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Response to Attack on Fat Mothers

Thanks to Carla for writing this incredible Op-Ed, which unfortunately NYT chose not to publish.




On June 06, 2010, The New York Times published Anemona Hartocollis’ article, “Growing Obesity Increases Perils of Childbearing.” The article received Sunday, front-page coverage in the continuing trend toward anti-fat panic and “obesity epidemic” hysteria in our country. In the typical tradition of this genre, the article featured sensationalistic, pitying, and shaming portrayals to supposedly illustrate the personal, social, and material high “costs” of fatness. Indeed, a byline proclaims: “Obese Mothers a Burden on Hospital Resources.” In what has become the most predictable and problematic aspect of this oeuvre, at least from a scientific perspective, the article also uncritically uses fatness as a proxy for illness and draws clear causal arrows pointing directly from fatness (always transformed into the supposed medical crisis of “obesity”) to a “constellation” of illness and disease, medical complications and accommodations, effects on society and others, and death.



It is never considered that, perhaps, some of the “burden”some accommodations being made for fat people in medical settings (such as sturdier examination tables, development of alternate examination methods, procurement of sophisticated medical technologies, and enhanced sensitivity training for medical professionals) might not only be a matter of social justice in medical care for fat people, but shifts that might ultimately benefit all patients. Instead, Hartocollis’ article centers on the vignette of “Ms. Garcia,” an “obese,” diabetic woman who gave birth, via Caesarean section, to an underweight and premature baby. It does not go unremarked that this was a costly delivery--more than fifteen times the cost of a “normal” delivery. From this vignette, we might come to believe that fat women and their glut of underweight, prematurely-delivered babies are jeopardizing the entire healthcare system. Are we to believe that Garcia’s situation is emblematic, even typical, of most fat women having children today?



Oddly, Hartocollis makes no mention of Ms. Garcia’s relatively advanced maternal age (38 years), her socioeconomic status (whether or not she had access to adequate prenatal care), or the fact that she is “Ms. Garcia” rather than “Ms. Smith.” Apparently, none of that might matter. This rabid focus on fatness obscures complicated intersections between many risk factors associated with health and illness--age, race and ethnicity, socioeconomic status, and access to non-stigmatizing and comprehensive medical care, to name but a few. Further, it never seems to warrant mention that the Garcia case study actually presents a scenario that is statistically less likely among fat mothers than thinner mothers-delivery of an underweight, premature fetus. Indeed, most articles seeking to link fatness with poor fetal outcomes warn about the tendency for fatter mothers to deliver fatter babies.



Some of the medical professionals contributing their perspectives on the issue of fat mothers describe being “anatomically… turned off” by them. They recount instances of becoming “angry” with them, “complain[ing]” about them, being “worried” that tables will collapse under their weight, counseling them to have medically-risky bariatric surgeries before becoming pregnant, and intoning “demand[s] and siren song[s]” that BMI be calculated for all patients since “eyeballing” them is insufficient surveillance for fatness, pitying and feeling “sympathetic” toward them, and being “stuck between Scylla and Charybdis” when it comes to their presumably-annoying and personally-inconveniencing
medical care. None of this is scrutinized as ethically problematic, insensitive, unprofessional, misinformed, or even plainly cruel.



Indeed, it does seem that we are met with a Scylla and Charybdis situation when it comes to fatness at this point in our own cultural mythos; but it is fat people who are truly “stuck” in this dilemma. No matter what the outcome, it seems that fatness, per se, will be resolutely assigned as the independent source of each and every social and medical problem. And our society’s (and medical professionals’) problematic, over-simplistic, and stigmatizing portrayal of fatness as the greatest public health plague of our time is subjected to little reasoned public critique. In this social context, it is actual fat people, like Ms. Garcia, who will continue to personally bear the blame and shame imposed upon their socially-unruly bodies, “promising” to go on “a strict, strict, strict diet” to placate the resounding, authoritative, and punitive clucks of social disapproval and disgust. I would suggest that it may not be only "water retention" that leaves fat people, like Ms. Garcia, “too numb… to feel anything.”



--Carla A. Pfeffer, Ph.D.

Assistant Professor of Sociology

Department of Social Sciences

Purdue University (North Central campus)


Damned if you do... | Help wanted

Notblue June 17th, 2010 | Link | Thank you for this...

When I see or read these articles and I lose all sense and turn into a swearing lunatic I can never really make the words fall into place to express how I feel. Case in point: http://www.notblueatall.com/archives/this-aricle-has-me-so-angry-right-now/
Rereading it now after reading this and other blogs on similarly awful articles I am so grateful to have FA in my life!

"Kind words are short and easy to speak but their echoes are truly endless." Mother Theresa

kmom June 18th, 2010 | Link | Fat Mothers Response

I have also written a response to this NYT article on my blog:

http://wellroundedmama.blogspot.com/2010/06/exaggerating-risks-again.html

The kind of distorted and one-sided reporting in the NYT article is not helpful. It should be seen for what it is, a shill for doctors who want to ghettoize fat women into highly profitable "bariatrics obstetrics" centers that will take fat women's birthing choices away from them.

Viola's picture
Viola
June 19th, 2010 | Link | Thanks, Kmom, that is a

Thanks, Kmom, that is a great response!

Viola's picture
Viola
June 19th, 2010 | Link | I didn't realize, until I

I didn't realize, until I read the comments on your blog, that MeMe Roth had a response to this article. All it basically said was HAES was dead, obesity is torturing our precious babies, and a normal pregnancy costs $13,000 while an obese one costs $200,000. She truly doesn't have the reasoning and critical thinking skills, I don't think I realized she was actually stupid.

vesta44's picture
vesta44
June 19th, 2010 | Link | MeMe Roth is all for eating

MeMe Roth is all for eating well and exercising at any size, but she refuses to call that HAES. And I have news for her, I was obese when both of my kids were born, and both of my pregnancies were normal, as were my deliveries. My daughter was born on her due date (8 lbs, 21"), my son was about 3 weeks past his due date (9 lbs 7 oz, 21"), so no premies or underweight babies there (I weighed 236 when my daughter was born, and 325 when my son was born). Of course, this was back in 1972 and 1975, before all the OMGOBEEEESITYEPIPANIC BS got started, so while the doctor was a little concerned with my weight the second time, I didn't get any lectures about it, and the only extra testing that was done was a glucose tolerance test (gave me heartburn and they wouldn't let me take anything for it) to see if I had gestational diabetes (nope). So I really doubt that my obese pregnancies cost 15 times as much as a "normal" pregnancy. MeMe should watch out for those generalities - they can come back to bite her in the ass (and I would pay to see that).

WLS - Sorry, not my preferred way of dying. *glares at doctor recommending it*

DeeLeigh's picture
DeeLeigh
June 29th, 2010 | Link | That's funny. Have you

That's funny. Have you already gone through menopause at 45? If not, then I don't think doctors can predict whether or not you're able to have children. I was in a terrible car accident when I was 19, and every time I've asked a doctor if there was any way to know if I can have children or not, they've said "There's no way to know until you stop using birth control. If you have regularly periods, then you can probably have children."

I've been in long term relationships almost continuously since I was in my early twenties, though. They can set whatever rules they want to for artificial insemination, I guess.

Sorry to hear about your mom, BTW.

DeeLeigh's picture
DeeLeigh
June 29th, 2010 | Link | "their control group showed

"their control group showed fat women to be more likely to lose children than not."
-Indiefilmchick

Indiefilmchick - thanks for linking to that, but I think you missed a few things.

I haven't seen the Star article, but that's not what the article you linked to (which is an associated Press release) says at all. It's about in-vitro fertilization. It doesn't give any statistics on natural conception. It states that normal weight women (defined as BMI 18-24) have miscarriages 22% of the time when they use in vitro fertilization, while overweight and obese women (BMI 25+) women have miscarriages 33% of the time.

33% is significantly less than half, so no. The article does NOT say that fat women are more likely to lose children than not. It says that roughly 1/4 of thin women and 1/3 of fat women miscarry after in-vitro. That's not a huge difference. I'd have to look at the original research in order to critique their methodology, but this study isn't as negative as you're making it out to be. Also, you talk about a control group, but no control group was mentioned.

Additionally, the article states that the study controlled for age, smoking, and medical history and implies that it controlled for other factors as well (drug use, for example?). So I don't think you can say that it didn't account for other factors. The thing is, the sample size was only 318 women, and once they started controlling for other factors, the sample size may have ended up pretty small. That makes the data less convincing. Again, I'd have to see the actual study to critique it.

DeeLeigh's picture
DeeLeigh
June 29th, 2010 | Link | Actually, sorry. I guess I

Actually, sorry. I guess I didn't read it as closely as I should have, either. It does mention some numbers for miscarriages after regular conception, but it's not possible to tell exactly what the statistics are for fat women; they're pretty vague: "can be three to four times higher." Under what circumstances? Maybe I'll do some research.

wriggle99 June 30th, 2010 | Link | Make a wish, you never know

Make a wish, you never know who's listening!

Yeah, the nouveau voodoo, nocebo element of all this is creepy.

kmom June 29th, 2010 | Link | Actually, there is a fair

Actually, there is a fair amount of research to back up the idea that women of size have higher rates of miscarriage, whether conceived naturally or by IVF.

Likely it has to do with PCOS, which researchers rarely control for. In PCOS, the balance of hormones in the woman is off and often does not support keeping a pregnancy once one happens. One theory is that they may not produce enough progesterone to sustain a pregnancy until the placenta can take over that function. This is true of skinny women with PCOS as well as fat women with PCOS....it's a function of the PCOS itself more than fatness. But since the majority of women with PCOS are fat, it gets correlated with fatness in these studies.

However, rest assured that many women of size DO carry pregnancies to term as well. Just go read the birth stories of many many women of size on my website, www.plus-size-pregnancy.org, to see that. Despite having PCOS and a higher rate of miscarriages, many women with PCOS do carry to term; I have a special section on PCOS birth stories on my site.

But basically, yes, there is a higher rate of miscarriage among women of size. More research needs to be done to figure out WHY that is and what can be done to prevent it, not just studies that publicize the higher rate and assume that losing weight will fix the problem. Specifically I'd love to see more research study fat women who have miscarriages vs. those who do not and see what differences there are. THAT might yield useful information than just beating the same old drum about the risk of miscarriage etc.

Beware the studies that just publicize a higher rate of a problem without ever actually trying to do any meaningful investigation as to why that higher rate happens. The former are just looking for press and hyping anti-obesity hysteria, the latter are actually trying to find meaningful answers.

DeeLeigh's picture
DeeLeigh
June 29th, 2010 | Link | They don't mention PCOS as a

They don't mention PCOS as a risk for miscarriages, but they do mention gestational diabetes. Do you know if there are any studies that support the assertion they keep making that fat women who lose weight are more likely to have successful pregnancies? Is that based on any evidence?

kmom July 1st, 2010 | Link | Miscarriage is not one of my

Miscarriage is not one of my areas of significant research so I'm not super-familiar with the range of research available on it, but I have seen at least one study abstract (Clark 1998, www.pubmed.gov/9688382) that losing some weight can decrease the rate of miscarriage in women of size undergoing fertility treatment.

Of course, they don't distinguish wt loss from improvements in exercise and nutrition (how typical) and so the question is whether the improvement was due to the actual wt loss or whether increasing exercise etc. resulted in lower insulin levels and THAT decreased the rate of miscarriage, esp for women with PCOS where high insulin levels are the probable source of the hormone imbalances.

Do you see what I mean? It's kind of a chicken and egg thing. Simply increasing exercise and decreasing high glycemic index foods may decrease insulin levels and thus improve hormonal factors......but we don't really know at this point whether THAT is the real source of improved outcome or whether weight loss is, or whether the two are synergistic.

For example, Huber-Buchholz 1999, www.pubmed.gov/10199797, found that improving lifestyle factors alone improved ovulation in anovulatory fat women, even though it didn't lead to "rapid weight loss." The study was small and limited in scope, and only looked at ovulation and not miscarriage rates, but even so, you see that lifestyle improvements can affect outcome regardless of actual significant weight loss. Might they also do so for miscarriage? Good question.

IMO, they are far too willing to blame fatness when they actually may be looking at hormonal disturbances due to PCOS, and as is so common, they nearly always fail to separate actual weight loss from increased exercise/better nutrition. Therefore, definite conclusions are difficult to draw.

I was also disturbed by their speculation in the press release that fat may interfere with uterine lining and that might be the source of miscarriage issues. If so, then why do many OTHER fat women carry to term with no problems? To me, it's obviously not that simple. Many fat women get pregnant easily and carry to term with no problems; if it was only a matter of fatness, that would not be likely.

They need to be comparing the groups of fat women that do have miscarriage problems with those who do not and see if they can further elucidate the exact cause of the problems, rather than just blame fatness.

I HATE simplistic research that doesn't look below the surface for more meaningful answers.

kmom July 1st, 2010 | Link | I should probably also

I should probably also mention that while I was looking for the Pubmed ID numbers of the studies I mentioned above, I came across a number of OTHER studies on obesity and IVF and other fertility assistance methods and the outcomes vary from study to study.

Some studies definitely found lower success rates and/or higher miscarriage rates (www.pubmed.gov/18707913, www.pubmed.gov/19171335 and www.pubmed.gov/11499322) in "obese" women, but some did not (www.pubmed.gov/18425574, www.pubmed.gov/16417960, and www.pubmed.gov/18549686).

Some studies were in the middle (www.pubmed.gov/16816057 and www.pubmed.gov/19490792) and found some effects but not as severe as those reported in other studies. One recent 2008 study (www.pubmed.gov/18503054) found that BMI negatively affected fertility treatments more in younger women than in older women.

So yes, some research suggests that IVF rates and subsequent miscarriage rates are higher in women of size, but some do not, and some studies found effects in between these two extremes. The research picture is a little more complex than the press release of this most recent study shares.

DeeLeigh's picture
DeeLeigh
July 1st, 2010 | Link | Thanks so much for all of

Thanks so much for all of that information, kmom! I love your blog, BTW.

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