Obesity and Pregnancy: Time to change the Conversation

On Sunday, the New York Times published Claire Putnam’s article Pregnant, Obese … and in Danger. Like most articles about obesity and pregnancy, it focuses on the increased risks and calls for care providers to have frank conversations with their patients about their weight. The reality of “health” and how plus size women are best supported, however, is much more nuanced. These conversations may very well have the opposite of the intended effect.

The framework of such conversations must be one of compassion and support, rather than fear and shame. Studies have proven that when people of size are shamed by their care provider, they are less likely to receive routine medical care and more likely to gain weight. I hear from plus size women nearly every day who have been told by care providers that their “vagina is too fat” to birth their baby or they need to have a c-section based only upon their BMI. Obese women do face increased risks in pregnancy and birth. They need to be informed of those risks in a straightforward manner, rather than being scared by exaggerated possibilities or subjected to additional risky medical interventions only because of their weight.

Articles like Putnam’s tend to be fear based and don’t share uplifting stories or positive research. For example, there was a study by Oxford University that found otherwise healthy women, did not have as increased risks associated with obesity as have been previously reported. “The chances of first-time mums of normal weight having medical interventions or complications during childbirth are greater than for ‘very obese’ but otherwise healthy women having a second or subsequent child.”

All pregnant women, regardless of size, can reduce their risks by being proactive with their nutrition, remaining physically active, managing stress and by paying attention to weight. “Health” cannot be reduced down to a BMI. Many plus size women are perfectly capable of healthy pregnancies, but you wouldn’t know that from what you see in the media or often hear in a typical prenatal consult. Focusing narrowly on a number on the scale misses the bigger picture of “health” and can sabotage the efforts of women at a time in their lives when they are more motivated than ever to make positive lifestyle changes to benefit their precious babies.

It’s time to change the conversation about obesity and pregnancy. Rather than only focusing on the risks and making people feel ashamed about their bodies, it’s time to start promoting positive information and resources to empower women to make healthy decisions. This includes not classifying women as high risk based only upon their BMI and thus limiting their options during childbirth.

We need to stop placing the blame for poor outcomes solely on obese women and start looking at the entire maternity care system. When healthcare providers are size friendly and practice evidence-based, compassionate care, patients are more likely to follow their advice. That can make all the difference.

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