More weighty responsibilities for women: pre-pregnancy BMI and medical shaming

There’s a new study out this week with results on links between pre-pregnancy BMI and infant mortality.  Researchers examined 6.4 million singleton (as opposed to twin or multiple) births and more than 36,000 infant deaths in 38 US states.  What they were looking for was the relationships among pre-pregnancy weight of women, weight gain during pregnancy, and infant mortality (up to the first year of life).  So what did they find?

It depends on who you ask.

If you ask me (a person who waded through the article, which is chock-full of loads of pretty complex data), it paints a complex picture of the state of womens’ health in the US.  In terms of pre-pregnancy weights, low BMIs (<18.5) confer increased risk of some types of infant deaths and higher BMIs(>40) confer increased risk for other types of infant deaths (the researchers distinguished between infant deaths in the first month and in the subsequent eleven months).  Also, infant mortality rates are MUCH higher for non-white women giving birth according to this study.  Everyone in public health knows this, but it bears repeating, as it’s a horrific reminder of the state of racially-based health inequality.  For my money, THAT should be the headline in the press coverage.  But it’s not.

Another result of the study concerns weight gain during pregnancy.  According to the tables, gaining less weight than recommended confers increased risk of infant mortality in almost all BMI categories.  And, gaining more weight than recommended confers increased risk in only the lowest and highest BMI categories.  So the picture is complex, because biology is complicated.

If you look at the press coverage, though, you get a different story.  In this news story you get the following headline:

Even before pregnancy, your health matters:  Mom’s obesity linked to higher risk of baby’s death

The stories in the news are doing four things that I object to:

1.They are (as usual) distorting the scientific results for the purposes of sensational headlines.

2.  They are using inflammatory language– talking about “Mom’s obesity”, referring to women who are in fact not even pregnant.

3. They are sending a message that women who are NOT pregnant, but of child-bearing age, have the responsibility for potential risks to future children and obligation to lose weight (which, as we all know, is nigh unto impossible) to mitigate those potential risks.

4. The researchers, in their discussion, write that their results should encourage more public health campaigns to promote pre-pregnancy weight loss, as if public health weight loss campaigns have ever had any effectiveness at all.  This kind of tone deafness to the intractability of body weight management by medical means doesn’t surprise me, but it is tiresome and once again weight stigmatizing, targeting women.

We’ve heard this type of story recently, in the Centers for Disease Control report released last month stating flatly that women of childbearing age who consume alcohol and don’t use birth control are risking their future babies’ health.  This report provoked articulate responses like this one (by Fit is a Feminist issue guest blogger Rebecca; really worth a read).

As I said above, science is complicated.  This study suggests complicated relationships between pre-pregnancy body weights and infant mortality.  But distortion and fat shaming and freighting women with unbearable burdens should play no role in the dissemination and response to complicated science.

Sigh.  Have a nice day…

 

 

 

About catherine w

I'm an analytic philosopher, retooled as a public health ethicist. I'm interested in heath behavior change, particularly around eating and activity, and how things other than knowledge affect our health decisions.I'm also a cyclist (road, off-road, commuter), squash player, x skier, occasional yoga-doer, hiker, swimmer and leisurely walker.

12 thoughts on “More weighty responsibilities for women: pre-pregnancy BMI and medical shaming

  1. Sam B says:

    Thanks for this Catherine. It sounds very complicated. Like you I hate how the messaging ignores how hard it is to do much of anything about weight. Mostly I’m able to weigh myself and be pretty neutral about it even in medical settings. (It helps that I’m super healthy.) But pregnancy was the one time–well, three times–I really hated getting weighed. Fear of gaining too much and being judged made me dread doctors’ appointments. And I loved being pregnant was very healthy and happy. But the scolding and the praise was just weird.

    Liked by 2 people

  2. Emily says:

    I lost 2 stone (28lb?) 8 years ago and have kept it off. “Nigh unto impossible” is simply wrong.

    Liked by 1 person

    • marilyndunk says:

      This gets repeated by some blog posters completely unchallenged, far too often. The rest of the blog’s great though!

      Like

    • catherine womack says:

      Hi Emily and Marilyndunk- it’s true that individuals do report losing weight, and some of them do manage to maintain weight loss long-term. The National Weight Control Registry in the US uses data from a 10,000+ person database of such folks. But all the medical studies of every weight-loss program show very low rates of long-term maintenance of weight loss even after one year (rates vary from 5–20%). Even bariatric surgery doesn’t result in as substantial weight loss maintenance in the long term as one might hope, and it’s expensive and has substantial side effects.

      Even in very comprehensive weight loss studies, like the one I cite below in which voluntary and motivated participants with type 2 diabetes are given intensive lifestyle support and counseling, the long-term success rates aren’t great: as one blogger put it, nearly 25% of all participants maintained a 4 year loss greater than 10% of their initial weight.

      http://www.ncbi.nlm.nih.gov/pubmed/21779086?dopt=Abstract

      I repeat, that’s in a study that offers intensive intervention and follows participants regularly for 4 years. In the world, we don’t have access to that kind of support (which many studies report increases long-term weight maintenance) and insurance doesn’t pay for it. So is long-term maintenance of substantial weight loss possible? Yes, it does happen in some isolated cases and under some special laboratory-induced circumstances. Is it maintainable for the population at large outside the lab or hospital? All the results point to no. But this doesn’t mean we can’t be fit or healthy. BMI is not a primary clinical indicator of health; it’s a population-level indicator for various trends. See here:

      http://www.sciencedirect.com/science/article/pii/S0277953613001627

      What’s a better predictor of health? Physical activity:

      http://cpr.sagepub.com/content/15/3/239.abstract

      I hope you find some of these sources useful or interesting. And I’m glad we’re all involved in this conversation. Thanks for your comments.

      -catherine

      Like

  3. rebeccakukla says:

    Great post, Catherine. Totally predictable how science got translated into media here. Sigh.

    Liked by 1 person

  4. DaisyWillows says:

    On a lighter note It’s a good job us ladies are tough cookies to take all this blame . 😀

    Liked by 1 person

  5. Kay Mathiesen says:

    Hey Catherine. Are you going to talk about this in our panel “Weight Speech, Hate Speech” for the Information Ethics Roundtable? It sounds perfect.

    Liked by 1 person

  6. Lyn Brakeman says:

    Thank you Catherine! Amazing how both science and religion get distorted and used in abusive ways—often against women.

    Liked by 1 person

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