Tackle taboos and missed opportunities to improve women's health

Obesity is one of the biggest risks to women's health and can have a major impact on the health of those women's children and grandchildren, the Chief Medical Officer, Professor Dame Sally Davies announced today as she published her latest annual report Health of the 51%: Women.

In England in 2013, 64 per cent of women aged 34-44 and 71 per cent of women aged 45-54 were classified as overweight or obese. Dame Sally says that the escalating obesity problem is so serious it needs to be included in national risk plans across Government to make tackling obesity in the whole population a national priority.

Chief Medical Officer, Professor Dame Sally Davies will say:

"Obesity has to be a national priority. Action is required across all of society to prevent obesity and its associated problems from shortening women's lives and affecting their quality of life. We need to address the educational and environmental factors that cause obesity and empower women and their families to live healthier lives."

Being the first female Chief Medical Officer inspired Dame Sally to focus her latest report on women's health. In this year's report obesity is described as a 'golden thread' which can impact on all aspects of a woman's life from birth, family planning, pregnancy and right through to menopause and later life.

She highlights planning for pregnancy as a key missed opportunity to give women health messages to improve their mental and physical health and that of their children. If a woman is obese, there is an increased chance of miscarriage and preterm delivery.[1]

The Chief Medical Officer wants to bust the myth once and for all that women should eat for two when pregnant. She has asked all women to work with healthcare professionals make positive changes when planning to get pregnant and to stay healthy throughout their pregnancy. Eating a healthy diet with fruit and vegetables, getting exercise, not smoking and avoiding alcohol are all things a woman can do to maximise the chances of a healthy pregnancy.

Dame Sally continues:

"In women obesity can affect the outcomes of any pregnancies they have and the health of any future children they may have. This is a difficult message to convey, as it risks burdening women with guilt and responsibility, but I believe that it can also empower women to take positive steps like eating more healthily and taking more exercise. It is never too late to take action for a healthier lifestyle - for you and your family."

Elsewhere in the report Dame Sally encourages women not to suffer in silence about some of the more taboo problems they face, such as incontinence or the menopause, which they may find embarrassing to talk about.

Urinary and faecal incontinence affects more than five million women in the UK and along with prolapse, cost the NHS more than £200 million a year in treatment and support.

Women should not be afraid to discuss urinary or faecal incontinence with their doctor, and the earlier they do, the better. There are a variety of treatments that can help, including weight loss, physiotherapy and medication.

Six weeks after pregnancy, 33 per cent of women report urinary incontinence and 10 percent report faecal incontinence.

Dame Sally says:

"We need to challenge taboos around the menopause and incontinence to make sure embarrassment is never a barrier to better health. Problems 'below the waist' are not generally seen as attractive topics for public discussion, and women are often reluctant to seek help for common disabling conditions. This needs to end - women should never suffer in silence. Breaking the taboo around these subjects will help more women come forward and get the care they need."

The Chief Medical Officer goes on to examine women's cancers, particularly ovarian cancer. This is the second most common gynaecological cancer and the most lethal, with 6,483 women in England diagnosed with ovarian cancer in 2012 and 3,988 deaths in 2013. Survival in England and the UK is among the lowest in the OECD nations, with five year survival rates around 36 per cent.

The report calls for a national audit of ovarian cancer to improve outcomes for the disease. It also highlights the benefits of better surgery - often meaning longer operating times - for ovarian cancer. Operating times of over three hours are more successful in removing the cancer cells compared to operating times of less than three hours.

Dame Sally says:

"Deaths from ovarian cancer are still stubbornly high - a national audit of ovarian cancer is surely long overdue given the numbers of deaths we are seeing from this silent killer. We have seen such audits improve outcomes for lung, bowel, head and neck cancers and I want to see the same happen for ovarian cancer."

In a wide ranging report, the Chief Medical Officer has also recommended that:

• More research is needed to improve maternal and child mental and physical health.
• More research on screening tests, preeclampsia and fetal growth is also needed.
• Clinical Commissioning Groups should ensure prompt access to evidence-based enhanced cognitive behaviour therapy (CBT-E) and family based therapy for people with eating disorders. This should be available in all areas and not restricted to specific age groups.
• Children should receive integrated personal, social, health and economic education (PSHE) with sex and relationships education (SRE) as a routine, if necessary statutory, part of their education.
• A full range of contraception services should be available to all women, at all reproductive ages.
• The Royal College of Obstetricians and Gynaecologists should make sure that sub-specialist training in gynaecological oncology equips doctors to perform optimal surgery for gynaecological cancers and reduce mortality from ovarian cancer.
• A national clinical audit should be undertaken of treatment and survival trends for women with ovarian cancer in England. High priority should be given to including this topic in NHS England's National Clinical Audit and Patient Outcomes Programme commissioned by the Healthcare Quality Improvement Partnership.
• Bosses should make it easier for women to discuss the menopause in the workplace, without embarrassment - this could even lead to reduced sick leave and improved employee health.

Response from Royal College of Paediatrics and Child Health:

Responding to the Chief Medical Officer's (CMO) report on women's health, Professor Russell Viner, Officer for Health Promotion for the Royal College of Paediatrics and Child Health, said:

"There's good evidence as we know linking maternal obesity to childhood obesity - and maternal mental health to child & adolescent mental health. So improving child health needs to start with mothers.

"Currently, around one in five 5-year-olds and one in three 10-year-olds are overweight or obese in the UK and with 50% of children predicted to be overweight or obese by 2020; we fully support the CMO's recommendation to include obesity in the National Risk Register. We also urge Government to go one step further by supporting people to make healthy choices by implementing a tax of sugary drinks and foods high in salt, sugar and fat.

"Just as we need to tackle obesity, we must focus on prevention when it comes to children's mental health and wellbeing. This includes reducing rates of teenage pregnancy. Compulsory Personal, Social, Health and Economic Education (PSHE) covering topics such as bullying, drug and alcohol use, mental health and healthy relationships in all schools is a strong vehicle for this. And as recommended by the CMO, the College will also work with other royal colleges to ensure information is captured about women's mental and physical health before, during and in the years after pregnancy."