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Fatphobia & Fertility Treatment

by Say Yes to Nourish 7 months ago in pregnancy
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It's discriminatory... and deadly.

Fatphobia & Fertility Treatment
Photo by Charles J on Unsplash

TW: Use of words ov*rw*ight and ob*sity in references.

Anti-fat bias is alive and well in the fertility space, and becoming a parent is already a big deal. It can derail birth plans, ruin the pregnancy experience, and for some folks, be deadly.

Let’s chat some scenarios:

Fat folks are routinely recommended or even required to lose weight prior to accessing IVF, despite evidence showing no change in pregnancy success when compared to those who don’t attempt weight loss. Some insurance companies may even “require” an individual to attempt weight loss in order to access coverage for fertility treatments. In fact, a recent study actually showed that, when compared to folks engaging in dietary changes and exercise for the purposes of weight loss, folks who don’t lose weight and live in larger bodies have just as much success in pregnancy outcomes and no significant increase in pregnancy complications (1).

Plan B is less effective for fat folks, yet we don’t have alternatives widely available and providers are not educated in how to recommend modifications for emergency contraception (2). A fat person may require a double or more dose of Plan B in order to prevent unintentional pregnancy, but you probably won’t hear this from a general practitioner. I can only imagine how terrifying it would be to not only have limited access to pregnancy prevention because of fatphobia and also fear the medical system in which fat pregnant bodies are stigmatized. What a way to feel disconnected and distrustful of your body and providers!

Pregnant fat folks are recommended to avoid weight gain or lose weight during pregnancy for the fear of diabetes, which can affect any pregnant body particularly those with a strong genetic history (3). Having gestational diabetes does not mean that you’ve failed as a pregnant person or that you are unable to care for yourself. Health is not a moral obligation, nor is it accessible to everyone. Pregnant fat folks are also more likely to be told they will require a C-section delivery regardless of their birth plan, which can be disheartening and traumatizing when done without informed consent or support (4). Fat bodies are just as capable of delivering vaginally as thin bodies.

Social stigma exists around existing in a fat body as a parent, as if this has any indication about your ability to raise tiny humans (5). Being a parent is like any other job – your body shape and size has no bearing on how well you can do it. And the idea of “bouncing back” to a pre-pregnancy body is rooted in white supremacy and capitalist patriarchy; the urgency to “do something” and promotion of products for the approval of others and social standing are hallmark indicators.

Informed consent is the ONLY way to provide fertility care, and you CAN decline weight loss recommendations. You deserve access to providers who see you as a person and not as a number on a scale or BMI chart. You can even request that your weight not be taking in prenatal care appointments, or request that they be taken without you seeing them (6). There are only a few cases where your weight absolutely is necessary to direct your care, and you can ask a provider for more information about this in appointments.

You also deserve the ability to choose your own adventure when it comes to reproductive health, pregnancy and birth (which, by the way, I’ve officially decided to use as a phrase in practice on the regular now… “choose your own adventure” feels so fitting when I think about the journey to family planning for some clients).

I’m a guest in the fat positivity and activism space – I’m a thin white provider and have no lived experience as a fat person.

It’s CRITICAL to learn from fat folks about navigating the fertility world and overall life – Nicola Salmon (at Fat Positive Fertility) is one of my favourites, with her program Fat Positive Fertility and resources dedicated to helping fat folks get pregnant and empower their deliveries!

References:

1. Legro RS et al. 2022. Effects of preconception lifestyle intervention in women with obesity: The FIT-PLESE randomized control trial. PLOS Medicine; 19(1). DOI: 1003883.

2. Villines Z, 2021. “Is there a Plan B weight limit?”. Medical News Today. Article available at: https://www.medicalnewstoday.com/articles/plan-b-weight-limit. Link accessed April 11 2022.

3. Shah A et al. 2011. The association between Body Mass Index and gestational diabetes mellitus varies by race/ethnicity. Am J Perinatol; 28(7): 515-520. DOI: 10.1055/s-0031-1272968.

4. Lee J. 2020. “‘You will face discrimination’: Fatness, motherhood, and the medical profession. Fat Studies; 9(1): 1-16. DOI: 10.1080/21604851.2019.1595289.

5. Friedman M. 2014. Reproducing fat-phobia: Reproductive technologies and fat women’s right to mother. Journal of the Motherhood Initiative. Article available at: https://jarm.journals.yorku.ca/index.php/jarm/article/download/39755/35989/48832. Link accessed April 11 2022.

6. Stone C, 2022. “‘Don’t Weigh Me’ cards help empower patients at the doctor’s office”. Motherly. Article available at: https://www.mother.ly/news/news-viral-trending/dont-weigh-me-cards/. Link accessed April 11 2022.

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About the author

Say Yes to Nourish

I help people with periods navigate menstrual health education & wellness with a healthy serving of sass (and not an ounce of nutrition pseudoscience).

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