Tag Archives: women

Has strong become the respectable face of skinny for young women?

A generation of Instagram stars and personal trainers are challenging old-fashioned notions of femininity, replacing images of thinness or fecundity with brute strength. Whether this is healthy is another matter

Young woman with a six-pack


Cult of muscle … young women increasingly aim for a ‘ripped’ physique. Photograph: Getty Images

”Imagine you’re a Page 3 girl and they’re going for the butt shot,” says Chloe Madeley, helpfully.

It is a grey January morning in a gym near Leicester and Madeley, a former TV presenter turned personal trainer and Instagram phenomenon – and the daughter of daytime telly pairing Richard Madeley and Judy Finnegan – is trying gamely to teach me the correct posture for squats with weights. Bum stuck out, shoulders pinned back, move from the hips. None of this is dignified. It is also killing my hamstrings, although there is only a wimpy 5kg weight on the bar I am lifting, compared with the 60kg she usually manages.

But Madeley is kind, funny and ridiculously encouraging. Half an hour of pumping iron with her leaves me in an unexpectedly good mood. My head feels clearer, lighter. And there is something very appealing about the insouciance with which she strolls through the weights area, past all the men in sleeveless Ts doing press-ups.

Once upon a time, gyms divided rigidly by gender: treadmills and pilates classes for the ladies; grunting men lifting weights by the mirror. Women shied away from dumbbells for fear of getting bulky or embarrassing themselves. Men’s fitness magazines featured rippled torsos and articles about protein shakes, while the female versions were all bikini bodies and how to be your happiest self.

Well, not any more. “Shed kilos, build muscle, strip fat,” screams the cover of January’s Women’s Health magazine, alongside features on getting a “strong mind” and “killer abs”. Inside, editor Claire Sanderson describes proudly how she hip-thrusted 130kg (a move that involves lying down with a barbell across your middle and pushing your hips skywards) as part of a January transformation feature.

Rival magazine Women’s Fitness, meanwhile, offers “21 days to strong”, a diet and workout plan that will ensure you can shift furniture upstairs on your own. Even Davina McCall now boasts the jutting abs and sharply carved physique of a bodybuilder, prompting the Sun to ask whether the 50-year-old has “gone too far” for her latest fitness video.

Gaby Hinsliff works a pair of dumbbells under Chloe Madeley’s instruction


Gaby Hinsliff works a pair of dumbbells under Chloe Madeley’s instruction. Photograph: Fabio de Paola for the Guardian

Yet she is only reflecting a cult of muscle that is all the rage on Instagram, led by a new generation of so-called fitness influencers such as Madeley, the 26-year-old Australian blogger Kayla Itsines, the 29-year-old American Massy Arias (famous not only for her abs, but for the speed with which they snapped back after the birth of her baby last year) and Alice Liveing, the British personal trainer who coached Sanderson for her hip-thrusting challenge.

Their feeds are a mixture of filmed workout routines, zippy motivational messages and photographs of their dogs and their breakfasts. Itsines in particular is hot on sharing “before” and “after” pictures of ordinary women who have followed her method. But the best adverts for their burgeoning business empires are invariably their own bodies. These women are built like athletes, not scrawny models: slim, but with biceps, calves and formidable six-packs (plus, in the case of 24-year-old US fitness guru Jen Selter, a famously Kardashian-esque behind). What is most striking, though, is how influential they have become in young women’s lives.

Middle-aged readers are more likely to be familiar with Madeley’s parents than with the 30-year-old personal trainer herself, yet her diet and fitness book The 4-Week Body Blitz has shot into the January bestseller charts. You may never have heard of Liveing, but at 24 she has three bestselling books, a clothing line at Primark and numerous corporate partnerships to her name.

These women’s brands were built independently of mainstream media, on Instagram and YouTube, where moody shots of perfect abs combine with ass-kicking, vaguely feminist sentiments. If that sounds superficial, their “strong in mind and body” mantra perhaps resonates deeper with anxiety-prone millennials, who increasingly use exercise to manage their mental health.

Five years ago, Madeley was working in TV, worrying that she lacked a passion in life, when her then-boyfriend introduced her to weightlifting. At the time, she says, she suffered badly from anxiety and was experiencing “panic attack after panic attack”. But lifting made her feel capable and strong.

“I would say weightlifting – this methodical act that results in physical and mental feelings of strength, capability, accomplishment – has absolutely had a massive ripple effect on my life. I feel like if I got into a sticky situation I could handle it, I can do it, it’s fine,” she says.

xmlns=”http://www.w3.org/2000/svg”>

The ‘ripped’ look – where every muscle stands out – involves stripping away almost all your body fat

“If I do start to get anxious, I have an outlet, a form of CBT, something I can do to focus all my energy.” She compares lifting to cooking, another soothingly repetitive process that many find relaxing because the rhythm – all that chopping and stirring – takes over.

There is something unexpectedly touching about this, just as there is something thrilling about shattering the myth that strength and power are not feminine. But have we really learned to value bodies for what they can do, not merely how they look? Is strong becoming the respectable face of skinny?

Vicky McCann’s fitness career began at the age of 13, when she got a job tidying the changing rooms of a local gym. She moved into teaching aerobics, then lifting weights. In 1990, she entered her first bodybuilding competition. Since then, she has twice been world champion in the so-called natural branch of the sport, which strictly forbids the use of steroids, male hormones and other artificial enhancements, including cosmetic surgery. She also runs her own gym in Perth, Scotland.

McCann, who at 48 still competes, says more women are entering the sport, but primarily via “bikini-body” competitions, a kind of bodybuilding-lite where contestants must be extremely toned, but much less musclebound than in traditional contests.

“It’s a halfway house, almost a cross between a fitness pageant and a beauty pageant,” says McCann, who prefers the more heavyweight version. “A lot of these women, I don’t see them as muscular – I’d almost describe it as a wedding day. They get a chance to wear a fancy bikini and have their hair and nails done and look pretty.” Hopefully, she says, some will be inspired nonetheless to move into bodybuilding proper.

Massy Arias models her clothing line for US retailer Target.


Massy Arias models her clothing line for US retailer Target. Photograph: Target

However, even this much muscle on a woman can be controversial. The actor and Strictly Come Dancing contestant Gemma Atkinson, who owes her strong physique to boxing and weights, endured sniping from some Strictly fans last year about being supposedly “too masculine” for dancing. Yet she was one of Women’s Health’s most popular cover stars, reflecting changing aspirations among younger women.

“We have a very different ideal of what we aspire to be. That’s shifted, even looking at things like covers of magazines and female role models that have risen up the ranks,” says Liveing. “Serena Williams – she wouldn’t have been a typical aspirational physique before, but she’s physically strong, she’s amazing, she’s achieved so much.”

Liveing got into weights while studying musical theatre, after her dance teachers told her she wasn’t strong enough. She says the perception that lifting was not for women only made it more appealing. “I love it when my clients are shocked by their own strength, because we haven’t been allowed to believe we were able to do that until now,” she says. “It’s breaking the taboos of being as strong, if not stronger, than men.”

She argues that the biggest case for women lifting weights, or working against their bodyweight in “resistance” exercises such as press-ups, lies in the health benefits. It can help maintain bone density, which is important for avoiding osteoporosis; it can help prevent muscle wastage as women age, potentially allowing them to stay active and independent for longer. (The actor Sheila Hancock recently announced that she had taken up weights, aged 84, after realising that she was struggling to lift hand luggage into plane lockers.)

Pumping iron can also aid weight loss. The greater a woman’s muscle mass, the higher her metabolic rate and the more calories she should burn, even at rest. According to Sanderson, this is what is driving many women away from burning fat through running or cardio and towards building muscle. “I was a complete cardio queen 10 years ago, doing triathlons and spinning classes like my life depended on it and running marathons,” she says. “Now I don’t do much of that at all and I’m probably in the best shape of my life.”

But there is a crucial difference between being in shape and the very lean – “shredded” – look gaining currency. Aiming to be strong, capable and powerful is one thing. Wanting to look it takes us into murkier waters. Women can certainly build muscle by exercising, albeit more slowly than men, given their lower testosterone levels. But the “ripped” look – seemingly borrowed from bodybuilding, where every muscle stands out – involves stripping away the body fat that would otherwise blur that definition. That is where diet comes in.

Sanderson says it is important to be honest about how much effort goes into looking like the Instagram poster girls and how attainable it is for mere mortals. “It’s their job to look that way – and all power to them. They live and breathe it. But, in my experience, in order to look that lean, that cut, you have to follow a really strict nutritional plan, which not many people would want to do.”

Judging by the meal snapshots these women constantly upload, that means a high-protein, fairly low-carb diet involving a lot of eggs, sweet potatoes, kale and chickpeas. Cutting out alcohol or sugar is relatively common, as is training five or six days a week. They may look like girls next door, but these women have the iron discipline of professional athletes.

Jen Selter is one of the Instagram influencers to have built her brand outside of the mainstream media
Jen Selter is one of the Instagram influencers to have built her brand outside of the mainstream media. Photograph: jenselter/Instagram

“I eat all day long, I have a very varied and balanced and healthy diet, but it’s very structured and disciplined,” says Madeley, who manages by giving herself a break from the regime every few weeks. “You get three weeks of not drinking at parties, not sharing the birthday cake at the office and you think: ‘At some point, I’m going to have to give myself at least a day off or I’m going to get really fed up.’”

McCann eats 2,000 calories a day in the run-up to a competition, when she is focused on shedding fat and revealing muscle, but her diet will be heavily restricted and precision-calculated. “I eat very bland when I’m dieting. I count out my food, weigh and measure it. But I don’t crash diet, I do it over a long period of time.” She worries, however, about newcomers to bikini-body contests relying on very low-carb plans to get in shape fast.

Eating this strictly is not necessarily disordered in itself, but rigid diets can easily be taken to extremes by vulnerable people. A recent spate of stories about anorexic people crediting bodybuilding for their recovery set distant alarm bells ringing. It is easy to see how such a regime might satisfy a need for control.

There is anecdotal evidence of people with eating disorders channeling their fixation into exercise, says Liam Preston, head of the Be Real body-image campaign, launched by a group of charities following a parliamentary report on the crisis in young people’s body confidence. “They can get obsessive about going to the gym, rather than obsessing about eating. But that’s a mental health problem, so I don’t know that exercise solves it.”

The broader problem he identifies, however, is people chasing fashions in body shape – strong or skinny – regardless of whether they are healthy. “We see so many crazes online and you’ll find people who go from one to another, trying everything. It’s about trying to build resilience, a feeling that their body is fine the way it is.”

The YMCA-led campaign is now working with schools to boost younger children’s body confidence, in the hope that this will make them less likely to seek solutions for imaginary faults in their teens. “We always try to go with the message that being happy and healthy is more important than anything else; it’s not about the way you look. If you want to go to the gym, that’s great, but are you doing it for the right reasons?”

xmlns=”http://www.w3.org/2000/svg”>

Aiming to be strong, capable and powerful is one thing. Wanting to look it takes us into murkier waters

In fairness, Instagram’s fitness queens seem intensely aware of their social responsibilities. They constantly repeat that there is not one “right” way to look, that followers should be kind to themselves, that it is all about balance.

“It’s really important, I think, to impress upon your audience the importance of not using social media as a way of comparing us – use it as a tool of information, but don’t sit there letting it make you feel bad about yourself,” says Liveing. She was originally known as Clean Eating Alice, but reverted to her name recently after becoming worried about clean eating’s association with faddy, exclusionary diets. Food matters in training, she says, but “not excessively so”.

Madeley is cheerfully upfront about putting on five pounds over Christmas. She reminds followers regularly that the aspirational images they see all over social media are invariably of fitness models at their competitive peak. (A common tactic is training hard for a photoshoot, then trickling out the resulting pictures over several weeks of posts; that way the public persona stays eternally ripped, even if the model does not.)

Sanderson, meanwhile, insists it is unfair and outdated to accuse magazines such as hers of potentially fuelling eating disorders. “We look at wellness in a much more holistic way these days – there’s much more awareness of mental health and nutrition. We don’t have a certain aesthetic – I’m almost 40, I’m curvy, I’ve got two kids and I run the biggest fitness magazine in the country.” In this month’s editorial, she stresses that, after a few Christmas parties, her abs are not looking like they did in the issue’s photoshoot – and that is just fine.

But however seriously individuals take their responsibilities, the cumulative effect of scrolling through endless pictures of washboard stomachs can be powerful. While writing this article, I created an Instagram account following only fitness influencers, clean-eating bloggers and the odd celebrity suggested by the site’s algorithms once it had detected me behaving like a millennial gym bunny.

My time on fitness Instagram was, admittedly, nicer than my usual social media experience (arguing about Brexit on Twitter). But when all you see all day on your phone is amazing bodies, it is surprisingly easy to get sucked in. On day one, I rolled my eyes at all the posts about sautéed kale. After a week, I had been running, cooked a lot of chickpeas and wondered about the hand weights that have spent the past 15 years in the loft.

Arguably, that is no bad thing, given that the biggest threat to the average Briton’s health is failing to get off the sofa. Many of us need a gentle prod. But the risk of promoting any one shape as ideal is that those whose bodies do not conform naturally can easily be left feeling inadequate. “Thank God we’re getting rid of the stigma that women shouldn’t have muscles, that if a woman does she looks like a man. I’m so happy we’re breaking down those barriers,” says Madeley. “But why do we need to bash other people in order to get there?”

Has strong become the respectable face of skinny for young women?

A generation of Instagram stars and personal trainers are challenging old-fashioned notions of femininity, replacing images of thinness or fecundity with brute strength. Whether this is healthy is another matter

Young woman with a six-pack


Cult of muscle … young women increasingly aim for a ‘ripped’ physique. Photograph: Getty Images

”Imagine you’re a Page 3 girl and they’re going for the butt shot,” says Chloe Madeley, helpfully.

It is a grey January morning in a gym near Leicester and Madeley, a former TV presenter turned personal trainer and Instagram phenomenon – and the daughter of daytime telly pairing Richard Madeley and Judy Finnegan – is trying gamely to teach me the correct posture for squats with weights. Bum stuck out, shoulders pinned back, move from the hips. None of this is dignified. It is also killing my hamstrings, although there is only a wimpy 5kg weight on the bar I am lifting, compared with the 60kg she usually manages.

But Madeley is kind, funny and ridiculously encouraging. Half an hour of pumping iron with her leaves me in an unexpectedly good mood. My head feels clearer, lighter. And there is something very appealing about the insouciance with which she strolls through the weights area, past all the men in sleeveless Ts doing press-ups.

Once upon a time, gyms divided rigidly by gender: treadmills and pilates classes for the ladies; grunting men lifting weights by the mirror. Women shied away from dumbbells for fear of getting bulky or embarrassing themselves. Men’s fitness magazines featured rippled torsos and articles about protein shakes, while the female versions were all bikini bodies and how to be your happiest self.

Well, not any more. “Shed kilos, build muscle, strip fat,” screams the cover of January’s Women’s Health magazine, alongside features on getting a “strong mind” and “killer abs”. Inside, editor Claire Sanderson describes proudly how she hip-thrusted 130kg (a move that involves lying down with a barbell across your middle and pushing your hips skywards) as part of a January transformation feature.

Rival magazine Women’s Fitness, meanwhile, offers “21 days to strong”, a diet and workout plan that will ensure you can shift furniture upstairs on your own. Even Davina McCall now boasts the jutting abs and sharply carved physique of a bodybuilder, prompting the Sun to ask whether the 50-year-old has “gone too far” for her latest fitness video.

Gaby Hinsliff works a pair of dumbbells under Chloe Madeley’s instruction


Gaby Hinsliff works a pair of dumbbells under Chloe Madeley’s instruction. Photograph: Fabio de Paola for the Guardian

Yet she is only reflecting a cult of muscle that is all the rage on Instagram, led by a new generation of so-called fitness influencers such as Madeley, the 26-year-old Australian blogger Kayla Itsines, the 29-year-old American Massy Arias (famous not only for her abs, but for the speed with which they snapped back after the birth of her baby last year) and Alice Liveing, the British personal trainer who coached Sanderson for her hip-thrusting challenge.

Their feeds are a mixture of filmed workout routines, zippy motivational messages and photographs of their dogs and their breakfasts. Itsines in particular is hot on sharing “before” and “after” pictures of ordinary women who have followed her method. But the best adverts for their burgeoning business empires are invariably their own bodies. These women are built like athletes, not scrawny models: slim, but with biceps, calves and formidable six-packs (plus, in the case of 24-year-old US fitness guru Jen Selter, a famously Kardashian-esque behind). What is most striking, though, is how influential they have become in young women’s lives.

Middle-aged readers are more likely to be familiar with Madeley’s parents than with the 30-year-old personal trainer herself, yet her diet and fitness book The 4-Week Body Blitz has shot into the January bestseller charts. You may never have heard of Liveing, but at 24 she has three bestselling books, a clothing line at Primark and numerous corporate partnerships to her name.

These women’s brands were built independently of mainstream media, on Instagram and YouTube, where moody shots of perfect abs combine with ass-kicking, vaguely feminist sentiments. If that sounds superficial, their “strong in mind and body” mantra perhaps resonates deeper with anxiety-prone millennials, who increasingly use exercise to manage their mental health.

Five years ago, Madeley was working in TV, worrying that she lacked a passion in life, when her then-boyfriend introduced her to weightlifting. At the time, she says, she suffered badly from anxiety and was experiencing “panic attack after panic attack”. But lifting made her feel capable and strong.

“I would say weightlifting – this methodical act that results in physical and mental feelings of strength, capability, accomplishment – has absolutely had a massive ripple effect on my life. I feel like if I got into a sticky situation I could handle it, I can do it, it’s fine,” she says.

xmlns=”http://www.w3.org/2000/svg”>

The ‘ripped’ look – where every muscle stands out – involves stripping away almost all your body fat

“If I do start to get anxious, I have an outlet, a form of CBT, something I can do to focus all my energy.” She compares lifting to cooking, another soothingly repetitive process that many find relaxing because the rhythm – all that chopping and stirring – takes over.

There is something unexpectedly touching about this, just as there is something thrilling about shattering the myth that strength and power are not feminine. But have we really learned to value bodies for what they can do, not merely how they look? Is strong becoming the respectable face of skinny?

Vicky McCann’s fitness career began at the age of 13, when she got a job tidying the changing rooms of a local gym. She moved into teaching aerobics, then lifting weights. In 1990, she entered her first bodybuilding competition. Since then, she has twice been world champion in the so-called natural branch of the sport, which strictly forbids the use of steroids, male hormones and other artificial enhancements, including cosmetic surgery. She also runs her own gym in Perth, Scotland.

McCann, who at 48 still competes, says more women are entering the sport, but primarily via “bikini-body” competitions, a kind of bodybuilding-lite where contestants must be extremely toned, but much less musclebound than in traditional contests.

“It’s a halfway house, almost a cross between a fitness pageant and a beauty pageant,” says McCann, who prefers the more heavyweight version. “A lot of these women, I don’t see them as muscular – I’d almost describe it as a wedding day. They get a chance to wear a fancy bikini and have their hair and nails done and look pretty.” Hopefully, she says, some will be inspired nonetheless to move into bodybuilding proper.

Massy Arias models her clothing line for US retailer Target.


Massy Arias models her clothing line for US retailer Target. Photograph: Target

However, even this much muscle on a woman can be controversial. The actor and Strictly Come Dancing contestant Gemma Atkinson, who owes her strong physique to boxing and weights, endured sniping from some Strictly fans last year about being supposedly “too masculine” for dancing. Yet she was one of Women’s Health’s most popular cover stars, reflecting changing aspirations among younger women.

“We have a very different ideal of what we aspire to be. That’s shifted, even looking at things like covers of magazines and female role models that have risen up the ranks,” says Liveing. “Serena Williams – she wouldn’t have been a typical aspirational physique before, but she’s physically strong, she’s amazing, she’s achieved so much.”

Liveing got into weights while studying musical theatre, after her dance teachers told her she wasn’t strong enough. She says the perception that lifting was not for women only made it more appealing. “I love it when my clients are shocked by their own strength, because we haven’t been allowed to believe we were able to do that until now,” she says. “It’s breaking the taboos of being as strong, if not stronger, than men.”

She argues that the biggest case for women lifting weights, or working against their bodyweight in “resistance” exercises such as press-ups, lies in the health benefits. It can help maintain bone density, which is important for avoiding osteoporosis; it can help prevent muscle wastage as women age, potentially allowing them to stay active and independent for longer. (The actor Sheila Hancock recently announced that she had taken up weights, aged 84, after realising that she was struggling to lift hand luggage into plane lockers.)

Pumping iron can also aid weight loss. The greater a woman’s muscle mass, the higher her metabolic rate and the more calories she should burn, even at rest. According to Sanderson, this is what is driving many women away from burning fat through running or cardio and towards building muscle. “I was a complete cardio queen 10 years ago, doing triathlons and spinning classes like my life depended on it and running marathons,” she says. “Now I don’t do much of that at all and I’m probably in the best shape of my life.”

But there is a crucial difference between being in shape and the very lean – “shredded” – look gaining currency. Aiming to be strong, capable and powerful is one thing. Wanting to look it takes us into murkier waters. Women can certainly build muscle by exercising, albeit more slowly than men, given their lower testosterone levels. But the “ripped” look – seemingly borrowed from bodybuilding, where every muscle stands out – involves stripping away the body fat that would otherwise blur that definition. That is where diet comes in.

Sanderson says it is important to be honest about how much effort goes into looking like the Instagram poster girls and how attainable it is for mere mortals. “It’s their job to look that way – and all power to them. They live and breathe it. But, in my experience, in order to look that lean, that cut, you have to follow a really strict nutritional plan, which not many people would want to do.”

Judging by the meal snapshots these women constantly upload, that means a high-protein, fairly low-carb diet involving a lot of eggs, sweet potatoes, kale and chickpeas. Cutting out alcohol or sugar is relatively common, as is training five or six days a week. They may look like girls next door, but these women have the iron discipline of professional athletes.

Jen Selter is one of the Instagram influencers to have built her brand outside of the mainstream media
Jen Selter is one of the Instagram influencers to have built her brand outside of the mainstream media. Photograph: jenselter/Instagram

“I eat all day long, I have a very varied and balanced and healthy diet, but it’s very structured and disciplined,” says Madeley, who manages by giving herself a break from the regime every few weeks. “You get three weeks of not drinking at parties, not sharing the birthday cake at the office and you think: ‘At some point, I’m going to have to give myself at least a day off or I’m going to get really fed up.’”

McCann eats 2,000 calories a day in the run-up to a competition, when she is focused on shedding fat and revealing muscle, but her diet will be heavily restricted and precision-calculated. “I eat very bland when I’m dieting. I count out my food, weigh and measure it. But I don’t crash diet, I do it over a long period of time.” She worries, however, about newcomers to bikini-body contests relying on very low-carb plans to get in shape fast.

Eating this strictly is not necessarily disordered in itself, but rigid diets can easily be taken to extremes by vulnerable people. A recent spate of stories about anorexic people crediting bodybuilding for their recovery set distant alarm bells ringing. It is easy to see how such a regime might satisfy a need for control.

There is anecdotal evidence of people with eating disorders channeling their fixation into exercise, says Liam Preston, head of the Be Real body-image campaign, launched by a group of charities following a parliamentary report on the crisis in young people’s body confidence. “They can get obsessive about going to the gym, rather than obsessing about eating. But that’s a mental health problem, so I don’t know that exercise solves it.”

The broader problem he identifies, however, is people chasing fashions in body shape – strong or skinny – regardless of whether they are healthy. “We see so many crazes online and you’ll find people who go from one to another, trying everything. It’s about trying to build resilience, a feeling that their body is fine the way it is.”

The YMCA-led campaign is now working with schools to boost younger children’s body confidence, in the hope that this will make them less likely to seek solutions for imaginary faults in their teens. “We always try to go with the message that being happy and healthy is more important than anything else; it’s not about the way you look. If you want to go to the gym, that’s great, but are you doing it for the right reasons?”

xmlns=”http://www.w3.org/2000/svg”>

Aiming to be strong, capable and powerful is one thing. Wanting to look it takes us into murkier waters

In fairness, Instagram’s fitness queens seem intensely aware of their social responsibilities. They constantly repeat that there is not one “right” way to look, that followers should be kind to themselves, that it is all about balance.

“It’s really important, I think, to impress upon your audience the importance of not using social media as a way of comparing us – use it as a tool of information, but don’t sit there letting it make you feel bad about yourself,” says Liveing. She was originally known as Clean Eating Alice, but reverted to her name recently after becoming worried about clean eating’s association with faddy, exclusionary diets. Food matters in training, she says, but “not excessively so”.

Madeley is cheerfully upfront about putting on five pounds over Christmas. She reminds followers regularly that the aspirational images they see all over social media are invariably of fitness models at their competitive peak. (A common tactic is training hard for a photoshoot, then trickling out the resulting pictures over several weeks of posts; that way the public persona stays eternally ripped, even if the model does not.)

Sanderson, meanwhile, insists it is unfair and outdated to accuse magazines such as hers of potentially fuelling eating disorders. “We look at wellness in a much more holistic way these days – there’s much more awareness of mental health and nutrition. We don’t have a certain aesthetic – I’m almost 40, I’m curvy, I’ve got two kids and I run the biggest fitness magazine in the country.” In this month’s editorial, she stresses that, after a few Christmas parties, her abs are not looking like they did in the issue’s photoshoot – and that is just fine.

But however seriously individuals take their responsibilities, the cumulative effect of scrolling through endless pictures of washboard stomachs can be powerful. While writing this article, I created an Instagram account following only fitness influencers, clean-eating bloggers and the odd celebrity suggested by the site’s algorithms once it had detected me behaving like a millennial gym bunny.

My time on fitness Instagram was, admittedly, nicer than my usual social media experience (arguing about Brexit on Twitter). But when all you see all day on your phone is amazing bodies, it is surprisingly easy to get sucked in. On day one, I rolled my eyes at all the posts about sautéed kale. After a week, I had been running, cooked a lot of chickpeas and wondered about the hand weights that have spent the past 15 years in the loft.

Arguably, that is no bad thing, given that the biggest threat to the average Briton’s health is failing to get off the sofa. Many of us need a gentle prod. But the risk of promoting any one shape as ideal is that those whose bodies do not conform naturally can easily be left feeling inadequate. “Thank God we’re getting rid of the stigma that women shouldn’t have muscles, that if a woman does she looks like a man. I’m so happy we’re breaking down those barriers,” says Madeley. “But why do we need to bash other people in order to get there?”

Has strong become the respectable face of skinny for young women?

A generation of Instagram stars and personal trainers are challenging old-fashioned notions of femininity, replacing images of thinness or fecundity with brute strength. Whether this is healthy is another matter

Young woman with a six-pack


Cult of muscle … young women increasingly aim for a ‘ripped’ physique. Photograph: Getty Images

”Imagine you’re a Page 3 girl and they’re going for the butt shot,” says Chloe Madeley, helpfully.

It is a grey January morning in a gym near Leicester and Madeley, a former TV presenter turned personal trainer and Instagram phenomenon – and the daughter of daytime telly pairing Richard Madeley and Judy Finnegan – is trying gamely to teach me the correct posture for squats with weights. Bum stuck out, shoulders pinned back, move from the hips. None of this is dignified. It is also killing my hamstrings, although there is only a wimpy 5kg weight on the bar I am lifting, compared with the 60kg she usually manages.

But Madeley is kind, funny and ridiculously encouraging. Half an hour of pumping iron with her leaves me in an unexpectedly good mood. My head feels clearer, lighter. And there is something very appealing about the insouciance with which she strolls through the weights area, past all the men in sleeveless Ts doing press-ups.

Once upon a time, gyms divided rigidly by gender: treadmills and pilates classes for the ladies; grunting men lifting weights by the mirror. Women shied away from dumbbells for fear of getting bulky or embarrassing themselves. Men’s fitness magazines featured rippled torsos and articles about protein shakes, while the female versions were all bikini bodies and how to be your happiest self.

Well, not any more. “Shed kilos, build muscle, strip fat,” screams the cover of January’s Women’s Health magazine, alongside features on getting a “strong mind” and “killer abs”. Inside, editor Claire Sanderson describes proudly how she hip-thrusted 130kg (a move that involves lying down with a barbell across your middle and pushing your hips skywards) as part of a January transformation feature.

Rival magazine Women’s Fitness, meanwhile, offers “21 days to strong”, a diet and workout plan that will ensure you can shift furniture upstairs on your own. Even Davina McCall now boasts the jutting abs and sharply carved physique of a bodybuilder, prompting the Sun to ask whether the 50-year-old has “gone too far” for her latest fitness video.

Gaby Hinsliff works a pair of dumbbells under Chloe Madeley’s instruction


Gaby Hinsliff works a pair of dumbbells under Chloe Madeley’s instruction. Photograph: Fabio de Paola for the Guardian

Yet she is only reflecting a cult of muscle that is all the rage on Instagram, led by a new generation of so-called fitness influencers such as Madeley, the 26-year-old Australian blogger Kayla Itsines, the 29-year-old American Massy Arias (famous not only for her abs, but for the speed with which they snapped back after the birth of her baby last year) and Alice Liveing, the British personal trainer who coached Sanderson for her hip-thrusting challenge.

Their feeds are a mixture of filmed workout routines, zippy motivational messages and photographs of their dogs and their breakfasts. Itsines in particular is hot on sharing “before” and “after” pictures of ordinary women who have followed her method. But the best adverts for their burgeoning business empires are invariably their own bodies. These women are built like athletes, not scrawny models: slim, but with biceps, calves and formidable six-packs (plus, in the case of 24-year-old US fitness guru Jen Selter, a famously Kardashian-esque behind). What is most striking, though, is how influential they have become in young women’s lives.

Middle-aged readers are more likely to be familiar with Madeley’s parents than with the 30-year-old personal trainer herself, yet her diet and fitness book The 4-Week Body Blitz has shot into the January bestseller charts. You may never have heard of Liveing, but at 24 she has three bestselling books, a clothing line at Primark and numerous corporate partnerships to her name.

These women’s brands were built independently of mainstream media, on Instagram and YouTube, where moody shots of perfect abs combine with ass-kicking, vaguely feminist sentiments. If that sounds superficial, their “strong in mind and body” mantra perhaps resonates deeper with anxiety-prone millennials, who increasingly use exercise to manage their mental health.

Five years ago, Madeley was working in TV, worrying that she lacked a passion in life, when her then-boyfriend introduced her to weightlifting. At the time, she says, she suffered badly from anxiety and was experiencing “panic attack after panic attack”. But lifting made her feel capable and strong.

“I would say weightlifting – this methodical act that results in physical and mental feelings of strength, capability, accomplishment – has absolutely had a massive ripple effect on my life. I feel like if I got into a sticky situation I could handle it, I can do it, it’s fine,” she says.

xmlns=”http://www.w3.org/2000/svg”>

The ‘ripped’ look – where every muscle stands out – involves stripping away almost all your body fat

“If I do start to get anxious, I have an outlet, a form of CBT, something I can do to focus all my energy.” She compares lifting to cooking, another soothingly repetitive process that many find relaxing because the rhythm – all that chopping and stirring – takes over.

There is something unexpectedly touching about this, just as there is something thrilling about shattering the myth that strength and power are not feminine. But have we really learned to value bodies for what they can do, not merely how they look? Is strong becoming the respectable face of skinny?

Vicky McCann’s fitness career began at the age of 13, when she got a job tidying the changing rooms of a local gym. She moved into teaching aerobics, then lifting weights. In 1990, she entered her first bodybuilding competition. Since then, she has twice been world champion in the so-called natural branch of the sport, which strictly forbids the use of steroids, male hormones and other artificial enhancements, including cosmetic surgery. She also runs her own gym in Perth, Scotland.

McCann, who at 48 still competes, says more women are entering the sport, but primarily via “bikini-body” competitions, a kind of bodybuilding-lite where contestants must be extremely toned, but much less musclebound than in traditional contests.

“It’s a halfway house, almost a cross between a fitness pageant and a beauty pageant,” says McCann, who prefers the more heavyweight version. “A lot of these women, I don’t see them as muscular – I’d almost describe it as a wedding day. They get a chance to wear a fancy bikini and have their hair and nails done and look pretty.” Hopefully, she says, some will be inspired nonetheless to move into bodybuilding proper.

Massy Arias models her clothing line for US retailer Target.


Massy Arias models her clothing line for US retailer Target. Photograph: Target

However, even this much muscle on a woman can be controversial. The actor and Strictly Come Dancing contestant Gemma Atkinson, who owes her strong physique to boxing and weights, endured sniping from some Strictly fans last year about being supposedly “too masculine” for dancing. Yet she was one of Women’s Health’s most popular cover stars, reflecting changing aspirations among younger women.

“We have a very different ideal of what we aspire to be. That’s shifted, even looking at things like covers of magazines and female role models that have risen up the ranks,” says Liveing. “Serena Williams – she wouldn’t have been a typical aspirational physique before, but she’s physically strong, she’s amazing, she’s achieved so much.”

Liveing got into weights while studying musical theatre, after her dance teachers told her she wasn’t strong enough. She says the perception that lifting was not for women only made it more appealing. “I love it when my clients are shocked by their own strength, because we haven’t been allowed to believe we were able to do that until now,” she says. “It’s breaking the taboos of being as strong, if not stronger, than men.”

She argues that the biggest case for women lifting weights, or working against their bodyweight in “resistance” exercises such as press-ups, lies in the health benefits. It can help maintain bone density, which is important for avoiding osteoporosis; it can help prevent muscle wastage as women age, potentially allowing them to stay active and independent for longer. (The actor Sheila Hancock recently announced that she had taken up weights, aged 84, after realising that she was struggling to lift hand luggage into plane lockers.)

Pumping iron can also aid weight loss. The greater a woman’s muscle mass, the higher her metabolic rate and the more calories she should burn, even at rest. According to Sanderson, this is what is driving many women away from burning fat through running or cardio and towards building muscle. “I was a complete cardio queen 10 years ago, doing triathlons and spinning classes like my life depended on it and running marathons,” she says. “Now I don’t do much of that at all and I’m probably in the best shape of my life.”

But there is a crucial difference between being in shape and the very lean – “shredded” – look gaining currency. Aiming to be strong, capable and powerful is one thing. Wanting to look it takes us into murkier waters. Women can certainly build muscle by exercising, albeit more slowly than men, given their lower testosterone levels. But the “ripped” look – seemingly borrowed from bodybuilding, where every muscle stands out – involves stripping away the body fat that would otherwise blur that definition. That is where diet comes in.

Sanderson says it is important to be honest about how much effort goes into looking like the Instagram poster girls and how attainable it is for mere mortals. “It’s their job to look that way – and all power to them. They live and breathe it. But, in my experience, in order to look that lean, that cut, you have to follow a really strict nutritional plan, which not many people would want to do.”

Judging by the meal snapshots these women constantly upload, that means a high-protein, fairly low-carb diet involving a lot of eggs, sweet potatoes, kale and chickpeas. Cutting out alcohol or sugar is relatively common, as is training five or six days a week. They may look like girls next door, but these women have the iron discipline of professional athletes.

Jen Selter is one of the Instagram influencers to have built her brand outside of the mainstream media
Jen Selter is one of the Instagram influencers to have built her brand outside of the mainstream media. Photograph: jenselter/Instagram

“I eat all day long, I have a very varied and balanced and healthy diet, but it’s very structured and disciplined,” says Madeley, who manages by giving herself a break from the regime every few weeks. “You get three weeks of not drinking at parties, not sharing the birthday cake at the office and you think: ‘At some point, I’m going to have to give myself at least a day off or I’m going to get really fed up.’”

McCann eats 2,000 calories a day in the run-up to a competition, when she is focused on shedding fat and revealing muscle, but her diet will be heavily restricted and precision-calculated. “I eat very bland when I’m dieting. I count out my food, weigh and measure it. But I don’t crash diet, I do it over a long period of time.” She worries, however, about newcomers to bikini-body contests relying on very low-carb plans to get in shape fast.

Eating this strictly is not necessarily disordered in itself, but rigid diets can easily be taken to extremes by vulnerable people. A recent spate of stories about anorexic people crediting bodybuilding for their recovery set distant alarm bells ringing. It is easy to see how such a regime might satisfy a need for control.

There is anecdotal evidence of people with eating disorders channeling their fixation into exercise, says Liam Preston, head of the Be Real body-image campaign, launched by a group of charities following a parliamentary report on the crisis in young people’s body confidence. “They can get obsessive about going to the gym, rather than obsessing about eating. But that’s a mental health problem, so I don’t know that exercise solves it.”

The broader problem he identifies, however, is people chasing fashions in body shape – strong or skinny – regardless of whether they are healthy. “We see so many crazes online and you’ll find people who go from one to another, trying everything. It’s about trying to build resilience, a feeling that their body is fine the way it is.”

The YMCA-led campaign is now working with schools to boost younger children’s body confidence, in the hope that this will make them less likely to seek solutions for imaginary faults in their teens. “We always try to go with the message that being happy and healthy is more important than anything else; it’s not about the way you look. If you want to go to the gym, that’s great, but are you doing it for the right reasons?”

xmlns=”http://www.w3.org/2000/svg”>

Aiming to be strong, capable and powerful is one thing. Wanting to look it takes us into murkier waters

In fairness, Instagram’s fitness queens seem intensely aware of their social responsibilities. They constantly repeat that there is not one “right” way to look, that followers should be kind to themselves, that it is all about balance.

“It’s really important, I think, to impress upon your audience the importance of not using social media as a way of comparing us – use it as a tool of information, but don’t sit there letting it make you feel bad about yourself,” says Liveing. She was originally known as Clean Eating Alice, but reverted to her name recently after becoming worried about clean eating’s association with faddy, exclusionary diets. Food matters in training, she says, but “not excessively so”.

Madeley is cheerfully upfront about putting on five pounds over Christmas. She reminds followers regularly that the aspirational images they see all over social media are invariably of fitness models at their competitive peak. (A common tactic is training hard for a photoshoot, then trickling out the resulting pictures over several weeks of posts; that way the public persona stays eternally ripped, even if the model does not.)

Sanderson, meanwhile, insists it is unfair and outdated to accuse magazines such as hers of potentially fuelling eating disorders. “We look at wellness in a much more holistic way these days – there’s much more awareness of mental health and nutrition. We don’t have a certain aesthetic – I’m almost 40, I’m curvy, I’ve got two kids and I run the biggest fitness magazine in the country.” In this month’s editorial, she stresses that, after a few Christmas parties, her abs are not looking like they did in the issue’s photoshoot – and that is just fine.

But however seriously individuals take their responsibilities, the cumulative effect of scrolling through endless pictures of washboard stomachs can be powerful. While writing this article, I created an Instagram account following only fitness influencers, clean-eating bloggers and the odd celebrity suggested by the site’s algorithms once it had detected me behaving like a millennial gym bunny.

My time on fitness Instagram was, admittedly, nicer than my usual social media experience (arguing about Brexit on Twitter). But when all you see all day on your phone is amazing bodies, it is surprisingly easy to get sucked in. On day one, I rolled my eyes at all the posts about sautéed kale. After a week, I had been running, cooked a lot of chickpeas and wondered about the hand weights that have spent the past 15 years in the loft.

Arguably, that is no bad thing, given that the biggest threat to the average Briton’s health is failing to get off the sofa. Many of us need a gentle prod. But the risk of promoting any one shape as ideal is that those whose bodies do not conform naturally can easily be left feeling inadequate. “Thank God we’re getting rid of the stigma that women shouldn’t have muscles, that if a woman does she looks like a man. I’m so happy we’re breaking down those barriers,” says Madeley. “But why do we need to bash other people in order to get there?”

Has strong become the respectable face of skinny for young women?

A generation of Instagram stars and personal trainers are challenging old-fashioned notions of femininity, replacing images of thinness or fecundity with brute strength. Whether this is healthy is another matter

Young woman with a six-pack


Cult of muscle … young women increasingly aim for a ‘ripped’ physique. Photograph: Getty Images

”Imagine you’re a Page 3 girl and they’re going for the butt shot,” says Chloe Madeley, helpfully.

It is a grey January morning in a gym near Leicester and Madeley, a former TV presenter turned personal trainer and Instagram phenomenon – and the daughter of daytime telly pairing Richard Madeley and Judy Finnegan – is trying gamely to teach me the correct posture for squats with weights. Bum stuck out, shoulders pinned back, move from the hips. None of this is dignified. It is also killing my hamstrings, although there is only a wimpy 5kg weight on the bar I am lifting, compared with the 60kg she usually manages.

But Madeley is kind, funny and ridiculously encouraging. Half an hour of pumping iron with her leaves me in an unexpectedly good mood. My head feels clearer, lighter. And there is something very appealing about the insouciance with which she strolls through the weights area, past all the men in sleeveless Ts doing press-ups.

Once upon a time, gyms divided rigidly by gender: treadmills and pilates classes for the ladies; grunting men lifting weights by the mirror. Women shied away from dumbbells for fear of getting bulky or embarrassing themselves. Men’s fitness magazines featured rippled torsos and articles about protein shakes, while the female versions were all bikini bodies and how to be your happiest self.

Well, not any more. “Shed kilos, build muscle, strip fat,” screams the cover of January’s Women’s Health magazine, alongside features on getting a “strong mind” and “killer abs”. Inside, editor Claire Sanderson describes proudly how she hip-thrusted 130kg (a move that involves lying down with a barbell across your middle and pushing your hips skywards) as part of a January transformation feature.

Rival magazine Women’s Fitness, meanwhile, offers “21 days to strong”, a diet and workout plan that will ensure you can shift furniture upstairs on your own. Even Davina McCall now boasts the jutting abs and sharply carved physique of a bodybuilder, prompting the Sun to ask whether the 50-year-old has “gone too far” for her latest fitness video.

Gaby Hinsliff works a pair of dumbbells under Chloe Madeley’s instruction


Gaby Hinsliff works a pair of dumbbells under Chloe Madeley’s instruction. Photograph: Fabio de Paola for the Guardian

Yet she is only reflecting a cult of muscle that is all the rage on Instagram, led by a new generation of so-called fitness influencers such as Madeley, the 26-year-old Australian blogger Kayla Itsines, the 29-year-old American Massy Arias (famous not only for her abs, but for the speed with which they snapped back after the birth of her baby last year) and Alice Liveing, the British personal trainer who coached Sanderson for her hip-thrusting challenge.

Their feeds are a mixture of filmed workout routines, zippy motivational messages and photographs of their dogs and their breakfasts. Itsines in particular is hot on sharing “before” and “after” pictures of ordinary women who have followed her method. But the best adverts for their burgeoning business empires are invariably their own bodies. These women are built like athletes, not scrawny models: slim, but with biceps, calves and formidable six-packs (plus, in the case of 24-year-old US fitness guru Jen Selter, a famously Kardashian-esque behind). What is most striking, though, is how influential they have become in young women’s lives.

Middle-aged readers are more likely to be familiar with Madeley’s parents than with the 30-year-old personal trainer herself, yet her diet and fitness book The 4-Week Body Blitz has shot into the January bestseller charts. You may never have heard of Liveing, but at 24 she has three bestselling books, a clothing line at Primark and numerous corporate partnerships to her name.

These women’s brands were built independently of mainstream media, on Instagram and YouTube, where moody shots of perfect abs combine with ass-kicking, vaguely feminist sentiments. If that sounds superficial, their “strong in mind and body” mantra perhaps resonates deeper with anxiety-prone millennials, who increasingly use exercise to manage their mental health.

Five years ago, Madeley was working in TV, worrying that she lacked a passion in life, when her then-boyfriend introduced her to weightlifting. At the time, she says, she suffered badly from anxiety and was experiencing “panic attack after panic attack”. But lifting made her feel capable and strong.

“I would say weightlifting – this methodical act that results in physical and mental feelings of strength, capability, accomplishment – has absolutely had a massive ripple effect on my life. I feel like if I got into a sticky situation I could handle it, I can do it, it’s fine,” she says.

xmlns=”http://www.w3.org/2000/svg”>

The ‘ripped’ look – where every muscle stands out – involves stripping away almost all your body fat

“If I do start to get anxious, I have an outlet, a form of CBT, something I can do to focus all my energy.” She compares lifting to cooking, another soothingly repetitive process that many find relaxing because the rhythm – all that chopping and stirring – takes over.

There is something unexpectedly touching about this, just as there is something thrilling about shattering the myth that strength and power are not feminine. But have we really learned to value bodies for what they can do, not merely how they look? Is strong becoming the respectable face of skinny?

Vicky McCann’s fitness career began at the age of 13, when she got a job tidying the changing rooms of a local gym. She moved into teaching aerobics, then lifting weights. In 1990, she entered her first bodybuilding competition. Since then, she has twice been world champion in the so-called natural branch of the sport, which strictly forbids the use of steroids, male hormones and other artificial enhancements, including cosmetic surgery. She also runs her own gym in Perth, Scotland.

McCann, who at 48 still competes, says more women are entering the sport, but primarily via “bikini-body” competitions, a kind of bodybuilding-lite where contestants must be extremely toned, but much less musclebound than in traditional contests.

“It’s a halfway house, almost a cross between a fitness pageant and a beauty pageant,” says McCann, who prefers the more heavyweight version. “A lot of these women, I don’t see them as muscular – I’d almost describe it as a wedding day. They get a chance to wear a fancy bikini and have their hair and nails done and look pretty.” Hopefully, she says, some will be inspired nonetheless to move into bodybuilding proper.

Massy Arias models her clothing line for US retailer Target.


Massy Arias models her clothing line for US retailer Target. Photograph: Target

However, even this much muscle on a woman can be controversial. The actor and Strictly Come Dancing contestant Gemma Atkinson, who owes her strong physique to boxing and weights, endured sniping from some Strictly fans last year about being supposedly “too masculine” for dancing. Yet she was one of Women’s Health’s most popular cover stars, reflecting changing aspirations among younger women.

“We have a very different ideal of what we aspire to be. That’s shifted, even looking at things like covers of magazines and female role models that have risen up the ranks,” says Liveing. “Serena Williams – she wouldn’t have been a typical aspirational physique before, but she’s physically strong, she’s amazing, she’s achieved so much.”

Liveing got into weights while studying musical theatre, after her dance teachers told her she wasn’t strong enough. She says the perception that lifting was not for women only made it more appealing. “I love it when my clients are shocked by their own strength, because we haven’t been allowed to believe we were able to do that until now,” she says. “It’s breaking the taboos of being as strong, if not stronger, than men.”

She argues that the biggest case for women lifting weights, or working against their bodyweight in “resistance” exercises such as press-ups, lies in the health benefits. It can help maintain bone density, which is important for avoiding osteoporosis; it can help prevent muscle wastage as women age, potentially allowing them to stay active and independent for longer. (The actor Sheila Hancock recently announced that she had taken up weights, aged 84, after realising that she was struggling to lift hand luggage into plane lockers.)

Pumping iron can also aid weight loss. The greater a woman’s muscle mass, the higher her metabolic rate and the more calories she should burn, even at rest. According to Sanderson, this is what is driving many women away from burning fat through running or cardio and towards building muscle. “I was a complete cardio queen 10 years ago, doing triathlons and spinning classes like my life depended on it and running marathons,” she says. “Now I don’t do much of that at all and I’m probably in the best shape of my life.”

But there is a crucial difference between being in shape and the very lean – “shredded” – look gaining currency. Aiming to be strong, capable and powerful is one thing. Wanting to look it takes us into murkier waters. Women can certainly build muscle by exercising, albeit more slowly than men, given their lower testosterone levels. But the “ripped” look – seemingly borrowed from bodybuilding, where every muscle stands out – involves stripping away the body fat that would otherwise blur that definition. That is where diet comes in.

Sanderson says it is important to be honest about how much effort goes into looking like the Instagram poster girls and how attainable it is for mere mortals. “It’s their job to look that way – and all power to them. They live and breathe it. But, in my experience, in order to look that lean, that cut, you have to follow a really strict nutritional plan, which not many people would want to do.”

Judging by the meal snapshots these women constantly upload, that means a high-protein, fairly low-carb diet involving a lot of eggs, sweet potatoes, kale and chickpeas. Cutting out alcohol or sugar is relatively common, as is training five or six days a week. They may look like girls next door, but these women have the iron discipline of professional athletes.

Jen Selter is one of the Instagram influencers to have built her brand outside of the mainstream media
Jen Selter is one of the Instagram influencers to have built her brand outside of the mainstream media. Photograph: jenselter/Instagram

“I eat all day long, I have a very varied and balanced and healthy diet, but it’s very structured and disciplined,” says Madeley, who manages by giving herself a break from the regime every few weeks. “You get three weeks of not drinking at parties, not sharing the birthday cake at the office and you think: ‘At some point, I’m going to have to give myself at least a day off or I’m going to get really fed up.’”

McCann eats 2,000 calories a day in the run-up to a competition, when she is focused on shedding fat and revealing muscle, but her diet will be heavily restricted and precision-calculated. “I eat very bland when I’m dieting. I count out my food, weigh and measure it. But I don’t crash diet, I do it over a long period of time.” She worries, however, about newcomers to bikini-body contests relying on very low-carb plans to get in shape fast.

Eating this strictly is not necessarily disordered in itself, but rigid diets can easily be taken to extremes by vulnerable people. A recent spate of stories about anorexic people crediting bodybuilding for their recovery set distant alarm bells ringing. It is easy to see how such a regime might satisfy a need for control.

There is anecdotal evidence of people with eating disorders channeling their fixation into exercise, says Liam Preston, head of the Be Real body-image campaign, launched by a group of charities following a parliamentary report on the crisis in young people’s body confidence. “They can get obsessive about going to the gym, rather than obsessing about eating. But that’s a mental health problem, so I don’t know that exercise solves it.”

The broader problem he identifies, however, is people chasing fashions in body shape – strong or skinny – regardless of whether they are healthy. “We see so many crazes online and you’ll find people who go from one to another, trying everything. It’s about trying to build resilience, a feeling that their body is fine the way it is.”

The YMCA-led campaign is now working with schools to boost younger children’s body confidence, in the hope that this will make them less likely to seek solutions for imaginary faults in their teens. “We always try to go with the message that being happy and healthy is more important than anything else; it’s not about the way you look. If you want to go to the gym, that’s great, but are you doing it for the right reasons?”

xmlns=”http://www.w3.org/2000/svg”>

Aiming to be strong, capable and powerful is one thing. Wanting to look it takes us into murkier waters

In fairness, Instagram’s fitness queens seem intensely aware of their social responsibilities. They constantly repeat that there is not one “right” way to look, that followers should be kind to themselves, that it is all about balance.

“It’s really important, I think, to impress upon your audience the importance of not using social media as a way of comparing us – use it as a tool of information, but don’t sit there letting it make you feel bad about yourself,” says Liveing. She was originally known as Clean Eating Alice, but reverted to her name recently after becoming worried about clean eating’s association with faddy, exclusionary diets. Food matters in training, she says, but “not excessively so”.

Madeley is cheerfully upfront about putting on five pounds over Christmas. She reminds followers regularly that the aspirational images they see all over social media are invariably of fitness models at their competitive peak. (A common tactic is training hard for a photoshoot, then trickling out the resulting pictures over several weeks of posts; that way the public persona stays eternally ripped, even if the model does not.)

Sanderson, meanwhile, insists it is unfair and outdated to accuse magazines such as hers of potentially fuelling eating disorders. “We look at wellness in a much more holistic way these days – there’s much more awareness of mental health and nutrition. We don’t have a certain aesthetic – I’m almost 40, I’m curvy, I’ve got two kids and I run the biggest fitness magazine in the country.” In this month’s editorial, she stresses that, after a few Christmas parties, her abs are not looking like they did in the issue’s photoshoot – and that is just fine.

But however seriously individuals take their responsibilities, the cumulative effect of scrolling through endless pictures of washboard stomachs can be powerful. While writing this article, I created an Instagram account following only fitness influencers, clean-eating bloggers and the odd celebrity suggested by the site’s algorithms once it had detected me behaving like a millennial gym bunny.

My time on fitness Instagram was, admittedly, nicer than my usual social media experience (arguing about Brexit on Twitter). But when all you see all day on your phone is amazing bodies, it is surprisingly easy to get sucked in. On day one, I rolled my eyes at all the posts about sautéed kale. After a week, I had been running, cooked a lot of chickpeas and wondered about the hand weights that have spent the past 15 years in the loft.

Arguably, that is no bad thing, given that the biggest threat to the average Briton’s health is failing to get off the sofa. Many of us need a gentle prod. But the risk of promoting any one shape as ideal is that those whose bodies do not conform naturally can easily be left feeling inadequate. “Thank God we’re getting rid of the stigma that women shouldn’t have muscles, that if a woman does she looks like a man. I’m so happy we’re breaking down those barriers,” says Madeley. “But why do we need to bash other people in order to get there?”

‘I knew I was in labour’ – why are women being turned away from hospital during childbirth?

As a number of women recount how they were mistakenly told to go home and wait, before giving birth on the pavement or in a lift, experts warn that more investment in early-labour care is needed

Some women who have been turned away from maternity units have soon after given birth in the street.


Some women who have been turned away from maternity units have soon after given birth in the street. Photograph: Alamy Stock Photo

Because her first baby had arrived quickly, Lizzie Hines was told at all her antenatal midwife appointments that she should go to hospital as soon as she recognised the first signs of labour. So, a couple of hours after she first felt twinges, cramps and contractions, she and her husband set off for a hospital in central London, but when she arrived, the midwife who examined her told her she wasn’t in labour. “I knew that not to be true,” she says. “I knew I was in labour.”

They were told to go home for a few hours; Hines asked if she could stay, but was told she couldn’t unless she wanted to wait in the corridor. Her husband booked them into a nearby hotel to wait it out, and they walked around the corner, with Hines, wearing pyjamas and a coat, steadying herself against the walls of the building with each contraction. It was 7am.

“We checked in at the hotel and I was probably there all of about 15 to 20 minutes when I said to my husband, ‘I’m having the baby. This is happening.’ I couldn’t really talk to him, but I could feel this was imminent. He said: ‘No, I’m going to get you [to hospital], we can’t do this here.’” He carried her across the road, and as another contraction came, Hines sat down on the street. “Apparently I let out a huge noise, but I don’t remember that at all. People came over, and I do remember ankles starting to appear around me.”

Then, she says, her son Louis “came out, and I remember feeling every limb fly out of my body and on to the floor and into my pyjamas. Someone in the crowd reassured me, saying, ‘Don’t worry, we’re going to get to the hospital, you’re going to be fine’. I said: ‘No, he’s here.’ They opened my pyjamas and saw him red and squirming, attached to me with the umbilical cord. He wasn’t screaming at first. Someone said put him against you so I lifted up my T-shirt and put him against me.”

She doesn’t remember much of what happened next, but last month she pieced her son’s birth together after a post she put on Facebook to search for the strangers who helped the family in December 2016 went viral. People have told her that her waters were running down the street, that someone in the crowd had tried to film her giving birth and a fight broke out to stop them. She didn’t even know when Louis was born – she was told it was 7.30am.

Lizzie Hines, in the street outside a hospital, moments after giving birth to her son Louis.


Lizzie Hines, in the street outside a hospital, moments after giving birth to her son Louis. Photograph: Courtesy of Lizzie Hines

The temperature was zero degrees. Some people in the crowd who helped her worked at the hospital. Hines and her newborn were taken there, using a wheelchair. She had a few stitches but all was well, and they went home that afternoon.

It was, she says, “a wonderful experience. He was healthy, I felt physically and mentally good about it, and I felt really joyful – I think the hormones were a huge part of that.” But, she adds: “There is also the thought that there was a misjudgment there.” It was a straightforward birth. “I feel very fortunate,” she says. “He didn’t have the cord round his neck or any immediate problems.”

Michelle Booth had a similar experience in 2013 with the birth of her son George, her first baby, who arrived in a hotel bathroom across the road from the hospital she had been turned away from a few hours earlier. She had been told she wasn’t dilated at all, and to go home. “The really stressful thing about it was I felt I was really on top of it, and then all of a sudden people were telling me I wasn’t in labour. When you haven’t had a baby before you don’t know. It freaked me out – if this wasn’t labour then what was it going to be like?”

Nearly three hours later, she called the hospital for advice and to ask if she should come in, but they told her to take a paracetamol. Soon afterwards, she gave birth in the hotel room. Like Hines, she says, it was a “really positive experience”, but she puts that down to being very prepared before the birth, having practised hypnobirthing and reading a lot about the birth process. “I think if I hadn’t done that, and had that experience, it would have been really scary.” She did, however, lose a lot of blood, and she and George were taken to hospital by ambulance quickly afterwards.

It was frustrating not to have been listened to, she says. “You’re having an experience and someone is telling you that it isn’t the experience you’re having. If you’ve never had a baby before, you’re reliant on the professionals giving you advice. I suppose what I’ve learned is the whole thing about birth is based on data.”

Being turned away in early labour, only to give birth soon afterwards, is “a symptom of something that affects women in maternity care a lot, which is not being listened to,” says Rebecca Schiller, chief executive of the charity Birthrights. “One of the problems we’re keen to address is changing culture in maternity care, so that women’s perceptions, experiences and information about their own bodies, own pregnancies and own labour is taken seriously. It’s something that’s important from a safety point of view. It’s been shown that some women who have had serious problems like stillbirths have reported worries and concerns, turned up to their maternity unit several times and been ignored, and gone to have tragic consequences.”

It can also be distressing to be told that you are not in labour when you feel you are, she says. “We know that how women feel giving birth can have an impact on their emotional wellbeing for quite a long time. It’s important for safety, and it’s important for women’s entry into motherhood and how they go on to feel about themselves and their experience of birth that they’re listened to.”

Michelle Booth and her son George.
Michelle Booth and her son George. Photograph: Courtesy of Michelle Booth

For Antonia Kennedy, who lives in the north-east, the birth of her fourth child, Oscar, in December 2016, was distressing. “Once you’ve had three other children, you know when you’re in labour,” she says. “[The midwife] said I was 1cm dilated and I should maybe go shopping – there was a shopping centre not far from the hospital – for a couple of hours.” She asked if she could stay at the hospital, but “they were adamant that I couldn’t. I said I really didn’t want to go back home. I felt ‘thank god we’re here’ but they said they wouldn’t let us stay.”

By then, she had been having contractions for a couple of hours, and at the hospital they were so strong, she couldn’t move. Her partner drove them the 15 minutes home, where they stayed for five minutes, before heading back to hospital. She made it through the doors, but gave birth to her son in the hospital lift. Her partner caught him. There were people watching and she says she felt really embarrassed. Since then, she has been plagued by thoughts about what might have happened if her partner had not caught the baby, if he’d hit the floor, and she believes the experience has contributed to the anxiety she has felt since the birth.Labour is unpredictable, acknowledges Schiller. “In my second labour, I went suddenly from not really feeling I was in labour to having a baby 40 minutes later. Sometimes you can’t predict those things and there will be women who give birth very quickly, and won’t be able to make it to a unit in time. But I think if a woman is at a unit and that’s where she feels safe, and she says like she feels like she’s in labour, it’s important that medical professionals don’t just rely on their traditional observations and vaginal examinations. It can be very easy to reduce a woman’s labour to measurements and standards, but we’re individuals and our bodies don’t often play that game.”

Early labour should be a time when women can feel safe, and while many women prefer to be at home, for some women, being in hospital might provide more reassurance, particularly if the hospital is not close to home, or an uncomfortable drive away.

The Royal College of Midwives declined to comment, but some hospitals have invested in early labour care. At Chelsea and Westminster hospital, they have a room called the Nest, which opened in 2012 and can be used by women in the early stages of labour, before going on to the hospital’s midwifery-led unit, or the labour ward if they choose to. There is low lighting, comfortable seating, such as beanbags, and relaxing music. It is staffed by doulas, who support women at this stage, rather than (expensively) trained midwives.

“There isn’t a lot of investment in maternity services at the moment,” says Schiller, but a simple, comfortable room might not be unreasonable to expect. “It’s a vulnerable time,” says Hines. “There is so much care taken by the NHS during pregnancy and after the birth, to such a high level of expertise, but for this splice of time in early labour, for maybe two hours or 10 hours, that doesn’t seem to be considered part of the care.”

Have you had a difficult experience going into labour? Please comment below.

Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Women get worse care after a heart attack than men – must they shout louder? | Ann Robinson

Women are getting worse medical care than men after a heart attack, resulting in unnecessary deaths, according to a new analysis of 180,368 Swedish patients, followed up for 10 years after a heart attack. When women were given optimal treatment (surgery or stents, aspirin and statins), they did as well as men. And the situation is likely to be even more obvious in the UK, says the British Heart Foundation, which part-funded the study.

And is this glaring gender divide because women ignore their symptoms? Get different symptoms – more easily confused with indigestion? Are taken less seriously by GPs? Are less likely to have heart disease when investigated for chest pain? Are less likely to have tests such as an ECG? Receive different treatment in hospital? And are less likely to be offered implantable devices that prevent later deaths?


This study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment

The likely answer to all these questions is yes. There’s a subconscious bias at work that means if I see an overweight, middle-aged male smoker with a bit of breathlessness or chest discomfort in my GP surgery, I’m more likely to think “heart disease” and if she’s female to think “acid reflux”. Historically, that may have been statistically understandable, but it’s now an unjustified bias that GPs need to recognise and counter by following proper referral pathways.

Even the most objective of GPs will respond to what a patient says. So women and men alike do themselves no favours by underplaying symptoms or suggesting that they’re sure it’s indigestion or muscle pain. In my experience, women are more likely to self-blame than men: “I let myself go over Christmas and have put on weight so probably I need to just cut down and this pressure in my chest will go.” This is exactly what a woman said to me recently but an ECG showed signs of strain on the heart and triggered an urgent assessment at a rapid access chest pain clinic for specialist care to prevent a heart attack.

I’ve always assumed that although a woman is less likely to present their symptoms and be referred appropriately by the GP, once she gets to hospital, she’ll be treated the same as a man. But this study suggests that even once a heart attack is confirmed, that woman is less likely than a man to get recommended treatment. This doesn’t chime with my clinical impression; our female patients discharged from hospital after a heart attack are on the same drugs and have undergone the same procedures (stents or surgery) if needed as our male patients.

Clinical guidelines are based on objective criteria and gender is not one of them. It requires further interrogation of UK databases to verify whether this same apparent damaging discrimination is happening elsewhere. It would also be useful to hear comment from Swedish cardiologists and their department of health to understand what lies behind this scary story.

On the plus side, we continue to live longer than ever and the rates of circulatory disease (heart disease and stroke) continue to fall. In the UK, most of us will die of cancer, circulatory disease or dementia. Falls in smoking rates, changes in lifestyle and medical advances have all made the chances of having a heart attack and surviving one better than we could have imagined in the 1970s, when my dad died aged 48 after his third heart attack.

But the tragedy is that there are still 42,000 premature deaths a year from heart disease in the UK that are now potentially avoidable. Men and women alike need to recognise the signs, seek medical help and demand prompt and optimal care. And it seems that, as in so many areas, women may need to shout louder to be heard.

Ann Robinson is a GP

Young women most likely to be physically restrained in mental health units

Patients in mental health units were physically restrained by staff more than 80,000 times last year, including 10,000 who were held face down or injected to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years. Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used more often on women than men.

■ Face-down restraint is used on fewer women than men, but more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards that had low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems. A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6m patients ended up in hospital receiving treatment.

Young women most likely to be physically restrained in mental health units

Patients in mental health units were physically restrained by staff more than 80,000 times last year, including 10,000 who were held face down or injected to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years. Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used more often on women than men.

■ Face-down restraint is used on fewer women than men, but more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards that had low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems. A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6m patients ended up in hospital receiving treatment.

Young women most likely to be physically restrained in mental health units

Patients in mental health units were physically restrained by staff more than 80,000 times last year, including 10,000 who were held face down or injected to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years. Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used more often on women than men.

■ Face-down restraint is used on fewer women than men, but more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards that had low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems. A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6m patients ended up in hospital receiving treatment.