The problem is as repeated over and over again in the article that there is no absolute data that obesity at any level is bad for getting pregnant and carrying a pregnancy to term. We do know (at least this week but data may change tomorrow) that obesity during pregnancy is associated with an increased risk of problems for the mother (premature birth, spontaneous abortions, abnormal sugars, etc.) AND the developing fetus (higher risk of obesity, type 2 diabetes, increased cardiovascular events, shorter life span, etc.). As long as the potential mother (and father) understand that there are risks and accept them, then there is no reason that IVF, IUI, etc., shouldn't be attempted, and certainly sooner is better than later since there is a higher risk of poor outcomes as the patient ages (Down syndrome, autism, etc.)
There is also good data that the occurrence of pregnancy with weight loss certainly in PCOS increases the likelihood of conception; there are also simple, safe and effective medications short of invasive procedures that can increase the likelihood of pregnancy.
I also note that all Endocrinologists (like me) are NOT evil, uncompassionate people.
11
I’m glad that this article shed light on this topic. I was also told I needed to be a certain BMI before I would even be considered for fertility treatment. This advice was given by Dr. Rachel Ashby who is quoted in this article. She is stating that she would treat a woman with a high BMI, but I was under the “cutoff” and she still refused to treat me and my PCOS. I was able to have a healthy baby boy after seeing a different reproductive endocrinologist. I’m so thankful for my new doctor when Dr.Ashby wouldn’t even give me a chance. To who ever is going through this have faith and know you’re not alone.
7
I think you may be overlooking a physician's concern for women who are pregnant, and over a certain weight. Granted, some docs are jerks, and treat patients unkindly. I'm retired now and have not followed the literature, but I worked with OB-GYNs for two decades. A doctor told me long ago, that he was deeply worried about a co-worker who was pregnant and obese. He wasn't judgemental, he was worried that mom and baby would be healthy. (We all worked together, he was fond of her, and this was before HIPAA. Mom and the baby did fine.) Later at another clinic, we referred women over a certain weight for their height, to a hospital because of concerns for their safety. Referring obese women to the hospital for treatment is/was the standard of care for the medical procedures we performed. And if women were over 300 pounds, we could not operate the OR tables. It is difficult to move a 300 pound person, who has been given anesthesia, off of an OR table. It is difficult to expand the vagina to see the cervix, and sometimes we would have to have extra staff members to hold back fat on a woman's thighs to access the vagina. (I'm not fat shaming. I'm older and a bit overweight, myself.) There are mechanical aspects involved in health care. and risks for people who are overweight, and those who care for them.
15
I am a bit confused about the anger and indignation. If fertility clinics have a BMI cut-off (because of all the issues described, including increased risks associated with anesthesia, etc.), how can that be construed as "fat shaming?"
When you go to a doctor for anything, they check weight and height. A healthy weight is basic to good health. Aside from a specific disease or condition that predisposes someone to weight gain (which would indicate that the woman get specific care for *that*), what is the problem with advising an obese woman to take steps to lose weight? Apart from pregnancy, anyone wanting bariatric surgery from a reputable doctor must first lose a certain number of pounds and undergo nutritional counseling, prior to that surgery.
It seems like a false premise to say obese women (without an underlying condition that predisposes them to weight gain) who want fertility treatment have a choice between bariatric surgery or a drastic diet to "lose 50 pounds in a month." Isn't it common sense to eat less fat, eat more fruits and veggies, etc. and get more exercise?
There's never any excuse for callous or rude treatment of a patient. But isn't there a place where discussing good health, including the healthiest weight for a given individual (realizing everyone has different predispositions regarding weight) and "fat shaming"? This article seems to conclude that suggesting weight loss to an obese woman is equivalent to fat shaming.
11
The photos of Ms Balzano show a woman of above-average weight but she doesn't appear morbidly obese. Her son is a much wanted child and I hope her experience helps others.
1
I had a sister-in-law who weighed over 350 pounds (she's no longer my sister-in-law as I am divorced from her brother and have no contact), she had no problem becoming pregnant and gave birth to seven healthy children, six boys/one girl. I don't think that obesity itself causes infertility, there has to be other causes. Also, my sister-in-law started having babies in her mid-twenties, age may have something to do with the infertility of the women mentioned in this article. As far as doctors go, many do believe that losing weight cures everything. Many heavy people in my acquaintance never go to doctors unless they are very ill or in terrible pain. The docs dismiss their symptoms and chalk it all up to obesity. This is so unfair.
5
This article exemplifies how the medical industrial complex utterly fails patients because of the bias, ignorance and lack of insight and compassion from DOCTORS. "Medical science" is so deeply tied to capitalism and white supremacy that almost all of the people I know who rely on the advice of mainstram doctors are profoundly unhealthy: physically, mentally and spiritually.
To suggest that a woman have bariatric surgery before conceiving in order to lose weight is unconscionable and wholly contrary to the health and wellbeing of the mother and child. To advise any woman to drop 50 pounds in a month prior to conceive is just down right
stupid. It truly defies common sense.
Only greed, stupidity, hostility and ego would lead a doctor to give such advise let alone act on it give such advise on a woman planning to conceive and carry a child to term.
Plenty of so-called "obese" women have no problem at all getting pregnant. Even if a heavier weight carry the higher risks of complications later in pregnancy that should not all persuade a heavy woman from trying to conceive. Risks alone NEVER determine outcomes!!
I also want to alert the Times to all of the many comments on this thread that are hateful toward big woman under the guise of "good health". There is so much hatred, arrogance and elitism among liberals that it is sickening. There is so much hatred, ignorance and misogyny among these Male-named commenters that it is sickening.
This society is sick.
4
This is my story as an overweight woman. At 182 lbs I became pregnant w/o medical intervention and delivered a healthy full term baby w/o complications. It was noted that I had post-partum thyroiditis, no further testing was done. When we tried for another pregnancy, nothing (same weight). My period began to become irregular, it was blamed on my age and weight. I was sent for a infertility procedure, wasn't given a pregnancy test, turned out I was pregnant and miscarried afterward. Scheduled for another procedure, turned out I was pregnant again. Lost that one, the specialist said I had to lose 3 before they would explore why. Lost another pregnancy 2 months later. The possibility was presented that my irregular periods were really early term losses. I then went to another specialist who did the surgery that my GYN wanted in the first place, turned out I had developed adhesions that wouldn't let the embryos implant(theory). I was told to lose weight and lost 15lbs, no pregnancies... Got disgusted, gained my weight back to 182lbs and Bingo! Got pregnant at 42 and delivered another healthy full term baby. I'm still overweight, in my late 60's, have no health issues except it turned out that I have Hashimoto's, which can cause early term loss and/or infertility. It's not always weight even when you are overweight.
6
With few exceptions, obesity is a result of what people put in their bodies. Obviously the American 'food' industry has done no one any favours by poisoning our food system - pesticides and chemicals yes - but more importantly highly metabolic chemicals and substances - and every imaginable form of sugar. Ever wonder why Phillip Morris acquired Nabisco... the name of the game is addiction.
In a sense, we've all been victimised; yet it's time we recognise the truth of the matter and take charge of our own bodies - and in slower time shine the light on those that are poisoning us for profit.
That said, we're learning the health of the mother at the time of gestation - including her metabolics - plays an outsize role on fetal development, notwithstanding what is fed to a child in a household as they grow. To put it bluntly, people should be getting their health in order before having children. Regardless of reason, being obese is not in any way healthy.
If people wish to predispose their offspring to an increased susceptibility to metabolic diseases and disorders (diabetes, etc), amongst other issues, then please by all means, have children whilst your obese.
Obesity runs in families - and dietary habits - and genetics. Personally I became trim via food choices, despite chubby family 'genetics'... meaning it wasn't primarily genetics. Many trim people (doctors included) come from trim families - they started on dietary home base.
Many of us don't. Educate yourselves.
8
Probably a box of cheeseburger needs the same health-hazard warning as a box of cigarettes.
7
If you are getting cheeseburgers out of a box, maybe weight isn't your only issue.
8
don't see any women of color in this story...what are their experiences ?...
9
Why is the fact that the baby was born 5 weeks early not being discussed? Preterm babies are at risk for developmental and behavioral problems. Infants born 4-5 weeks early have been shown to have cognitive deficits not seen in full term babies. We don’t know if her infant was born prematurely due to her BMI, but we do know that the risk of preterm delivery increases with maternal BMI.
To answer your question, it absolutely makes sense medically and ethically for fertility clinics to refuse treatment.
9
I cannot find the commenter who noticed the electrical cord for the baby monitor hanging within reach of the child on the crib. Good eye.
This is where you should absolutely NOT put a video camera. Several cases of infant strangulation have unfortunately been reported in the past when babies would entangle themselves in baby monitor’s power cords.
3
So the percentage of Americans who are obese has increased substantially. The public health profession has long since recognized that Americans live in an obesigenic environment. Fast foods, sodas, and fatty restaurant meals are constantly thrust at us. If you are poor and have the misfortune to live in a food desert neighborhood, your ability to access healthy food may be limited.
The increasing time poverty of Americans also contributes to obesity. Americans work among the longest hours in the world, often shuttling between two or even more jobs. The situation is that much worse for single parents. There isn’t time to cook a healthy meal. More obesity.
Public health leaders have suggested interventions, like sugary beverage taxes—“soda taxes.” These have passed in a few places, but usually the multi-billion soda industry has fought them off.
I don’t pretend to make a medical judgment about the cases presented in the article. It’s been noted in other contexts as well as this one that doubling of a tiny risk is still a tiny risk.
I realize that doctors and medical practitioners are very pressured, in our distorted health care system. Reforming it is another story. Stll, it would be nice if doctors facing an obese woman would understand that her obesity is probably at least in part a social product—not just the woman being “out of control” or “irresponsible” or bad.
5
An anesthesiologist blamed my weight for his inability to place an epidural while I was in labor (though his colleague was successful on the first try, as was another who did the spinal block). I’ve had specialists immediately point to my weight as a factor regardless of why I was seeing them, without actually consulting my medical history. Not everyone who is overweight is unhealthy, and when I come in for a symptom, I’d like to know all potential causes and treatments are being considered. Anything else is biased, incompetent and lazy medicine.
4
interesting that the pictures you chose of these women do not show their actual body size: if you are against fat shaming why can’t you represent fat women ? I am overweight, have been obese but the premise of this article is absurd. Liniting some fertility treatments is about safety, period. this is not prejudice. you ignore the very very real risks to baby and mother inherent in a super obese mom pregnancy.
9
In breeding animals it's been a long-standing practice to raise or lower the female's weight while promoting exercise to"bring the female into condition".
I'm a thin woman who is moderately prejudiced against fat people and who adopted a child because I was unable to conceive with my husband. Some thoughts:
1. These women are all so lovely! Really beautiful, and I don't mean "inner beauty."
2. I agree with the comments that there are legitimate medical reasons for concern regarding assisted pregnancy for obese women, but that doctors should be considerate and compassionate regardless.
3. There needs to be more education around nutrition starting when children are young, and in high school, bring back home economics!
4. There needs to be a lot stricter regulation of the food industry - which should be an oxymoron. For companies to get away with foisting such incredibly unhealthful and fattening foods on the public as to cause an obesity epidemic - with all the associated degradation of health - is only somewhat less harmful and immoral than what the pharmaceutical industry has done with opioids and fentanyl.
5. We need a country that provides adequate education, housing, jobs and childcare for its citizens so that they don't need to take drugs or eat themselves to obesity to feel ok.
6. Did these women consider adoption? And if not, why not?
7
Unquestionably a topic that it's difficult to view objectively.
To a great extent, what constitutes beauty, health, and social acceptance is imposed via 20th century standards of a thin, white (supposed) norm.
Which brings up another question about the perspective of this article: what about women who are not white? or women from cultures where thinness isn't a prerequisite to beauty and health?
Seems as if this is a narrowly formed perspective.
2
It's easy for the writer of this article to hand-pick studies that support her argument. However, obesity is indeed a disruptor of female fertility.
A plethora of other studies have shown that weight loss programs through lifestyle modification in obese women have been proven to restore menstrual cyclicity and ovulation and improve the likelihood of conception. Notwithstanding her "cold" bedside manners, the doctor was right to advise Balzano to lose the weight and have more sex.
Also, one should remember that medical insurance premiums for OB/GYNS are one of the highest, if not the highest, compared to other medical specialties. If I were Balzano's reproductive endocrinologist, I would have done the same thing.
And one more point: A two-fold increase is considered remarkable. And 10 stillbirths per 1,000 deliveries is NOT regarded as a rare event!
7
It's easy for the writer of this article to hand-pick studies that support her argument. However, obesity is indeed a disruptor of female fertility.
A plethora of other studies have shown that weight loss programs through lifestyle modification in obese women have been proven to restore menstrual cyclicity and ovulation and improve the likelihood of conception. Notwithstanding her "cold" bedside manners, the doctor was right to advise Balzano to lose the weight and have more sex.
Also, one should to remember that medical insurance premiums for OB/GYNS are one of the highest, if not the highest, compared to other medical specialties. If I were Balzano's reproductive endocrinologist, I would have done the same thing.
And one more point: A two-fold increase in an event is considered remarkable. And 10 stillbirths per 1,000 deliveries is NOT regarded as a rare event!
3
Why have B.M.I. indexes been going up? Look at photographs from the 1960’s and 70s or before and you will see predominantly thin people. What happened since then? Our food industry has poisoned us with sugar mainly in the form of corn syrup which in America is in all food found in the middle section of the grocery store. Look at breakfast cereals and sodas, they are just vehicles for sugar.
Pregnancy is complicated, health care professionals are just trying to do their best with what they know and if working for a hospital, they are not making the decisions on who to treat, the hospital mandates and again is based on safety and medical outcomes. In the case of IVF it will be anesthesia guidelines that dictate whether this treatment is offered. This is based on safety. Medicine is based on science and analyzing results. Then there is the legal industry, if a patient has a bad outcome which science could predict, the result will be a lawsuit with no one but the lawyers benefitting.
7
I'm thinking about the racial disparities in birth outcomes and the reported deficits in the way black women are medically treated during childbirth.
I have the impression that higher body weight is more prevalent among black women, although this may be completely wrong, and if so I apologize.
But if overweight is more prevalent among black women, I wonder whether the poorer birth outcomes experienced by black women may be due in part to the same misconceptions about weight discussed in this article. Does misinformation and prejudice about weight lead medical providers to look at women of size, ascribe medical problems to weight and fail to identify actual emergencies? If women of weight are thought to be less disciplined, could this lead to ignoring their reports of pain or distress? I hope that researchers who are examining the causes of racial disparities in birth outcomes incorporate the possibility of weight prejudice into their study.
2
I am a liberal democrat and very much believe in trying to eliminate bullying and discrimination, but we also have to begin to draw a line between "shaming" and facts. We will never achieve a society defined by the rule of law and human rights if we begin to attack facts simply because they are not convenient. I kept wondering as I read this article whether the next article would look at woman shamed at being alcoholic or drug-addicted and facing discrimination in their efforts to get pregnant.
13
I'm 62 years old, so I am well past the fertility stage. Every time I visit my general practitioner alone, he spends the whole appointment lecturing me about my weight. If my husband attends the appointment with me, he does not mention my weight at all.
I am overweight, but I am physically fit. I swim, walk and lift weights. He has asked me before if I knew how to exercise.
I was treated for breast cancer last year. At one appointment with him, while I was on chemo, he told me that I needed to skip breakfast and only eat 800 to 900 calories a day.
4
Why keep going to that doctor? He's not giving you good medical care.
9
I didn’t see any mention of Polycystic Ovarian Syndrome. PCOS is a hormonal disorder and a leading cause of infertility. It also results in weight gain and insulin resistance. So women who have a recognized medical disorder that causes both infertility and weight gain are told that they are too fat to get help with infertility? That’s called blaming the patient for an illness beyond her control and then denying treatment. Makes no sense.
14
PCOS is associated with not producing enough progesterone at the right time in the menstrual cycle.
I kept waiting for the REAL reason for denying fertility treatment to women over a certain BMI. It's because of success rates! Fertility clinics live and die by their success rates and try to limit anyone who doesn't conform to the stats that will give them the best outcome. I'm sorry this wasn't discussed.
15
Mandating parameters for IVF is not unreasonable from a clinical or legal perspective; the way health care workers interact and communicate with high BMI patients could certainly be improved.
Ultimately, the overall health of the child and family should dictate the process of reproduction.
2
Obesity is an epidemic in this country. The rate of diabetes is skyrocketing. Both women and men are the victims. It is not entirely their fault. The food industry has been forcing our population to eat unhealthfully for years and unfortunately many of the women referred to in this article may be the victims. Many of course may have medical etiologies for their obesity. But this epidemic should not be normalized and the medical profession should not accept it and be forced to adjust to it. BMI definitely has its shortcomings as an accurate measure of obesity. But there is a big difference between BMI’s of 30,40, and 50. This article should not confuse this fact. I know how difficult it is to loose weight from my own practice. I have had patients who have had bariatric surgery. It is a tragic problem. However, mothers to be should consider that pregnancy is an extreme physiologic burden on their bodies even if they are a healthy weight and even if modern obstetrics has helped reduce mortality and complications. They should not place further burdens on the obstetricians practicing than these doctors already carry.
18
I found the article thought provoking and well worth reading. But I absolutely LOVED the beatuful cover photograph of Ms. Balzano breast feeding her little son. What an image of serenity, motherhood, and love. Thank you for that gift.
6
The latest obesity numbers from CDCtell a horror story: America has again gained 20% more in its obesity rate -- about 40% today -- than 33% a decade ago.
the double pathology is that we continue to fight for rights as an obese person than reclaim our LIFE as a stronf, healthy and fit person. Whatever has happened to our basic calculus about what matters first and foremost?
Unfortunately, America has always topped in obesity among the five largest most advanced democracies of the world: UK, Germany, France, and Japan fall behind in that order in obesity rates.
Maybe we should learn to look at the upstream causes and not be fixated with the downstream mess we have created
5
I am appalled at the harsh mistreatment of the women interviewed for this article and I applaud their success in becoming mothers.
2
This sad story is the awful result of the Fertility Industrial Complex’s hubristic sense of false certainty combined with their evil financial incentive to only treat the most easily treated, which often means those who need treatment less than those who are excluded from having it. Until success rates are done away with as a tool of competition in our broken healthcare system, these stories will continue to proliferate.
2
This article, while about infertility, is about more about weight. All women who are over weight are told that losing weight will solve everything. Being thin is the ultimate goal regardless of how you get there. And low and behold losing weight does change one thing - how socially acceptable you are. And Once you're deemed socially acceptable you can then access medical treatment, you have less stress, you are treated better everywhere.
Where are the studies on yo-yo dieting? Does being consistently overweight really contribute more to health issues or does the constant radical swing in weight contribute more. There will probably never be those studies because overweight women in particular are not considered worth it.
From a 2002 study produced by the Rand Corp.: "Two RAND researchers, health economist Roland Sturm and psychiatrist Kenneth Wells, examined the comparative effects of obesity, smoking, heavy drinking, and poverty on chronic health conditions and health expenditures. Their finding: Obesity is the most serious problem."
We're not talking about being "overweight" here. Overweight is defined aa BMI of 25 to 29.9 while obese is defined as a BMI of 30 or greater. A BMI of 51 is morbidly obese.
We must stop accepting that it's OK to be morbidly obese and, without judgement, work to supportively help those that are obese to lose weight. Obesity is a huge societal problem and we must give it the same attention as we gave smoking and other dangerous addictions.
15
I am an overweight person who has neen obese. I am 100% against fat shaming. But this aricle totally ignores the fact that pregancy complications are far more than reported in this article, and significant birth defects in the infants (spina bifida, omphalocoele, heart defects etc. are more common in the offspring of the mordidly obese.
100% against fat shaming, but pretending you can be healthy and nor suffer medical consequeces with a BMI > 35 is sad fantasy.
18
I only wish folks the best, but have like a couple of other folks in this thread have to wonder why in the world any woman goes through such contortions to get pregnant. If it's a simple problem, fine, but otherwise it seems to me that taking Mother Nature's no for an answer and considering adoption would be the better way to go. As far as the weight issue is concerned, sorry but if you're obese/morbidly obese, you have a condition that needs to be dealt with,and not fault doctors for pointing this out.
6
@H Silk - My friend had fertility issues. Adoption, for reasons I will not go into here, was not an option for her. We are fortunate to live in a time where fertility treatments can help people have children. My friend didn’t have to take Mother Nature’s “no” for an answer. She now has two wonderful children today and is a great mother, which I always knew she would be. Telling people desperate to have children and who can use fertility treatments to successfully have those children that they need to take Mother Nature’s “no” for an answer is insulting.
For the record, adoption isn’t for everyone. Aside from the fact that it is prohibitively expensive and not everyone qualifies, it can sometimes present prospective parents with issues they’re not prepared to confront. Parenting a child with behavioral, trust, or psychiatric issues is no walk in the park. Adoption is not an easy road at times. If I couldn’t have children, I’m not sure I’d adopt because I don’t think I could handle parenting a child who might have significant serious issues. It’s not a crime to want your own kids, and it’s not a crime to say adoption isn’t for you. Better to say that than adopt a kid you can’t bond with and whom you struggle to raise.
6
I have lipedema and that's why I am overweight. I wasn't diagnosed for 17 years. It's a condition I have since my teens. But who cares about fat women? Not the medical personell nor research staff.
So I know exactly what this article is talking about even though I never pursued IVF. But my experience is that basically I could go to the emergency room with a broken leg or arm and they would still tell me to lose weight and my problem would solve itself.
Most doctors don't even know my condition even though it's a chronic illness that causes a lot of pain and only gets worse if not treated.
7
How a medical professional words things is key!
And as a formerly morbidly obese woman, high risk pregnancies can end up being life threatening, so from a liability standpoint one should be able to see the concern an IVF professional of medical team overseeing a high risk pregnancy may have.
Not to mention the a fact even cardiologists/heart surgeons, orthopedic surgeons dread operating on morbidly obese patients. Because the patient could DIE!!
Yet what is NOT questioned by many is would the same medical folks turn down a woman who is or has been anorexic, a drug user, a smoker, a alcoholic, promiscuous or is in a abusive relationship, or doesn't have the funds to fully support a child until age 18?
4
I can never understand why adoption is such a vague thought, if thought at all. As much as we rescue dogs, she be as much and more that we rescue those unwanted babies.
2
Oh Lord please do some research on adoption.
5
I have Hashimitos and have been overweight as an adult as a result. I have seen multiple endocrinologists at multiple research institutions and, without exception, I have found them to be the most callous, uncaring, and arrogant of any specialists I’ve seen. They do not care a whit about symptoms, they treat numbers not patients, and unfailingly have come across as misogynistic and—woman and man alike—distrustful of women. One woman actually asked me whether I had children or whether I lived alone, intimating strongly these were my problems, not my thyroid or other genetic difficulties. I am now treated by my OD/internist with great success and will never darken another endocrinologist’s door. I see as part of the problem with fertility doctors terrorizing fat women and flippantly making their life decisions for them as owing to, in large part, the socialization of this medical speciality.
34
@S Otto I have Hashimoto's and I'm not overweight. Hashimoto's, properly treated, shouldn't result in weight gain or obesity.
10
@Vanessa The problem is getting proper treatment. Most MDs just look at numbers and will prescribe other medications instead of what's really needed in some cases, which is a med increase.
5
Living in New York City, I don’t see many obese people - we’re a pretty healthy city and it helps that we can walk everywhere. But right now I’m on vacation in Florida, where Americans from all over the country come this time of year, and literally every third person is obese, the kids included. You cannot tell me with a straight face that all these people have a “medical problem”. This did not exist to such a vast extent 40 years ago.
14
Who’s paying for the procedures? Insurance? Government? Then they get to decide. You have no right to have other people pay for your optional and irresponsible actions.
6
When the medical personnel determine that your weight (and consequently, your health, being morbidly obese is directly related to your quality of life and your fitness to he a parent), maybe you should listen to them. For the health, well being and future of your baby. Just because you WANT A BABY, and it is probably your right to have one no matter what your health is, maybe, your body is not able to have a baby for a good reason.
8
Is adopting a homeless child such a disagreeable option?
1
@Gloria Utopia - No one said it was disagreeable, but it is very expensive. Fertility treatments can, to a certain extent, be covered by insurance. Adoption isn’t, and I’ve heard that it can cost anywhere from $30,000 to $50,000. Do you think the average American, obese or not, has that kind of cash lying around? That’s a down payment on a house in many places.
Speaking of that house, adoption agencies have strict requirements and social workers arriving for that always-intrusive “home visit” often go beyond making sure the house is normal and safe and make note of everything. Some agencies may favor homeowners over renters, seeing them, perhaps erroneously, as more stable; others won’t adopt to anyone over a certain age; and still others won’t adopt to people who have or have had certain illnesses, such as cancer, due to the risk of recurrence. Also, adoption sometimes presents prospective families with a whole host of issues - health, behavioral, educational, psychiatric - that they aren’t necessarily prepared to confront, and adopting from foster care, while less expensive, can often be challenging for all the reasons stated above and heartbreaking if the child with whom a family has bonded is forced to return to his or her biological parents.
The desire to have a child is a very strong human drive. I’m tired of people telling those who want their own kids but can’t have them to adopt, as though adoption was easy and those particular kids a consolation prize.
5
@Lindsay K I haven't heard, adoption in the US can cost $30-50, 000. I know of someone who adopted and never heard that she'd paid that amount, and she adopted 3 children, two siblings and a troubled child.
They were initially fostered, and she received much help (financial)from the agency. One child needed therapies of all sorts. Admittedly, adoption isn't always easy, anymore than IVF is easy, only adoption helps a child already here, and in need of help.
In some cases, adoption is done out of a desire to adopt, not as a consolation prize, merely for the reward of potentially saving a soul who might otherwise be condemned to foster care and possible abuse.
I do agree, there's a lot of red tape in adoptions. There's a lot of heartbreak, expense and problems in IVF also.
2
I always wonder how morbidly obese moms manage little children. Bathing, running after them, the car seats, the tantrums.... but if they can do it, why shouldn’t they be able to? There is no such thing as a perfect parent.
3
If you've got the money, you can find a doctor who will tell you what you want to hear.
“I would never give you I.V.F.,” they recall her saying. “You’re too fat. Have more sex and lose the weight.”
1
BMI is an imperfect measure. A couple of years ago, I recall a conversation about the issue at a conference that had assisted reproduction experts from both Australia and New Zealand. The New Zealand experts, who saw women from the Pacific Islands, said you could not apply BMI cutoffs to them, given that they tended to be heavier and that most women with high BMIs from their cultural backgrounds still became pregnant easily. ‘Healthy’ BMIs are not one size fits all, so we need more nuanced research to meet women’s needs and protect our rights and interests. And no one should ever be treated disrespectfully on account of any characteristic, including size!
12
As a larger woman, who suffers from PCOS and the related infertility and weight concerns, this article infuriated me.
I'm glad I didn't have to ultimately pursue I.V.F., but when I was first diagnosed, I was told that was the route we'd probably have to take. NONE of my doctors or the other medical personnel told me we couldn't have children because of my weight. Yes, it was a concern, and I was monitored closely. However, I was high risk due to my PCOS rather than my weight alone.
These doctors sound woefully misinformed and misogynistic. Not to mention completely dismissive and uncaring. What they are worried about is NOT her health -- it's the liability. It's the extra work, extra cost, arguments with insurance...tell me I'm wrong.
I've had three healthy children and been overweight my entire adult life. What my doctors HAVE told me is that, in my case, I would be unlikely to lose weight - ever. So, knowing that, if I had consulted with these doctors, I would have been treated like Ms. Balzano was - dismissed.
We need to have better understand around "fat" shaming and stigmatization. Is being overweight ideal? NO. However, overweight people are STILL HUMAN, with FEELINGS, NEEDS, and WANTS like everyone else. We have to live our lives no matter what weight we are. On our way to an ideal weight or not, time marches on.
I wonder how many other women it was too late for, as it was almost for Ms. Balzano?
61
@CMC Lets take it to the other extreme. When i was a teenager, I became anorexic and stopped having menstrual periods. Wouldn't it have been irresponsible for a doctor to attempt this very expensive procedure on a person that it is very unlikely to be succesful, in a body that is in no condition to support a pregnancy?
10
The fact that this entire article does not mention Polycystic Ovary Syndrome (PCOS) even once time is astonishing. My understanding (but read the link yourself) is that PCOS causes both infertility and weight gain. "Correlation is not causation." It would appear that the reporter, commenters, and the doctors quoted need some education. Telling patients to "go loose some weight" without screening them for PCOS is not acceptable. I guarantee that infertility doctors know about PCOS these days.
https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes
19
This is exactly why I do not support "Medicare for all"
Why do I have to downgrade my private healthcare to socialized medicine in order to support millions of Americans who are obese by their own choice?
At current statistics over 60% of US citizens are obese- I watch "my 600lb life" .. I love Dr. Now - he routinely helps the morbidly obese .. all of is patients are angry, arrogant, selfish and manipulative... With "Medicare for all" I would have to subsidize their self-centered, over indulgent lifestyles... No thank you!
13
@Aaron - Do you actually think that the people on "My 600 lb Life" are representative of the obese in general?
It might be better to stop watchin g so much TV.
34
And no one who subscribes to your private insurance is obese? Are you sure?
10
@ Aaron Wow, that is beyond insensitive. and by the way, insurance works by pooling risk. We all pay for other people whether their conditions are "self-indulgent" or not.
8
Hair. Pulling. Out. Time. Howmany more patients (and readers!) will continue to be harmed by medical ignorance and lazy reporters?
Obesity is NOT CAUSED by overeating or under exercising!
It IS caused by insulin regulation disorders, aka insulin resistance. It's a medical metabolic problem, not a personal failing, character flaw or lack of will power. And it's easily treated with a 180 degree change of diet, though caloric *reduction* will only make things worse.
And in this case, perhaps with metformin as well, since it is likely this young woman had/has the insulin resistant variant of PCOS. Which has nothing to do with ovaries, has a genetic proponent (males can carry and pass it on), and can strike men as well. I call it Metabolic Syndrome XX. It's often difficult to diagnose, but there are symptoms, the biggest one being perfectly normal levels of insulin - that is stunningly inefficient, Metformin can reverse that.
It seems to me that the least a reporter writing about obesity as part of the story can do is a little basic research into obesity's causes. The doctors treating this young woman may not have known better (to their shame), but this story's readers could have learned something important.
9
So true. If you look closely at some of the photos from POW camps you will see the occasional morbidly obese prisoner suffering from insulin issues. I heard it creates a lot of tension in the camps.
2
The craziest thing here is that I looked at the pictures of these women and didn't think any of them looked particularly fat—but then realized that's because we Americans have generally gotten so much fatter over the last 25 years or so that my eye has recalibrated to see their silhouette as the "new normal." This is not good.
14
Holy Hanna, it is unbelievable that you are attacking doctors for determining who they can successfully treat. Doctors who treat people knowing that the chances of failure are high end up being called defendant in a lawsuit.
Moreover, if a doctor gives you and opinion that is poor, Go to see another doctor for Heaven's sake, don't beat yourself up because you go to see one dope. Why sit and pity yourself and your fate when you can see another doctor.
Oh, and to the complainers who say it is being done for money only, you don't seem to understand that if you don't treat you can only bill for a consult. No one is turned away to get more money.
Always get a second or a third opinion. I will not give examples of people who were told that they were going to die, went to see another doctor, and now, years later, are alive and well
12
Thank you!!!
2
Body size varies dependent on so many factors. Losing large amounts of weight usually boomerangs into even more weight gain. Doctors are notorious for judging their female patients for being overweight.
Years ago I developed an eating disorder trying to reach some silly ideal of what I should look like. Even when I was thin, I could not see it or feel it. I still felt fat.
Today I am of a "normal" weight but my pushback against this insane focus on women's size is to refuse to weigh in at a doctor's appointment. I also tell them why. It makes some of them stop and think, which is a good thing.
6
Years and years ago I remember reading that women who were obese when they began menstruating and later lost weight often had fertility issues. So this push to universally tell everyone to lose seems suspicious.
1
Reading the comments, it becomes easy to see why people have long said that fat is political. Worth noting is a curious business anomaly relating to weight: The weight-loss industry is the only growth industry with a completely dissatisfied customer base. Chew on that for a while...
https://emcphd.wordpress.com
7
So if losing weight to get pregnant is the cure, why have so many of my thin friends not been able to get pregnant?
8
Every time someone loses weight, if they put it back on, they usually get more. It's long past time to realize that the Diet Industry is a factor in the increasing obesity of the nation.
5
Being obese is not new. Most of my female ancestors (grandmother, great grandmother, etc.) were morbidly obese and they all outlived their physically fit farming husbands, some by decades.
What is new is the shame that society places on those who are obese.
Perhaps there are good reasons to not give IVF treatments to the morbidly obese. I am not a doctor so I don't know. What I do know is that the dismissive statement "You're too fat" is motivated, primarily, by contempt, not medical concern. I have heard it too often myself to not know the thought process behind it.
13
Do we know anything about fetal health in women who have undergone bariatric surgery? Do they digest enough nutrients to sustain a healthy pregnancy?
9
I’m curious - are there not also age cut-offs for IVF? And do these not also probably vary by clinic/doctor? Obviously you cannot tell people to get younger like you can tell them to “lose weight” (as if it was as easy as it sounds) but there does seem to be a parallel here.
4
Obesity in the mother leads to health problems in the baby. It isn't just a societal shaming. It is scientifically demonstrated. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203757/
The obese biome passe from the mother to the child during birth, further affecting the health of the child.
You show photos of mothers who are overweight, not the morbidly obese candidates you describe in the article. Spending scarce health resources to do IVF on women with BMI's over 35 is not good policy.
16
“When you’re fat, you get used to people assuming weight loss will fix everything wrong in your life,” is so true of our society; years ago, I saw a psychiatrist—who, to his credit, didn't medicate me—and he repeatedly told me to lose weight because I was over 25% overweight. He seemed to think being fat was the crux of my problems, and that losing weight would make me pretty, happy, and popular.
This was in addition to multiple physical and emotional problems in the wake of a car crash that he didn't see fit to address. I was heavily medicated—with anti-convulsants—at the time, and was able to lose most of the weight by quitting the medication that was making me suicidal. I had also quit the judgmental psychiatrist; problem solved!
9
A doctor that is willing to do anything a patient wants is not a good doctor.
My mother in law had choice words for a doctor who told her she should lose weight before he would perform hip replacement surgery. (She is 5’4” and over 300lbs.) She found another doctor who performed the surgery, and although there weren’t complications, she still complains about pain in her hip and is no more mobile than she was before the procedure.
Just because someone tells you something that is painful to hear doesn’t automatically mean that the intention is to shame. It may actually reflect genuine concern based on experience.
48
I am not into shaming anyone for anything to do with their body, but as a health professional who works with pregnancy, labour, birth and breastfeeding everyday it is obvious that obesity/being a woman of size/fat does have a major impact on this experience and also affects babies of these women as well. And the effects of being large are not usually positive for either mothers or babies.
We can be as PC as we like, but biology doesn't care about our preferences. How much weight we carry does make a difference to our physiology (and not just in relation to having a baby). Much can be overcome by modern science and technology, but not everything can be mitigated.
44
My husband and I were in our mid-thirties when we married. Within a year it became apparent that we needed help conceiving - I was exposed to DES in utero, and my husband was exposed to agent orange.
We applied to a program being started at the local teaching hospital, only to be told that because they were just starting, only applicants under age 25 were being accepted!
We then applied to a hospital program in Nevada that was accepting older women. We were discouraged by the cost since we were out of state, and the procedure was not covered by insurance.
They did, however, send us the literature outlining the procedure. The first requirement was that the woman must have a uterus. We howled with laughter!
4
I was 5'1 32 years old and weighed 180 pounds. When a friend asked me to get my Thyroid checked, my PCP gave me a condescending look and told me I just needed to control my eating. I insisted and she put me in for a Thyroid test. My TSH was at 39 (in a normal person it should less than 4).
A few years later, I was trying to get pregnant. The PCP said I needed to lose weight I mentioned my periods were on time. I worked out regularly. No high cholestrol, no diabetes. The PCP said I needed to lose weight and swould prescribe weight loss pills. I was prescribed Meridia.
Within 2 months of being on Meridia, I lost 30 pounds. My periods stopped completely. After being on Meridia for 6 months and not having had a single period, I stopped taking it. I gained back the 30 pounds I had lost and an additional 15 pounds. I bled continuously for 10 months. There were huge blood clots. My hair fell out. I became so anemic I needed a blood transfusion. I was then on Depo-Provera (normally given to criminals for chemical castration).
As a last life saving measure, I had a hysterectomy. Kaiser then identified me as a candidate for bariatric surgery. I was too traumatized by the experience to undergo more surgery.
Iam now in my late 40's, weigh 250 pounds. I finally decided to undergo bariatric surgery and wrote to Kaiser to check if I was still a candidate. They responded denying my request. Their denial letter said "Denied due to overeating"
Meridia is now a banned drug in US.
13
There are several studies that clearly and definitively link obesity with between 37% and 88% increase in infant problems like heart defects, nervous system malformations and limb deformities. So sorry, yeah, a doctor who knows that risk to the babies you will produce may is allowed to make a medical fact based risk assessment and decide not to assist a woman having a baby will be deformed.
13
Maybe they shouldn't have allowed comments on this article.
It's the perfect storm of obesity ("Just eat less/ calories in calories out/I weigh the same as I did in high school, why don't you?") and infertility ("Why don't you just adopt/how selfish to want your own child/the world is overpopulated").
Allowing comments here is like throwing chum to a piranha. Let the frenzy begin!
21
The bizarre idea that a morbidly obese person is completely healthy, save for the extra weight, is a myth that ranks right up there with the belief that the human body replaces itself every seven years.
A psychologist once ruefully told me, "The American national pastime is denial." We see that reflected in many of the defensive comments here.
https://emcphd.wordpress.com
39
I am in Portugal now. When I walk in the streets, I see thin women and plump women. But I don’t see morbidly obese women - or men. The only woman I saw who clearly weighed more than 200 pounds spoke American English. Unless you believe Americans are a different species from the rest of humanity, you have to admit that the fat plague of the US is the preventable result of a bad diet, lack of exercise, and self-indulgence. Stop normalizing fat. If you are obese, lose weight first and then deal with infertility issues, if any.
51
@Mor you are so right.
6
So one doctor recommended IUI, and Balzano refused. Years later, another doctor recommends IUI, Balzano finally goes along with it, and it works.
This has nothing to do with fat shaming, this is a self-inflicted wound.
27
Why would a doctor turn down a paying customer? Because the duty of the doctor is to tell the truth to their clients. Americans are getting to be spoiled little brats who feel entitled to what ever they want regardless of reality. Obviously, these would be parents are woefully uninformed as to the medical issues involved and get insulted when told the truth. That is American today in microcosm, self absorbed dopes who just don't get it.
19
@sob Yes, and people who no longer respect the lengthy training of experts. It is one thing to raise questions and discuss implications; it is another to refuse to hear the facts when one has no training or expertise with which to counter the doctor's assertions.
8
They would because they have to submit their success rates the CDC every year, a lower rate means other prospective clients might choose a different clinic believing it is better even though it might just have a higher success rate because of stringent BMI requirements.
Getting pregnant and giving birth cannot be the only objective here. These women have to raise the children they want, and their obesity, if not dealt with now, will cause serious health problems at SOME point during these children's lives, even to the point of leaving them without a mother before they are fully grown. Obesity is not an accident, it is a result of behavior.
28
Obesity is not always behavior driven. To learn more, look up Dr. Robert Lustig’s (UCSF) articles and videos where he goes into great detail about the chemically addictive qualities of sugar. I’m a believer in doctors using fact based decisions, like using BMI, to determine whether or not they are going to perform a procedure and many European countries have much stricter requirements around having healthy BMI before they will perform many types of procedures. But it is wrong to say that all obesity is caused by behavior - that is patently false.
2
The article doesn't explain why she turned down the letrozole and IUI, which feels especially perplexing since she had to get IUI anyway before insurance would cover in vitro (maybe she didn't know about the insurance coverage requirement when she turned it down?) and it's IUI that ended up working for her. It seems like for some reason she really wanted to go straight to in-vitro, even if it would require bariatric surgery first?
I'm surprised this article didn't touch on the idea that fertility clinics turn down overweight patients because they're worried about keeping their own success rates as high as possible.
15
Exactly, success rates have to be submitted to the cdc every year, I doubt there is an actual medical reason to deny treatment at a BMI of 30.
2
Physicians weigh the risk of obesity on pregnancy complications. Gestational diabetes and miscarriage increase with BMI. If there is an obesity-related complication during the pregnancy the physician could be held liable. Each doctor makes decisions based on their risk aversion. They make similar calls with women predisposed to having birth complications who aren't obese. The women in the article had healthy children. Good for them. They beat the odds.
7
Ms Balzano had a preterm infant that was 5 weeks early. The article does not elaborate on her pregnancy complications, but preterm delivery could have been related to gestational diabetes or pregnancy induced hypertension, both of which happen with greater frequency in obese women, as many commenters have noted.
In addition, preterm infants often spend time in the NICU, have breathing problems, sucking problems and are at higher risk for infections.
Ultimately she beat the odds, as the article suggests her baby is at home with her and nursing well, but initially the baby appears to have been at more risk than a baby delivered at full term.
1
I cannot recall an article that has made me more angry than this one. I wonder how much the male physicians in this article weigh? Overall health should be the consideration for in vitro, not numbers on a scale. But then, since fertility clinics are more concerned with their financial bottom line than the service they should be providing, I am sure they do any and everything to be able to hype their "successes". This for-profit focus is just a part of a larger system of delivering medical care in this country that is completely profit driven. Sadly, for many patients forced to seek health care in such system, profits will always come before the care they deserve to receive.
68
In all my life, I've never actually encountered an obese doctor. They know the risks of obesity and that it takes decades off your lifespan, and they avoid it. Overall health is always worsened by obesity. Why deny reality?
61
Ummm. Men don’t get pregnant. I don’t get your analogy.
Pregnancy is hard enough. No one is ENTITLED to be a mother. Why would a doctor risk a baby’s (or Moms life) if mom is obese? Sorry but if I can keep my weight at 70 at 110, a young woman can lose weight if her hormone levels and health are stable. Eat a plant based diet w NO processed foods and it’s impossible to not lose weight unless you are eating double calories. Yes I feel hungry a lot but God never intended constantly satiation.
I see what the obese/overweight women eat in our office just for lunch. Not fooling anyone.
56
@Dan Stackhouse, I would guess that you have encountered quite a few doctors who were obese by BMI, but you didn't realize it, particularly if they were male doctors. The vast majority of 50-year old men in the US are technically overweight, but I would guess that if you saw a 50-year old man with a BMI of 26 walking down the street, you would be unlikely to consider him overweight.
32
I've never, ever performed an Autopsy on a morbidly obese person, over the age of Sixty. Can you guess why ??? Because they don't live that long. And no, I'm NOT fat shaming, just stating a fact.
Good luck.
38
Well my grandmother is turning 89 this year, I can introduce you two if you’d like.
4
I'm struck by how almost all the comments (at least so far) continue to focus on what's "wrong" with the fat person's body rather than the shame, stigma and discrimination fat women deal with that this article describes.
Is anyone else enraged that one woman had to have a surgery that creates chronic malnourishment so she could get a chance at fertility treatment, only to find out that there was at least one provider who would've worked with her at her original weight, AND as it turned out her fertility issue was not weight related? Many fat people have treatments denied to them (joint replacements are another example) unless they are willing to have "stomach removals". This is disgraceful *at it harms people*
As this article mentions, there is growing evidence that much of the health risks associated with fat bodies is due to the ongoing stigma fat people face day in and day out. If you are here commenting on the problem of "obese" bodies and how to fix us, you are contributing to it.
221
She didn’t HAVE to have surgery. She CHOSE to INSTEAD of following the second fertility doctor‘s recommendation of medication first to treat possible ovulatory dysfunction followed by IUI if medication alone was not enough.
Ultimately she did become pregnant through IUI. Too bad she rejected the advice. Maybe she could have avoided surgery had she been willing to follow it.
Nothing to be enraged about here...
110
Dub,
With the continued increase in obesity in the US comes the pushback that those affected are stigmatized and face daily challenges of bias and judgement. This is a distraction to the health risks of obesity.
Severe obesity leads to multiple co-morbidities including diabetes, joint and back pain, sleep apnea, infertility, cancer (yes) and cardiovascular disease.
She had a BMI of 51. If she did not take serious action she would have likely continued to gain weight as she aged to the point where her mobility and health would have been seriously impaired. Her child would be accommodating her at a young age...
Complaining about the stigma people with obesity face helps those with obesity rationalize their situation when they need to take accountability and address a serious health issue.
95
@dub I am saddened at the stigma and fat shaming that people experience, yes. However, refusing to provide elective medical procedures, including surgeries, protects patients. The health risks from *elective* surgeries are significant for obese folks. Those health risks are NOT caused by stigma. The example you cite from the article actually shows the opposite of what you argue. She refused to have IUI the first time it was offered to her, but ended up getting pregnant through IUI later after losing weight. Doesn’t sound like the cause of her fertility problem was identified. It could have been her weight, in fact. What I am frustrated with is the assumption that doctors must do whatever patients want, and if they don’t, it’s because of discrimination rather than sound medical advice.
48
Thanks NYT and the patients featured for sharing your stories. Such an important topic. As a fertility specialist, I'm honored to take part in the journey of any patient/couple as they try to conceive. It's imperative that we all, especially medical providers, are aware of underlying biases, and that ALL patients are treated with respect and compassion. It is always disappointing to hear or read that a patient felt mistreated by a physician, someone who they should inherently be able to trust.
This article highlights that many IVF clinics have "BMI cutoffs." This means it is a policy of the clinic to not perform egg retrievals on patients who have a BMI over that cutoff. The way this is portrayed makes it seem like this is put forth arbitrarily by the fertility physicians as a way to improve success rates or, worse, to exert control over patients they feel shouldn't become mothers.
This is completely inaccurate.
The reason for the BMI cutoff at most clinics is for the patient's safety in undergoing the egg retrieval procedure itself, which involves IV sedation. It is an anesthesia concern, not a fertility concern. The literature clearly shows that heavier patients are at higher risk during anesthesia, and are more likely to require intubation (a breathing tube), which outpatient IVF clinics don't routinely do. This would put the patient's life at risk and require emergent transfer to a hospital. This is a life or death issue, not a judgement call.
"First, do no harm."
776
Thank you for clarifying this. The author of the article should have done the research necessary to include this in the article in the first place so we wouldn’t have to rely on a reader to clear this up.
117
@Multimodalmama thanks for your comment. I agree that BMI is not a perfect health marker. But for our clinic’s BMI cutoff of 45, an average height woman (5’3” in the U.S.) would have to be over 250 lbs to reach that BMI. I absolutely agree that BMI comes in many shapes and degrees of health, but the data simply show that anesthesia is higher risk for these patients. For any “gray area” patients, a pre-operative consult with an Anesthesiologist can be helpful.
When I see patients who are above this cutoff, I try to figure out the best solution for them personally. This may mean trying less invasive options first (usually a good approach in general), weight loss, or referring them to a hospital-based practice where they can safely undergo an egg retrieval with the appropriate anesthesia.
This is not about denying care. Just the opposite: it’s about delivering the safest, most optimized care possible.
132
@Multimodalmama It's pretty accurate unless you are a body builder. These women are not competitive athletes with a large amount of muscle. Its clear from the photos that the majority of weight is due to fat.
40
The level of ignorance about body weight is astounding and in today’s world — inexcusable. Nearly every study that has been done on people who are what is called “grossly obese” (very high BMI) indicates that body weight is mostly determined by GENES! The inability to reach satiation in eating is determined by body chemistry and that is under the control of an interaction between the brain and the stomach. It is why people have to resort to surgery to attempt to cut that connection. But sometimes it doesn’t and in spite of the physical inability to eat larger quantities of food the person stays hungry!
Sometimes there is a connection between obesity and inability to conceive but overweight alone is not an obstacle. Lots of overweight people are perfectly normal and healthy. A bigger obstacle it would appear is the bias and lack of sympathy in the physician.
That bias in and of itself can get in the way of conception because it blocks the physician’s ability to think medically about how to care for the patient. Find another doctor and don’t waste your time or money trying to “turn” someone who clearly doesn’t want to be bothered.
3
Stop making excuses. The human body is not meant to be 200,300,400 pounds. If it was "genetic", humans would have been that heavy forever but we have not. Propensity to addiction might be genetic, in this case food addiction or gluttony, but just like with other addictions, but there is a personal choice component. You can work on the underlying reasons why you are killing yourself with food while working on lifestyle changes or you can continue eating yourself to death. For some people, whatever pleasure their drug of choice is giving them in this case food, is worth dying for. For others is not and they do something, psychologically and physically to free themselves from.the addiction.
24
@B. Rothman
Hogwash.
The obesity rate in the USA has more than tripled since 1950. The humane genome has not changed appreciably during that time.
Americans are fat now because they are sedentary and eat poorly and excessively.
It is not genes that makes half the nation fat, it is simply overeating and underexercising.
22
200 is perfectly healthy for very tall people. My dad is 6’4 and is around that weight and has a healthy BMI. Maybe not over generalize.
1
“I was willing to lose a limb to have a baby” shocked me. Why not adopt if you cannot conceive? Especially now on a planet of 9 billion humans.
21
@Karen Green But she wasn't willing to lose weight
6
@Karen Green
First and foremost for millennials: adoption is many times more expensive than most types of assisted reproduction. For those of us who don't have family wealth, adoption is out of the question (unless you are/you're married to a tech bro, of course).
Even if you have the money, open adoptions require adopting families to blend with the child's birth family--absolutely the best option, but one that is immensely challenging for both families. Closed adoptions, the norm in the 20th century, are rife with abuses and extended traumas, intentional and unintentional (the Sixties Scoop of Indigenous children in North America; the secret, forced adoptions of children born to unwed/younger/poorer mothers everywhere in the English-speaking world until shockingly recently are just the most obvious examples which would give any thoughtful prospective parent pause).
6
Going the foster-to-adopt route is a much less expensive option. There is often a lot of uncertainty, and the prospective parents can't be sure at the outset that the children they foster will ever become available for adoption. It's risky in that way, but work out beautifully in some cases. And, in most situations, it would be up to the adoptive parents to determine if the adoption is "open." Many will choose to have some contact with the birth family, but some will decide its better for the children to prohibit contact until the children are old enough to understand the situation and can decide for themselves if they want to connect to their birth parents.
3
I know people who were told by their orthopedic surgeon that they could not get a knee replacement until they lost significant weight. This is just responsible medical practice.
I know a woman who had bariatric surgery, lost 70 pounds, and became pregnant, by accident, within a year of her surgery. There is a lot of anecdotal evidence to be found in the surgical weight loss chats of women's fertility ramping up after significant weight loss. There may be something going on here, as many different species will respond to environmental changes by rapid rises in reproduction rates.
9
I am always amazed by the number of NYT readers who are so offended by fat. I’m fat, and the majority of people in my life, both close and acquaintances, are understanding and supportive of me or politely keep their negative opinions about my weight to themselves. How is what I experience in my everyday life so different from the fat-shaming in NYT comments? Do I live in an alternate reality?
9
The reaction you see here is because the article seems to shame doctors who did not provide women featured what they wanted because they were obese. The fact is that such actions were the right thing to do as obesity is a pregnancy huge risk factor.
15
@Debbie
I've been fat. People won't say it to your face. Much easier to shame a stranger online.
1
The weight bias that women experience during pregnancy needs to stop. Too many health care professionals assume that losing weight will make everything better when someone's weight is just one piece of a large health puzzle (and it's not just pregnancy but almost anything else that goes wrong). Thanks for the well-researched insightful article that I hope will reach many health professionals!
1
Fat shaming continues to be the one form of discrimination that is socially acceptable. We all know thin people who have terrible diets and can eat all the junk food they want, sit on the sofa all day, and not gain an ounce. And heavy people who eat like birds, exercise daily, and cannot lose weight. Fat is not a character flaw! Smoking is the biggest cause of preventable deaths, but smokers are never harassed or derided by the public like fat people are.
My mother, who was very overweight, died after having a cancerous kidney removed. Doctor after doctor told her to lose weight and her back pain would go away; by the time her kidney cancer was discovered, it had spread throughout her abdomen. In the hospital after having her kidney removed, she complained of leg pain, and again it was attributed to her weight--she died of a blood clot that traveled from her leg to her lung.
Fat shaming doesn't just hurt people; it can kill them.
11
A doctor telling their patients that their weight is going to negatively affect their short-term and long-term health does NOT EQUAL FAT SHAMING.
Literally who else's job is it to look out for and help you improve the condition and wellbeing of your body, inside and out?
Yes some MD's are very callous and rude in their delivery of the message. But it is the job and duty of the doctor to inform patients of the risks that they are undertaking via certain health conditions.
Obese people do not have bigger bones, organs, etc than small people. They have pounds and pounds of extra fat on their body, fat which produces its own hormones, requires blood supply, and affects their cardiovascular and endocrine systems (along with most every other system) throughout their lives.
Pregnancy in obese and morbidly obese women is much more dangerous than in normal-BMI patients, and carries innumerable risks for mom and baby. THIS Is why REI's are being held accountable for getting very obese women pregnant.
The medical community never sets out to do things in order to "shame" people. They want to save lives and prevent deaths.
40
@jgilroy08 Shame patients? You are right - maybe none of these doctors tried to shame anyone. BUT I think the medical community can be callous - that is addressed in the article, really. Not being willing to talk compassionately with a patient about the impact of their weight is the piece missing in the puzzle. Doctors owe that compassion to their patients as healers. And those who don't believe so - well - they won't fulfill their highest, human purpose.
1
Body shaming by calling people fat is hurtful and usually unnecessary. On the other hand doctors and other specialists should point out the problems it entails. This article seems to want to suggest that the 'fault' lies with the latter.
5
The fact is that no matter what various pro-heavy posters assert, if you are majorly obese, you are subjecting the entire superstructure of your body to stresses it was not designed to bear. Pregnancy makes it even more stressful.
I remember having a discussion some years ago with an anti-smoking person. At the time I smoked and was making my usual disingenuous smoker’s defense of being in perfect health. He said “how many eighty year old smokers do you know?” I managed to name one. It’s the same with obesity. Denial. The body cannot easily take such punishment. Longevity is greatly compromised.
A large part of our society has abandoned the concept of calories in = calories out. Over-indulgence is de rigeur for millions of our fellow citizens and the results are right here, right now and don’t look to be leveling off any time soon.
15
@Anthony Taylor: as an erstwhile friend told me many years ago, "The American national pastime is denial."
https://emcphd.wordpress.com
3
@Anthony Taylor
Medical and science denial, willful ignorance, is behind the entire anti-vax movement. Sadly I see elements of this in this article and in the comments.
It would be far more difficult to write a balanced article, examining the complexities on both sides of this issue. The author took the easy way out, simply slamming the medical field for its maltreatment of obese people. A survey from 1952 was sited as the prevailing evidence that obesity impacts reproduction. What?! It is possible to care for obese people with compassion and still not ignore the fact that having 15cm of adipose between the epidermis and the fascia makes performing medical procedures and monitoring more difficult.
12
Let’s talk about women’s health....I am obese, yet have low blood pressure, normal cholesterol and blood sugars. I go to the doctor about a car accident, and they want to test me for diabetes and prescribe exercise.
In my twenties, i went to the doctor about sleep issues, and was told I was depressed. In my thirties, a nurse suggested a sleep study for apnea, however I had a much more serious disease.
Doctors don’t see a person, all they see is fat.
So I guess the moral of the story is if you want to get healthcare, lose weight.
9
@MRS I soooo indentify with you! All my numbers are good except my weight. I could write the same response as you.
3
@MRS There is more to good health than numbers. How old are you? How long have you carried all that excess weight? More than a couple of years and it is impacting your bones. Your knees or hips will go first and you will just say you have arthritis, with no acceptance that your long term obesity is the root of it. I work with an obese young mother whose legs are bowed at the knee from her weight. She will be crippled by 40.
4
Regardless for the reason of your initial visit, the government and insurance companies require all doctors to treat you for obesity, diabetes, smoking, drug use and other underlying conditions you may present with. If they don’t, they get cited and their reimbursements are cut. Similarly reimbursements are affected by treatment success rates and lowering the percent of patients who have underlying risk conditions.
These regulation are promulgated by the Federal Government through the Centers for Medicare and Medicaid Services (CMS). These rules, which have significantly impacted the practice of medicine and distorted the doctor patient relationship, are the cause of many of the complaints expressed by the commenters.
The patient profiled here went to a doctor who was "unsmiling" and told her to lose weight before trying IVF, medically sound advice. She does not follow the advice, waits two years to see another doctor, who offers IUI. The patient declines the treatment because the doctor is insufficiently sympathetic. Finally, she loses the weight, gets pregnant with IUI, and somehow blames the doctors who gave her the medically correct advice years earlier.
It is not "fat shaming" for a doctor to treat the patient who sits in front of him/her in accordance with best medical practice. It is not "fat shaming" to refuse to perform a dangerous procedure on a patient who refuses less intrusive options. The patient did not want to be reduced to one characteristic, but you do not get to choose which characteristics effect your medical options. I do not want my age to dictate my medical options, but it does. I don't blame the doctor for that.
28
@ML Yes, but it is simply wrong to deny patients the gift of compassion. Treat the whole of the person - not just the numbers on a chart.
4
Two issues.
First, the clinics get rated based on success. If they can prescreen to increase probability of pregnancy, they increase their marketable number.
Second, the statistics apparently support the notion that fat women are less likely to get and stay pregnant. See above.
Net - fat women are desperate to get pregnant, know their probabilities increase with less weight, but still stay fat.
16
@George That's all I was thinking as I read this. It seems pretty obvious that besides the other issues, the clinics are protecting their stats.
4
Baby proofing alert: is anyone else noticing the baby camera cord attached to the crib in photo of Gina Balzano and her baby? This is such a huge safety no no - it’s a major strangulation hazard. The camera should be placed at least 3 feet away from the crib or as recommended by the instructions.
12
I wish the article had addressed how African-American women of size are treated. My bet is that they are subject to even more scorn, condescension, and hostility than the fat white women described here.
10
Morbid obesity is a serious medical pathological condition of ill being. No morbidly obese person should subject themself or their potential offspring to the the risks of pregnancy. It costs all of us money to take care of the consequences of such risk-taking.
Find a way to get healthy. Then get pregnant. Keep the odds in your favor. This ain’t rocket science.
28
I've noticed several comments that exclaim over the huge jump in the numbers of people classified as obese after 1994; I've also noticed several comments exclaiming about what a lousy tool it is.
The article mentions that the BMI scale was officially adopted in 1995. Coincidence? Hmmm.
(Of course it's also true that all you have to do is look at crowd photos from 50 or 60 years ago to realize that people were indeed a lot thinner then. Remember Mama Cass, who was as famous for her fatness as for her voice? She wouldn't stand out in a crowd nowadays.)
11
....and Mama Cass died young.
5
I have PCOS. I’m 275lbs, 5’6”. And odds are I’m healthier than most. And I have the blood work to prove it. I eat better than most. But like my grandmother from the home country I am fat. Trying to be something I’m not made me unhappy and not surprisingly gain weight. Living my best and trusting my body I feel better than ever. I don’t have any health problems other than the infertility caused by my PCOS. More than once I’ve had “skinny” people who haven’t had a salad since Bill Clinton was on Arsenal Hall lecture me about “healthy eating”. It’s annoying and offensive. But I’ll outlive them all just like my Grandma did.
13
Weight is not a "prerequisite for motherhood". Proof of that is that nobody removes kids from obese mothers.
However, obesity IS strongly correlated with various failures to conceive by natural and by artificial means & to then bring a child to term.
These procedures generate lots of income for the MDs. They do refuse simply b/c a women is fat and offends their esthetic sensibilities. They refuse because the success rates *in general* are low and the failure rate for obese women is even lower.
BTW - In the photo of Ms Balzano in the article, she does not seem to weigh 317 lbs!
At 317 lbs, even without pregnancy there is strain on the heart, lungs, pancreas - everything!
Obesity is, all by itself, a set of difficult medical conditions that pregnancy only worsens.
Although not stated - I imagine that the Swedish women who lost 20 lbs and conceived at the same rate as the controls probably had complication rates closer to those of thinner women than to heavier women.
And .. what happens when there are serious complications? The patient calls a malpractice lawyer who sues claiming that the MD should have been aware of vastly increased risk and refused treatment that endangered the patient's health!
The oath to "Do no harm" is enough to justify any doctor's refusal to perform fertility treatments on obese women who do not exercise.
17
#1. Do No Harm, if you can avoid it.
#2. Do the best/most ethical thing for all parties, especially the not yet conceived baby.
I do sympathize with that desire in many women to conceive their own. I am a man and can't begin to share that emotion fully and, as a man who was brought into the birth of a child that I had firmly opted to not have, told that birth control pills were being taken (and they weren't), who contributed unknowingly to the creation of a child and lost so much because the created child forced me out of my professional long term occupation. The glee of the mother with being pregnant was the uproar of the former place of employment.
I can't adopt a Bill Clinton, "I feel your pain." That is not it. I can only say that there is a line between fulfilling your desire and doing a possible greater harm. Fulfilling your desire should not be at the expense of others. Selfless acts are often borne alone but selfish acts should not be glorified.
A very noted lady with a genetic disorder refused all words of caution from professionals that she had a good probability of passing that on to a child she wanted to conceive. She had the child & did pass that very heartbreaking genetic disorder on to the child. She later divorced the equally noted father. I do not know the rest of the story, but I do know that desire & vanity are often close neighbors.
Last, there are tons of ways to safely lose weight, making a winner for all. Obesity hurts everybody, even the unborn.
13
The reality is that children of obese mothers, and children of obese parents, have worse health outcomes than children of normal weight mothers and parents.
The chances that a child of an obese mother will develop diabetes are two to three times greater than for the child of a mother of normal weight.
The National Institutes of Health confirm that maternal obesity provides a major challenge to obstetric practices. "Maternal obesity can result in negative outcomes for both women and fetuses. The maternal risks during pregnancy include gestational diabetes and preeclampsia. The fetus is at risk for stillbirth and congenital anomalies. Obesity in pregnancy can also affect health later in life for both mother and child. For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621047/
Instead of arguing that obese and very obese women should be given infertility treatments so they can risk having defective or unhealthy offspring, anyone concerned about the health of mothers and children would instead advocate for exercise, good eating habits, and normalizing weight.
The ideal of a healthy mind in a healthy body should be a guiding principle. Instead the trend these days is to coddle and normalize every abnormality and pathology, making the nation a weak one of sedentary obese unhealthy people.
19
It's true that people who are obese suffer discrimination. It's also true that very obese people don't live to an old age. If you don't believe that, look around in your own world for very obese old people. The body positivity movement is empowering, but sometimes it obscures the inconvenient truth that obesity is inherently unhealthy.
24
A BMI of 50 is, frankly, mind boggling. If you have a BMI of 50 you shouldn't be challenging why you can't access IVF, you should be asking what am I doing to be at a BMI of 50.
Care factor, 0%.
35
On the flip side, I have known more than 1 woman who was told she needed to gain weight before receiving any reproductive assistance.
4
OBGYNs are always threatening everyone with death. Instead of telling you the benefits of getting a flu shot, they tell you what will happen if you don’t get a flu shot: you or your baby could die. For me, it seemed like they were always telling me I was going to die when I went to the OBGYN as if I wasn’t already stressed and worried enough.
I spoke to a doctor friend who explained OBGYNS are like this because obstetrics is the most litigious area of medicine and they are trying to protect themselves.
7
On-Gyn’s are in the most litigious medical practice. Part of the reason is because nobody ever thinks “it’s going to happen to me”.
When you have seen a few things in practice and do your due diligence to keep up with the latest research, it is your duty to discuss the facts with patients. Women and infants have died as a result of preeclampsia, uncontrolled diabetes, influenza that turns into pneumonia during pregnancy, cholestasis of pregnancy, lupus during pregnancy and multiple other things.
Get a flu shot because it prevents you from getting so ill you end up in the hospital unable to breathe except by a machine. It prevents the flu which can cause high fevers which are detrimental to you and baby. Get your TDap vaccine in your third trimester of pregnancy because it keeps you healthy and your baby will passively receive antibodies from you to keep him/her healthy before your baby can be vaccinated for whooping cough, which has a high mortality rate in affected infants. Maintain your blood sugars in a normal range so your baby’s organs will develop normally and your baby will not have difficulty breathing with an enlarged heart or abnormal kidneys. In addition, your baby will be able to go home with you from the hospital without a stay in the NICU on oxygen or having an IV to maintain sugars or receiving antibiotics.
If you don’t want the doctor to tell you worst of what can happen, follow every instruction and let them know you prefer not to be informed as to why.
The end game is to have a beautiful cherished healthy baby not simply getting pregnant. Obesity during pregnancy carries risks of premature birth, pre-eclampsia, stroke, blot clots in the lung and death. Quite frequently obesity with body mass indices over 40 literally squeezes oxygen away from the unborn baby as the mother sleeps. This risk should be presented to all obese mothers and oxygen levels followed across the pregnancy, especially in sleep. There are two patients.
18
@SC
I have no doubt all of this was explained to the people in the story; they just didn't want to hear it and that info was not included in this piece.
This is the thought process behind anti-vaxxers as well.
2
This is a sensitive topic.
As a physician, one needs to make sure, the patients understand... you are with them, not against them.
I did one year of Ob/Gyn and left it to come to CCM. But I do take care of complicated pregnancies in ICU, and obesity, not just bmi 30-40 range but morbid obesity (bmi 40 and above) is becoming common. Ask any ICU physician, we dread such patients. From general care, to intubations, to central lines, to anything we test or procedure we want to do... weight is a "major" constraint.
I think trying to get testing done, I've broken two CT scanners (because of heavy patients).
No one was happy with me.
More prospective research seeing outcomes of pregnancy in bmi above 30 is required. I do know a lot pf fertility physicians balk and cringe at any bmi past 30, just because of the weight, when workup reveals no evidence of a medical disease.
They are thinking of, what if things went wrong. It is a valid concern but also feel, it is cop out.
=> Two points to emphasis.
An average US female's size has gone from 10-12 range, now to 14-16 range.
It is a fact and a worrisome one.
Second, this fat-bashing culture, simply needs to stop.
Some folks do genuinely have genetics that puts them at risk, and some have diseases that make it difficult to loose weight.
But whatever the reason, when focus is on someone's weight, you deny them their inner being, their humanity, their self-worth.
19
After 4 yrs of infertility, this article has NO appeal to me! I don't have empathy for obese women to become pregnant-- they will be v limited in being able to be good mothers on a physical level.
If they want to conceive, simply lose weight.
15
As a physician involved in the care of many morbidly obese pregnant women, there are many health risks to consider for pregnancy. First is the pregnancy, often complicated by chronic versus gestational hypertension with pre-eclampsia often involved. Gestational versus pre-existing diabetes is often involved. Consequently, these women are induced for labor, sometimes before their due dates. Higher BMI women have a more difficult time receiving their epidural (difficult for me to feel the interspaces for needle and catheter placement), increased risk of airway difficulty in the event of an emergency c-section, and difficult time with delivery. This population also has challenges with basic monitoring in the labor suite: IV access is challenging secondary to arm circumference and size, blood pressure cuffs are often in-accurate due until the extra-extra large cuff is applied, beds that do not fit these bariatric patients, and most importantly, fetal monitoring is difficult because the contraction and heart rate monitors have limited detection secondary to the abdominal wall mass.
More women should receive counseling on maternal and fetal risks during conditions during pregnancy and these discussions should occur prior to conception. Included diagnoses for these discussions would also include morbid obesity along with congenital heart defects, organ transplants, etc.
17
Can we please figure out and treat the deep-seated psychological issues-trauma, stigma, etc.- that cause people to get fat in the first place? If diet and exercise were a solution, then we obviously we wouldn't have an epidemic!
19
@Sarah - Why do you assume it is psychological? Could it not be physiological?
5
I admit I haven't read the entire article but I have read many of the comments.
Obesity is a very serious disease which leads to many other pernicious symptoms.
Untreated I will shorten one's life. The desire to have a child is a legitimate one but if an individual doesn't care for oneself who will care for that child should they die.
There are many anti vaxxer parents who are fearful that their children will develop autism from being inoculated which has been debunked by research. My point is, could the rise be due to obesity?
4
Two points: 1) Fat-shaming is real!
I started pregnancy at a normal 130 lbs. I had severe pre-eclampsia which lead to a weight gain of 70 lbs. Having been part of the military my OB care changed at 7 months and again while in labor. I was treated awfully, worse than ever before in my life! When I returned 2 weeks after successfully giving birth and surviving, sporting 135 lbs I was greeted by two of the treating Physicians during labor with: I quote " Oh my god, you are not fat." I did not attribute the ill treatment I received during labor to my bodyweight but firmly believe it as the root cause in retrospect.
2) As much as it is wrong to judge a person on their size, it is equally wrong to expect Doctors to do harm, even potentially.
There is enough data on the increased risk associated with obesity to allow Physicians to make this call, especially because they will be sued if anything goes wrong, and they have to live with having harmed one or two persons.
As someone who nearly did not survive childbirth despite normal beginning weight, young age , and perfect starting health conditions, I feel it is imperative for women who want to journey into motherhood to work on optimal starting conditions for their baby even if that means shedding some pounds.
17
What is most concerning here is that some doctors do not attempt to determine if there are health issues BEFORE blaming the patient's weight. I have struggled with weight myself and have gone to doctors for things like plantar fasciitis and had the doc simply tell me I was too heavy. No inspection of the foot. Some people are lazy and prejudiced, and some of them are doctors.
9
Nobody wants to be fat. At age 67, I finally found a doctor who's a bariatric specialist who helps you lose weight, giving you appetite suppressants, menus that are easy to follow, and a full bloodwork analysis to see if your thyroid or other factors are affecting your ability to lose weight. Since the beginning of April I've lost almost 30 pounds. This is unprecedented for me. Why don't primary care doctors tell people about these specialists?
6
@Frequent Flier - Because they're quacks?
3
Obesity is a huge issue in this country. It is contributing to health care costs. Almost 42 percent of women are considered obese which means they have a BMI of more than 30. That is an epidemic.
That being said, it does not mean being overweight causes infertility. But being overweight increases your risk of gestational diabetes which increases the risk of preeclampsia and having a C-section.
Everyone should strive for a healthy weight to help avoid h although issues associated with obesity and being overweight.
3
As much as I wholeheartedly agree that every person must be treated with compassion and empathy, it is not responsible to turn a blind eye to the greatly increased risk that obesity poses in pregnancy. The medical literature is chock full of evidence that obesity is associated with every sort of complication in pregnancy. You need not take my word for it. Not that it is by any means the only factor, it is no coincidence that rising maternal mortality in the US has paralleled rising obesity rates. Can you imagine what it takes to do a cesarean delivery on a woman with a BMI of 60? This article does not begin to do justice to the concerns that OBGYN's have about obesity and pregnancy. Empathy is critical to the care of all patients, and especially so when caring for those with conditions strongly associated with one's self-image, but representation of physicians as merely cruel and judgmental and not genuinely concerned about the health risks the patient and her potential baby will face does a great disservice to those who wish to be parents.
22
Reading through this, I was surprised to see Letrozole was used for fertility. I took it for cancer. After surgery, chemo, and radiation, a couple of my doctors were completely adamant with me about the importance of maintaining a healthy weight, saying I should never gain as little as even FIVE POUNDS because weight gain is significantly associated with increases in cancer recurrence. I have thought a lot about this. When I was younger, I remember thinking the three actresses on The Golden Girls were all a bit heavy. Now they seem thin. Our perceptions are changing. I was at the park recently watching the children play. At one point there were 35 children. Sadly, fewer than five appeared to be within normal weight range. Using plus-sized models to normalize obesity is unethical. Being obese is worse than smoking, drinking, drug use, and poverty, for devastating and deadly health consequences. Everyone should be realistic about the extensive dangers involved. No doctor should hide this information or sugar-coat it. Obese women are at much greater risk for almost every negative medical or physical condition. Pregnancy is no exception. Any doctor worth his salt would have to consider this information, share it with the patient, and do nothing which would unnecessarily increase her risks of death or dying.
12
Obesity is worse than smoking? I suggest reading some casual research on the matter.
Surely, at least in big cities, there must be some fertility clinics with hospital admitting privileges, so that it would be possible to do all the preliminary visits at their office and then the risky part (egg retrieval with sedation) in a hospital setting.
Of course, setting this up and becoming the go-to provider for this population has the potential to lower that clinic’s reported success rates, so it would also make sense to let people know if they have lower odds due to weight, age, or other conditions, and then track the conception success rate for that group separately.
2
The key in those first paragraphs is that she was healthy! Blood pressure, cholesterol... bodies are different. I run thin, but my BP and cholesterol changed for the worse with age and weight - not what this article would call a lot of weight, but my doctor sure noticed. However, she started with the problems: the damage high blood pressure and cholesterol could cause, and the possibility that less weight would help those problems. All of this at under 180 pounds - for me, that turns out not to be so healthy. For another person, fine. Those are the indicators that count. And conception problems are not closely connected, by the sound of it. Cannot believe that the earlier docs didn’t proceed with IUI ASAP. Good piece. Sobering stats, honest.
4
Unfortunately, the current weight-focused paradigm and the pervasive creep of diet culture makes it difficult for clinicians and the general public to see beyond weight loss as a treatment. Weight loss is NOT a sustainable intervention, and in remarkably ineffective in reducing many health complications. Shifting the focus to behaviors PROVEN to improve health management and decrease complications is a FAR better use of time and resources. Many women told to "lose weight" have been trying to do so for years, and suffer health issues directly related to yo-yo dieting. Why compound that damage? Do better, using effective interventions.
We need to avoid prioritizing weight loss as a primary treatment goal and instead shift attention to improving health. People who experience weight stigma have a 60% increased risk for mortality independent of body mass index. The cause of this startling statistic is not a single variable but a complex interaction of misdiagnosis and misattribution of symptoms based on weight and a higher likelihood of being "prescribed weight management instead of necessary interventions for actual health conditions". Provide the same treatments and services to higher weight clients as to individuals in the lower weight range. I.E explore the benefits of eating balanced meals, consistent exercise, adequate sleep, less stress, or medication vs weight loss. The same regard and curiosity are needed for higher-weight individuals as for those in smaller bodies.
3
As a health care professional, I think it’s important to recognize the challenges here. We are seeing patients who are too large to fit into diagnostic scanners, too large to reliably examine, too large to safely anesthetize and too large to safely perform surgeries and procedures. Some of them are bed bound due to their size, and their nurses are at higher risk of physical injury trying to simply turn them. Often it is hard just to read a simple chest X-ray for the obese patient. And yet it seems that the expectation, physician to physician, is that somehow the súper morbidly obese patient should be managed the same as any other patient. This article seems to reinforce that standard to the lay public. My position is that the extremely obese patient has a serious co-morbidity and sometimes their best care is NOT the same as it is for a normal size or even just obese patient.
That being said, the women pictured are beautiful and it’s wonderful they were able to have children. The issues of managing a hugely obese (and advanced maternal age) patient through fertility treatment, pregnancy, and delivery must be very challenging. And then people want to know why our infant mortality is higher in the US. Go figure.
13
IVF pregnancies already have greater statistical risk than a spontaneous pregnancy and frankly we don't know why. (So we shouldn't be comparing outcomes of obese women who had spontaneous pregnancies to IVF patients.) Then complicate that with factors like advanced maternal age and weight. Fertility doctors in America often can and do transfer more than one embryo (especially if the patient wants twins) which explains the twin and triplet phenomena seen in many major cities and in certain elite neighborhoods like in Tribeca where multiples are everywhere! But, some doctors, especially younger ones , are really trying to get women to better understand the risks of carrying multiples. The fertility business is big business as in these doctors earn way more than the average doctor and as others have stated, none of these doctors would turn a patient away unless it was absolutely deemed as something unsafe. I should also add that often patients with very high BMIs have to spend more money on the medication because they need more of it in order to have an adequate hormonal response. The article should have included more interviews and data from MFM doctors who primarily work with high-risk IVF patients in the major cities like San Fran and NYC. I enjoyed reading it, but think it missed some major differences between IVF and spontaneous pregnancies.
7
As an obstetrical anesthesiologist, I care for women both for IVF and in Labor and delivery and cesarean sections. In spite of the best informed consent, it is difficult to convey what the risks can be to carry a pregnancy and to go through the delivery process, especially in the setting of morbid obesity. Previous writers have commented on the increased medical complications. When caring for such a patient in Labor and Delivery, I warn my obstetric colleagues that if any surgical intervention is needed, to act early and give me enough lead time. With a patient of lower body weight, the anesthesiologists in my center can typically administer a spinal anesthetic within 2-3 minutes. This can be very difficult in morbid obesity when the spinal space can be difficult to find. Every other aspect can be difficult as well: placing intravenous lines, getting an accurate blood pressure reading, and especially endotracheal intubation when inducing general anesthesia can actually be life-threatening if not accomplished immediately on the first attempt. Keep in mind that these represent increased RISKS, not absolute certainties. We successfully care for these patients on a regular basis, however when other recent articles report the deplorable rate of maternal mortality in the US, this is a possible contributing factor. Pregnancy and childbirth is usually a joyful process, but the risks can be life-threatening. There is a place for compassionate counseling at the start of the process.
25
One point in the article is that it is very difficult to lose and keep off weight, which is true. But there should be more attention to how easy it is to maintain a healthy weight along the way in life, barring serious injury or illness. Sure, to drop fifty pounds and keep it off is tough, because the metabolism slows down if you do so by cutting a lot of calories. But why let the situation get that extreme? There are countless health problems associated with BMI over 25, let alone 30. Yet, a reasonable diet and daily exercise, cutting out calorific drinks and snacks, should maintain a healthy weight throughout life. If, you say, exercise isn't keeping off the annual weight gain, then I ask, why not exercise more? Most people on an exercise program do the equivalent of much less than 20 miles per week (3 miles per day). Gradually double it over time and see what happens.
5
BMI does matter. It makes getting pregnant and having a safe delivery more difficult. The problem is that even with proper counseling if something goes wrong (which is more likely in higher BMI patients), patients may blame the physician for not properly informing of the risks. Not saying this thinking is correct on the physicians part, but defensive medicine is a thing.
7
I wish more people who are unable to reproduce - for whatever reason - would give adoption some thought. I frankly always wonder about the mental state of women who would "cut off a limb to have a baby" - what is it about their notion of self-worth that drives them to such extremes? I'm a healthy, married, heterosexual female who came from a decent Midwestern background and, as a genealogy hobbyist, am as committed as anyone to the broader notions of familial context and the strong evolutionary pull that informs blood ties, but I never felt that being childless by choice somehow marked me as some kind of freak. Had I wanted children and couldn't conceive, I would have adopted. Simple as that. There are SO many innocent children in this cruel world who deserve the care and unconditional love I got from my own parents - giving those to a child, regardless of whether the child is yours biologically, is what real parenting is about, it seems to me.
631
@Sarah
That's a reasonable question. When I was going through IVF (and felt like I would have cut off a limb to have a baby), I did do a lot of research on adoption. I could care less about sharing DNA with my child. However, I was married to a man who did not want to consider adoption. And I did a lot of soul-searching and deep thought, and concluded that as much as I wanted a child, I did not want to be a single parent. Knowing myself, I did not think I could give a child a good life trying to go it alone.
49
@Sarah
I do think we as a culture overall would do well to expand our notions of family, but adoption is not always as simple as it might sound. It can be very expensive, possibly more expensive than IVF (after all, no insurance covers adoption), and requirements about couples' finances, jobs, time at home, health, age, etc. can be very strict. I know someone whose brother was adopted, and this was about 25-30 years ago, but their mother felt she had to quit her job for their family to be seriously considered. Depending on location, it may be quite difficult for queer couples to adopt, or older couples. I do think more people in general, whether they have other kids or not, should consider fostering and then adopting older children if they feel able to, but that's also very different than raising a child from infancy/toddlerhood, and I don't think it's fair to disregard the desire for that experience just because a person can't have a child in the conventional way. We don't really, as a culture, judge fertile couples for not adopting, even though it's really the same thing--desire for a biological child--animating the behavior in both cases, it's just easier for some to fulfill that desire. I think, though, it is a question all hopeful parents should ask themselves.
126
@Sarah I don't think that people don't consider adoption, I think that adoption is not a fit for everyone, just like motherhood is not a fit for everyone. Where I live IVF cost me about $5,500 while adoption would have cost me closer to $25,000. IVF gave me a 50% shot each cycle, while even after 18-24 months going through adoption many people are still childless. This also doesn't address the issue that many adoption agencies (specifically foster to adoption through government agencies and adoption from other countries) will not allow you to adopt if you have had mental illness in your medical history. For someone like me, who suffered from terrible depression 10 years ago after a sexual assault, I was told I would have extra hurdles (and extra fees associated with them) if I wanted to pursue adoption and I might still be denied. Fat people face stigma and shame in everything we do, which includes adoption. An agency is making a decision on if they think you are a fit parent, and that includes medical history. This is just another opportunity for your "poor health" to be used as a reason to deny you.
I think for most women who want children it has almost nothing to do with wanting a child that is biologically their own, or feeling less than or like a "freak". It has more to do with what works for them.
127
Doctors should absolutely not consider BMI, especially for women, a marker of whether someone is obese. I have a BMI of 30 - that is considered "obsese" and some of the doctors in this article would refuse to treat me. But I am a weight lifter who wears a size 6 - muscle mass and bone density are not taken into account with the BMI scale. It is also a measurement that was designed for men, and does not take into account larger breasts and hips of most women. If a woman is dealing with other health complications due to obesity - high blood pressure, diabetes, etc - I could understand a fertility doctor having concerns. Otherwise, this is absurd. Also, there is a strong correlation between poverty and obesity - the slightly higher number of stillbirths among larger mothers is likely more due to a lack of access to high quality medical care than excess weight.
159
@J
Great points!
15
@J
Nobody with a BMI of 50 is that size because of muscles or big bones. A BMI of 30 is above “average “ but not even close to morbid obesity - it’s probably at or below the American average at this moment in time.
69
Ever looked up pregnancy, diabetes, and the lives of abnormal birth weight infants?
It’s most instructive.
5
3..2..1....Here come the fat shamers, the perfect people with the answer to everything, the body police...
146
@Againesva Talk to medical professionals who blow out their backs trying to move sick patients who are much bigger than they used to be. Talk to the four firefighters needed to carry one of my relatives out of her apartment. She was in crisis and needed much longer to get to the hospital because she was so hard to get down the steps of her own home. How about another severely obese relative who had preeclampsia AND gestational diabetes and had to deliver her daughter two months early? The child was in the NICU for weeks and has premie-related developmental problems, and now at age 10 is getting raised on a daily diet of fast food.
I'm not saying that there aren't a mix of factors in each patient's situations, but crying "fat shamer!" isn't helping anything. When I see people who can barely walk down the hall at work, something you didn't see 30-40 years ago (look at yearbooks if you don't believe me), it's just sad.
132
Body positivity certainly isn’t making anyone thinner. Maybe we are tired of getting squashed in airplanes and other public transportation by the obese. Maybe we are tired of getting pushed out of the way in line by someone who is large. Maybe we don’t want to pay the additional health care costs. I truly wish those of you who are heavy could lose the weight, but you aren’t helping yourself by thinking it doesn’t impact the rest of us.
76
... the people who say "adopt instead"...
7
How about considering that the fertility problems and the excessive weight are both symptoms of an underlying endocrine problem? Note the irregular periods. PCOS is one such problem. People with pituitary or hypothalamus issues often have complex symptoms result. Women with them find fertility impaired. And medicine is not very good yet at knowing how to balance the complex interplay of hormones.
Not all obesity is simply a matter of eating too much. I suspect that most of the BMIs in the high 40s and above are much more complex and not the "fault" of the person with the problems.
194
@kgrodon Yes, yes, yes! I do not understand why none of these physicians investigate whether the two symptoms (obesity and infertility) are part of the same syndrome. It's infuriating. People are fat for different reasons. Often it's a hormonal problem.
66
@kgrodon Yes! Thank you for saying this. I was actually really surprised the author didn't mention PCOS or something similar in the article. It seemed like a huge oversight from the doctors quoted here not to consider that the weight and infertility were symptoms of a larger problem - a problem no amount of diet and exercise would solve.
45
@kgrodon and everyone in this comment thread. PCOS occurs mostly from unopposed estrogen produced by adipocytes in peripheral tissue! This root cause is still obesity, and all of these doctors clearly understood this.
40
Funny thing - I joined Overeaters Anonymous before trying to get pregnant at 26. I lost 100+ lbs in 12 months, and couldn't, couldn't, couldn't get pregnant. I was 30 when my husband and I finally got to the reproductive endocrinologist.
The doc said that part of the problem may be that since I had such a large weight loss, my body was essentially trying to figure things out. He said it was good that I lost the weight, but the body reacts to big changes in all sorts of ways.
Honestly, infertility is so complex. Trying to pin it on one reason seems foolish at best, dangerous at worst.
This is a great article.
187
@EP
Thank you for sharing your experience, strength, and hope.
6
Well thank you, Dr. Meyer for the lovely quote regarding husbands being thankful you spoke to their wives about THAT! I was very fortunate, at a large size, to be able to conceive and carry two beautiful children to term. I responsibly taught them about food. Both are "normal" weight, and one is a nutritionist. Have I adequately redeemed myself or should I lose another 20 pounds?
Talk about "incandescent rage."
114
Totally agree with you about Dr Meyer’s comments. Disappointing that it doesn’t even register how condescending the husband comment is.
50
@JacquieM, ugh. He sounded horribly condescending and 'I'm always right" even before that. I feel sorry for his patients.
23
If you are heavy every time you go to the doctor for *anything* someone helpfully points out that you are overweight, as if you hadn't noticed, and suggests that you lose weight "for your own good". (It's always for your own good.) After I had gastric bypass and lost half my body weight the body shaming stopped cold.
When I was in my early thirties, at 240 pounds, I got pregnant. I went to a freestanding birth clinic run by certified nurse midwives (they were RNs). They were women of size themselves and treated me like any other patient. They delivered both of my children. There was a mandatory visit with a consulting OB/GYN, who when I asked him if the baby was head up or head down, said "how am I supposed to tell with all that fat in the way?". (The head midwife was furious.) Size or not I never had any complications in either pregnancy and both babies were delivered by her. In the end I gained 18 pounds for an 8lb, 11oz baby. Two years later I gained 36 but had a 9 lb, 14oz baby. Both times all of the weight came right off and took me back to 240.
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@Susan
They tell you that because it is their job. It IS about your health. It IS not healthy to be overweight. Confusion between medical facts and you feeling picked on shamed by being told so. One maybe is heavy as they like. Not my business. Does not change the fact that it is not healthy to be too overweight for too long. People are rude agreed. That is a different thing.
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@Susan
If a doctor tells a patient they are overweight or morbidly obese and refers them to nutritionist, that's not "fat shaming."
Being at a a healthy weight (and I would argue being in good cardiovascular, aerobic and anaerobic shape) is indeed for "your own good." But even more than that, people who are morbidly obese and make no effort to change their habits are a drag on the health of everyone else due to significant resources spent on diabetes care and medicine, heart surgeries, etc.
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@Bob Lob way to ignore what the doctor actually told her. That wasn't a medical opinion - that was unprofessional and insulting.
50
At 225 pounds and 5'6", I had no problems with conceiving or delivery of 4 very healthy, term babies. When, at 38, after head trauma, I began to miss periods, my female ob-gyn immediately blamed my weight and said I needed to join weight-watchers. My husband, a physician, ordered an FSH level which indicates the probable onset of menopause. Mine indicated this was indeed the case. When I called to tell her that my levels indicated I was in early menopause, she replied, "Well, how could I tell you when I didn't have the results back?" I told her she didn't order the test, my husband did because all she could focus on was my weight.
According to my physician husband, blaming one's weight is a lazy approach to medicine and indicates a very poorly trained physician.
My thin, 115 pound mother also went into menopause at the age of 38. No one blamed her weight.
325
@Karen Is your husband sure it’s menopause and not hypopituitarism from traumatic brain injury? It’s been a while, but FSH goes up if the pituitary injury is bad enough from said trauma.
He’s right about obesity-shaming in medicine.
9
ADDENDUM: Ignore my statement. I misread your post.
5
@Karen Obesity is linked to early menopause (primary ovarian insufficiency, POI) so it's possible that obesity and genetics contributed to POI.
13
Let’s be kind and compassionate. Yes, a healthy weight is best. However, not everyone can be a perfect size.
I have struggled with my weight since my 30’s, I’m in my sixties now, and though I am still about 20lbs, too heavy, I have accepted who I’m and whom I was created to be. Health is crucial, weight is a number, not all thin people are healthy! Several of my friends have died who would have been considered much healthier than I.
There are no guarantees, be kind.
145
Finally, common sense and a dose of reality, rather than profit.
3
@Mari
Remarkable statement - "weight is just a number".
It is not.
10
@Mari
This is NOT about "ideal weight", cosmetic thinness, or being a size 14 rather than a 4. These women are morbidly obese.
There is a mountain of evidence connecting severe obesity with poor maternal and infant outcomes. We'd be quick to criticize a woman smoking a pack of Marlboros during pregnancy, why is this different?
The US is the fattest developed nation on earth, by far. The impact on our health system is significant. Yet articles like this seem to be determined to make the obese a "protected class."
27
So fertility clinics are reluctant to deal with obese mothers who want to become pregnant? I’m sorry but in the larger scheme of things that’s no biggie.
24
@Jay Orchard - :)) What is the emoji for "wiping the spewed coffee off of my monitor from laughing so hard" ?
9
Interesting article. Somehow they missed the point that hyperinsulinemia causes PCOS, which causes infertility. Hyperinsulinemia is also a root cause of obesity. Clinics that don't deal with the root cause of hyperinsulinemia will waste patients money and expose them to all kinds of drugs (and side effects) that have a much lower chance of working. That's no reason to be unkind, however.
18
Doctors follow their own standards which would include warning any woman of the risk of pregnancy and childbirth. Childbirth is one of the most stressful acts the human body can perform. People who are seriously overweight should consider the risks of bearing a child to their health and their children's. Medical science can't fix everything. It can help someone conceive. Whether that is a wise choice is up to the mother and her family, not the doctor. The OBGYN is responsible for explaining the risks of child birth to any mother based on her physical condition at the time. Obesity is a risk factor as are many other medical conditions. Obesity is a chronic, serious medical threat because of the harm it does to the body. Cautioning someone about the damages to physical well being isn't a judgement about appearance, it's an assessment of health.
10
If there were no BMI cutoffs, I could easily see a NYT Magazine piece on complications suffered by high BMI patients the money-hungry fertility clinics callously took on as patients despite their high risk.
24
Hmm. So in the end, she didn't need IVF at all (after she had lost weight; not saying that necessarily was the reason, but it should be mentioned). She got pregnant using a quite low-tech method - something that the second doctor involved was willing to do, but that she turned down herself because she didn't think it would work.
So the bottom line is she conceived after losing a lot of weight, by the good old turkey baster method.
A sample size of one is too small to say anything, obviously, but this certainly doesn't seem to validate the idea that the other doctors were wrong to refuse to give her IVF at her previous weight.
26
Many years ago I took care of a morbidly obese post partum patient. She was so overweight that she didn’t recognize that she was pregnant until she went into a pre-eclamptic hypertensive crisis. After which she was emergently delivered of a relatively healthy infant by C section. She then went into post operative intractable respiratory failure and was in the intensive care unit on a ventilator for several months until she so sadly passed away. Her weight was the main contributing factor in this tragedy. The issue of obesity is much more significant than hurt feelings.
49
“'There’s a lack of recognition of evidence that shows you can be healthy and still have a, quote-unquote, unhealthy B.M.I.'”
I'm sorry, but you can't be healthy and a 317-pound woman at the same time.
32
@Mike This is the crux of it. People think there's no difference between being 20 lbs overweight and being 150 lbs overweight.
7
Every morbidly obese person I have known, with one exception, has insisted that he's in perfect health. Remember what Chris Christie said to David Letterman, and thus the nation: “I’m like basically the healthiest fat guy you’ve ever seen in your life.” And then Christie underwent bariatric surgery.
People can lie to others, but simply cannot fool themselves.
Back at the age of 50, through diet and exercise, I took off more weight than my wife has weighed as long as we've been together. It was the best thing I ever did for myself, and I have kept the weight off, but medically I am paying the price for those lax years.
There simply are no healthy obese people. None.
https://emcphd.wordpress.com
29
I'vw completed 100's and 100's of hours with an internal medicine provider (preceptor) in a family nurse practitioner program, and I agree wholeheartedly. It's also noteworthy that you don't see many elderly, morbidly obese people walking around town. It's just a fallacy.
8
I’m not moved by this story. When you enter into fertility treatment, you should be as healthy as you can possibly be, for the sake of the baby (or babies) you are creating. If that means losing some weight, why not do that? If you are not willing to put in the effort for a healthy pregnancy, maybe you should rethink making a baby. Babies require commitment.
As for the cold doctors and the “have more sex” advice, no surprise there. I got the same insulting attitude when (back in the 1990s) I asked a (female) Ob/Gyn to do a fertility workup on me. Women often know when something is not right with their reproductive system. I knew. I was disbelieved and disrespected. And I was a very thin, extremely healthy and athletic woman in my 30s at the time. So it’s not just morbidly obese women being judged and dismissed. Doctors can be jerks. No surprise there.
24
I believe these clinks are private institutions. Thay can choose to deal with whomever they want to. Iti s not the NY Times business who they deal with.
9
Do you really believe that only government funded organisations and their practices should be reported on? Wow. I can't agree that there should be no discussion about what private organisations do. How scary would it be if they could do whatever they wanted and newspapers were not supposed to report on it.
1
A BMI of 50 for a woman is a 98th percentile body size. Only 2% of American woman are bigger. This is an extreme situation, not the run of the mill person carrying a few extra pounds An extreme body size such as this precludes nearly all prenatal screening, makes conventional care during labor impossible (fetal monitoring), and increases the rate of every pregnancy-related complication. The fertility doctor would have to be mad to provide assisted reproduction in this situation.
Yet, when the fertility doctor is pushed to go ahead in this ill-advised situation and the patient dies or is injured from a
pregnancy-related complication or, even worse, there is a poor fetal outcome who, may I ask, do you think is portrayed as negligent in the aftermath? Why, her doctors, of course.
579
@Drevil, thank you for that. I agree one hundred percent.
43
@Drevil:
speaking as a former Labor and Delivery RN, this is totally untrue.
Monitoring can absolutely be done on very obese patients and they can have a healthy labor and delivery.
Of course, if they have pre-existing conditions (like anyone of any weight) such as uncontrolled high blood pressure or poorly controlled diabetes, there are more and other problems, which, again, can happen to anyone of any weight.
19
@Drevil
Who died and left you the oracle of maternal and baby life, disability and death. Some 43 years ago, when I gave birth, I too was fat and a smoker. Our baby weighed weighted 8 pounds 11.25 ounces and appeared screaming with an APGAR score of 10. Back then it was smoking, that was the horror which would cause premature births. That song and dance is still sold today. While do not believe that smoking is good for you, during pregnancy, its what you eat that counts more than a cigarette.
I was obese and gained a grand total of 20 pounds during that pregnancy. I carried my baby to term. and actually a little beyond. I ate sausages, red meat, a gallon of milk a day, chicken, fish, cheeses, 100% whole wheat bread, and fresh veggies and fruits. I also took vitamins, minerals and brewers' yeast, lecithin, Vitamin E, C and calcium. I ate absolutely no garbage. Garbage being fast foods, for example, cakes, pies, fried foods [that I didn't make myself], alcohol, and anything that caused my mouth to feel as if I ate something very sour.
Our little one is 43 years old, 6 foot 3 inches and while in my belly, he ate all the foods that I ate. According to him today, he claims 'its what we do'.
4
I went through successful IVF 20 years ago. I came away with an impression about IVF clinics that I didn't see in this article, and that is that the clinics have a business incentive to exclude any type of patient who statistically has lower odds of IVF success. Their success rates are a selling point to potential patients.
I would guess this is a factor with BMI, supported by the statistical data reported. It is certainly a factor with age - most clinics have a maternal age limit, even though some women above the cut off could have successful IVF.
32
Exactly. Two themes run through this article - sexism and financial business success. They aren’t protecting or truly seeing the patient’s side. They are protecting themselves ! I have known many higher weight women who had babies just fine. And I have know many normal weight women who had multiple miscarriages before they had a successful pregnancy. As a higher weight older woman, doctors always expected me to be to be on multiple meds and have multiple conditions. They were ALWAYS wrong. No illnesses or conditions whatsoever. No meds necessary at all. Doctors are not geniuses. Many are businessmen first and doctors second.
4
As an anesthesiologist who works in a fertility clinic, I am a gatekeeper for obese patients desiring IVF. For BMI 30 to 40, we examine the patient and make a determination. Over that, no dice. Egg retrievals can require significant sedation, and they take place in isolated clinics in suburban strip malls. I am not willing to manage a possible airway problem in a massively obese patient in that setting, with no help available. In general, there is an upper limit for BMI in outpatient surgery centers, and fertility clinics are no exception.
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Isolated clinics in suburban malls seem a very odd place to do these sorts of medical procedures. Wart removal, maybe, but egg retrieval? Is this to save costs? You are saying that if anything went wrong (and let's face it, even a "healthy" person can have an adverse reaction to sedation) you wouldn't be in a good position to deal with this. This is frightening. For the sake of patient safety (not to mention equitable access to care in the first place) it seems to me that your American medical system seriously needs reform away from a competing business based model.
4
It’s all about a clinic or doctor’s live pregnancy and live birth success rates. I sought the assistance of a few fertility clinics before I had eventual success with my boys. At first, they were eager to take me as a patient. I was 31 years old, looked like I had a high number of eggs relative to my age, and had a BMI less than 20. But I had PCOS and was not ovulating. The standard cookie cutter fertility treatment should have worked given my age and health. After several IUIs, eventual I.V.F, and about 7 miscarriages, doctors were much less eager to take my case as every failure diluted the clinic’s success rate. What I found is that fertility clinics don’t really deviate from the standard procedure. They have a formula and they stick to it. They are less interested in figuring out why you might be infertile and treating the root cause in the hopes that it would improve your odds overall.
12
They are businesses first.
1
Medicine is difficult. Doctors make decisions every day balancing the potential risks and benefits of a procedure, the likelihood of the procedure being successful, and whether it makes sense to go forward. This is made both easier and more difficult with a procedure, like IVF, that has no physical risk associated with its deferral (although of course the psychological impact can be substantial).
I would agree that one-size-fits-all exclusion criteria and insensitive bedside manner are rarely good medical practice. But body mass does have effects on ovulation, fertility, and the success of IVF and pregnancy, as well as increasing the risks of procedural complications. To assume that all refusal of initial IVF is due to weight discrimination is an oversimplification.
15
Medicine is a business, read that profit & loss statements. The patient is not first and their list.
1
An article about people who care less about statistics and more about making themselves a victim. The doctor does not take patients because of risk. They are required to go by certain guidelines designed by researchers. If a patient is considered risky by a doctor he or she should go find another doctor who doesn’t follow guidelines as religiously, they don’t need to write an article to fulfill their victimhood.
Being 300 pound and 5’5” is just straight dangerous and by guidelines would classify them as having metabolic syndrome regardless of their cholesterol or sugar levels. This woman is negligent and I would feel terrible if their child was born with disabilities because of her weight, so would she.
41
Until you can get pregnant, Gregory, run along.
16
@Curiouser This is reductive. Men can be informed about fertility issues and have opinions too. Speaking as someone who can get pregnant.
7
I thought they had stopped telling people they were too fat to get pregnant. In my younger years they routinely did that, but judging by the number of hugely obese pregnant women and mothers of infants I routinely see in New York City I just assumed they had decided to stop, perhaps because it would be challenged with charges of racism (at least here in NYC).
9
I have to recall the late Ellen Peck's "The Baby Trap"* and paraphrase: what *is* this genetically narcissistic obsession with getting one's very own zygote going?
*ISBN-10: 0523009038
*ISBN-13: 978-0523009032
11
This is a fascinating piece. The ethics involved are complex, obviously.
Beyond motherhood though I'm concerned that American women have such a high rate of obesity, which used to be relatively rare - very rare when I was kid in the 1950's, and now it's over 41%!
That is shocking and we need to figure this out.
214
@Sophia Figure it out? It may be unfathomable. But if there is virtue in tolerance, then we should acknowledge to possibility that ir is all a matter of genetic drift.
6
@westernman
Of course it is not genetic drift. It is behavioral changes that affect all of us. Obesity is increasing, diabetes is increasing, end stage renal disease is increasing, all because of increased consumption of calories. It has little to do with genetics and mostly to do with the mismatch between our diet and what is actually health promoting food. The Western diet is poison to most humans. Let's be tolerant to people of size but we shouldn't stick our heads in the sand and pretend there is not an obesity epidemic and that there are not actions that could change this.
31
@Sophia:
Fast foods, hormones fed to animals to increase THEIR size, and lack of normal day to day exercise (such as climbing stairs instead of using elevators or walking to go shopping).
20
People don't understand the multitude of risks that obesity carries in pregnancy. For patients who are morbidly obese, pregnancy carries an increased risk of pre-eclampsia, blood clots, diabetes and subsequent still-birth risks, birth defect risks. Morbidly obese patients have increased rates of dysfunctional labor and should they require a Cesarean delivery, it can take significant time to deliver the infant safely given the abdominal and visceral fat present. They are at increased risk for injury, wound infection and blood loss, both with vaginal deliveries and Cesarean deliveries.
It is one thing to provide the best care to a patient who is obese and became pregnant spontaneously, but entirely an other matter to compel a physician to make someone pregnant when it could put the patient's life at risk.
309
@odysseus There are many conditions that can make pregnancy difficult. Only the obese get picked on - the rest are heroes.
16
@odysseus Westerman is right.
People of any size can have all of those pregnancy risks.
And if you read the story, you will note that even if some risks are "double," they still may be quite rare.
Meanwhile, I have read an epidemic of bloggers who have fertility problems. All the ones I've read are thin.
Has science actually studied this recently.
Most of the people with problems I know are thin or average size.
9
@odysseus And, yet, we rarely see those problems in women who are supported by Traditional Midwives.
We need to ask why medicalized births cause more problems on all levels with too many women.
3
Where is the justice in spending $45,000 to get a single woman pregnant, covered by insurance to socialize the cost of a pregnancy? Regardless of her weight.
What possessed states to require insurance premiums to be increased to provide a benefit that does not improve a woman's health? How many people are unable to afford insurance, of for whom the taxpayer has to cover the cost, because the highly paid fertility industry has "lobbied" the state legislatures to make it "essential?"
Is Medicaid required to provide fertility services?
169
@ebmem - "Is Medicaid required to provide fertility services?"
I just checked their site and they do not cover any fertility services.
26
@ebmem, the coverage bothers me a great deal, too, but for me it’s because fertility treatment is entirely an optional thing. It’s not a health problem. It’s not life or death. It is as optional as plastic surgery. But health insurance coverage is unfair in many areas. Viagra is covered, for instance.
My health insurance package covers some fees associated with adoption, btw. I guess they threw that benefit into the mix to balance out the coverage for fertility treatment.
11
I work within the public health system as a GYN provider No fertility services are covered under Medicaid other than some basic lab work. Our folks are referred out to pay out of pocket.
11
If a physician is taking you into their specialized practice they determine whether or not they can get you through the entire procedure safely. Pregnancy and childbirth can be fairly dangerous to a woman's life. If your BMI is over 40 and then you get pregnant, Labor and Delivery can be extremely complicated. Your likelihood of surviving without suffering a fatal complication increases dramatically. That baby is going to be more difficult to deliver safely because of your size. You have to undergo an anesthetic and recovery period that is much more complex. If you become pregnant without fertility treatments everyone just takes the risk and hopes for the best. It's really unfair for you to expect multiple physicians to take on the risk of attempting to get you to term and through delivery safely if you don't meet the criteria that indicate safety. The man who implanted 8 embryo's into Octomon did so irresponsibly. This is similar.
223
@Sasha There is a subculture of large/obese women utilizing Traditional Midwives. Complications listed in these comments are extremely rare among them. We need to ask why.
2
@Sasha, I was thinking about Octomom, too. The same patients who expect a doctor to take on excessive risk will be the first to sue when there are complications with the birth. I know surgeons who will tell patients to lose weight before surgery that is not time sensitive. Nothing wrong with that, since it’s for the good of the patient. Why is fat so political when it’s large women we are talking about?
A Japanese woman I know was told — bluntly — by her doctor (in Japan) that she was too fat to get pregnant and should wait until she lost some weight before even thinking about having a baby. (The woman was plump, but not remarkably so.) That doctor’s admonishment was way too harsh by US standards, but I think that here we have swung too far to the other side of PC medicine.
13
@Sasha:
Yes, the "octomom" doctor was totally unethical, criminally so.
BUT, as former Labor and Delivery RN,
monitoring can absolutely be done on very obese patients and they can have a healthy labor and delivery.
Of course, if they have pre-existing conditions (like anyone of any weight) such as uncontrolled high blood pressure or poorly controlled diabetes, there are more and other problems, which, again, can happen to anyone of any weight.
5
Yes, it makes sense. Obesity, especially among young females who seem to be the most obese, is the number one health problem in America. Listen to the doctors who individually treat prospective mothers.
Have you seen any doctor turn away a potential patient who's care could mean thousands of dollars? No doubt, there is a justifiable reason in each case the clinics refuse.
88
These clinics are very concerned with their “success rates.” They need high success rates to keep the money flowing in. These are not simply altruistic clinics helping couples realize their dreams. Don’t think they aren’t weighing other factors here along with health, and the science on this doesn’t sound conclusive to me.
8
@Pam Thomas Don't you want your doctor to be concerned about the "success rate" of any procedure that he or she performs on you?
8
@rl Number one health problem? Only among young women? Come one....no way.
7
The main subject of the article appears to have turned down less-invasive fertility procedures that were offered, only to have those same procedures work years later. Why is this the medical profession’s fault?
32
@TM
Years later...after she lost a bunch of weight. Hard to say whether that ended up being relevant or not. But it could well be the case that the reason she has a baby now is precisely that those heartless doctors told her that they weren't willing to do IVF until she lost weight.
15
I love that we're so PC now that a physician can't tell a fat person that they may be too heavy for a particular procedure.
Can a doctor tell a smoker that smoking is unhealthy?
Under Trump, doctors can't tell women about abortion options.
...the right and the left have totally lost their minds.
61
I’d rather err on the side of kindness.
3
@Mari I'd rather err on the side of safety - for both mother and child.
32
Stanford established the BMI. Rather than looking at the underlying science, it has been adopted widely and pronounced as the "standard". Poppycock. When I was pregnant, doctors told us not to gain more than 15 pounds. Why? Because pre-eclampsia was easier to spot. Later, "studies" showed that the fetuses were starving. Do NO Harm. Doctors who shame women do harm. This article shows another area where doctors harm patients psychologically. Insurance companies control their practices. More articles like this would help keep both insurance and medicine honest.
24
@Kathryn
I don't believe you when you say a doctor recommended you only gain 15 pounds. Why? Were you given a valid reason? It has never been a recommendation by OB/GYNs.
13
They were books published in the ‘70s saying gain no more than 20 pounds! I gained 30 and lost it within a month no problem.
6
@ach - For overweight women, that’s actually normal. From WebMD: “A woman who was average weight before getting pregnant should gain 25 to 35 pounds after becoming pregnant. Underweight women should gain 28 to 40 pounds. And overweight women may need to gain only 15 to 25 pounds during pregnancy.” Google it yourself and you’ll see that she is not in fact lying, as you claim.
8
I am against fertility clinics so let's make those illegal. Then this is a mute point.
8
@RCJCHC: moot.
21
I have three children that are the result of an amazing fertility clinic. I think your statement is ignorant and rude.
10
@Rev. E. M. Camarena, PhD Yes, five seconds after I typed it in my current state of exhaustion, I realized that. Thank you.
2
I've always been a healthy weight, but was recently taken aback by my midwife's obsession over my diet and weight. I ended up switching providers over it, and am so glad I did. It gave me a teeny tiny taste of what other women must experience routinely at the doctor's office.
In my case, my pre-pregnancy BMI was in the healthy range, my weight gain throughout pregnancy was within the recommended range, and I had no issues with blood pressure or diabetes or anything else. Yet, my healthcare provider kept harping on not eating too many carbs, kept mentioning how "huge" my previous baby was (8.5 lbs at birth) and how that was probably due to my diet (no, she's just a tall and athletic kid!), and would pop-quiz me on my eating habits and evaluate them (tho never found much wrong with them).
I got irritated enough to switch providers. It was easy for me to find someone better, but I can see that is not the case for everyone! And I can't imagine what it would be like to have your weight and eating habits scrutinized for every single medical issue that may or may not be related.
So glad these women found their pathway to motherhood. Best of luck to them!
36
Big babies run in many families. My mom was tiny and yet always had big babies. So did her children.
4
Every single person has to choose their own path. I made a baby with my wife later in life (I was 37, my wife 39). For a second child that we didn't know we wanted until my wife was 43, we decided to adopt.
It cost some money, all legal through a judge, but not $15,000 a try.
I wish more people considered adoption, it's truly wonderful. I've never once thought of my children as being different due to their genetics. I don't ever think of my "adopted" son, just my son. When I die, they're in the wills as equal shares. I didn't have to gain or lose weight to adopt, just prove I was not a criminal or a psycho.
The struggles these families face are sad to hear. I hope they are happy once they are done spending all of that money. I suggest that adoption as a much easier process, and in the end, the love you get from your new child, and the love you feel for your child is the same.
37
Adoption is not for everyone. Bless you though for adopting!
1
@Charlie Arbuiso, I am very happy that adoption was an easy process for you. I have friends who also had happy, easy adoption outcomes and have wonderful children now. However, I also have a high school classmate who has watched helplessly as three different birth mothers have changed their minds (as they are allowed to do) after giving birth. He and his wife are now considered "too old" by many birth parents. They considered adoption. They tried adoption for over 5 years. They were open to adopting biracial children. And it did not pan out for them. While you know and understand the adoption process, having been through it, I suspect others believe it's as easy as going to the adoption agency, picking out a baby from the glut of adorable infants, and getting an easy match. It is not. More often than not, it works, and parents get the children they dream of. Adoption is a wonderful, wonderful thing. But for the outliers, it's a painful, painful process.
10
Our fertility efforts failed over many years, and I was the picture of health, husband too. We then had a disastrous adoption in which all parties ( except us) were evil to varying degrees. Gave up, husband with reluctance, me with a broken heart. Suddenly we heard about a baby to be born. Rolled the dice and hit the jackpot. 23 years later we feel blessed every day . So many of the comments to this were just plain mean. Let's be happy for all of the happy moms and dads, however they come to parenthood; after the sorrow and loneliness of infertility-- they deserve it! And lucky babies too: to be welcomed and loved!
10
I am of the opinion that not only is fat shaming cruel, it is also an issue of civil rights. Although their baseline tests show them to be in good health, these women are being discriminated against simply because their weight isn't the societal ideal. This happens every single day in this country to people of size. My heart aches for them.
22
@Mary While I agree that making fun of anyone for their weight is cruel and morally repugnant, I don't think a health care professional telling someone to lose weight or that their child might be at risk because of their weight is irresponsible or incorrect. Do we call it "smoke shaming" when we tell our loved ones that their habit is unhealthy? The effects of obesity and smoking are similar.
35
Most doctors know zero about nutrition. This attitude towards larger women is misogynistic and sexist. I have accompanied patients to many doctors, most of whom never brought nutrition and what to eat. And this was across several specialties.
8
My friend died of a heroin overdose after successfully conceiving two babies. The thing is, having a child isn't a success story that stops once they are born, and now these two are growing up motherless. And the elephant is still standing in the room - as the eldest child is obese but we are forbidden to talk about it.
I have little sympathy for those who cannot conceive after watching this woman go through years and countless dollars to conceive. In the end, it was still about her addictive personality and how the medical community ignored these warning signs before allowing her to go on a path to get pregnant, starting with her being overweight and then to the painkillers she was given after her gastric bypass surgery. It was an easy jump to heroin.
I hope by the time her daughter has an overwhelming desire to become pregnant, that there is a better consensus out there beyond whether weight is a factor in becoming pregnant, but also on the mental health of the parents and whether they are fit to raise children - because the warning signs are likely already apparent.
13
@Hill Walker: “And the elephant is still standing in the room - as the eldest child is obese but we are forbidden to talk about it.”
How is her weight or her reproductive decisions any of your business? You shouldn’t be talking about them at all.
@Gabby B. My interest is from a health perspective and making the right eating choices. She's not; she can't. That's already been decided and she'll be hard pressed to be able to change to healthy choices at her current age. It's my business because I care. I'm posting because I'm frustrated that I can't say anything, and I'm likely not alone. And frankly, it's a national health issue that we as a society pay for in the end with our tax dollars and as insurance costs average in paying for these fertility costs that y'all feel are a 'right' (while eating healthy isn't even a factor). Go figure.
2
@Hill, it is difficult to watch such a sad situation evolve. I hope things can work out better for the daughter than they did for her mother and you find a way to support her to a better life than her mom.
Every woman deserves a chance to pursue pregnancy and a chance at the gift of a healthy child. Every patient deserves the kindness and compassion of their physician.
Unfortunately, this article misrepresents physicians in their mission to "Do No Harm". This article does not help women in achieving the goal of optimizing their health and goals, but rather stokes anger and conflates a sound medical justification for the health of the mother and fetus into a faux social-justice issue. This is shameful.
BMI is not a perfect metric, but a BMI of 45 or above is not subtle. It is a serious, impending danger on the life of a patient and unborn fetus. Pregnancy is taxing, physically, in a way that puts a woman with a BMI of 45+ at an unreasonable risk. The goal of fertility physicians is to allow a woman to achieve pregnancy as a safe undertaking.
Likely few readers have had intimate, first-hand experience with the real-life tragedies of a serious complication from elective procedures such as IVF and the subsequent pregnancy: stroke leaving permanent paralysis, seizures, heart attack, fetal demise, severe post partum bleeding, or maternal death. A BMI of 45+ puts you at a dramatically higher relative risk of these conditions.
No physician trying to "Do No Harm" would ever electively allow this risk on their patients. To suggest otherwise is shameful, inaccurate, and drives a wedge between compassionate, well-meaning doctors and the patients they care for.
106
There is no such thing as a "right" to get pregnant. Especially if others are needed to assist in the process.
38
@Roy P No, there's no right to have a child, but until about 60 years ago, women didn't have a choice either way.
1
@Roy P - :) Everyone needs some help getting pregnant.
13
@tom harrison, thanks for making my point for me. That is why it is not a "right." I am all for those who wish to help others with this, but 100% against anyone being forced to, or being taxed to do it, or having the burden pushed on anyone but the parents. If it is true that it is "her body, her choice," then by obvious nature, it is "her responsibility." And no one else's.
So many stories of determined women and their partners, some who are successful in reaching their goal of a healthy child as part of their family after many obstacles are placed in their paths and some who are not successful despite determination and extraordinary action to become the body that I.V.F. requires. I am pleased that the author was able to write that her friend found the child in her life was worth every effort. It is worthwhile to be given a look inside a very specialized niche of what women will go through to achieve a healthy pregnancy and birth of a healthy child.
B.M.I.'s and weight above defined numbers affect many treatments and tests in healthcare from X-ray machines to devices for getting prescriptions for eye glasses, from standard doses to custom doses of medication and from wheelchairs that don't fit through doctors' office doors to hospital beds that don't fit through hallways.
These days when every doctor seen by persons with a B.M.I. above a certain level is required to comment on the patient's weight and suggest options, many obese patients find common ground with the women in this article who can come to believe doctors think "weight loss will fix everything" despite any lab report results that indicate otherwise. The cautions of weight loss through surgery programs that losing pounds will not guarantee a perfect life stand in stark contrast to this attitude that the first prescription from a doctor no matter the specialty is "lose weight".
7
I have mixed feelings about this story. As a woman who has struggled with weight my entire life, I can attest to the cruelty of fat shaming. I also was unable to conceive. We eventually adopted and I have never regretted taking that route. I think many doctors are sincere in their concerns. This story tells us of obese women who succeeded in conceiving and delivering healthy babies. I am very happy for them. But I wonder about all the women who suffered health emergencies. We didn't hear about them. Finally, I have never met anyone -- woman or man -- who regrets losing weight by adopting healthy eating and exercise habits.
135
I think all American women should focus on being healthy for a long time (like at least a couple years) before trying to conceive. It’s the norm in other cultures (eg China) to make a healthy population.
After my first pregnancy I had some health problems and started seeing a hippy-dippy naturopath (although I was slim for the first pregnancy too, and an avid runner.) I cleaned up my diet to eat mostly whole foods and lots of veggies. I did this about two years before my second pregnancy. Of course there may have been some luck and my body was trained, but after two years of being as healthy as possible, my second pregnancy and labor was SO much easier. Every baby deserves to have their mom do this.
16
@Mel I would not point to China as an good example of how to approach reproduction and fertility.
21
So after going to her second fertility clinic she declined getting started on IUI. But then several years later that's what got her pregnant. Regardless of your health issue (unless maybe a life threatening emergency) you should always start with least invasive and move up from there. If you hurt your knee, do you jump right to knee replacement? While I understand her emotional and mental state were in play because of what she considered a second rejection, she was not making good health choices by jumping right to barbaric surgery without trying the 2 other things the doctor recommended. Which, again, was the thing that got her pregnant in the end.
51
I wonder about the long-term health outcomes of babies born to obese women? (Although I was not planned and have a dysfunctional family, I am lucky that my mother and father were always active and ate healthy.)
14
@Mel I bet there are people who think "although my parents were obese, I am so lucky I had a happy and loving (and non-dysfunctional) family life!"
20
@Mel Your comment reminds me that in our society, being fat really is the worst thing imaginable. I also was raised by thin dysfunctional people, and personally would rather be fat than carry the trauma of my abusive upbringing, but to each their own.
28
I think it’s crazy that people pay thousands of dollars to have a child. And why should insurance pay for it? It’s an elective procedure and certainly not required. Or is it a disease? I’ve never heard of anyone dying from infertility. If this article was about fat women being discriminated against by actual doctors providing actual necessary medical treatment, then I would be outraged. But fertility treatment? Sorry but, who cares?
56
@Maryjane People are entitled to make their own choices. Grappling with infertility is intensely personal and difficult for many women and the last thing they need is someone judging their decisions. We need to move past caring about other people's reproductive decisions. Not your uterus? Not your business.
12
That seems rather insensitive. Many people I know have undergone fertility treatment to have children, including myself. Fertility treatments can be modern miracles for anyone with any sort of fertility issue, whether or not you care about them.
And relax, my insurance didn’t cover it.
12
@Maryjane
I think the women who want to be mothers care.
11
Maybe it is just where I live but today I see so many obese, young mothers in the supermarket and other places. I am amazed at their size(s) and very often they have more than two children or are maybe even pregnant again.
It is not healthy.
55
This is a horrifying story. Whatever happened to do no harm? Who are these judgmental, uneducated "doctors" who think they have all the answers? I am stunned that this poor woman was pressured into dangerous surgery (that can cause lifelong complications) in order to get decent care from a fertility specialist.
This is so sad. Doctors, treat your patient, and leave your judgment and ignorance at the door.
7
The second doctor in Boston offered a fertility drug and the IUI procedure to the author's friend when she was 340 pounds WITHOUT the condition that she loses weight. The friend declined both. The friend then gets weight loss surgery. And then she gets pregnant with the second round of IUI. Don't get me wrong. Obese people do face biases, but this was an example of a woman whose own personal biases caused her to undergo weight loss surgery.
27
Most likely, having the bariatric surgery has added years to her life and she will be around to see her baby grow up, so I’m not sure how the surgery violates “do no harm”
11
This article doesn’t mention the fact that fertility doctors’ success rates are widely published. To take on fertility patients who might not become pregnant (like overweight women) would lower their rates and possibly hurt their career, though certainly no doctor would want to admit that this might influence their decision making. Doctors are incentivized to take on patients who will get pregnant.
23
Is it even worse for women of color who are "overweight"? How are they treated when seeking the same help?
20
"“When you’re fat, you get used to people assuming weight loss will fix everything wrong in your life,” "
Perfect quote.
53
BMI is a garbage health statistic and every reputable doctor and every statistician and every under-writer knows it. Even the developer of BMI back in the 19th Century warned that is ONLY meaningful when describing an existing population, not for predicting what someone is or is not likely to have happen.
BMI is nothing more than a height to weight ratio that doesn't account for ANYTHING else, not body frame size (The old Met Life actuary tables do that), nor for activity level, fitness, blood chemistry and hematology, blood pressure and resting heart rate, or anything else.
But insurance companies can charge a higher rate if someone's BMI is over 30, which is classified as "Obese" when it may not be anything of the kind. A highly active "obese" person will be generally at far less at risk than a sedentary skinny one.
There's a woman who runs marathons who's about 5'5" and weighs 245 #. The woman who set all the records for time and distance swimming in Arctic waters (Brrr!!!) APPEARS to be obese. Are either of these? No! The new Heavy Weight Champion of the World, Andy Ruiz, who spent his life being called "chubby" just clobbered the super-fit ripped former champion. Ruiz is not ripped and appears fat, but he's as fit a boxer as there is, with speed, endurance, and punches like a battering ram.
You don't know if a "fat" person is healthy or not just by looking at them. Nor a skinny person. It's the last acceptable bias.
And it's disgusting. MYOB, people!
31
@Dadof2
Ridiculous. I’m a doctor and we all know that BMI is a fantastic tool, and is almost always informative on normal people. There are extreme examples of people for whom BMI may not tell the whole story, but they are by far the exception not the rule.
We are talking about a woman with a BMI of 50. That’s not evidence of a faulty measuring system, there’s no way somebody with a BMI that high can be one of these healthy superhumans you want to point to . It’s like you want to deny that obesity is real — a new, largely liberal alternative to climate denial has become obesity denial.
61
So 317 pounds sounds better than a BMI of 51?
14
@ES I wish I could upvote you multiple times. The comparison of obesity denial to climate denial is apt. If the facts are uncomfortable, just deny and move on.
4
women over 32 years old are high "risk" are we going to ask them to not get pregnant or abort?
7
@nml false equivalents will not help the conversation.
3
Obese people should not be shamed, but weighing over 300 pounds is extremely unhealthy and definitely makes a pregnancy high risk.
167
So from 1994 to 2016, obese women went from 25.4% to 41.1% of the American public.
What part of this is vague?. What part of this is normalizing obesity?. I'm done with big body beautiful. You're obese.
In youth @ 30 years old, you may not have problems, but at 50, you're a mess of health issues. Let's see those articles.
Let's see the ones at 60? What about 70?
The hypocrisy is killing women with kindness and empathy. Don't say diet's don't work. Show me lifestyles that do.
144
@Mrs. Sofie you don't and cannot know from BMI whether someone is obese or not. It is an extremely poor indicator of personal fatness - like 10-25% prediction value. It is even less useful for children. Give it up.
13
@Mrs. Sofie
My response to people who wish to normalize 'fat' is: "come speak to me when you're my age or older, when you have gone up and down those stairs a few tens-of-thousands more times or in/out of the car, etc., or cannot get up off the floor by yourself.
Point: it should not be an issue, much less a chore.
Granted, there's other issues with aging, esp. muscle loss, but looking at friends, relatives, and others, I don't recoil from an obese person because I find it disgusting or offensive, but I do feel sorry because the amount of pain, limited mobility, and poor quality of life that will be the Norm for many of those peoples' lives is simply sad.
Life gets difficult enough as one ages. One should do what one can to keep one's body in the best condition possible. Weight is admittedly only one factor, but it is a big one (no pun intended).
39
@Mrs. Sofie what is almost never mentioned is that a change in how obesity is defined was made during those years that increased the number of people who met the definition without their weight changing.
4
Our culture is so filled with fat fear and fat shaming. What is wrong with us?
19
@Jeanine
We eat too much, and too much junk.
Take a look at old newsreels, vintage clothing, even the very bowls and plates that were in use 50-100 years ago -- people, their apparel and their dinnerware all were a LOT smaller back then, and healthier. It was rare to see anyone lumbering around with rolls of fat and flab.
The family next door to me -- parents in mid-40s, kids from 14 down to 7 -- are ALL obese. Not pudgy, not chubby -- HUGE. The littlest boy was running around without a shirt the other day and he has slabs of fat on his belly, back and rump. The girl at 14 is tall and developing a figure but her huge gut and "saddlebags" project further off her body than her bust does. I'm 40 years older than her and the same height, and I wear jeans that are three sizes smaller.
And soon these kids will be obese adults who will put a massive burden on their employers, their insurers, the public health system and their fellow taxpayers. The father is a 300lb walking heart attack and the mother must be 3 feet wide.
They are affluent white-collar professionals in a $600,000 house with very short (5 min) commutes. We are not in a food desert -- within a two-mile radius are a Meijer, Kroger, three local upscale chain grocers that specialize in produce and meat; a Fresh Thyme and various small ethnic grocers. We also are a 10-min walk from a local farmers market that runs May-October.
These people are actively choosing to be obese. They are not victims.
94
@Jeanine: I'll tell you what is wrong with us: rampant depression. That is the source of overeating, and a host of other problems. Fat is a symptom. And no, nobody's fat because of being "big boned." It is just as natural to lose weight as to gain it.
https://emcphd.wordpress.com
17
@Rev. E. M. Camarena, PhD Depression? Or a lot of free-floating anger fueled by mindless social media feuds, junk food, inactivity? I agree with you that there must be a serious "spiritual" dimension when 80 per cent of a population is overweight or obese. Compared to 40 years ago, this is a large significant numerical shift.
12
vastly overweight women face life-threatening risks when pregnant. High blood pressure, out-of-control diabetes and rupture of the umbilical cord (during which the mother can bleed to death), regularly lead to tragic outcomes for mothers-to-be.
This risk is not theoretical. My OB department regularly resuscitates women who have had severe strokes and lapsed into diabetic comas and severe electrolyte imbalances that lead to cardiac arrhythmia and sudden heart failure.
It is very bad for the NYT to publish an article that downplays these risks. Medically tragic outcomes due to pregnancy while morbidly obese - happen daily in the USA.
165
@Winston - I think you mean abruption of the placenta, not rupture of the cord.
8
Thank you for making that correction, @PM.
1
Article glossed over health problems of obese women. It isn’t rude for a healthcare provider to point out and encourage weight loss. Infant mortality is an ongoing problem in this country. People should strive to be healthy and have a safe pregnancy. What is so discriminatory about that?
86
Yes, because in addition to often making it more difficult to get pregnant in the first place, obesity is also a huge contributor to complications for mother and child and infant and maternal mortality. Obesity during pregnancy increases the risk of gestational diabetes, preeclampsia, sleep apnea, cardiac dysfunction and delivery complications for the mother, including a need for emergency cesarean and wound infections. For the child, it increases the risk of heart defects, neural tube defects, preterm birth--which can cause long term health problems--and stillbirth.
Would we consider it offensive if a fertility doctor didn't want to help someone get pregnant if they intended to use drugs, alcohol, or tobacco during pregnancy? This isn't much different.
88
@Polly Yet, fertility doctors help "older" women (late 30s and 40s) get pregnant all the time--and that segment of the population is also at higher risk for complications, birth defects, Down Syndrome, miscarriage, stillbirth, etc etc.
10
@Itsy, two wrongs don’t make a right.
this article focuses on fertility, but across the healthcare spectrum we are not set up to treat obese patients. Equipment is not made for people of that size, drugs are not tested on people of that size, surgery is riskier when patients are obese, on and on and on.
Very little medical/pharm research is conducted on anyone other than relatively healthy males.
If we want more options for all people, we have to get serious about testing treatment and drugs to establish safe guidelines for everyone who is not male and 150lbs.
12
@Jan
relatively healthy YOUNG males. Great NPR story last night about the medical system similarly being ill-equipped to deal with health care for the elderly.
And we're surprised that, despite all of the emerging medical research regarding the physiology of "fat," most Americans (including a majority of commenters here) still see obesity as a moral failing?
9
"Does it make sense, medically or ethically, when fertility clinics refuse to treat prospective mothers they consider too large?"
Yes, of course! And prospective mothers who are too thin. It's malpractice to perform an elective medical procedure on someone unless and until safety parameters (such as weight, among other things) have been optimized.
73
I take care of many women with high BMIs, and work with several reproductive endocrinologists who do not discriminate with a BMI cutoff. Although obesity is a health risk, we take care of women who smoke, women with cancer, women who are on opiate treatment, women who are incarcerated and other stigmatized groups, and we deliver mostly healthy babies.
I am concerned that the pictures in the article depict more twins than singletons. A twin pregnancy is much more risky than a singleton pregnancy, so it is worth making serious efforts to end up with a singleton when doing in vitro fertilization. It is not rational to stress about a patient's risks from obesity or superobesity, while ignoring the iatrogenic (doctor caused) risk of twins or triplets to the mother and her child(ren.)
37
It seems like a lot of commenters missed that the woman at the center of the article appeared not to have health problems other than being obese (including that she had normal blood pressure and cholesterol). At the beginning, it mentions that she went to fertility specialists to try to figure out why she wasn’t getting pregnant, and the point of the article seems to be that some doctors were dismissive of her concerns and didn’t try to figure out her specific situation because they wouldn’t look past her weight.
27
@Anonymous
Obesity is an independent risk factor for poor pregnancy outcome even in the absence of other health issues. We don’t entirely understand why yet, but it’s objectively true.
Some fertility clinics won’t treat women who smoke, either. It’s a similar problem.
13
@Anonymous There are potential complications in the operating room and beyond from severe overweight, as mentioned by Polly and others, above. Cholesterol and blood pressure are indicators but they do not sum up the whole group of risks presented in the scenarios discussed in this article (not to mention the long-term implications of overweight for joint health, mobility, and diabetes).
8
Seems like the concern doctors have when obese women want to get pregnant is valid. All the studies cited back it up. The more overweight a woman is, the more complications are likely for pregnancy.
It's funny that later in the article it claims women are policed over their fitness for pregnancy, are they drinking, smoking, do they have enough money and a partner. That's because drinking, smoking, not having enough money or a partner, all make for trouble during pregnancy and child rearing. If you can't afford to raise a child, don't have one. If you can't stop drinking or smoking, don't get pregnant, because you'll inflict major damage on that fetus. Not having a partner is more mild, but it's definitely a lot tougher to raise a kid as a solo parent than as a couple.
So it seems like the article is leaning hard against the facts of the matter. And despite all these peoples' desire to get pregnant, we have way too many people on the planet already, and anyone who can forgo having kids should do so.
39
@Dan Stackhouse the article merely established correlation, not causation. It's possible that hormonal imbalance can lead to both infertility and obesity. For example, many women gain weight when going on birth control. The excess estrogen causes weight gain. As evidenced by her irregular menstruation, the patient very well may have hormonal imbalance.
4
Dear ItsMe,
I'm sure in some cases hormonal imbalance can lead to infertility and obesity. But obesity, by itself, causes complications with pregnancy. Every single study mentioned supports this. Obese women having difficulty getting pregnant should have their hormone levels checked too, but most likely the problem is the obesity.
6
No one who is more than double a healthy body weight has any business adding to society's burden; YOU are going to be burden enough with your diabetes, strokes, limited mobility and other complications, trust me.
35
I've been a medical laboratory technologist for almost 30 years and I've worked with doctors, taken calls from doctors and have had a lot of experience with doctors Many have extreme difficulty talking to anyone "beneath" them with respect or acknowledging the help they get from staff. There's a myth perpetrated by the profession and by the public that states that b/c doctors treat disease they are compassionate. TV shows like ER, MASH, etc. help sustain the fantasy. Sorry but nothing could be further from the truth and anyone who's worked as a subordinate to them knows this. The story caught my eye not b/c obesity keeps women from getting pregnant but because of the obvious contempt the doctor is showing the patient. The MD has a lot of resources at their disposal and you'd think with all that education they'd use these resources but many just treat and street. How about working closely with the patient to lose weight, addressing all the issues surrounding obesity? LOL. NO, that would take too much time and they are such "busy" people. Doctors can keep showing contempt and continue to distance themselves from patients who they decide are unworthy. And patients will keep not losing weight. It's that simple and it's bad medicine.
27
@hmsmith0. I’ve been a nurse for nearly 30 years and though I have encountered Doctors such as you describe, I have found them to be far from the norm, and becoming less and less common. Maybe it is because I have become more experienced and knowledgeable, or maybe because I work in a small town, but I think young doctors have become vastly better in that respect. BTW, I have also encountered nurses, aides, therapists and, yes, lab techs who are disrespectful.
32
@Maggie The point is they are not doing right by their overweight patients and their contempt is obvious.
7
For all the persons out there frustrated that doctors can't see past their weight, doctors are just doing their jobs and pointing out the the number one health issue facing you. It's an issue that threatens nearly every bodily function and is a risk factor in nearly every condition and disease out there.
It's similar to having a house that is on fire, and asking a contractor to come look at renovating the kitchen. I'd bet they'd say "you should put this fire out, first."
62
@Jeff
And yet, for all their "concern," their only advice is "go lose weight." Via methods that are untested, and that we know fail for the vast majority of people.
Even better when it comes from a doctor who is obese.
But yeah. They're just "doing their jobs."
Please.
15
This article focuses on obesity-related health risks during pregnancy and childbirth, but it does not address the long-term health effects on children born to an obese mother. Among the research on this topic is a 2017 paper published in the Lancet titled “Influence of maternal obesity on the long-term health of offspring” that describes evidence on increased risks of obesity, coronary heart disease, stroke, type 2 diabetes, asthma, cognitive performance, neurodevelopmental disorders, and immune and infectious disease related outcomes. While further research is needed to better under the relationship between maternal obesity and long-term health of children, the New York Times should not limit this discussion of the public health implications of the obesity epidemic to the short-term risks to the mother and baby.
25
To answer the article’s title, yes, it makes sense from a medical safety standpoint. Obesity is not, nor should it ever be, characterized as normal. It’s not. It’s indicative of a wide range of serious health issues that can ultimately shorten the lifespan of the obese.
I sympathize with efforts to try to normalize obesity as a “body positive” alternative, particularly in the face of an epidemic where more Americans are obese than at any other time in our history and evidence that our very food source is a significant part of the problem.
But... it’s still not healthy or normal. No amount of campaigning or impassioned articles in the Times is going to change those salient facts. Pretending that there’s anything normal about it only ensures more Americans will fall prey to obesity as we continue to stick our heads in the sand.
68
@Dan
Normal may not be good or ideal or desirable but if 41% of women are obese, then obesity IS normal.
4
@Northway then it may become "normal" to not be able to safely have children.
3
@Northway, I see where you’re going with that, but it’s semantics. Obesity is not healthy or normal for the average human population. Period.
2
In our overly-litigious society, is the average obstetrician willing to risk getting sued if a fertility treatment of an obese patient goes bad? Fat chance.
24
So, let me get this straight.
1. The patient and her husband are furious at providers’ apprehension to proceed with IVF in a morbidly obese patient, claiming its biased and not her true issue anyway.
2. A first provider calmly explains that safety and efficacy are the rationale for that decision.
3. They are offered an opportunity by a second provider to try less invasive IUI and reject it out of hand because they are “sure it won’t work.”
4. She wastes 5 years not losing the weight, until finally electing to have an invasive bypass surgery to quickly shed the pounds.
5. She magically becomes pregnant through IUI—not IVF—and she’s still moaning that all the concern vis-a-vis weight and fertility is unfounded fat shaming.
Her life experience is literally defeating her own argument. What the heck am I missing? Sometimes we as a culture ostracize people for any number of health issues—obesity chief among them—in a way that is counterproductive to helping people, the ultimate duty of any healthcare provider. In the face of a worldwide obesity epidemic, this is emphatically NOT one of those cases.
151
@Mike G Well-written comment. It's a shame that the real issues and problems are obscured by all the stigma and judgment that surrounds weight. No doubt the patients' opinions have been shaped by their life experiences. This also speaks to the lack of trust and faith people have in doctors and the medical system. I don't know what the solution is. Doctors should not be sugarcoating things but overweight people need to be clearheaded about the true risks of their conditions to themselves and their babies.
10
This is the telling excerpt from this article:
"...thinner women over 35 were also almost twice as likely to have a stillborn delivery compared with their younger counterparts."
If fertility doctors don't tell women over 35 that they are too old for fertility treatment because of the increased risks, then when they decline to treat obese women, who according to this article have much lower rates of increased risk due to their weight, they are just showing their fat prejudice.
17
The physician treating each woman takes responsibility for her health and has to assess the risk. Pregnancy has a lot of health risks for a healthy woman, and many more for an obese one. It's the physician's job to warn the woman of those risk and to be guided by principle of first do no harm. If the physician's assessment is that pregnancy for this particular obese woman has too many risks for her AND her fetus, he is not obligated to provide the treatment, as it would be against the principle of first do no harm. Also, remember, that if something goes wrong that physician will later be sued by that same woman who was told this was too risky to begin with.
Overall this piece is a good illustration of broader patients' attitudes, those of a customer - patients know what they want and they just want physicians to make that happen. The fact that physicians have the knowledge and experience that patients don't does not factor into the process anymore. Unfortunately this is not how medicine works, patients are not customers, doctor-patient interaction is not a sale of services and first do no harm is still in place.
Special request to Virginia Sole-Smith, the author - when mentioning physicians please use "Dr." or "MD" next to their names - it is very inconsistent throughout the entire piece and underscores dismissive attitude characteristic of NYTimes health section.
32
It's not just about the high BMI mother becoming pregnant.
Where's inclusion about risks to her subsequent child or children?
Besides issues with delivery and airway compromise to the fetus, medial literature is replete with known subsequent post-partum issues of diabetes and the child itself being obese.
Major omissions in this mother-prioritized piece.
Surgeon, retired
23
"Does it make sense, medically or ethically, when fertility clinics refuse to treat prospective mothers they consider too large?"
Medically? Yes. Ethically? No.
Not everything (and everyone) in life is equal. There are pregnancies that are high risk, there are those that are not. No doubt those who fall in the undesirable category, it's not a nice feeling. It almost feels like a direct assault and personal insult when someone tells you that you're too large. But heck, there are evidence that supports the view. And if providers don't have sufficient liability coverage, or if they don't want or can't carry the risks, they would not be able to take on a case. To me, it's just a fact of life.
10
Yes!
If someone cannot control and take care of themselves, they cannot take care of a kid. It’s that simple.
Junkies, whether drug or otherwise, should not be parents.
16
@ScottB Feel free to contact my healthy, highly successful young adult child and advise her that her “junkie” mother should never have been a parent.
4
To answer the article's lead: yes, it most certainly does in some cases.
Really obese females are what are termed "very high risk patients" during pregnancies.
59
Asking a mother if she is drinking is not unreasonable policing. Fetal alcohol syndrome is a real, predictable consequence of legitimately irresponsible behavior by a mother and should be heavily discouraged.
52
The complications of massive obesity during pregnancy, labor, and delivery and well known.
[They're also well known to insurance companies, who have to try to spread the cost to the general population to cover it.]
A physician MD
84
BMI limits are not always about the safety of the patient. Doctors may also screen out patients they believe have poor odds of success, who will negatively impact their success rates.
It's also important to know the connection between PCOS, which causes ovulation difficulties, and higher BMI. PCOS patients also have a difficult time losing weight.
On a personal note, I was a patient of Dr. Legro's at Penn State--and thanks to him and his colleagues I successfully delivered my second child.
18
@Alexis
Overweight makes PCOS more easily diagnosed, but does not cause obesity. Although there was once poorly designed study that found that overweight women with PCOS has slightly lower RMRs than normal weight, eumenorrheic women, two subsequent studies have shown no RMR difference. Women with PCOS have the same struggle to lose weight as anybody. However, overweight women with PCOS are already demonstrating symptoms of insulin resistance which should serve as motivation for weight loss.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470767/
RMR is not the only indicator of a difficulty in losing weight.
1
Sure, go ahead and greatly increase your risk of gestational diabetes (if you are not already a diabetic). Any individual has every right to do so. I question, however, the rationale.
The normalization and societal acceptance of obesity does not make sense from a medical perspective. The number of diseases and ailments that are either caused or exacerbated by obesity is a well documented medical fact.
126
@Christopher Robin Jepson, "The normalization and societal acceptance of obesity does not make sense from a medical perspective." You're right on.
This is the kind of PC nonsense that has run amok. Just because someone doesn't want to accept that fact, everyone must not utter a word, lest they feel slighted. But, that does not make the fact - and risks - go away.
40
@Christopher Robin Jepson
Having family members that have struggled with their weight while others eat away and don't gain any weight at all, you also have to realize individual metabolic rates and genetic factors can really increase the likelihood of being overweight for some folks. Not everyone who is large eats like a slob, and some skinny people have very poor diets but enjoy higher metabolisms.
12
@Christopher Robin Jepson please present your medical credentials and the peer-reviewed medical literature that guided you to your conclusions.
Cite it, don't handwave.
5
If weight was the cause of infertility, then I would have many children now. But, despite my BMI holding steady at 24, I still only managed one child (through IVF) over 9 years, with several miscarriages (from IVF cycles) along the way. Weight might be a contributing factor for some women, but it ignores the fact that there are several unknown reasons why someone is unable to get pregnant, or maintain a pregnancy. Infertility is hard enough without the judgement of others.
39
@Jennifer exactly. And doctors need to explore those other possible causes without just dismissing the patient as simply obese. It doesn't mention in the article if the initially consulted doctors did any bloodwork or anything else to see if there was a larger issue here. And that's where the bias lays. A patient with a normal BMI, they may have started there.
4
I am a normal,healthy weight individual who conceived without any intervention. As a fit, healthy mom, I had trouble keeping up with my energetic baby boy, then toddler, then adolescent. The energy level required to be a mom is enormous. How someone with an BMI of 50 proposes to do that is beyond me.
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@Robin Richmond I have a BMI well above 30 as well and just got back from a wilderness hike with my two school aged children, and now we’re going swimming for the afternoon. My son calls me the “cool mom” because I’m one of the few who actually plays soccer and basketball with him, and gets in the pool to play. That’s in spite of several health issues and medication effects which have piled the pounds on my former athlete’s body. You’d be surprised that we are not all sitting around on the couch all the time.
13
@Robin Richmond My BMI is around 30, but I wear size 14 clothing and participate in cycling tours clocking 60+ miles a day and kayak races. I had plenty of energy for my kids despite my weight. I celebrated my 50th birthday with a century ride. Don't let your imagination outstrip your sense of reality.
58
@Durham MD BMI of 30 is something that is pretty reasonable if you are muscular and active. At a BMI of 50, which is what the article is talking about, it's like carrying a second person on your back. That's a completely different story.
3
A BMI of 50 is morbidly obese. Whether or not fertility is affected isn’t the question. Mostly physicians would not perform non-emergency procedures or surgeries in this population. However one presents the story anyone with BMI in that range is going to statistically (not anecdotally) have health issues at a greater ratw than people with a BMI of less than 30.
One of the women in this story refused treatment with letrazole and IUI because she wanted IVF. I don’t think it’s fair to accuse that doctor of denying treatment to this patient because of her weight. Ultimately IUI worked for her and was the right first, less invasive option.
147
@Me Yes! The refusing letrazole was telling. This piece wrings its hands about how substandard this woman's care was; but maybe she was also not a realistic patient. If the MD's dismissal of the patient is accurate, it of course is inexcusable. BUT...the exact same option of letrazone and IUI would have been the first option offered to a woman of 'normal' weight, too. Listen, I understand how ludicrous women's health providers are about weight. I was thin when I got pregnant, then gained 60lbs while pregnant, was told by a non-pregnant-yet-obese midwife that I was I was literally ruining my unborn baby's life -- no I didn't even have gestational diabetes -- and went on to deliver a healthy baby and he and I are both of healthy weight 8 years later. Women's health care is incredibly paternalistic and even the sainted midwives internalize its messaging. BUT -- Not only did this article not do enough to represent the risks of any medical procedures for obese patients, it did not elucidate fully this patient's self-imposed barriers and psychological state of mind.
3
Obesity’s impact on fertility is as yet unclear. Until more is known, big women should have equal access to fertility treatments. Obesity does illustrate a major lack of self discipline. I wish these people cared enough to avoid obesity before undergoing having children.
11
@Mary Ann
Fertility treatment is an elective procedure and not everyone is a candidate for it because of risks involved
23
@Mary Ann
"Obesity does illustrate a major lack of self discipline."
Nope.
12
I thought this too for a long time. I was ashamed that my obesity meant I was lazy, lacked discipline. As an adult I’ve questioned whether that’s the case. I am accomplished professionally, work very hard and don’t lack discipline or determination. Over the past few years I’ve met many like me, professionals who work or have worked in Congress, at the White House, own their own companies, are partners at law firms and on and on. They have also dealt with being overweight their whole life. There are other factors at play. It’s convenient for people like you to say it’s about self discipline because that means your weight (assuming you’re thin) is a product of your self-discipline. The alternative - that our weight is affected by a multitude of factors and more often than not is a crapshoot doesn’t square with how our world likes to assign blame.
To be more explicit - you are not any more special than I am because you’re thin, and more likely than not you haven’t done anything to earn / deserve your thinness. Just luck of the draw. Does that feel uncomfortable? Good. Welcome to how us overweight people feel every minute of every day.
26
Honestly it's not good reporting to try and put a spin on such an issue as discrimination against women's bodies due to social stigma. IVF is a medical issue, pregnancy and delivery to is a medical issue. Yes bmi might not be the most accurate indication however past the point of 35,45,50 we are in a territory of severe obesity. It has been well documented in the literature that not only is obesity to this degree is extremely unhealthy even for the mother, but that it can cause other medical issues that affect fertility and that it is much more dangerous to go through childbirth. There are complications that can arise for both the pregnancy and the attempt at pregnancy due to the way things like anesthesia and fertility drugs are affected by weight. Even the morning after pill is ineffective at a much lower weight than obese. This article severely glosses over such complications. While women have had successful pregnancies at an obese weight one should not blame the doctor for refusing IVF due to complications they know under professional medical opinion. It has never been good medical practice to grant procedures to patients when there is unnecessary levels of risk. I would expect that these clinics would also refuse those with other medical complications. Severe obesity is not healthy and should not be treated like race or sex because it is in your own control. This article belongs in the opinion section.
177
I found this article very poorly represented the risks associated with morbid obesity and elective medical procedures. Equating a medical condition such as obesity to characteristics such as race and religion is truly a non-sequitor. There are risks that go up with BMI for all pregnancy outcomes including risks of miscarriage, diabetes, hypertension, preeclampsia, preterm deliver, malformations etc. Additionally for IVF the egg retrieval requires anesthesia whose risks also go up with BMI. Perhaps you should ask an orthopedic surgeon how likely they are to perform a knee replacement on a patient with a BMI greater than 50.
Weight is a sensitive subject because of our cultural attitudes about it-blaming an individual when there are countless environmental factors that are likely contributing to our collective weight problems. But then we are not interested in making real change in our environment with the rallying cry of freedom and having a nanny state taking away our soda. Clearly something has to give. The first thing should be our culture of blaming and the resultant shame. We need to be able to talk about our lifestyles and how they contribute to our health in straightforward and factual ways without value judgement.
In my work as an ob/gun I’ve had countless patients who have struggled with their weight and who have suffered serious consequences because of it and pretending these problems aren’t there won’t make them go away.
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@Swathi Arekapudi Morbid obesity is not diagnosed with arbitrary BMI numbers.
3
Many thanks to Virginia Sole-Smith for her continued work to show how anti-fat bias leads to poor care. If doctors took the time to look at their patients’ health holistically they would find that people can be healthy at any size, and that no matter what they have a right to health care. These arbitrary BMI cut offs may be good for a clinic’s success statistics but it comes at the price for all patients receiving the care they deserve.
20
@MHM
That's actually wrong, the myth of "healthy obese" unfortunately did not pan out in real life
21
It's simple. IVF clinics are ranked and judged on successful live births. It is harder to get pregnant if obese. Some fertility clinics don't want patients who will skew their success rates. Refusing obese patients is a simple screen clinics may perceive as likely to improve the clínics' success rate. As scarce as egg donors are I was told outright that I wouldn't be picked for a shared cycle due to my (at the time) somewhat high BMI. Clinic staff said obesity is the #1 reason egg donors (or sharers) are rejected. Indeed I was not picked, despite multiple factors that were very much in demand by egg recipients.
17
@IVF2xv - I imagine obese women are turned away from egg donation due to difficulty in inducing ovulation in heavier women.
I also imagine that egg donation recipients might decline an obese donor because obesity may be genetic and - God forbid - the resulting child might end up fat.
2
I also wondered how this article could miss any reference to PCOS. I would really appreciate an article going into some depth on this condition. I see it referred to as a cause of both infertility and weight gain, but neither the trigger for it or effective treatment are ever explained. Is there any effective treatment, and if not, why not? There are treatments for other hormone imbalances for both men and women; is anyone working on help for women with PCOS?
27
@Patricia Hi Patricia. PCOS is a genetic condition which sometimes runs in families. It can manifest in either the mother's or father's line - in other words, you can inherit it from your bio dad, even though PCOS is a condition in women. It is common among Ashkenazi Jews and Hispanic women. Since insulin resistance is a factor, a low -carbohydrate diet is often, though not always, effective in promoting ovulation. So is losing around 10% of body weight. Medications, such as metformin, may also help. It's a tough diagnosis to live with - I know - I have it myself. IVF was the answer for me - I have 24-year old twins.
19
@Patricia You're absolutely right. Why, oh why can't people be more informed on this condition. I have it. So does my daughter. A nd once I knew what it was, I finally understood why I could eat the same things that other people were eating and still gain weight. Dr's could really help out on this one.
6
There really is no treatment.
2
Stanford, the Swedes and Scandanavian data instead of dysphoric judgment. How about the age data too, not just BMI. Advanced Maternal Age is a factor for early delivery, high risk pregnancy, too. So many factors, so many differences in each person.
Has anyone noticed how prevalent the fear of fat and aging is in our society? How much cryo-botox-surgical alteration there is? Where's the story on that? It's a 'thing' now. Yes there is health, exercise, sleep, etc - but there is also fear.
I am glad the women in the story are finding health care professionals who drop their judgment and take care of mother and baby. The Moms in the pictures look more normal than the skeletor-social x rays airbrushed into perfection -that people put in media these days. A personal opinion.
20
One of the leading causes of infertility is PCOS. PCOS contributes to weight gain and can make it difficult to lose weight. So it would be nice if it wasn’t a knee jerk reaction to blame women for their infertility.
52
It could also be a factor that many of these clinics want to have high success rates for advertising so are more likely to go for patients that they believe will be the most successful. It has happened and been reported on that older patients were turned away because of the negative impact their age would have on the results, why wouldn’t this also be the case for fatter women? In addition to of course the automatic bias that the woman is at fault for her size and hasn’t yet “earned” the right to have a baby.
15
It's too bad that men don't suffer the same type of scrutiny, blame, humiliation, and discrimination regarding their weight. Turn on the TV, and every other commercial is a pharmaceutical company promoting their version of a cholesterol/diabetes medication. Bother to watch these insipid ads, they follow the same formula; overweight man enjoying and celebrating his obesity-which usually includes the obligatory montage (cue in 80's pop music); dancing, tag football, baseball, fishing, golfing, or just plain rough-housing with the kids. Message: Fat, unhealthy men shouldn't have to put up with trying to lose weight. They just need to take a few pills and carry on. The double-standard provides vast insight about who controls what women should be doing with their bodies, whether it be trying to get pregnant or trying to terminate one.
22
Dear Sadie,
Taking a wider view than just pharma ads, in society, men are humiliated and discriminated against when they're overweight. Not quite as much as women, but it happens to them too, they make less money then people of normal weight, they have a lot more difficulty dating, they don't get onto sports teams, they're casually mocked by strangers. Not an easy life to be very overweight, regardless of gender.
14
@Sadie
Actually, if you are obese ( or not pretty or handsome) our society is cruel, period.
7
I would like to discuss this further with the author, after years of sub-fertility including miscarriage, stillbirth, years of trying to no avail, I have learned quite a hit as to why weight is relevant. There is more to the story.
16
No one should ever, for any reason, feel discriminated against by anyone involved in care for their health. Period.
That is a separate issue from whether having a BMI over 30 or 35 or wherever we draw a cutoff line is healthy in general for a body, or a healthy way to be pregnant. It isn't -- not for either one. Yes it is POSSIBLE to have a healthy pregnancy at these BMI's, but the risks of many serious problems go up dramatically with BMI and that matters!
It is up to an individual to live as they choose and feel comfortable, and everyone should be treated with respect and humanity. It is complicated, though, when another person is directly affected -- in this case the fetus-baby-future child&adult. &, although this is personal and individual, we also collectively share costs for these public health issues -- hence heavy taxes on alcohol and cigarettes which are personal behavior choices that cost a lot of money in health problems. High BMI is the same, period. Individuals should always be treated with humanity and respect, but the fact is that whatever we should call 'obesity' it IS a public health issue with serious health risks in pregnancy and otherwise.
30
@Jen So an overnight person is as "unhealthy" as a raging alcoholic or someone who smokes two packs of cigarettes a day? Please. Your bias is showing.
6
Can someone help me understand this? “Until I found my doula and midwife, I had never had a medical professional touch my body with compassion,” says McLellan, who identifies as a fat woman and had a healthy pregnancy.
I truly mean it. What does it mean to be touched with compassion? I do not expect medical professionals to touch me with compassion - they are there to do their jobs and often I find the experience of them touching my body highly uncomfortable. No one is there to be touched with compassion. Is there something I'm missing? I understand feeling judged, perhaps I am taking this too literally?
I thought it was also interesting that the author chose the wording "identifies as a fat person". I have never heard it phrased that way before.
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@K
I weigh 120 lbs at 5'3", which I guess means that my body would be "touched with compassion." Before I had my first child I needed to see an endocrinologist who diagnosed my thyroid issue. At a follow up visit, he touched my neck and back with such "compassion" that I felt uncomfortable and told him to stop. Never went back and never wanted or expected to be touched compassionately by any doctor again!
21
@KI was also struck by the description of the specialist as "unsmiling". I would prefer a serious, hard working "unsmiling" doc, personally. I'm just there for the medical information. Now, if they won't answer questions, that's a problem.
21
@K People are not aware just how much their insecurities are inhibiting their ability to perceive reality. That’s what’s up.
19
The spin placed on this article is ill-informed and dangerous. There are numerous pregnancy complications related to obesity. You can argue that BMI is a poor metric of health, but being obese puts women at higher risk of preeclampsia, gestational diabetes, etc. these pregnancies are dangerous for mom and baby, so how is it ethically sound for reproductive endocrinologists to move forward with helping these women get pregnant without encouraging weight loss?? We have a maternal mortality crisis in our country. We don’t need to contribute further to it.
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@Danielle
Maternal mortality in the US has very little to do with obese women who want to use assisted reproductive technology. It has more to do with women who are poor, who are of color, who are on Medicaid and by the cuts the current administration to Medicaid. A complicating factor - the rate of closings of rural hospitals causing poor, rural women on Medicaid to have to travel more than an hour each way to an ob/gyn appointment. (There was an article about this in the Times just a week or two ago.)
Put your privilege aside - women on Medicaid can't get IVF. They are lucky if they can get pre-natal care. That's what's causing the maternal mortality crisis in the US.
28
@Danielle Maternal mortality has more to do with basic access to health care. The US lags far behind most industrialized nations in this.
26
@Danielle
I’m a specialist in perinatal autopsy, and obesity is objectively a risk factor for fetal death. It is true that many obese women carry healthy pregnancies, but the risk for both mother (preeclampsia, HELLP syndrome, cardiomyopathy, etc.) and fetus is much higher.
I also diagnose gynecologic malignancies and we have a brewing epidemic of endometrial cancer in young, obese women. The obesity is the direct risk factor, leading to excessive estrogenic stimulation of the uterine endometrium. The vast majority of women in their 40s, 30s, and even 20s who I diagnose with endometrial cancer have a BMI over 35. Some as high as 70+. BMI seems to negatively correlate with age at presentation, but that’s a subjective impression as I haven’t done the study to prove it.
Pointing out the medical risks of obesity is our responsibility. Respecting individuals who deal with obesity is also our responsibility, and understanding the complexity of the problem on a societal and biological level. But ignoring the risks is completely irresponsible and on the level of climate science denial.
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It isn't only in fertility-related medicine that one finds this type of stigma. A friend of mine is currently recuperating from a foot surgery for a congenital bone defect in both feet. She has been in pain since childhood but was told it would "go away" if she lost weight. After bariatric surgery, the pain did not go away, and surgery is now needed on both her feet to stop her from being in a wheelchair. Fifty years of avoidable pain and an inability to exercise.
31
@Emily S
Yes. Your anecdote is representative of a pattern in health care.
4
Weight, as a number, or BMI, is not generally a good indicator of health or wellness. Many "larger" people have better diet, exercise and lifestyle habits than some thinner people. Doctors need to consider the whole person, and all the possible factors, before isolating the problem down to weight. Some people are just naturally larger or smaller, and extreme, unsustainable weight loss tactics are not healthy for anyone.
25
@Witheld
Being taller, or smaller, or having muscles like a body builder will not explain away BMI of 40.
17
I bet chronic stress plays as much of a role in infertility as weight. My sister and I are 6 years apart and we both started having sex about the same age but while I got pregnant at the drop of a hat she's never even had a scare. I think the big difference is I had kids when the economy was good and even when the bottom fell out I wasn't as stressed since my husband was a soldier that had just re-enlisted in 08 for 6 more years and there was little risk in him losing his his job or benefits or having to take a pay cut. While he only made 24k gross in 08 and things were insanely tight with 2 kids we didn't have to turn to family for money just to keep the car or avoid eviction. In the army the pay is salaried and there are sick days, paid vacation and free healthcare. Until sequestration hit in 2013, the commissary and PX was heavily subsidized making sundries affordable. It was still incredibly hard to get by but compared to what the rest of the country was going through I felt lucky by comparison.
Meanwhile, my sister got certified as a phlebotomist 4 months before she got married in 2010 and within 8 months was the family's main breadwinner after her husband's employer, a construction company, went bankrupt and he was laid off. He got a job 3 weeks later but at only $12.50 an hour (an hourly pay cut of almost $6) dependant on him working the graveyard shift. It was then that my sister really started gaining weight, going from 160 at 5'7 to 210 in a year.
18
I was surprised that no one mentioned PCOS (polycystic ovary syndrome). This is an underlying cause of infertility which also causes your metabolism to shut down and causes weight gain along with many other symptoms. It also makes it nearly impossible to lose weight. That was the cause of my infertility which was only diagnosed correctly after finding an amazing reproductive endocrinologist who treated me with respect and truly listened to me after being dismissed and incorrectly diagnosed for years. I was 39 and terrified I had lost my chance.
Thanks to him I have a 15 year old son.
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@Regina
One of the risk factors for PCOS is obesity.
If this article is advocating for larger women and the stigma they suffer trying to cope with a sensitive heath issue, why does the photographer compose the article's photos in such a way that seems to hide, conceal and obscure each of the subjects' bodies?
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@Jay Why
I don't think that their bodies were hidden or concealed. Readers just expected them to look bigger due to the subject. They don't look that big to me-nothing like what one sees on " My 600 pound Life ". Because they were just in the 200 range. That is overweight but not huge.
18
@Jay Why It's likely that the women's bodies are "concealed" in the photos either because the focus is on their *babies,* not their bodies, or in an effort to avoid cruel comments from readers.
14
Really? One of the subjects is crouching behind a table. Of the 150 shots that were taken, why was that particular one chosen.
And the photos of the other women seem carefully composed to not display their larger bodies in full.
Which, I think, undermines the point of an otherwise powerful story.
48
I notice the sentence "delivered five weeks early" did not factor into the discussion at all. Five weeks of NICU care probably cost well over $150,000 and possibly quadruple that. These children who are born premature often suffer from lung and heart issues (sometimes for life). The costs of these issues can be extensive and ongoing. Yet, mothers are more than willing to roll that dice in order to have a child. This article did not address this issue at all.
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@politicsandamericanpie
Babies born at 35 weeks don’t necessarily need NICU stays. I had two babies born at 34 weeks and 1 was in the NICU 9 days and the other 15 days. Neither bill was $150,000. If either made it to 35 weeks and met certain criteria, they would have gone to the regular nursery. It’s very likely her baby went home with her and was fine right from birth.
29
@politicsandamericanpie Five weeks early does not equal five weeks in the NICU. My second daughter was born almost four weeks early and required no time in the NICU. In the article it said that the baby was five weeks early but healthy.
In any case, babies can end up in the NICU for many reasons. Are you implying that all of these mothers are irresponsible? Or only those that are overweight? No one chooses to have a child in the NICU, just like no one chooses to have cancer. Why is it selfish to seek treatment for this?
24
Five weeks early does not necessarily mean five weeks of NICU.
7
I mean, fat is an endocrine tissue that aromatizes and forms estrogen compounds which can make pregnancy difficult. You're body relies on cycling estrogen to release eggs. It is perfectly plausible, and probably most likely, that being extremely overweight is the underlying cause for this woman's infertility.
But that's the problem many people are not understanding: medicine is all about Bayesian probabilities that help us quickly and effectively assess what is ailing our patients. When an obese patient comes in with infertility and heavy irregular periods, the most obvious diagnosis is infertility secondary to PCOS. That's not saying that you do not entertain other possibilities, but the pre-test probability for PCOS is extremely high.
The guidelines for hypertension dictate that lifestyle modifications should be attempted first before the patient is started on antihypertensive therapy. The question this article should really be asking is: why is this issue different?
88
@Zack I think one reason that the issue is different is that patients are generally losing fertility with age, so lifestyle modifications made before beginning further treatment may actually reduce the patient's likelihood of concieving due to the delay.
11
@LRD
One small study from the mid-1950s (when obesity rates were substantially lower) showed a relapse rate of 95% for a single diet attempt. Subsequent studies have shown much better results. Many people also relapse multiple times before successfully learning to control their intake.
Smoking is a good analogy for obesity. It's a lifestyle choice as well as a risk factor for fertility, pregnancies and other health conditions, yet physicians recommend that "people who identify as smokers" stop all the time, whether or not they are currently healthy. Smokers make, on average, 8-30 attempts to stop smoking as well. However, many people do eventually stop smoking just as many people stop overeating.
6
@Stella B People can go cold turkey with smoking. Not so with eating. It's a totally different thing.
6
I never struggled with weight until I turned 64. I had 3 very healthy children when I was between the ages of 30-36. Nevertheless I had serious complications with labor and delivery twice and nearly died once. No one gave me a hard time about my troubles. The attitude seemed to be-well, you are an older mother and these things can happen. Now that I have a metabolic condition that has caused a lot of weight gain my eyes are open to a new world. People are ready to be quite judgmental and you know you have been relegated to the overweight world. I was in the hospital for a recent surgery and on my chart they wrote " overweight 66 year old woman ". My sister , who went in for hip surgery said : " Well, they wrote obese on mine." I'm not that big though- I'm a still muscular and fit size 14- but that is seen as huge and the truly large are treated even more high handedly. I do think these women are tuning in to the idea that professionals feel they don't "deserve" a baby. So they are told to get bariatric surgery which results in vitamin deficiencies and high risk to the mother and baby.This is awful and I believe is a response to a social prejudice, not a health issue.
32
-----"and implant it back into a woman’s uterus."
The fertilized eggs (once they multiply) are transferred to the uterus, not implanted. The embryo must then attach itself to the uterine wall.
18
Every single article ever written about in vitro fertilization makes this mistake. I have given up attempting to correct it. The reason IVF does not in fact work every time is because the embryos frequently fail to implant.
7
So glad t fertility industry is finally catching up to the idea that not all medical issues can be solved by weight loss. Maybe someday they will stop being so dismissive, and actually look for real medical reasons for people's complaints. Rather than blaming it on the size of their body.
11
Look this is anecdotal and I do live in a state with bad health and horrid maternal care. I have known more than one morbidly obese young lady have life threatening out come to their pregnancies. Both were directly related to their morbid obesity. One can never again birth a child. uterus removed. Permanent heart damage and host of meds for the rest of her 235 pound life.
Excess weight in mom, higher incidence of a diabetic pregnancy. Higher chance of type 2 diabetes for both mom and child later in life.
Don't mislead any women that being over weight is not a threat to your and the baby's life. And, to not forget to mention this, the hundreds of thousands of dollars in hospital costs.
How the junk food biz world yearns to make us ok with unhealthy weight.
140
My friend had gastric bypass surgery to lose weight to conceive. Our sons are close in age, almost 7. She died about a month ago at the age of 41. Complications from the surgery. This mindset is literally killing beautiful otherwise healthy, but bigger, women.
52
@Michele There's nothing "beautiful or healthy" about obesity. Suggesting otherwise is misleading and dangerous.
81
@Michele ancedotal. Yes, there are risks from weight loss surgery, but most do not die from it. My sister had it done in 1999 and it improved her life vastly. She lost 100 lbs and is very healthy.
20
@Michele I am so sorry for your loss, and I agree with you completely. My heart aches for you and for her son.
13
Thank you for this, I hear this from my clients a lot - it is such a huge issue in the maternal fetal medicine world.
5
I am also struggling with the same issue as the woman in this story -as a matter of fact I wouldn't be surprised if we had the same doctor deny us their services, since we are from the same general area. Ive seen or spoken to at least 5 different doctors or fertility clinics about being helped with IUI rounds and all of them refused me because of my high BMI of 54. I have FINALLY found a doctor who has agreed to work with me. Im still in the bloodwork phase with Dr. Vito Cardone and yes, honestly, I'm still sort NH of waiting for the other shoes to drop and have him refuse to help me. That said, it was incredibly encouraging to have a medical professional not deny me on sight alone. I feel motivated to eat healthier and invest in my health BECAUSE I wasn't turned away at the door by Dr. Cardone. His clinic works through Boston IVF which was odd for me because they are the one's who refused to help me. It has been deeply wounding to be told over and over that I'm too fat to be a mother and that it wouldn't be responsible of the doctor to offer services. This whole experience has been borderline discriminatory. The one good thing I've taken from my own experience is my increased ability to advocate for myself. I hope other women of size read this article and stay strong. Keep looking, ask weight limit requirement questions over the phone and if you are in the Massachusetts/New Hampshire area look up Dr. Vito Cardone.
18
Amazing how none of these doctors ever seem to consider the possibility of a medical condition underlying both the obesity and the infertility. Polycystic ovarian syndrome (PCOS) for example, is associated with both. Maybe they should be open-minded enough to check for underlying issues before assuming that the problem is simply the weight and losing weight will be both possible to do and a likely solution to the problem.
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@Nikki Came here to say that it's absurd that none of these doctors seem to be aware that PCOS causes both weight gain and infertility--and losing weight wouldn't help the infertility at all. Not, of course, that treating patients the way these women were treated is justifiable, regardless of the reasons for their size. If a patient has a condition that increases risk, explain it to them and make a plan to go forward based on their informed decision--don't cut off options like this. My mother has had to yell at doctors who blame all of my sister's health problems on her weight--and if she hadn't, my sister would have developed colon cancer at 24, because doctors refused to consider that something was going on aside from her being overweight. Luckily they caught it and were able to treat her while it was still pre-cancerous, but if my mom hadn't pushed for testing they would never have found it in time. Doctors' biases about weight absolutely damage outcomes. I'm not overweight, but I run all the time so I have a lot of muscle in my legs, which is heavier than fat and pushes my BMI toward the high end of healthy. Last time I went to the doctor--after a month sick with mono!--she harped on that, was very shaming about it, and made me feel so bad I don't want to go back, even though I know I'm not overweight and, more importantly, that I eat healthy and exercise, and that BMI is a nonsense statistic. No one deserves to be treated like that, regardless of their size.
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Congratulations for your successful pregnancy, Gina (and the other moms profiled in this article)!!! I am so sorry you had to go through what you did to get there.
My BMI is in the "healthy" range, and I dealt with infertility for years in my mid-to-late 30's. What did it teach me? That the human body still holds great mystery in spite of medical advances. I had elevated FSH at age 36, and my response to IVF seemed to corroborate low ovarian reserve. I had 5 unsuccessful IVF attempts. I went to 3 different highly-regarded IVF clinics in Massachusetts.
I did a lot of work to accept the fact that I would never be able to get pregnant.
Years later I was in a different relationship and we were not using birth control (we weren't trying to conceive, that wasn't even on our radar). Eight months after stopping birth control, I got pregnant. I was floored. I had a miscarriage at 10.5 weeks, but knowing that I *could* get pregnant, I gave it another shot. Five months after the miscarriage, I was pregnant again. My healthy daughter was born 2 months shy of my 44th birthday. So I was able to get pregnant twice in approximately 17 months in my 40's without really trying , years after being diagnosed as having elevated FSH and low ovarian reserve.
This is my long way of saying that there is a LOT about the body that doctors still don't know, and for doctors to be unwilling to treat someone due to her weight is ridiculous. There are just too many other factors that could be at play.
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Congrats to you, too, charmander! I bet you're a great mom.
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as an obgyn, i have taken care of many obese, morbidly and super-morbidly obese patients throughout their pregnancies. most jave normal pregnancies and can be great moms (weight makes no difference!). however, there is a bmi where care and delivery can be very difficult-- this article does not address that. when someone has a bmi >60 or a weight >500lbs, exam and operating tables cannot accommodate them. c-sections can be very dangerous through a foot of fat tissue. there are logistical and safety issues when equipment doesn't fit or work.
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@n I am sure this is true - about the equipment not being built for superfat bodies - and the good news here is that *we can create new equipment* including new surgical instruments.
If the medical establishment woke up tomorrow believing that very fat people were valuable and important members of society, they would be falling all over themselves to innovate solutions and handing out awards and honors to the clinicians and engineers leading the way.
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There IS special medical equipment for patients of larger size. The point is that it is still more risky.
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@dub Thank you for this comment
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Why is the first assumption it's the woman's problem? Why not test his sperm first?
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@Norah
Yeah, given that IUI worked, I was wondering if the problem was really low sperm motility. It amazes me that so many doctors just automatically dismissed the possibility that the problem could lie with the male without even doing any testing.
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When I went to a fertility clinic, the first thing they did was test my husband’s sperm.
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@Norah Do you really think they didn't test the sperm? Just because it isn't reported in this article?
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"Then he outlined a daily plan for her: Drink a gallon of water, eat fewer than 900 calories and exercise for an hour. If Robben followed these directions correctly, the doctor expected her to lose 50 pounds in a month, much more than the monthly rate of four to eight pounds considered safe by major health organizations. "
What the actual WHAT?
That is obviously an unhealthy, terrible idea for literally anyone. Whatever happened to "do no harm"?
Sure, she needed to lose weight, but how about (a) looking at the initial cause of gain and reasons for not losing, and (b) a reasonable goal and diet? Though, based on some of the doctors I've seen in my life, I'm not surprised. Many of them would be much better off as car mechanics where they can use their knowledge to fix something without actually interacting with any living creatures at all, much less a woman who's aching to become a mother.
If doctors view weight as a problem, why not address infertility AND weight? This article makes me really angry and for the record, I'm not at all overweight, just a normal human being with feelings.
Congratulations to all the parents on their beautiful families.
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@L also love this doctor apparently not being aware that eating under 1200 calories a day can actually make your body retain weight rather than lose it. because it goes into starvation mode. Eating that little can mess with glucose and insulin and, over time, even damage your heart. Healthy!
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@Emily
“Starvation mode” is pop-sci hogwash. I don’t know the history of the term but it’s been around since I was a kid, and it’s total nonsense. Eating less leads to weight loss. There is no physiologic “starvation mode” that causes people not to lose weight, and you can look at people kept in states of extreme food deprivation even for relatively short periods for visual evidence.
Losing large amounts of weight suddenly is not healthy. But everybody is quick to accept what was self-reported in this article as fact. It is very common for people to misreport what was said to them by a doctor, either because their emotional state has led them to misremember it or they never understood it in the first place or even, perhaps, because their anger leads them to intentionally exaggerate or misrepresent. It is possible the doctor said exactly that (though, honestly, not incredibly likely), but it is also possible he said something much less extreme which has been translated through emotion into the report we read.
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A large number of pregnancies achieved with assisted reproduction techniques have complications depending on the affected fertility factor, and this is a reality. If we add that to a mom with a high body mass index, the risk for complications in that mom, fetus, neonate, infancy, adolescence and adult life of the person resulting from that pregnancy is also greater . The benefits of weight loss outweigh the risks and frankly I do not see an issue of discrimination. What is essential is to identify the individual risk and discuss it with the patient and her family.
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@Rodrigo - did you read the article? Your response seems to be the perfect example for the medical establishment to see beyond a very specific set of norms, which is not always evidence based. Disappointing, but not surprising, that you don’t see an issue with the discrimination. Que pena.
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@Rodrigo Zamora MD A dear friend of mine, who does not have an ounce of fat on her body, lost her child during delivery. She is now pregnant again and not a single doctor has refused to treat her because of the fear of potential complications. If a doctor is unable to understand that complications can occur is any pregnancy, perhaps that doctor is in the wrong profession. And exactly what gives you the ability, or the right, to predict that the offspring of an overweight mother is somehow at risk during "adolescence and adult life"? What an absolutely ridiculous assertion, lacking any scientific basis.
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Until we end putting whatever it is into our bodies that causes obesity, this story is only going to happen again and again across all fields of medicine. What thing is the culprit? Big food with its sugar and other food additives? Big pharma with its gut destroying vaccines and antibiotics? Our own lack of control? At the moment only we are getting the blame. I think the blame lies with one or both of the biggies.
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@SW Gut-destroying vaccines are not a thing.
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@Erica
Sorry but an acute case of "the runs" after a vaccine is wiping out everything, at least in the short term...whose to say it all comes back...?
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@Erica I had a reaction to the shingles shot, took sulfa drugs for five days, and now I can't drink wine.
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