The cake smash: a messy, raucous wedding trend that suggests trouble ahead

July 26, 2023

Among the Tujia people of Zhangjiajie, China, brides traditionally cry for an hour a day the month before their wedding, according to Zhangjiajie Tour Club. What’s more, the Insider reports, in the final days leading up to the wedding, a bride’s mother, grandmother, and sisters join in the crying too.

But that’s nothing compared to a Western tradition that continues to be a “smash hit” at many ceremonies, notes The Guardian.

Name: The Cake Smash.

Age: Ancient, allegedly.

Appearance: A messy, affectionate harbinger of doom.

What is a cake smash? It’s the act of smashing cake into someone’s face.

When would such a thing happen? At a wedding. The bride and groom smash cake into each other’s faces.

How awful. And I thought my wedding was a car crash because my uncle punched a waiter. The cake smash is meant to be a lovely, playful tradition. It’s getting pretty popular too, especially on TikTok: the #cakesmash hashtag has had more than 449 million views.

So how did it start? Hard to say. At ancient Roman weddings, barley cakes were crumbled over the bride’s head for good luck. This evolved into the throwing of crumbs; and then later still, rice.

I don’t see the connection. There probably isn’t one. It is more likely the modern cake smash is just a prankish offshoot of the tradition of the bride and groom feeding each other cake as a symbol of trust.

So, a symbol of mistrust, in other words. You’re not wrong. According to UK-based TV psychologist Dr Becky Spelman, a nonconsensual wedding cake smash could spell trouble for the couple’s future. “The act could potentially highlight issues related to control, disrespect, or disregard for boundaries,” she told metro.co.uk.

It is also a complete waste of cake. Not to mention the ruined clothes, hair, and makeup, along with the prospect of being sticky for the whole night.

It must be a health and safety nightmare, too. It can be. One bride gave her husband a bloody nose, although it is generally the groom going overboard.

Does anyone have a good word to say about cake smashing? Not really. Wedding planners frown on it, etiquette experts disapprove, and there are loads of cautionary cake-smash-gone-wrong videos on TikTok.

Those I will watch. Some end up involving the whole cake. Honestly, it is amazing that these people stay married for the rest of the reception.

Any other time-honored wedding traditions worth dumping? The bouquet being tossed to the single women in attendance is thankfully on its way out.

I didn’t know anyone still did that. Likewise, modern wedding trends are moving away from garter tossing, long speeches, balloon arches, registries filled with domestic appliances, and fireworks.

Are any of those an accurate predictor of future problems? Not as accurate as a big fat cake in the face, no.

Do say: “Instead of the traditional cake smash, my husband and I will be recreating the climactic routine from Dirty Dancing.”

Don’t say: “And then we’re going to re-enact a fight scene from Kill Bill.”

Research contact: @guardian

Sepember 12, 2024

The Centers for Disease Control and Prevention (CDC) reported in back in September 2016 that one in four Medicare participants age 65 or older—that’s 5 million people—do not take their blood pressure medicine as directed. In fact, 20% to 30% of prescriptions for chronic health conditions are never filled, and about half are not taken as prescribed, reports the Association of American Medical Colleges (AAMC).

Patients’ failure to follow their medical treatment regimens is a common and costly problem with potentially dire consequences. A 2012 study by the American College of Preventive Medicine found that nonadherence accounted for an estimated 125,000 deaths annually and at least 10% of hospitalizations. The repercussions also cost the U.S. health system as much as $300 billion a year, according to a 2014 study by Johns Hopkins University researchers.

Depending on the patient, provider, and situation, contributing factors may include the patient’s social and economic status or education level, the complexity of the treatment and instructions, health system variables, poor provider communication, patient depression or stress, or physical or financial obstacles to drug access.

Patients may also stop taking a medication if they experience unpleasant side effects, are not seeing any immediate benefit from the therapy, or if they simply grow tired of taking pills.

medicine we have a blind spot,” said Victor Montori, M.D., an endocrinologist and professor of medicine at the Mayo Clinic. “Being a patient—especially being a patient with a chronic condition—is a lot of work.” And there’s no curriculum about the work of being a patient, he noted.

Adherence rates haven’t changed significantly in the past three decades, despite efforts by the World Health Organization and the Institute of Medicine to address the problem, according to the American College of Preventive Medicine.

In addition to poorer patient outcomes, hospitals now also suffer the costs of readmission penalties for Medicare patients who return to the hospital because they haven’t followed a doctor’s instructions.

There’s no one-size-fits-all remedy for this problem: physicians and health systems can support adherence in a combination of ways.

At Mayo’s Knowledge and Evaluation Research Unit, Montori focuses on “minimally disruptive medicine” that is designed not to overburden patients. He said clinicians often are unaware of the cumulative effects of what they ask patients to do. Montori noted, for example, that patients may have to go through several bureaucratic steps and pharmacy trips to refill each maintenance prescription.

Montori suggests that healthcare systems focus treatment on the goals patients and clinicians agree to achieve, “and then make sure in the process that we don’t overwhelm [the patients].” In some cases, it’s virtually impossible for patients to do all that their providers ask, Montori says. “Are the treatments, tests, appointments, that we’re asking people to go through, are they really necessary?” he asked. “If we medicalize every moment of their lives, patients will struggle.”

In addition to being more judicious about how many appointments are necessary, the healthcare team can make it easier for patients by trying to bundle appointments or procedures on the same day, he suggests. Or clinicians can help mobilize social resources for patients who need help with housing, food, or addictions—factors that can affect their ability to maintain a treatment regimen, Montori said.

Prescribing more affordable generic drugs, simplifying dosages, synchronizing refills, and finding ways to reduce pharmacy trips may reduce the burden on patients as well, Montori adds. Or, if the patient has stopped taking a medication because of unpleasant side effects, the physician can work with the pharmacist to find an alternative.

At NYU School of Medicine, Adina Kalet, MD, MPH, professor of medicine and surgery and codirector of the Program on Medical Education Innovation and Research, is exploring the use of a Patient Empowerment Program to help patients become more active partners in their care. In a current study, she and colleagues are training patients with diabetes to better communicate with physicians during two two-hour sessions.

So far, said Kalet, “it does what we are hoping it [would do]…. It changes the dynamic in the doctor’s office. We’ve had nothing but positive responses from physicians about how much more satisfying it is to be able to engage as partners with patients.”

For Steven Feldman, MD, PhD, professor of Dermatology, Pathology, and Public Health Sciences at Wake Forest Baptist Medical Center, close follow-up and establishing trust with patients are the keys to patient adherence. Prescribing a drug and then following up in 8 weeks to 12 weeks is not enough to ensure compliance, he says.

“Doctors are the only people on the planet who have the idea that you can tell people, ‘Here, work on this every day and I’ll see you in two or three months.’”

Feldman has found that being a caring provider leads to better patient accountability. When prescribing a new treatment, for example, he writes his mobile phone number on a business card and tells his patient to call in three days to report on progress. “That adds to their trust in me, which adds to their trust in the medicine,” Feldman says.

Wake Forest has spun off a company based on Feldman’s adherence-improvement methods, asking patients to report their treatment status through online surveys. Using that approach, acne patients doubled their adherence to treatments.

Providers may do well to remember that the intangible can be invaluable. “It is the relationship between the doctor and patient that drives the compliance,” says Helen Shields, MD, associate chief of Brigham and Women’s Hospital, Division of Medical Communications.

“I believe strongly that patients are more compliant if they trust you, believe you, and if they can understand what you’re saying.”

Research contact: @AAMCtoday