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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.

Jen McLellan, CBE
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Friday 30th of April 2021

I am very happy for anyone who has had a healthy pregnancy without complications, despite their pre-pregnancy BMI, and I do find it disturbing that some people tend to communicate scientific information in degrading and shameful ways! But, as a scientist who works on the effects of maternal obesity, I think it is important for women to understand the effects their body can have on their child's development. It's great if you managed to avoid the immediate pregnancy complications for you and your child, but a lot of new research is finding there are likely effects on the child's cognitive and behavioural development as well. There is fairly strong evidence that maternal obesity is linked to cognitive deficits, reduced academic performance and behavioural problems. This is besides the increased risk for the child to become obese in their lifetime, have hypertension and increased inflammatory markers. We need to work on communicating scientific information in a factual way, without shame, because this information is very important to disseminate. We should love our bodies, but we also need to stress the importance of a healthy living, for us and our future generations.


Friday 30th of April 2021

I'm interested in learning more, as from what I've read, the increased risks are present but small when we look at the actual risk and not the relative risk. Talking about increased risks is important because it empowers people to be proactive with their health throughout preconception, pregnancy, and postpartum. With that said, so often, the information is presented misleadingly. Thanks!


Wednesday 3rd of March 2021

I am considered obese. I'm 5'7 and was just over 200 when I got pregnant. I have had regular mensural cycles and it took my husband and I only 3 months of trying to get pregnant after his vasectomy reversal. I'm currently very early (9 weeks) but my ultrasound turned up a healthy heartbeat of 167 bpm. "Everything looks terrific!" and "I would have to get a doctor if there was something wrong." my radiographer said to us. I have always been an athlete and I am very strong (stronger than my husband :-D). So I do not feel that a BMI chart defines me, but it also doesn't represent those of us that are more muscular than our thinner counterparts. I don't have high blood pressure and I eat relatively well most of the time (darn those cravings!). Articles like that, really anger me. They don't know me, my story, or my background. Shame on them!


Wednesday 9th of August 2017

Thank you for this article , I am really glad I found it through Pinterest . I am 7 weeks pregnant currently and I was really scared what will happen , will my doctors treat me correctly , will I be able to give normal delivery coz I weigh 220lbs on my conception , I feel really motivated by hearing so many success stories. I am less scared now Thanks


Thursday 29th of June 2017

I am 5 months pregnant and was 275 when we conceived. We weren't really trying to concieve but we weren't really trying not to either. I don't have any health issues or conditions other than obesity. So far, no weight gain. All tests given have produced normal levels... I received a bill in the mail from the doctor's office and thought it to be in error. When I called, I was told that I had been designated as high risk from my doctor which then meant that my appointments were "specialty" with an added cost. I emailed my doctor asking if there was a reason other than my weight as the cause for her designating me as high risk. Her response was no and that she had gone over the elevated risk of gestational diabetes and preeclampsia with me due to my weight. I was taken aback and in shock that although the tests all came back as normal, she still had me as high risk because of my BMI.... and didn't tell me. I think that if she had taken the time to speak to me as an educated, aware person I may have understood her reasoning a bit better. Although my blood pressure has been normal, I recently received an email from her suggesting that I take low dose/baby aspirin daily as it has been linked to lowering rates of preeclampsia. I don't know if in her experience all overweight women that she has treated have developed preeclampsia but it bothers me... after discussing with my husband, we decided to not challenge her reasoning further because if it means I get more treatment then we are fine with that! We've also discussed with her our goal of a vaginal birth and she seemed on-board. I'm not sure what to think as I haven't felt shamed exactly but more or less questioned on whether or not I am able to have a healthy pregnancy. And it seems to boil down to my weight.


Wednesday 6th of May 2015

I was 250 pounds when I became pregnant with my now 5 year old. My doctor said he would not treat my pregnancy as high risk just on my weight alone unless I developed complications. He was honest about the possibility of complications but did not automatically treat me as high risk just due to my weight. I only gained 15 pounds during my pregnancy. I did develop preeclampsia at 34 weeks and was induced at 36 weeks. My doctor had the goal of it being a vaginal birth but after 24 hours with no progression it was an emergency c-section. My son was 5 lbs 2 oz. I did deal with secondary infertility as I suffer with depression and PCOS and gained up to 300 pounds after his birth. Thanks to PCOS I do not ovulate at that weight. I have lost back down to 250 and am now ovulating and having fairly normal cycles again. We are trying for number 2 now. I am still trying to lose weight but have been stalled for a long time. I am worried about preeclampsia again as I do know it is a risk but I'll be 35 this year and can't wait forever. I am a lot healthier and happier at this weight than at my heaviest. It is not perfect but I am healthy other than my BMI and PCOS but then I had PCOS as a teenager at 160 pounds so it's not going away any time soon. I don't have diabetes or high blood pressure. All my blood work was normal. I lost weight to help my menstrual cycles regulate which they did but don't feel I need to be thin to have that second baby.


Tuesday 16th of June 2015

Thanks for sharing your journey with us and I'm sending ***baby dust*** your way!