Given there’s a gym on every other corner, a trend of starting the day with a green smoothie piled with powder which promises to transform our mind and bodies and a new breed of wellness influencers, the question that heart and lung surgeon Dr. Nikki Stamp raises in her new book 'Pretty Unhealthy Why our obsession with looking healthy is making us sick' is a valid one...
In her new book, she examines why our health is declining despite our (sometimes unhealthy) obsession with health – the answer is simple: we’re focusing too much on our appearance and ignoring what’s going on inside.
Nikki is frank and not afraid to speak her mind. She talks openly about the misconceptions around the wellness industry. In a recent article for The Washington Post, she wrote: “The growth of Goop and, more broadly, of the multitrillion-dollar wellness industry is cause for concern. On the surface, it looks full of promise and hope. Dig just a little deeper, beyond the claims of all-natural miracles — the energy healing, the cold therapy, the anti-aging treatments — and what we find is at best, a waste of money and at worst, harmful methods that actually compromise your health. Research has shown that for those with cancer, using alternative therapies such as homeopathy or specialized diets led to people opting away from proven treatments and an increased risk of dying from that cancer. Make no mistake: What wellness sells is by no means harmless.” Her concern is that we’re bypassing traditional medicine in favour of a quick fix.
Our founder Georgie Abay chatted to Nikki over the phone, when lockdown first began, about some startling statistics around heart disease and why we need to raise more awareness – did you know that Cardiovascular disease (CVD) is a leading cause of illness and death among Australian women – along with what it’s like to work in healthcare right now. She also opens up about the fact that the mental health of healthcare workers is overlooked, and also about the bias that exists in the profession. We also talk about her first book, Can You Die of A Broken Heart and her answer is fascinating.
Shop Pretty Unhealthy Why our obsession with looking healthy is making us sick | Read more about Dr. Nikki Stamp here | Image: Stef King
You've spoken very openly about how the growth of the multi-trillion dollar wellness industry is cause for concern. What are the biggest concerns you have and why is the wellness industry experiencing such growth?
It’s a really good question because I think that on the surface it looks benign. It’s a bit of ‘fun’ or it’s ‘all-natural’ – these kinds of words get thrown around. One of the biggest problems that I have with it, is it can open the door to not so healthy practices, ignoring proven or conventional treatments. Misinformation is not empowering.
For those reasons, it’s more sinister than we give it credit for. That being said, I don’t think you have to throw it all away. You can 100% integrate some parts of wellness practice and ethos into your life, but when you start to take it on board, and it becomes harmful for you, that’s a problem.
As to why it’s getting so big, god, it’s such an interesting question, because it is enormous. It’s growing faster than most other industries. It’s outselling the pharmaceutical industry. There’s a real push to take control over your own health and wellbeing and that is one thing that the wellness industry does tend to try and offer. I don’t think that naming that autonomy is necessarily a bad thing at all, it’s really important that we all know about our bodies.
I think also the wellness industry is attractive. It’s often sold as a quick fix or a secret potion. These are things we all want and so it has hit a sweet spot in our psyche.
Why do you think women are more often dissatisfied with medical care than men?
Women have plenty of reasons to be dissatisfied with medical care. You can look at pretty much any medical condition, including female conditions (gynecological things, endometriosis, pregnancy, and childbirth and breast care) that are supposed to be female centric and female dominant, and then general overall health and wellbeing, and you’ll probably find that most women don’t have great stories about their dealings with the healthcare system.
This is a real problem. Some of that comes from a lack of knowledge. Up until recently, there wasn’t as big an interest in investigating the biological differences between men and women. So therefore, that lack of knowledge didn’t get filtered through. And we basically treat women like small men, and that’s not accurate. We have very different bodies, the way they work, the biology, which means that sometimes we don’t get the treatments that we need or want.
There’s still a lot of bias in society. Women are more likely to be caregivers, so it makes it really hard for them to prioritise their doctor’s appointments. There’s not much wiggle room in the system for that. Women are more likely to have bad perceptions from health care workers. Their pain is dismissed. Their concerns are dismissed. Their different symptoms are dismissed as being anxious.
We’ve been at the mercy of a system that’s been designed for men by men, and it really doesn’t fit with what we need. That’s where wellness comes in, because wellness by and large is a female dominated industry, both by consumers and also the people who are wellness practitioners are more likely to be female. So it’s natural to gravitate towards that.
In your newest book, Pretty Unhealthy, you look at how we are sicker and happier and poor than ever before, despite the wellness movement being bigger than ever before. So where do we go wrong? Is it the fact that we're not listening to medical advice and we're taking matters into our own hands or?
There are a lot more chronic diseases, diabetes, heart disease, high blood pressure, cancer… there are a lot more of those diseases at a population level. We’re aging, we’re an older population and the older you are, the more likely you are to have these diseases. But also, I think we’re seeing the results of real differences in our lifestyles over the last several years. There are more people who are incredibly disadvantaged, have poor diet, aren’t able to exercise, cigarette smoking is still a problem… at a population level we’re getting sicker.
You contrast that with the fact that every street corner has a gym, there’s holistic health cafes and it doesn’t quite fit. Diets are a great example. We’re told that you have to diet and eat a certain way to be healthy, but we know that dieting doesn’t necessarily guarantee you health. It can create a whole bunch of other problems, nutritional problems, physical problems, emotional problems.
We’re focusing on this outer perception of health. We’re focusing on what it should be, and that it’s a set of behaviors that are usually aspirational, social media driven, appearance driven, and that’s not really health. The process to get those things often means we are inadvertently sacrificing our physical and mental wellbeing.
There is such an obsession with weight, which is something that you talk about in Pretty Unhealthy. And it is a topic that we spend an awfully unhealthy amount of time thinking about. What do you think are the biggest roadblocks for women when it comes to losing weight?
For women, weight has always been tied up with how we look, even from when you’re small. I remember reading magazines as a teenager, having those diet plans, and magazines aimed at preteen and teen goals to lose weight. It was always about looking a certain way. For women, that pressure to lose weight has always been tied up with appearance and when you have an appearance motivator as a goal, it’s just such a bad thing. It’s not going to be sustainable. It’s not going to make you feel good. And it’s more likely to lead to yo-yo dieting, dangerous dieting, excessive exercise or conversely, actually detract from focusing on those healthier behaviors like good diet and exercise.
Weight is a bit of a loaded topic. If there is a medical reason that someone needs to change their weight, and we need to talk about both extremes here, then that shouldn’t be done based on something you’ve read from a magazine, that needs to be done with professional care and supervision. That is the best way forward.
What about your approach to alcohol?
Drinking alcohol is such a cultural thing and alcohol is something that probably isn’t talked about enough in terms of its effect on our physical and mental health. It is such a normalised behavior to go out and get pissed and have a glass of wine every night or even several. It’s just such a normal part of what we do and it shouldn’t really be thought of in that regard. We need to stick to the guidelines of alcohol consumption, which if you read them, are very, very low. It’s 1.4 standard drinks a day, which is probably a glass of wine.
One of the things that I’ve found recently – and obviously the whole world is in the midst of a crisis and looking for anything to calm everything down – is people saying “Wow, I’m drinking so much more lately.” Alcohol is such a coping mechanism, and that’s not good either. We need to change our cultural approach to alcohol, which is not easy at all.
Women are two to three times more likely to die of heart disease and breast cancer and I don't think that many people are aware of statistics like that. And research has shown that women are more likely to die after a heart attack than men, especially when they are young women. What are the reasons for this?
Most people don’t know that heart disease is the leading cause of death. Women’s hearts are a bit different to men and the way they experience heart attacks from a biological level is different. Their symptoms can be different, for example they might not have that Hollywood star chest pain that we’ve all associated with heart attacks, so it makes it a little bit harder for the woman herself to realise that she’s having a problem and sometimes it’s harder for the healthcare workers also.
One of the really important things that we can all do is raise awareness around this. The Heart Foundation did a population survey, and found that two to three women out of 10 thought that heart disease was something they had to be personally concerned with. The United States has had a campaign in place for about 20 years now called Go Red for Women.
You've written a book called Can You Die of a Broken Heart? What was the answer to this question?
If you have a terrible thing happening in your life, whether it be your relationship ending, or the death of a loved one or some other horrific stress, no, you are not going to die of a broken heart, but there are some really interesting things about the emotional connection to your physical health and the heart is really at the center of this.
We know that when you do have, say a relationship breakup, there are physical effects, and the heart really feels a lot of these. So you have things like your blood pressure going up, your heart beating faster, your blood getting stickier, your sleep being disturbed, your stress hormones like cortisol and adrenaline going up, and the heart really feels the effects of these. But for most of us, those effects are transient and if we’re fit and healthy, we’ll get over it.
However, in people who have underlying heart disease, they may or may not know about it, those effects can be enough to precipitate a heart attack. One of the coolest statistics about this is that if you have someone who has preexisting heart disease, and they’re watching the soccer world cup grand final, they are four times as likely to have a heart attack. This is stress and soccer. I’m not a soccer fan, so I can’t relate. But that’s a really interesting way in which the physical health can be affected by our mental health. It’s also why sometimes we see stories of elderly people who die within close succession of each other. It’s the physical stresses from the emotional turmoil, on top of a body that’s maybe not a 100%, that leads to their sickness or their death.
Finally, there’s a really interesting disease that’s called Takotsubo cardiomyopathy [“Broken Heart Syndrome”], which is a really fancy way of saying, that the heart doesn’t pump so well during times of stress. This is an illness that was only described in the 80s and Takotsubo is obviously a Japanese word. It was described because when the heart doesn’t pump so well, it balloons out. So it looks like a type of Japanese Fisher pot. It’s quite an uncommon illness and tends to happen more commonly in postmenopausal women and has to do with hormonal factors, such as lack of estrogen or effects of low estrogen on a female heart.
And what about women such as Arianna Huffington who has spoken about collapsing from exhaustion? And a lot of women have experienced this. What does that culture of busy-ness do into our hearts? And when do we realise that it's not sustainable?
I’m probably not a good example of this. I like to work a lot. I like to work myself into the ground sometimes. But it’s such a thing, isn’t it? And it’s not even productivity, it’s just busy-ness. When I was a bit younger, everyone talked about, “Oh, who had the busiest shift at work? And who has the most patients? And who stood up the longest?” And you’re like, “If you want to win to say that you’re the tiredest, please be my guest. This is one competition I do not want to win, thanks very much.”
We need to really start to take into account that our work habits, our life habits, this need for busy-ness, and if we’re not paying as much attention to our overall health and wellbeing, it’s not good for our physical health. We do actually need to start slowing down and trying to take better care of our bodies.
This particular time in the world, where everything’s being thrown into disarray, a lot of people have found some enforced stop time, slow down time, or however you want to look at it. And maybe that’s a good thing. Maybe that will realign our priorities and help us to try and work out what’s actually important in our lives. But winning the busy contest is not that important.
You've spoken a lot about the mental health of doctors saying that they're burnt out, depressed and scared. And I was amazed to read that in Australia, quarter of doctors have had thoughts of suicide in the past 12 months. How do you feel about this topic, especially right now?
Working in healthcare is a stressful environment and you’re never going to be able to take all of that stress away. There’s a lot of unnecessary stresses as well that need to be dealt with. I always find that the most striking part about doctors’ health and wellbeing, in mental health predominantly, but also in our physical health, is that for a profession that is literally there to take care of other people’s health and wellbeing, we completely disregard our own. And it’s encouraged. It’s encouraged both at a cultural level – you need to be at the toughest – but it’s also encouraged from a systemic level as well that, you don’t call into work sick, for example. There’s a joke that’s been around for ages: “If you call into work sick as the doctor, you better present a death certificate.” That is the only legitimate excuse for not turning up to work.
So that kind of pressure is not good. We know that doctors who are really, really struggling, don’t do as good a job. I would like to see a little bit more compassion from the profession and support from the public.
During the height of the pandemic the UK, every Thursday night, everyone would go outside and clap for the workers in the NHS – it’s just so uplifting. It makes me tear up because I think it’s beautiful. I’m so proud to be part of that profession. I’d love to see something like that here, because it’s just such a beautiful way of saying thank you. Even though I’m not in the UK, I feel so buoyed to see people’s appreciation.
Another thing that medical doctors experience is dealing with patients who have suffered from domestic violence. You've spoken about how the single biggest threat to a young woman's health in Australia is violence. Can you tell me about the first time that you saw a woman who had been injured by her partner and how it impacted you?
When I was a really junior doctor, I saw a woman who had been burned by her partner. I sat in the shower in the emergency department with her because we had to cool her. I think back to that time now and it’s just heartbreaking. I’m always on the lookout for it, just trying to make sure that I don’t miss anything, but it’s hard to pick up and it’s hard to deal with.
In the past, there have been people who I’ve suspected are being hurt by someone deliberately. When you ask them, and they deny it, it’s such a disempowering interaction because you can’t do anything about it if they don’t say anything. It’s really important that people know that a hospital or your doctor is a safe place for you to say that something is not right.
Back in 2018, you were one of only 11 female heart surgeons in Australia. I'm interested in what the figures are like today and what kind of change do you want to see? And also what's it like being a woman in medicine today?
Around 12% of surgeons are female which is very low given in the last 20 or 30 years, at least half of medical school graduates are female. We just can’t seem to get them into surgery. So it’s interesting.
We’ve made some tremendous strides but the way women get treated in the workplace is very different. There’s still bullying, and discrimination, and sexual harassment. And while we’ve moved away from that mad men style, smack on the bum, the very overt sexism, it’s now a little bit tricky to point out. And it makes it really hard to fight.
Finally, what do you hope that people will take away most from Pretty Unhealthy?
I would like people to focus on their health for reasons that are not anything to do with appearance. That they look at their health holistically. They look at it from a way of improving themselves on all kinds of levels, but nothing to do with appearance. That they don’t get suckered into feeling like they have to reach a certain unattainable goal. And that they’re a bit more aware of the world that we live in at the moment, and take everything in. I want them to take social media, media, mass media, television and magazines with a grain of salt and work towards achieving true health.