Or we could teach them to fly

I am in the middle of a five and a half hour layover in an airport that is 2 hours from my house.  If I weren’t so tired I would rent a car but as it is I’m just going to hang out.  I was planning to catch up on e-mail and the first e-mail that I had was from a blog fan who was writing me because she is fat dancer who is conflicted about her day job.   Before I get into this I want to say to the person who wrote me that I’m going to very honest about this situation but I’m not angry with you – you have every right to do whatever you want for a job and I sincerely hope that you don’t feel that this is an attack on you, what you describe happens constantly and so made a perfect example, but for me this is about the situation and not you personally.  Cool?

Okay, she writes:

On the other hand, I am highly conflicted. For my day job, I work as a communications professional for a public health campaign. We focus on Preconception Health (getting women healthy before pregnancy, even if they are not planning) and for many years we focused on folic acid alone. Last year, we expanded our campaign to include other health messages that includes “Healthy Weight.” Our leadership decided that there are so many obesity programs out there, but they don’t do enough to to target women who may become pregnant. We had an MPH student research the relationship between weight and adverse outcomes for both mom and baby. When we started this whole “healthy weight” thing we looked for evidence-based programs that are effective in reducing weight. Guess what? There are none! However, we decided to plug away anyway.

The first problem with this is that there is a correlation vs. causation error.  Even if it’s true that fat women have worse pregnancy outcomes (and I’m not sure that it is, because often these studies are done by people coming from a place of confirmation bias – already sure that fat causes problems and just looking for proof), still even if it’s true that fat women have worse pregnancy outcomes, that doesn’t prove that making them thin will solve the problems.  It’s possible that the fat and the pregnancy problems are both caused by a third factor (for example, the stress of being constantly stigmatized).  It’s possible that the fat and the pregnancy problems are unrelated.

But the biggest problem with this situation is that it doesn’t matter if being thin would be better for women who want to become pregnant because there is not a single proven method to make them thin. If women with narrow hips have worse pregnancy outcomes the solution isn’t to try to make them have wider hips.  If short women have more negative outcomes the solution is not to try to make them tall.  It might also be better for pregnant women to be able to fly but nobody is running a “Flying Preggos Initiatives”.  Because there is absolutely no evidence that we can get any of those things done.  Just like there is no evidence that we can make fat people thin.

A tremendous amount of time, money (and confirmation bias) goes into researching why people would be better off thin.  What if we spent all this time and money trying to research how to make people’s (including fat people’s) lives better. It’s bad enough that programs like this waste time and money suggesting that people do something that isn’t possible.  What’s worse is that by far the most frequent outcome of weight loss attempts is weight gain.  So if it’s true that being fat is an issue for women who want to become pregnant, then suggesting that they lose weight means that the intervention will actually make the situation worse for 95% of clients.  Clients, by the way, who are under the impression that these programs are run by professionals who know what they are doing and wouldn’t set them up for failure.  How is that responsible? How does it meet the requirements for evidence-based medicine?

Absent any evidence that we can make people thin, it’s time to stop researching if fat people’s lives/health/whatever would be better if they were thin.  Let’s just figure out how fat people can make their lives better and healthier if they choose.  If you are interested in information about fat pregnancy, check out The Well Rounded Mama, her work is awesome!

This blog is supported by its readers rather than corporate ads.  If you feel that you get value out of the blog, can afford it, and want to support my work and activism, please consider a paid subscription or a one-time contribution.  The regular e-mail subscription (available at the top right hand side of this page) is still completely free.   Thanks for reading! ~Ragen

Published in: on February 18, 2012 at 8:42 am  Comments (59)  

59 CommentsLeave a comment

  1. My doctor suggested bariatric surgery, said it had really good outcomes. Said I should do it for my joints. How would you rebut that? I’d like to, but I’m scratching my head…

    • First I would point out that the doctor wants to amputate a perfectly healthy organ that has many functions (the stomach is not just a passive sack that holds food) on the hope that it will improve joint pain. I would say that people die from bariatric surgery complications, there are lifelong consequences of removing the part of your body that chemically digests food and many bariatric surgery patients regain their weight leaving them morbidly obese but without the ability to properly digest vitamins (and all bariatric patients are sure that they won’t regain their weight when they get the surgery). Some bariatric surgery patients live with near constant nausea, some get severe health problems, some can’t stop vomiting, develop bile reflux disease, some experience dumping syndrome and more. Are you actually having joint problems? If so, what have you tried to solve them? There are a number of interventions for joint pain that don’t have anything to do with weight loss (strengthening muscles around the joint, fixing movement patterns, increase core strength, making sure that joints aren’t pulled out of alignment by too tight muscles, it bands etc. There is also no guarantee that the surgery will solve joint issues – some people who lose weight do not experience decreased joint pain so the risk could be for nothing, but you would have to decide if the risks are worth the possible positive outcome, whatever that is. Here is a list of side effects: adhesions and polyps, massive scar tissue, advanced aging, anemia, arthritis, blackouts/fainting, bloating, body secretions (odor like rotten meat), bowel/fecal impaction, cancer (of the stomach, esophagus, pancreas, and bowel), chest pain from vomiting, circulation impairment, cold intolerance, constipation, depression, diarrhea, digestive impairment due to heavy mucus, digestive irregularities, diverticulitis, drainage problems at incision, early onset of diabetes, early onset of hypertension, electrolyte imbalance, erosion of tooth enamel, excessive dry skin, excessive stomach acid, esophageal contractions, esophageal erosion and scarring, feeling ill, gallbladder distress, gynecological complications, hair loss, hemorrhoids, hernia, hormone imbalances, impaired mobility, infection from leakage into body cavities (peritonitis), infertility, intestinal atrophy, intestinal gas, involuntary anorexia, irregular body fat distribution (lumpy body), iron deficiency, kidney impairment and failure, liver impairment and failure, loss of energy, loss of muscle control, loss of skin integrity, low hemoglobin, lowered immunity and increased susceptibility to illnesses, malfunction of the pituitary gland, muscle cramps, nausea, neural tube defects in your children, neurological impairment (nerve and brain damage), osteoporosis, pancreas impairment, pain along the left side, pain on digestion, pain on evacuation, peeling of fingernails, potassium loss, pulmonary embolus, putrid breath and stomach odor, rectal bleeding, shrinking of intestines, stomach pain, sleep irregularities, suicidal thoughts, thyroid malfunction, urinary tract infection, vitamin and mineral deficiency, vitamin and mineral malabsorption, violent hiccups that persist daily, vomiting from blockage, vomiting from drinking too fast, vomiting from eating too fast, vomiting from eating too much (more than 2 ounces), weight regain. Hope that helps! ~Ragen

      • it shocks me that doctors could recommend possibly going through all that ^^ instead of being fat.

      • Two more for your list: alcoholism and medical surprises.

        I’ve know a couple of people who became alcoholics after the surgery. “Substituting one addiction for another” is the usual explanation, but it’s at least as true that alcohol hits the bloodstream much faster after WLS, and that makes it a more interesting drug. I’ve wondered whether alcohol being a very compact source of calories might also make it more attractive.

        The medical surprise was a friend who was having trouble with treatment for pneumonia until someone figured out that she had much less ability to absorb oral antibiotics than most people. I don’t know whether they increased the dose or went to intravenous.

      • Betcha they’d blame a lot of those side effects (like high blood pressure and diabetes, for example) on the fact that the patient was obese before the surgery!

      • Added to what Nancy said, apparently it’s not uncommon for post-WLS patients to develop non-substance-related addictions – most often, gambling and shopping. I’ve read numerous accounts of this. They usually cite ‘addiction substitution’ for this too, but since many of the people it happens to don’t (to go by my, non-medically-qualified reading of the situation) appear to have been binge eaters in any meaningful sense prior to surgery, I’m not so sure.

      • Actually, I have read at least one article or more of patients who end up with substance issues as well, especially alcohol since WLS affects how you are affected by alcohol.

        There’s a blog I used to follow that sort of showed me that WLS was not the way to go. She got the surgery, lost a bunch of weight but STILL struggled with her weight and I think she did eventually put a fair amount of it back on. I know she feels she did what was necessary for her health but it bothers me that doctors sell this as not just a way to lose weight but even the best/only way to lose it.

      • Just FYI- I have no joint pain whatsoever. The doctor based his decision on looking at me. He’s a cardiologist, I went there for a suspected arrhythmia, which turned out to be a normal beat variation.

    • I saw a doctor a couple of years ago and I told him about these horrible headaches I’d been having and he said “Have you ever thought about gastric bypass” I just looked at him and said “Have I thought about being butchered to get rid of headaches? no why would I do that to myself?”
      We sat an stared at each other a little bit. I never went back to him. What a dumb ass. Do not assume that doctors have your best interest at heart or even give a crap about you. I have finally found a good doctor it’s taken years.

    • I *do* have joint issues. It runs in my family, partly congenital, partly genetic response to environment. My dad is “normal” weight according to BMI, yet has had to have five hip operations and two knee operations. The doctors I see are all given this information, yet still all they can come up with is that I should lose weight. I have taken a different tact: I do lots of yoga-like stretching and strength-building exercises, and have adjusted my diet (how I eat, not how I starve) to address inflammation. Guess what? It works. No starving necessary.

      • I wear a size 1-2, and I have bursitis in my left hip. Go figure! (Well, the Cerebral Palsy might have something to do with it…)

        But it’s lovely to know that if I were “overweight”, I’d get a prescription for weight loss instead of Percocet! :p And I certainly wouldn’t have been taken seriously or even taken down to x-ray, probably.

        And that really sucks, doesn’t it? Imagine how many people out there aren’t getting the meds they need because they’re being told that they need to fix their weight first. It makes me really angry when I think about it.

      • You’re supposed to get an x-ray and Percocet?
        I was diagnosed with hip bursitis based only on stated symptoms, and got a steroid shot and some sort of NSAID type pills. It keeps flaring up periodically since the shot wore off over a year ago, but I don’t want to get more steroid shots due to side effects…

      • 32 years ago when I went to the gynecologist for a tubal ligation he said I was too fat (215 Lbs. @ 5.10″) and would have to drop 30 to 40 pounds before he would agree to operate. Having excellent health insurance at the time, I went to a different doctor and had the operation done right away. This is the sort of prejudice that makes overweight people avoid doctors at all costs!

  2. Excellent post! This really is the crux of the matter. It just doesn’t matter how unhealthy fat is, if it’s near impossible to get thin and more dangerous to try and fail than to stay fat. So the whole conversation needs to move on, and focus on health, not weight. Thank you. That really helps me — I keep struggling with the “giving up is bad” feeling. I’m not giving up, though, I’m just focusing on something possible and realistic (increasing healthy behaviors) instead of an impossible fantasy (changing my body size, shape, and chemistry.)

  3. Well Rounded Mama definitely goes in depth in a lot of her posts about the potential HARM that may be done to a baby when the mom loses weight (especially the traditional, food restriction way of losing weight that is so popular) before becoming pregnant. She also goes into depth in as far as some of the other risk factors that may come into play during pregnancy including social-economical, ethnicity, etc. What’s concerning about programs that look into losing weight before pregnancy is that well, pregnancy happens and the way some women who are fat are treated by their OBs and midwives is truly atrocious. But anyway, LOVE Well Rounded Mama, she got me through my last pregnancy when I just felt SO down about myself and my weight because the pregnancy was unexpected. There was SO much more crap out there about how being fat and pregnant was SO BAD compared to when I had my older daughter and it was really hard on me especially since I was in South Korea which has an obesity population MUCH smaller than what we have here (which I’m sure has a lot to do with the fact that they were literally a 3rd world country until just 50 years ago and it just hasn’t caught up yet). When the articles and comments on Facebook really started to get to me, I would go and read her blog and her website and it helped. I went on to have a healthy baby and have my VBAC despite some very difficult odds (returning to the US at 30 weeks to find a VBAC AND fat friend provider was NOT at all easy, let me tell you!) and I have to say her website did help me keep some of my sanity during what was a very difficult time.

  4. “Our leadership decided that there are so many obesity programs out there, but they don’t do enough to to target women who may become pregnant.”

    Seriously??? Is there seriously a woman out there (who may become pregnant or not) who has never been made to feel bad about her weight (too fat, too thin)?? Is there seriously a woman out there who hasn’t yet gotten the message that ‘fat is BAD and you WILL DIE ALONE AND UNLOVED!!!”?

    Because if there is, I want to meet her.

    • Fraid not, at least, it isn’t me. I’m thin, always been thin, never counted calories, never dieted, and once when I told someone my weight they discussed my “anorexia” with the other kids. Then there was the friend who called me chicken bones, who later decided he had a crush on me and eventually sexually harassed me, forced me to hold hands with him, kissed my shoulder, told me to oil his male parts, and at one time slipped a hand under my leg despite my repeated protests, and after the dean punished him refused to restrict contact to text messages only. So I just cut off contact completely.

      Oh yeah, when I threatened to call him rooster bones if he didn’t stop he got mad at me for supposedly calling him fat. Go figure.

  5. Yeah, I’m pregnant right now and at my first appointment my doc earlier this week made a very big point of drilling it into my head that I should not gain as much weight as somebody who is smaller.

    He also told me that I shouldn’t go crazy with food, because despite what we stupid womenz-typez think, he (a big smart man) knows how harmful weight gain during pregnancy can be.

    I’m finding a new doctor. :)

    • GOOD! If you’re able to, try to find a midwife. I was even able to coming in at 30 weeks. Granted, money was a factor but I was able to at least hire her on as a monatrice which to me was the best of both worlds. I didn’t have to go to the hospital early, I had WONDERFUL labor support at home (and personally feel men should be BANNED from labor and delivery altogether like they used to be but that’s another story) from my doula who was also a good friend I was staying with and the midwife. I went to the hospital when I was well past the sticking point with my older daughter (the point where I ended up having the cesarean with her). This meant I was only at the hospital for two and a half hours before my little one was born. It may not be easy, it may seem like it’s one heck of a fight (because it can be) but you definitely deserve a provider who believes in you, believes in your ability to give birth, and believes in your ability to provide what your baby needs while inside and a fat phobic jerk of a doctor is NOT what you need. (((HUGS))) and good luck!

      • I have the feeling that a lot of us fat moms go outside the conventional maternity care system for exactly these reasons. (I’m speaking of the U.S. – of course, in most other countries, the conventional maternity care system includes midwives.) In my opinion, it wasn’t only that midwives – in my experience – were able to focus on health behaviors like nutrition and exercise rather than weight, but also that in our own homes, with a small midwife practice attending us, we’re able to exert more control over who is directing our care. It’s might be possible to find the most fat-friendly, HAES-friendly OB imaginable, yet still be at the mercy of his/her practice partners, whatever L&D nurse is on shift, and other hospital staff – and who knows what their views might be. When I interviewed midwives, I asked them, “Have you taken care of women my size before? What advice do you give them?” Way before my births came around, I was rock-solid confident in the support of my midwives. You can get this result with hospital care, but I think it’s harder to get to that satisfactory end point. As always, YMMV, and no one suggests that one model of birth is right for all women.

        FWIW, being pregnant and giving birth was for me, I think, a little like dancing is for Regan: it really gave me a sense of the soundness and power of my body. I wish this for every mother, fat and thin.

      • Thank you both for good opinions! I am actually looking into a midwife. Nothing against men of course, but I guess I would feel more comfortable with someone who has gone through it/ or has the right biological parts anyway. Haha.

      • Not to mention, OBs really are not there during the labor. They show up for the delivery and the stitching (when needed) and that’s it. I ended up having a guy on call and I saw him briefly when he came in to remind me just how risky what I was doing was (having a VBAC instead of going for the repeat scheduled cesarean) and then again when he came in to “catch” the baby and wouldn’t let me deliver in any position but the one HE wanted me in and made me spend all this time getting into the “correct position” before he would allow me to push. My doula kind of gave him a hard time about that one (he he he). I could not tell you his name if my life depended on it (though kind of think he slightly resembled that captain in the new Star Trek movie, the one who got killed off making Kirk’s father captain before he got killed). Yeah, kind of sad considering all the time he spent staring at and stitching my lady parts, you’d think I would have at least gotten a name. LOL

  6. When I was pregnant with my first child, I took a birthing class. There was one fat pregant woman in this group. Our leader informed her that if she ate healthy she would actually loose weight. Is this correct?

    • No, not necessarily – it also seems to assume that she’s not eating healthy already…

      ~Ragen

  7. I am so glad to see The Well Rounded Mama at the end of your post! When I was in the early paragraphs, I was thinking your reader’s boss needs to read her!

  8. Agree with you Ragen on all counts…except that I have read study after study that shows heavier women have more trouble getting pregnant than lighter women. But from what I’ve read, even if a woman loses just 10 or 15 lbs, her chances of getting pregnant increases. Of course there could be so many reasons as to why that is. Many predict hormonal factors attribute and such, but to me it seems it would make sense if you just thought about the physics involved. Sperm has to swim further on a larger woman. There is just more in the way (certainly myself included). When I am at different weights, certain sexual positions feel better than others. I am not saying losing weight will improve their health. It will probably have the adverse effect given the diet industry. But if a large woman is having trouble getting pregnant, I don’t see the harm in a physician showing them that data, and then together they can come up with a healthy strategy. There are some great progressive doctors out there, even ones that support this community, and they might present that data. I just don’t see the harm in that. It is my greatest hope, that your work will reach more physicians and the health community at large. And that one day, we’ll get to play something other than defense.

    • I have to wonder if this is yet another correlation vs causation thing. It could easily be that the very things that are causing weight gain are also hampering fertility.

      If you read some of the stories on The Plus Sized Pregnancy website, you’ll see that women of weights that would be considered impossible to conceive at not only conceiving but carrying and delivering babies with few, if any, complications. The HARM with a physician addressing this issue is HOW he/she addresses it. Some doctors will refuse to help a patient out over a certain weight (in fact, there are articles that talk about how some OBs will not AT ALL take ANY patients–pregnant or not–over a certain BMI in this country!). Or, that physician will push weight loss surgery or extreme diets which can actually cause issues for the fetus down the line if/when pregnancy does occur.

      It goes back to the same issues, fat people are treated differently all too often so YES, there is a MASSIVE potential for harm.

    • Where did you find these studies? I’d like to see links please. How was the information collected and who collected it?

      I am a fat woman. I get pregnant just thinking about sex. I have four happy and healthy children. I would have to disagree that fat has anything to do with fertility.

      Also, my first child was breach and c-section when I was at the lowest weight of all 4 pregnancies. My other 3 were all natural childbirths and my labor lasted only 4 hours. So anyone who says that being fat has anything to do with your ability to have a child can go take a flying leap as far as I’m concerned.

      I have to wonder, have they done studies trying to find out if a certain hair color makes you more fertile than others? Maybe people with brown eyes have an easier time conceiving? Please note the heavy tone of sarcasm and anger. I find your comment about sperm having a more difficult time traveling through my body HIGHLY offensive AND scientifically inaccurate. I really don’t see how the fat on my body influences my vagina or uterus or makes them any different than those of a thin woman.

      • Haha @Mari! You and me both. I quite literally got pregnant the first time my hubby and I tried. I mean, it might not be true for everyone but for me being a fatty did not make it hard to get pregnant. And I don’t think sperm has to swim farther in a fat woman…

    • Hi Lauren,

      I would also like to see some citing of the studies to which you are referring. The sperm thing sounds utterly ridiculous to me, it does not jive with my understanding of basic anatomy and I couldn’t find even a single reference supporting it through my google search – where did you get that information? The problem with recommending weight loss is that we don’t know of a single method that doesn’t have a 95% chance of ending up with people weighing more than they did when they started and being less healthy and, unless you can present some evidence I’ve never seen, weight and fertility is a correlational issue and therefore the problems could result from the stress of constant stigma, which will not be helped by failing at weight loss. Again I refer people with questions to The Well Rounded Mama who has excellent and well-researched information.

      ~Ragen

    • Didn’t think of this when I wrote my earlier reply but on the basis of that would that mean that taller women would also have more difficulty getting pregnant? And what about the guy, would his size have any effect on the woman’s ability to get pregnant? Would love to see the studies on that one! And I wasn’t talking about size of equipment when I wrote that sentence but I suppose that could be something to think about too! Though goodness forbid a study EVER be done about that!

      I have to wonder too if Lauren is referring to what some call “the fat vagina” theory which is just that, a theory, largely bogus but one that doctors do try to use on women especially when the concern comes up about large babies and their ability to be delivered by a fat woman without any problems. The Well Rounded Mama definitely talks a bit about this theory though some other midwives believe in it sadly.

    • I highly doubt that sperm has to travel farther in fat women, given that my doctor thought she’d have trouble fitting my birth control as I am apparently as short down their as I am in height…

      Also you want highly motile sperm to be fertilising the egg as that is generally a sign of good health.

      The losing weight thing might have more to do with relaxing and getting some of the stress lowered than having much to do with the actual weight.

    • The idea that sperm have to swim farther in fat women is just completely nonsensical. Our internal anatomy is exactly the same. My uterus is not bigger nor my fallopian tubes longer because I’m fat. And, in fact, my vaginal canal is rather shallow (I’m short), and my cervix is right the fuck there. You know jack shit about anatomy.

      • Weight MIGHT be an issue if the woman has PCOS or Hypothyroidism simply because those disease can cause problems with fertility AND they can cause obesity.

        However, in terms of the obesity you’re looking at correlation not causation. The obesity is occurring at the same time as the infertility but BOTH are actually caused by the underlying hormonal disorder of PCOS or Hypothyroidism.

        As far as sperm swimming farther. I would like for you to explain to me exactly how excess body fat LENGTHENS the vagina or increases the size of the uterus. That makes absolutely no fucking sense. If these things are a certain size/length before you get fat, that’s the size they are after.

        Pick up a copy of “Our Bodies, Our Selves” and hurry the fuck up and get born. Jeeze!

    • The only reason I could see for this is that PCOS tends to cause weight gain, and PCOS makes it hard to get pregnant. But not all heavy women have PCOS and not all people with PCOS are heavy.

  9. I struggled with infertility for 2 years. the only solution most doctors had was to lose weight. Of course when I found one who listened to me and treated the medical condition causing the infertility it changed things and I am now pregnant-and feeling very bullied. One incompetent specialist told me I was infertile, needed ivf and lapbanding surgery to get pregnant. I don’t know how she could tell that by looking at me, but her diagnosis was based entirely on my visual appearance.
    I’m in Australia and going through our public system instead of private (different setup to the US). I wanted to use midwife care but my options are shrinking and I am being forced into something I don’t want.
    I cannot have my baby at the closest hospital-as my BMI is over their cutoff. It can’t be equipment based as I could go there for any other procedure, but they’ve decided that BMI alone makes one high risk here.
    I have been sent to a high risk hospital, and while I wanted to see the midwives there I’ve been forced into seeing obstetricians instead in their high risk unit. My blood pressure is low/normal, I have no complicating health issues apart from PCOS and insulin resistance which is already managed by my endocrinologist. But I have been deemed high risk, and denied any choices by our medical system which stigmatises fat women.

    • I’m so sorry you went through that. I’m not certain because I haven’t had the courage to find out for sure but I think I’ll have infertility problems too. I have anorexia, and I have pretty much zilch when it comes to the hormones as I found, due to treatment for severe osteoporosis. I haven’t had a period in over a decade and I’m 34.
      I wonder, would these same programs have a cut off that discriminates people who are too thin, the way they do people who are too fat? I think it would be unfair because I can’t imagine them doing that.

  10. I was fairly disgusted with the attitude of my midwife in my last pregnancy and I was glad when I moved to a city where I could have an OB instead. Here I was pregnant with twins and my midwife was telling me that I should put no weight on during the pregnancy! She also told me I *would* have high blood pressure and develop gestational diabetes (none of my test results pointed to that possibility at that stage) and she gave me a drug to take which has a possibly miscariage risk – for a condition I didn’t have. And the kicker? She missed my extremely low levels of iron and B12 blaming my fatigue on my *weight* (when the Doctor’s nurse saw my results she was impressed I was still able to go ab out my day, that’s how low they were). And I’d like to echo that Well Rounded Mama rocks :)

    • Not all midwives are perfect, that I know. I still remember one who responded to my email (never met, just responded to an email I sent where I gave her my weight and BMI asking for help) and said she couldn’t take me because she was afraid that because of my girth (I mentioned she hadn’t met me, right?), it would be hard to tell position of the baby and she was concerned that the baby would be breech and she wouldn’t be able to know. UTTER BS considering the OB himself could tell position by palpating NO problem and the midwife I did see had no issues either. Still, the midwife I was able to see was wonderful and focused on nutrition and the importance of eating well (whole foods, lots of protein, etc) for the BABY’S health and for mother’s too but it was a joint thing, you know? But sadly, there ARE midwives out there who have taken on the mindset of OB’s, especially in heavily regulated areas due to concerns of lawsuits and what not. Sad but you definitely have to be careful who you choose. You don’t want a professional treating you like crap PERIOD, that’s the thing whether that professional is a midwife or an OB.

      • It’s much rarer to find midwives with that kind of attitude where I live (New Zealand) as we cannot sue for medical misadventure/mistakes plus we have a midwife-led maternity system; most women are under a midwife for their pre and post natal care and birth with only the ‘high risk’ cases – or those willing to pay big bucks – seeing OB’s.

        The main issues with our maternity system surround ideology rather than fat panic – usually, anyway.

      • Everyone has the potential to be fat-biased. Having a crunch-granola job* does not exclude them. Hell, some crunch-granola practitioners are just as bad, or even worse, than mainstream medical professionals.

        Go with a medical professional that treats you with respect regardless of the kinds of letters behind their name.

        *I’m a (non-practicing) LMT – pretty crunch-granola.

    • Agreed about crunch granola and fatphobia. It’s amusing (at least to me) to see books about “YOU CAN CONTROL YOUR REALITY BY THINKING THE RIGHT THOUGHTS!” which still assume that there’s no way to have a good life while being fat. Instead, you think the right thoughts to lose weight.

  11. I have zero intention of offending anyone and seriously apologize for any insensitivity. I deeply love this community and am proud to be part of it. I was in clinical research conducting fertility trials for many years and will look back to get some data together. I’m sure any research I could refer to will not prove causation and does not compare phenotypes. I worked with a start up company that would have put people in charge of their own healthcare comparing genotypes and phenotypes (think crowd-sourcing meets Google Health.) However, the physical part I was discussing was just a thought my sister and I discussed as she was having trouble conceiving. And no, I don’t think standing on your head would work (I’m not a complete idiot, it was just a thought.) But I presented that on this blog flippantly, and I can see how that could come across as a fat vagina reference. *Headslap* lesson learned…the one time I comment on this blog.

    I know that plenty of women of all sizes carry healthy babies and have zero problems conceiving. And so many doctors send dangerous messages by telling women to lose weight. I’ve lived it my entire life. I want to help change that too. This is why I’m here. But I think having a spirited discussion about these things is healthy too.

    • I almost brought this up earlier but didn’t because it was personal experiences but since you’ve brought up your sister and her struggles. I have two sisters with kids. Both sisters are 100 lbs or more LESS than I am. Both sisters have struggled with secondary infertility and/or pregnancy losses. Both sisters ended up having to end their ability to conceive permanently through surgical means. Neither were able to have a child past the age of 25. Again, both at least 100 lbs or more less than what I weigh. I have had no pregnancy losses. I have been able to conceive and bear children past the age of 25 (didn’t have my first until after I was 25). Longest it took me to get pregnant was six months after going off of the pill and my second I conceived trying NOT to conceive. I will say that I became pregnant with my second at the same weight I became pregnant with my first so if there’s some magic weight for me to reach to get pregnant, I’m going to try and not get back down to it because I would like to be done. lol My mother was also obese when she had me and my younger sister and had no issues during the pregnancies at all and she was 34 and 39 when she had us. So, I think a lot of factors come into play here not just weight.

      • I completely agree, Janeen. My sister is not overweight. I am, and have no reason to believe I wouldn’t be able to conceive. My mom was very overweight when she conceived my sister and me. I don’t think there is a magic weight for baby makin :) Thanks for sharing your story with me.

  12. I thank everyone for all the luvin’ and linkin’ they’ve been giving to my website and blog!! How lovely to hear the supportive words, and how wonderful to see discussions of these important issues on FA blogs other than mine. Very important!

    As for fatness and fertility, no one has mentioned PolyCystic Ovarian Syndrome (PCOS) yet. This is why fatness and fertility are connected in some fat women. The cause is hormonal imbalances and insulin resistance, which then makes weight gain more likely. [I have several posts already about PCOS in women of size, and will be returning to this topic soon.]

    It is true that some PCOS literature shows that weight loss can spark increased fertility for women with significant PCOS. However, they never differentiate between the effects of exercise and going more low-carb vs. the effects of wt loss itself. Many women anecdotally find improved fertility with more exercise and lower-carb eating, even if they don’t lose weight. But of course to most researchers it’s all about the weight loss ONLY.

    The other problem with these studies is that they don’t do long-term follow-up. Often, a quick weight loss results in a shock to the system and a temporary improvement in fertility, BP, glucose, etc., but those changes don’t last. So it’s a quick fix at best for most. And of course, they are recommending the one thing that is most likely to make those women GAIN weight in the long run.

    As far as the public health campaigns towards encouraging women of childbearing age to attain a “healthy weight” before pregnancy, they are emphasizing the wrong goal. They need to emphasize pre-conception check-ups and the importance of healthy readings before pregnancy (normal blood sugar, blood pressure, thyroid, vitamin levels etc.) and the importance of great habits in pregnancy (especially regular exercise), which is far more realistic and attainable than trying to get everyone to a BMI of 20-25. Changing the focus helps women have a healthier pregnancy without pinning all the hopes for improving outcomes to the unrealistic goal of massive weight loss.

    kmom
    http://www.wellroundedmama.blogspot.com
    http://www.plus-size-pregnancy.org

    • I mentioned PCOS, but after you did. I also mentioned Hypothyroidism, which can ether be exacerbated by PCOS or make PCOS worse (thyroid hormones and sex hormones influence each other) and can also cause problems with fertility and obesity.

  13. I have an additional problem with the program in the OP. I really have a serious issue with the idea that all women capable of conception are “pre-pregnant” and should be treating their bodies as they would if they were trying to conceive (which, btw, leaves out the trans men and genderqueer people who have uteruses). This centers pregnancy as more important than other concerns in a woman’s life, and reduces a woman’s importance to her ability to bear children.

    In order to maintain my health now, I must do a number of things that would be strongly contraindicated if I were trying to get pregnant. Several medications I’m on are necessary for my mental health, and are things I could not take if I were pregnant or trying to become pregnant (including birth control, which I take to even out my hormones rather than to prevent conception; for that, condoms!).

    But yeah, I find the idea that any woman who might possibly become pregnant should be behaving as if she would be at any moment deeply problematic, to say the least. I am not at all surprised that a program with that attitude would pull such a foul trick when it comes to weight, too.

    • This. ALL OF THIS.

      All I could think of while reading this entire post was that I have worth beyond my ability to reproduce and how DARE someone treat me otherwise? HOW FUCKING DARE THEY?

      It’s 9:30AM and I’m outraged. Today is not going to be a good day.

    • MadGastronomer, I think the idea of making sure you’re ‘ready’, health-wise, in case you might possibly conceive – when you’re not actually planning to – is problematic. But it becomes way more so in conjunction with some of the ‘personhood’ initiatives being touted around by pro-life lobbyists. People have already recognized that if such initiatives are passed, a pregnant woman who does anything that may harm the fetus may find herself legally culpable – but that begs the question: how do you know she’s pregnant? Most women don’t know themselves until a few weeks in, some much later. Would potentially harmful substances/activities end up banned for all women between menarche and menopause on the grounds that they might be ‘potentially pregnant’? Sounds a bit Handmaid’s Tale, I know, but it’s the logical conclusion of this view of women.

    • I personally didn’t take it that way. When I see pre-pregnant, I think we’re talking about women who intend to become pregnant one day but haven’t yet. As in, perhaps I am 25 and will consider children after I turn 30, I am not actively in the planning stages of having a child but I am fairly certain it will be something I will pursue in the future.

      As a woman who has no intent of having children in the future, I didn’t feel that the statement applied to me.

      • And yet, a lot of these programs are being suggested for all women of childbearing age, whether they intend to get pregnant or not, whether they intend to have children or not, because they might get pregnant, with the implication that then they’d be happy about it and decide to keep it, because no one really doesn’t want kids.

    • “I have an additional problem with the program in the OP. I really have a serious issue with the idea that all women capable of conception are “pre-pregnant” and should be treating their bodies as they would if they were trying to conceive”

      AMEN!

      “(which, btw, leaves out the trans men and genderqueer people who have uteruses).”

      And those of us who just *don’t want kids*.

      • Oh, no, they want you in those programs, too. Because no one really doesn’t want kids, and you might get pregnant and magically decide to keep it! Anyone with a semi-functional womb is pre-pregnant!

  14. Telling pregnant women to mess with their food and metabolism while they’re GROWING A HUMAN BEING is crazy irresponsible! Scientists have no idea what the effects of dieting are on the child, but there are enough danger signs to not take a chance on experimenting! For instance, children born to women who were pregnant during famines have historically developed schizophrenia at twice the normal rate, a much higher level of developmental disorders, clinical depression, and a high rate of miscarriage. This could be a combination of stress hormones and lack of adequate nutrition affecting the development of the baby’s brain. There are also thought to be epigenetic effects that carry through several generations! It seems horribly dangerous for such a small “advantage” as being slightly thinner after birth.

    • Actually, there was a study of some sort on the affects of famine/calorie restricted diets on pregnant women. I believe it was a study of women in post WWII Europe and/or Great Britain that examined what happened to them during pregnancy (during food shortages) and the affects on the children born to those women.

      Actually, it was a study of the Dutch Famine of 1944 and the affects on the pregnant women and their children.

      http://en.wikipedia.org/wiki/Dutch_famine_of_1944

      • “The Dutch Famine Birth Cohort Study, carried out by the departments of Clinical Epidemiology and Biostatistics, Gynecology and Obstetrics and Internal Medicine of the Academic Medical Centre in Amsterdam, in collaboration with the MRC Environmental Epidemiology Unit of the University of Southampton in Britain, found that the children of pregnant women exposed to famine were more susceptible to diabetes, obesity, cardiovascular disease, microalbuminuria and other health problems.[5]”

        I’m going out on a limb here but I would assume that restricting calories to avoid gaining weight, especially severe calorie restriction, would have similar affects.

      • Also from the Wikipedia Article:

        “Audrey Hepburn spent her childhood in the Netherlands during the famine. She suffered from anemia, respiratory illnesses, and edema as a result. Also, her clinical depression later in life has been attributed to malnutrition.[8]

        Subsequent academic research on the children who were affected in the second trimester of their mother’s pregnancy, found an increased incidence of schizophrenia in these children.[9] Also increased among them were the rates of schizotypal personality and neurological defects.[10]”

        Now, granted, Wikipedia is not always the most reliable resource, but I remember seeing a documentary that said much of the same — except the Audrey Hepburn stuff.

  15. I left a comment on a different post asking about fat pregnancy resources- found it! right on, thank you.


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