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Weight Bias in Pregnancy

I remember clearly the first time I walked into my local midwives’ office for my first pregnancy. There were smiles and earthy paintings of birthing mothers on the walls and I felt at ease. The feeling of peace would grow as I was trusted with taking my own weight and urine test strips in a private washroom. “I don’t find weight to be a good indicator of how a pregnancy is going, feel free to not weigh yourself”, I was told by my midwife who would look after me and my baby’s health for the next several months. What I didn’t realize, is that this ideal bubble of time was an isolated incident. My two subsequent pregnancies, and my health care thereafter, would be highlighted by weight stigma and fear.

What is weight stigma? Weight stigma, or weight bias, is discrimination or stereotyping based on a person’s weight.[1] You likely know many of these stereotypes and have possibly (likely) perpetuated them yourself: fat people are lazy, don’t care about themselves, aren’t intelligent or driven. These are stereotypes and do not reflect the reality of existing in a fat body. Danger creeps in when this is perpetuated by the health care community, especially related to pregnancy.

A new study was published in Health Psychology revealed that everyday weight bias in pregnancy leads to increased weight gain, weight retention, and depression.[2] This is concerning, especially considering the real known risks of postpartum depression on parents and infants.

Weight bias exists because in our culture diet culture reigns. It is easy to see the blur of scientific evidence and diet culture. Diet culture equates thinness with health, worth, and beauty. We are often bombarded with the media blaring the evils and dangers of obesity, but the other side of the coin is not represented. The other side is that you can not tell a person’s health by their weight. Your worth is not reliant on health. And that includes pregnant people. Pregnant people who are overweight or obese deserve to be treated and listened to by their provider. Another study showed that maternal healthcare providers were less likely to listen to, and have a generally negative view about their patients if they are overweight or obese.[3]

But, what about health? Asks every person ever. Especially someone who enjoys thin privilege.

Number one, you can’t tell someone’s health by their weight. You really can’t. Weight is determined by genetics, hormones, past traumas, socio-economic status, etc. Number two; health behaviours, such as movement and eating more plant-based foods, not size, are what lead to long term health. The science shows that BMI is nonsense.[4] Also, weight loss efforts and diets fail 95% of the time.[5]

Even if there is causation, as there may be, it is still the responsibility of the care provider to treat the person in front of them. And to show them dignity and respect.

So, I would argue that pleading with pregnant women to lose weight is not only mean, but unethical, uneducated and dangerous.

If you’re a pregnant person who has been bombarded with weight stigma, I feel you. I would ask that you do some of your own research; Health at Every Size, Intuitive Eating and Food Freedom/Body Love by Dr. Jillian Murphy, ND are all great places to start. Working on your health doesn’t mean count, restrict, omit food groups or engage in punishing exercise, it can be allowing yourself full permission to eat. It can mean trying to get quiet time, go for walks, drink more water and eat more veggies without any guilt or shame attached.

Pregnant people and new parents are at such a fragile time, they need support and understanding, not stigma.

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