions: there was nothing to mitigate Jackson’s differences. When other mainstream artists, like Lady Gaga, transgress boundaries on stage, the impact is often lessened by their private lives, which conform to societal norms. </p>
<p>In a 1985 essay about Michael Jackson, James Baldwin wrote that “freaks are called freaks and are treated as they are treated – in the main, abominably – because they are human beings who cause to echo, deep within us, our most profound terrors and desires.”</p>
<p>Michael Jackson – gender ambiguous; adored and reviled; human, werewolf, panther; black, white, brown; child, adolescent, adult – shattered the assumptions of a society that craves neat categories and compartmentalization. </p>
<p>Order and normality are illusions, he said though his life and art.</p><img src="https://counter.theconversation.com/content/33351/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Fast receives funding from Social Sciences and Humanities Research Council of Canada</span></em></p>The album cover for Michael Jackson’s album Dangerous was painted by American pop-surrealist artist Mark Ryden. In it, he depicts a world in which the boundaries between human and animal, living and dead…Susan Fast, Professor of Cultural Studies, Director, Graduate Program in Gender Studies and Feminist Research, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/145672014-06-01T20:19:36Z2014-06-01T20:19:36ZYou’re not Barbie and I’m not GI Joe, so what is a normal body?<figure><img src="https://images.theconversation.com/files/49862/original/m6w5t6xk-1401425953.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The virtual bodies around us are so unrealistic that it's not unusual for people to question whether they're normal.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/evilerin/3565026821">Emergency Brake/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>We live in a world of improbable bodies; they populate our television screens, magazines and billboards. If you’re like most Australians, you might sometimes get the feeling your body isn’t normal. But don’t fret — it’s all the virtual bodies around us that aren’t. </p>
<p>Pick up a Barbie doll and have a good look at her. Which part do you think is the most anatomically improbable? No, you’ll have to look lower. </p>
<p>Relative to the average young Australian woman, Barbie’s feet (adjusted for height) are 17 standard deviations below the mean. Other parts are <a href="http://link.springer.com/article/10.1007/BF01544300">almost equally unlikely</a>: her bust-to-waist ratio is 13 standard deviations above the mean. </p>
<p>It’s not just young girls who are presented with improbable bodies: the biceps on the GI Joe doll action figure has almost trebled in girth since the original version in the 1960s. And the ratio of chest girth to waist girth has increased by 40%.</p>
<p>So, here we are, surrounded by images of ideal bodies: actors, sports stars, steroid-pumped bodybuilders, shop mannequins, dolls, dolled-up personal trainers, air-brushed models and digitally-enhanced videogame avatars. And not one of them reflects reality.</p>
<h2>Bigger dresses</h2>
<p>Take <a href="http://itupl-ura1.ml.unisa.edu.au/R/?func=dbin-jump-full&object_id=72336">female shop mannequins</a>. On average, they’re 172 centimetres tall. That’s about ten centimetres taller than the typical Australian woman. They have much broader shoulders, narrower waists and longer calves.</p>
<p>Even dress sizes imply a body shape real people rarely match. That’s why it’s so hard to find a suit or dress that fits you; clothing size templates bear only a passing resemblance to the real shape of Australians. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/49860/original/s867mvf7-1401425121.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/49860/original/s867mvf7-1401425121.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/49860/original/s867mvf7-1401425121.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/49860/original/s867mvf7-1401425121.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/49860/original/s867mvf7-1401425121.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/49860/original/s867mvf7-1401425121.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/49860/original/s867mvf7-1401425121.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Barbie’s feet (adjusted for height) are 17 standard deviations below the mean.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/8113246@N02/7505346598/in/photolist-crdS4y-66dFrM-jXkYe-dYvJvt-7QgZYh-L1a4-8hsyG9-hKVv6i-fTHRRL-8eZpeS-j8ngik-kfRam6-ctoGdW-gg8MKC-j9yxUP-nj8txp-3hc1ku-npi9s9-m1TGkm-bBqHnN-78xAYi-7UnqB6-9Ejdz7-8mVdar-m1TuKs-fqNLDg-31h1AV-8Aky1H-8smEfA-83SBix-hNzuHz-4HV3Y-jj9z8E-b3HWjz-83ShQn-mKeCi1-mQzQPJ-beUHs2-iVFMmc-4Xe7QS-9VLZCV-jj9fY2-gZdSKp-niG3H8-nwMxzS-aWhGzx-kPRTzM-9Uv5m2-3MQim1-kfTyty">Pinke/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Australia uses, in principle, the Standards Australia system, which goes down to size eight. Sizes change by regular increments and you can use the size eight measurements to calculate what a size six or four would be. But hardly any retailers follow the Standards Australia system, or any system for that matter, and most label their clothes idiosyncratically.</p>
<p>A woman fitting the Standards Australia dress size eight would have to weigh 40.5 kilograms. In spite of this, 25% of young women report wearing size eight, and I was recently obliged to buy a size four dress for my 54-kilogram daughter. </p>
<p>How does that work? Well, over time there has been an <a href="http://ura.unisa.edu.au/R/?func=dbin-jump-full&object_id=unisa35893">inflationary debasement of dress sizes</a>: what is now called a size eight is actually closer to the original size 12 or 14. And a typical Australian woman actually fits size 16. </p>
<h2>Changing perceptions</h2>
<p>So pervasive are images of unreal people that we no longer know what real people look like. Asked to judge their own weight category, about <a href="http://www.nature.com/ijo/journal/v27/n7/full/0802293a.html">30% of US adults got it wrong</a>. Women tend to think they’re fatter, while men – I’m sure you can guess – think they’re leaner. </p>
<p>Parents are even worse when it comes to judging their kids’ size. A <a href="http://pediatrics.aappublications.org/content/early/2014/01/28/peds.2013-2690.abstract">recent meta-analysis found</a> over half the parents of overweight or obese kids’ thought they were normal weight or underweight.</p>
<p>Part of the problem is that there are few key metrics of size and shape. The most common are height, weight, body mass index (BMI, which is your weight in kilograms divided by the square of your height in metres), and waist girth. </p>
<p>While these are good measures across the population, they don’t always work well for individuals. BMI, for instance, doesn’t distinguish between fat mass and muscle, so almost every member of the current Australian Rugby team would be classified as obese.</p>
<h2>Real sizes</h2>
<p>In 2008, <a href="http://www.abs.gov.au/ausstats/abs@.nsf/MediaRealesesByCatalogue/334ACB1F0B88C61CCA257A450015AA7A?OpenDocument">the average adult Australian male</a> was 176 centimetres tall and weighed 85 kilograms, with a waist girth of 96 centimetres. That’s a BMI of 27.5, right in the middle of the “overweight” category. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/49600/original/jwvxj42v-1401245452.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/49600/original/jwvxj42v-1401245452.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=446&fit=crop&dpr=1 600w, https://images.theconversation.com/files/49600/original/jwvxj42v-1401245452.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=446&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/49600/original/jwvxj42v-1401245452.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=446&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/49600/original/jwvxj42v-1401245452.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/49600/original/jwvxj42v-1401245452.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/49600/original/jwvxj42v-1401245452.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Female shop mannequins are about ten centimetres taller than the typical Australian woman and have much broader shoulders, narrower waists and calves.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/michael-semensohn/6154656559/sizes/l">EYECCD/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>The average adult woman was 162 centimetres tall, and weighed 70 kilograms, with a BMI of 26.7. Her waist girth was 86 centimetres.</p>
<p>People are <a href="http://www.ncbi.nlm.nih.gov/pubmed/11758692">definitely getting bigger</a>. For over 100 years, height has been increasing at the rate of one centimetre per decade, and weight by one kilogram every decade. But it’s been up to three kilograms per decade in recent years.</p>
<p>About 63% of Australian adults and 25% of kids are overweight or obese. The <a href="http://www.ncbi.nlm.nih.gov/pubmed/19823187">proportion of overweight people</a> continues to increase in Australian adults, but has plateaued in Australian kids since about 1996.</p>
<h2>Myriad shapes</h2>
<p>The variety of body shapes is also increasing. Look at pre-war photos of workers or school kids, and you’ll be struck by how similar (and lean) their bodies are. Today, this distribution is skewed with more overweight bodies and more extremely overweight ones. </p>
<p>We’re also seeing increasing distribution at each extreme, with separate peaks for the fit and lean, and the overweight. Ethnic diversity is also increasing the spread of body shapes, as are extreme body practices such as steroid use and illnesses such as anorexia. </p>
<p>Athletes are <a href="http://www.ncbi.nlm.nih.gov/pubmed/11583103">changing size and shape</a> faster than the general population. Top level basketballers have been increasing in height at the rate of two and a half centimetres per decade, and shot-putters have been putting on weight at the rate of seven kilograms every ten years. </p>
<p>At the 1928 Olympics, the average weight of shot-putters in the finals was 80 kilograms; today it’s 140 kilograms. This extraordinary rate of growth is fuelled by (and fuels) new training techniques, supplements, growth-stimulating drugs and huge salaries to recruit the best and biggest around the world. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/49856/original/gm8gvc8b-1401424270.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/49856/original/gm8gvc8b-1401424270.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/49856/original/gm8gvc8b-1401424270.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/49856/original/gm8gvc8b-1401424270.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/49856/original/gm8gvc8b-1401424270.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/49856/original/gm8gvc8b-1401424270.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/49856/original/gm8gvc8b-1401424270.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Butter factory workers from 1926 showing great similarity in bodies.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File%3AStateLibQld_1_174703_Builders_and_butter_factory_workers_at_the_Biggenden_Butter_Factory%2C_ca._1926.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Big bodies are a very tradeable commodity.</p>
<h2>Nurture and nature</h2>
<p>So what kinds of things determine body size and shape? For height, the best advice is to choose your parents wisely. Genes account for about 90% of the variance in height, but both childhood malnutrition and exposure to infections can limit how tall you’ll be as an adult. </p>
<p>Weight is much more <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/phd-nutrition-childrens-survey">subject to environmental influences</a>, such as socioeconomic status; about 27% of Australian kids from the poorest quartile of homes are overweight or obese, compared to 19% from the richest quartile.</p>
<p>Body size and shape also <a href="http://en.wikipedia.org/wiki/Human_height">vary across ethnicities</a>. The Dutch are the world’s tallest people (184 centimetres for men and 171 centimetres for women), while the Indonesians are the shortest (158 centimetres and 147 centimetres respectively). </p>
<p>And the fattest seven countries are all in the South Pacific, headed by Nauru, where almost 95% of adults are overweight or obese. In spite of what we often hear in the media, Australia is not in the top 20 – but we’re getting there.</p>
<p>So I’m not GI Joe, and you’re not Barbie, but it’s not all bad news. There are a lot more people in this world like you and me than there are like these dolls. Best to aim for good health and get comfortable with your normality</p><img src="https://counter.theconversation.com/content/14567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Olds receives funding from the Australian Research Council.</span></em></p>We live in a world of improbable bodies; they populate our television screens, magazines and billboards. If you’re like most Australians, you might sometimes get the feeling your body isn’t normal. But…Tim Olds, Professor of Health Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/174952013-09-03T20:43:27Z2013-09-03T20:43:27ZWhen does ‘abnormal’ actually impact your health?<figure><img src="https://images.theconversation.com/files/30600/original/bc278k6w-1378189655.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Labelling a risk factor as a medical condition stimulates the therapeutic reflex to treat, which may have minimal or no benefit yet risk all the adverse effects.</span> <span class="attribution"><span class="source">John Chamberlain</span></span></figcaption></figure><p>Anyone, it seems, can create an epidemic. Witness a <a href="http://www.theage.com.au/national/cholesterol-findings-startling-20130805-2ra7i.html">recent article in the Fairfax papers</a> that provides “startling” news about the large number of Australians with high cholesterol who don’t even know they have it – an epidemic of high cholesterol!</p>
<p>Here’s an easy way to create your own epidemic that avoids handling any biological materials. </p>
<p>Choose any symptomless risk factor (such as a blood test or a physiological measure like blood pressure). Then propose that anyone with a single measurement above the median is at “above average risk”.</p>
<p>Give that risk group a medical label (“hyper-risk-factorosis”, for instance) then suggest that people with this label should be found and treated.</p>
<p>This process – with some nuances – has been applied to many risk factors such as blood pressure (hypertension), renal function (chronic kidney disease), bone density (osteopenia and osteoporosis) and, as above, cholesterol (hyperlipidaemia). </p>
<p>The same logic would suggest that since being male raises many disease risks (by as many of these risk factors), we might label all males as having “X-chromosome deficiency disorder”.</p>
<h2>Does the label help or harm?</h2>
<p>Of course, for people with very high levels of some risk factors, treatment may be worthwhile. Medication for people with very high blood pressure, for instance, has prevented many strokes. </p>
<p>But we also need to consider <a href="http://blogs.bmj.com/bmj/2012/11/05/paul-glasziou-should-we-abandon-the-term-hypertension/">the downside of drawing a line</a> across the risk factor level: the labelling of a large, and mostly asymptomatic, segment of the population as having a medical condition. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/30103/original/d4x6269x-1377672565.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/30103/original/d4x6269x-1377672565.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/30103/original/d4x6269x-1377672565.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/30103/original/d4x6269x-1377672565.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/30103/original/d4x6269x-1377672565.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/30103/original/d4x6269x-1377672565.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/30103/original/d4x6269x-1377672565.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Since being male raises many disease risks, we might label all males as having ‘X-chromosome deficiency disorder’</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The label itself can have psychological and social impacts. But labelling a risk factor as a medical condition also stimulates the therapeutic reflex to treat. For low-risk patients, that treatment may have minimal or no benefit yet risk all the adverse effects.</p>
<p>If these harms are outweighed by the benefits of treatment, then the labelling and diagnosis may be justified. </p>
<p>But the guideline panels defining diseases have usually provided little evidence to justify changing the definitions of diseases and rarely consider the harm the changes may cause. In fact, harms are are <a href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001500">often rapidly dismissed</a> on the few occasions they are mentioned.</p>
<p>Surprisingly, there’s no internationally agreed process for defining diseases. And even more importantly, there’s no agreed process for deciding where to draw the line across the spectrum of a risk factor that divides “normal” from “abnormal”.</p>
<h2>Are we all abnormal now?</h2>
<p>This has made me permanently sceptical about studies that look at the prevalence of risk factors. </p>
<p><a href="http://www.aihw.gov.au/publication-detail/?id=10737418510&tab=2">A recent ABS survey</a>, for instance, suggested 33% of Australian adults had “abnormal” cholesterol but <a href="http://www.theage.com.au/national/cholesterol-findings-startling-20130805-2ra7i.html">many were “undetected”</a>. </p>
<p>Aside from the problems of labelling someone based on a single measurement, there are several concerns in this judgement. </p>
<p>First, the dividing line between normal and abnormal is arbitrary. The fact the survey concluded “one in three Australians aged 18 years and over (32.8% or 5.6 million people) had abnormal or high total cholesterol levels” suggests “abnormal” is also very close to average. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/30101/original/rf56w8qf-1377671310.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/30101/original/rf56w8qf-1377671310.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/30101/original/rf56w8qf-1377671310.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/30101/original/rf56w8qf-1377671310.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/30101/original/rf56w8qf-1377671310.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/30101/original/rf56w8qf-1377671310.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/30101/original/rf56w8qf-1377671310.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Second, labelling people with a single risk factor as “abnormal” also ignores that fact that cholesterol alone is a weak predictor of future heart attacks. </p>
<p>Only when we combine all the weak risk predictors - age, smoking, cholesterol, blood pressure, diabetes - is there a reasonable chance of saying who is at increased risk. </p>
<p><a href="http://blogs.bmj.com/bmj/2012/11/05/paul-glasziou-should-we-abandon-the-term-hypertension/">Most guidelines</a> now only suggest treating cholesterol if there is sufficient risk based on a combination of these risk factors.</p>
<h2>Be still, my beating heart</h2>
<p>But don’t panic yet. Deaths from heart disease have been steadily declining for decades. </p>
<p>As a <a href="http://www.aihw.gov.au/publication-detail/?id=10737418510&tab=2">2011 report</a> from the Australian Institute for Health and Welfare concluded:</p>
<blockquote>
<p>The overall death rate for CVD [cardiovascular disease] has fallen by about 80% since the 1960s and continues to fall. Death rates for the major types of CVD, such as coronary heart disease, stroke, heart failure, rheumatic heart disease and peripheral vascular disease, have all fallen markedly in the past 20 years. </p>
</blockquote>
<p>We can thank much better treatment after the first heart attack for some of this decrease in mortality. But incidence of cardiovascular disease has also fallen, probably due to declines in smoking (reduced by more than 30% in the past 20 years) as well as better management of risk factors such as blood pressure and lipids. </p>
<p>This should be cause for some celebration, rather than a panic about undetected risk factors.</p><img src="https://counter.theconversation.com/content/17495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Glasziou was on the management committee for two large cholesterol-lowering trials. He is on the Board of Therapeutic Guidelines and the BMJ.</span></em></p>Anyone, it seems, can create an epidemic. Witness a recent article in the Fairfax papers that provides “startling” news about the large number of Australians with high cholesterol who don’t even know they…Paul Glasziou, Professor of Medicine, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.