Wwhen Ahlia* was waiting to check in for a routine pregnancy appointment, she says a receptionist walked by calling out directions to gestational diabetes education – then looked at her and waited for Ahlia to follow.
“I’m not here for that,” Ahlia remembers saying in front of the waiting room full of people.
It wasn’t the first time she had made assumptions about her and her baby’s health based on her body size alone.
Ahlia has had three healthy pregnancies with normal blood pressure and glucose levels, no pre-existing conditions and a nutritious diet – yet she has faced weight stigma throughout.
At her GP appointment after becoming pregnant with her second child, she expressed interest in a water birth. “The GP just laughed in my face and told me it would never happen.”
Health guidelines for a water birth cites “excess” weight as a risk only because it is necessary to ensure that a woman in labor can be moved out of the water in an emergency.
Ahlia worked with her midwife on a care plan, including safety planning so her partner could lift her if necessary, which was signed off by the consultant doctor.
But when she arrived at the hospital in labor and asked for the bath to be put on, Ahlia says the midwife on duty looked at her and said they would “just have to look into it”.
This delay in starting Ahlia’s birth plan led to what she describes as “a bit of a traumatic birth”.
The fear for her baby’s safety was “horrifying”, as was her feeling that none of this had to happen the way it did – and that her needs were “ignored” based on judgments about her body size.
Weight stigma already is more generally towards women. Women during preconception, pregnancy and postpartum are particularly vulnerable – and weight stigma has been shown to have negative health outcomes for mother and child.
But a study published in the journal Health Psychology Review proposed a new model earlier this year to reduce weight stigma around pregnancy.
Dr Briony Hill and PhD candidate Haimanot Hailu, from Monash University’s School of Public Health and Preventive Medicine, led the study. Hill says society’s strict beauty and behavior standards for women extend directly to this form of “mom shaming” – “mothers blame their weight and their body size, thinking that it makes them better by shaming them”.
“In reality, we are not 100% individually responsible for our weight, our body size, our body shape, because it is mostly genetically determined,” says Hill. “Eliminating weight stigma is about looking at the person as a whole, rather than just making assumptions about them simply based on their appearance or their body size.”
The authors noted that stigmatization begins with labeling women at higher risk of infertility or pregnancy-related complications because of their body size.
Negative impacts of weight stigma around pregnancy include avoidance of involvement in healthcare, psychological stress, reduced motivation to engage in healthy behaviors and disordered eating habits – which can themselves contribute to maternal obesity.
Other examples discussed in the study were societal expectations around “ideal” pre-pregnancy weight, negative comments about pregnancy weight gain, and pressure to “bounce back” to pre-pregnancy body weight.
Dr Gillian Gibson, the president of the Royal Australian and New Zealand College of Obstetricians and Gynecologists (Ranzcog), says while there is pregnancy risks associated with both a low or high BMI, “Ranzcog recognizes the importance of providing all women with care that is free from stigma and prejudice/discrimination”.
“An assessment of a woman’s overall health and well-being, including factors such as weight, is more complex than assessment by a single indicator such as BMI,” says Gibson.
While health care is one of the biggest areas where weight stigma exists, Hill says clinicians’ behavior stems from societal norms – which is the root cause that needs to be addressed.
In addition to raising public awareness about obesity factors, the study’s model suggests several interventions. This includes tackling the normalization of weight stigma such as “overmedicalization of obesity”, as well as equipping professionals to improve communication skills around the issue, and finally targeting structural stigma through strategies such as inclusive health care policies.
Dr Fiona Willer, the vice-president of Dieticians Australia and lecturer at the Queensland University of Technology, praises the Monash researchers’ model for addressing the broad range of precursors to weight stigma for this demographic in particular. She says the study addressed the prejudice and stereotypical ideas that health professionals have: “That’s how they end up delivering the care they deliver, which is substandard for large-bodied women.”
“I agree with [the study’s] point of view that when we try to ‘help’, there are all these unintended consequences, and these are actually those consequences that we need to pay close attention to if we want to take better care,” says Willer.
Willer says campaigns that simply say “stigma is bad” can have the opposite effect, opening the door for further stigmatizing attitudes and beliefs.
“The kind of intervention that is effective in reducing stigma is to make the people who have these stigmatized characteristics visible, to make those people much more visible in positions of power, to make decisions, fully integrated into the system.”
*First name is used for privacy reasons only.
