Weighty Matters

Obese Women Gain Too Much Weight During Pregnancy, Study Says

Oh, Lord. Keeping up with the ACOG theme of women being too old and fat to deliver normally, this headline really chapped my hide. Yes, obesity has health risks, and ideally we'd all begin pregnancy in perfect physical form, but really, Dr. Artal, is pregnancy really one of the leading contributors to the obesity epidemic? Women should try to limit their weight gain during pregnancy because they're too lazy to lose it postpartum?

The article harps on the fact that the current guidelines for weight gain in pregnancy state that overweight women ought to gain at least 15 pounds. Considering that that would barely cover baby, amniotic fluid, and breast growth, that hardly seems excessive. I find this especially ironic considering that the obstetrical community, with few exceptions, rarely offers anything in the way of substantive nutritional guidelines to women in its care. Those that do often offer such gems as, "Eat lots of peanut butter!" (Actual quote.) I do have a client whose OB employs a dietician on his staff, and I give major props to him.

In the words of Anne Frye, "Our culture has a tremendous loathing of large, especially fat, women." Her sensible advice is that women of size should cut out junk foods and refined carbohydrates, consume plenty of high-quality protein, vegetables, and whole grains, and walk or swim daily. Doesn't that seem more reasonable?

This attention to the weight gained by obese mothers seems, to me, to be yet another example of a reductive approach to maternity care by the medical community. Instead of "how can we help this person have the healthiest pregnancy and birth possible, given factors X, Y, and Z?" we see more of a "shame the patient who dared conceive outside our guidelines!" If nothing else, it's not an attitude that is likely to win a woman (who likely already agrees that she ought to lose weight) over to the idea of weight loss goals in the postpartum period. I'm not even going to delve into the fact that a high BMI does NOT equal an unhealthy or uneducated patient -- and neither is a low BMI evidence of a healthy, active person!

The sad thing, to me, is that focusing on one part of a woman's health and taking such an alarmist attitude towards it squanders, in my opinion, an opportunity to begin a lifelong dialogue about taking steps to improve one's health, make better choices, and embrace pregnancy as a time to implement positive, permanent health improvements. Remember, folks, this is the same community that used to advise women to smoke during pregnancy to ensure a small baby...