"I would not go so far as to say that we understand why maternal weight is associated with negative outcomes," says Dr. Chloe Zera, a specialist in maternal fetal medicine, who takes care of patients during pregnancies. at high risk at the Beth Israel Deaconess Medical Center in Boston. "Obesity may require special care, but a majority of women with B.M.I. over 30 years old have no complicated pregnancy or healthy babies. Even when the risk of complications increases, the frequency of such events remains low. When researchers from Stanford University analyzed more than 1.1 million birth records in California, they found that the overall prevalence of stillbirths was five per 1,000 deliveries. Among women with a B.M.I. above 30, the rate varied from 7 to 10 stillbirths per 1,000 births, a doubling, but remains a rare event. In comparison, in 2008, a review of data relating to the link between the age of the mother and the risk of stillbirth revealed that slimmer women over the age of 35 were also twice as likely stillbirth than their younger counterparts. And Stanford's study could not establish a cause-and-effect relationship. Stillbirths may be correlated with B.M.I. Due to technological limitations, it may be more difficult for physicians to detect fetal complications in large organisms. Larger women may also receive less prenatal care. When the researchers analyzed audio recordings of prenatal appointments between 22 providers and 117 pregnant women, they found that providers of treatment for patients with a high BMI asked them less questions about their lifestyle habits and shared fewer information. 39, information, according to data published in 2017 in the journal Patient Education and Councils.
All that can be said with certainty, according to Legro, at Penn State, is that there is no B.M.I. threshold above which it is absolutely dangerous to get pregnant. And weight loss does not guarantee a safer pregnancy. When Scandinavian researchers combined data on patients undergoing bariatric surgery with adverse effects on their child's health, they found that women who had undergone such procedures were more likely to give birth prematurely. babies who were small for their gestational age than mothers of weights having not undergone surgery. . "Patients are told to lose weight to have a healthy baby," says Legro. "But it is possible that in doing so, you run a higher risk of complications than before."
A day where Balzano was 19, she came out of a gas station and a man in a passing car shouted, "Big bastard!" "It's the moment I realized that my body was this problem for the whole world, "she recalls. Studies from the 1960s have shown that when children are presented with pictures of other children of different body types, they consider the fat body as the one they like the least. In 2013, researchers at Yale University asked 74 study participants to read a newspaper article published about Canadian physicians who wanted to deny fertility treatments to obese women B.M.I.s. One-third of the study subjects read the article next to the picture of an important couple eating junk food; the rest saw the same couple sitting on a bench holding hands or no accompanying picture. When researchers interviewed readers, those who saw junk food were more likely than others to support physicians' decision to deny fertility treatment to such patients.
Good health is often equated with a disciplined person, a responsible citizen, a more dignified mother. And stereotypes, such as the assumption that all fat people are greedy and voluminously bulky, can influence our understanding of a person's health and morals. "We all have cultural biases and health care providers are also people," says DeJoy. Studies have shown that doctors of all specialties are more likely to consider an overweight patient uncooperative, less obedient and even less intelligent than a thinner counterpart. An Australian study of prenatal health care found that doctors expressed less sympathy and approval for their larger pregnant patients. "Until I found my doula and midwife, no health care professional touched my body with compassion," says McLellan, who defines herself as a fat woman and has had a healthy pregnancy. "It seems normal for a tall person."
Weight scientists know that this lack of compassion can have health consequences. The kind of stigma that women like McLellan and Balzano face throughout their lives exposes fat people to a higher risk of depression, anxiety, and suicidal thoughts. They also have higher blood pressure and higher levels of stress hormones. And many researchers documenting these risks of control for B.M.I. when they collect their data. "It tells us that stigma, not weight itself, contributes to these adverse health effects," says Rebecca Puhl, author of the 2013 Yale study and deputy director of the Rudd Center for Food Policy and Obesity at University of Connecticut. "This evidence also challenges the idea that stigma will cause people to lose weight."
Balzano's husband, Nick, wanted a second opinion immediately, but it was not until two years before she could see another doctor. "I could not take another conversation like this," she says. "I felt like this mess." In private, she sobbed whenever friends announced a pregnancy. Then a friend, also heavy, told Balzano that she had a good experience in Boston I.V.F. So they made an appointment. When they arrived, a concierge greeted the couple as soon as they entered. Balzano responded by starting to cry. The place was too smooth and classy. She was sure that she would be judged unfit again.
The doctor listened to the story of Balzano and said that she understood how moving the situation was. But she wanted Balzano to lose weight. In the meantime, she was willing to prescribe letrozole, a drug used to promote ovulation or, in case of failure, intrauterine insemination. I.U.I. is a low-risk procedure practiced without sedation by the physician; the sperm is placed in the patient's uterus during ovulation to facilitate fertilization. "But that did not seem to be so interested in that," Nick said. "The impression I have is that no one thinks anything but I.V.F. The doctor told me that she remembered that she was "certainly willing to take medication and insemination", but she advised Balzano to consult a maternal fetal medicine specialist to discuss its potential impact. of his weight on a pregnancy. Balzano refused letrozole: "Essentially, she said the same thing as the first doctor: nothing would change until I fixed my weight."