Thank you so much for sharing this conversation! I am 26 weeks pregnant, and considered "obese" according to western medicine. And while fertility thankfully wasn't an issue for me, navigating the healthcare system and its' biases has been SO EXHAUSTING. Why are there only slim women with perfect basketball bumps in the brochures and apps? Where are all the other kinds of body representation? It really does feel isolating. I've had colleagues tell me "Oh, I didn't even know you were pregnant!" just because my body happens to be larger and I'm carrying the pregnancy weight discretely. It feels shameful sometimes, to not look like the "typical" pregnant person. I've also had some health challenges that unfortunately play right into the medical community's opinions about fat pregnancy (chronic hypertension, gestational diabetes). I have NEVER had these issues prior to getting pregnant, so it feels like my body is doing pregnancy wrong. It's also been so hard to find plus sized maternity clothes, and the ones I do find are sized so strangely. I just try to keep telling myself that this condition is temporary, and I'm doing it for my daughter, who is thankfully healthy so far. But it is hard, and these things take some of the joy out of what should be an exciting time for our growing family.
Raising a glass for the supportive docs out here: When I was considering having a second kid, I told my doc I was worried because my body grew considerably with my first kid’s early years and stayed that way. What if my body size affected the baby? She was unfazed. She said something like, “If you want to get pregnant, I see no medical reason not to try. We’ll watch and see what happens and take care of you.” I decided not to get pregnant, but she was great.
I think we also forget HOW MUCH other privilege intersects here. When we couldn’t get pregnant the old fashioned way, I went to the best fertility center in the state which was covered by my Cadillac level insurance at a max cost of $4K/year. (It was actually free to me because I’d had my gallbladder out that year.) No one at ANY time ever asked me to “consider losing weight” or “lose weight first” despite my BMI hovering around 40 for all of this. Instead I have had dozens of medical providers check my thyroid levels. Because they presume the rich white lady with an Ivy League degree and the very important law job knows not to eat whatever food they feel like demonizing that day. And when IVF worked, even my OB/GYN never told me not to gain weight. (I’m sure it did help that I didn’t gain much weight pregnant.) which is how you KNOW all these “medical” positions are BS and bias. Because they don’t apply when you have money.
Thank you for covering this! I could have used this discussion 12 years ago when we started our fertility journey because I often felt like a lesser woman, having PCOS to the extreme of not menstruating ever, and going through so many failed transfers and early losses. When I finally did get pregnant with a viable pregnancy, I had mild hypertension going into it that hadn't gotten better with weight loss (thank you, genetics) and while I was monitoring it, I still ended up with superimposed pre-eclampsia, ending in a c section at 30 weeks with twins. The entire time I was pregnant, I was anxious over another potential loss, overly sensitive of how people looked at me, and constantly compared myself to my best friend who was also pregnant at the time and had that cute baby bump I was so envious for...anyway, thank you again for highlighting this topic and helping to normalize fat people in the world.
Thank you for covering this- I did not struggle with infertility but the immediate healthcare bias when pregnant while fat is so frustrating- very first appointment I was being told to gain 20-25 lbs because I was already over the BMI of 30. And like I was sitting there saying well I’m having trouble eating anything except cereal and fruit and being praised for not gaining weight in the first 8 weeks?! Thankfully my pregnancies went fairly smoothly but I was stressed about weight gain and looking back with my ED history I definitely feel like I should have done blind weights at least. My oldest measured small and the fixation on his weight as a newborn was also really exhausting. The whole healthcare industry focus on weight is exhausting.
My closest experience with infertility is my twin sister, and she has always been straight size. There was a lot of frustration for her on the other side of Oh you seek so physically healthy, we are sure we can help you and yet her IUI treatments were unsuccessful. And despite me being deemed as a high risk pregnancy because I had high blood pressure and my mom had preeclampsia, I got pregnant in 4-6 months with both my kids. And to me just goes back to please don’t completely eliminate fat people from the treatment protocols! I have never felt like my body held me back from anything I wanted to do with my kids and they have certainly never seemed concerned about my body size. Those roller coasters at Disney were somewhat tough but also sitting next to a 5 yo and expecting the bar to hit at the right place on both of us is probably already unrealistic!
Ugh, yes. So frustrating the way that my fertility specialist seemed almost biased the other way with us- like y’all are young and healthy (at the time we entered treatment I was 29, and he was 32, we ended up spontaneously conceiving and had our daughter when I was 31 and he was 34), we should easily be able to help you get pregnant again. Also frustrating because the fact that I had had a miscarriage after getting pregnant the first cycle I went off birth control meant that it made it seem like I shouldn’t have had as much trouble as I did conceiving again.
Lizzy, I am always annoyed on your behalf by the weird stress on weight gain for those with slightly higher BMIs. It’s such an annoying thing to harp on.
Thanks for doing this episode! I used Nicola’s resources when I was navigating fertility treatments and they were very helpful. Even just to normalize my situation.
I experienced the most of the“greatest hits” of fatphobia in infertility. Being told to lose 100+lbs before even attempting to get pregnant, was told my best bet to have a baby was to go to a weight loss clinic (spoiler: what I actually needed was IVF and a surgery to remove a cyst), denied IVF care because of my BMI, driving out of state for a clinic that would take me, suggested to get WLS even though research has shown that IVF is less successful after WLS, told I had to do my egg retrievals without anesthesia, the list goes on and on and on.
It took all the resilience and profound privilege (healthcare literacy, amazing insurance coverage, money, whiteness etc) I could muster to get me through the process. But I have two daughters due to the fertility care I was able to access despite all the bullshit.
I was very interested by this headline and very surprised by the tone of the conversation that seemed to lack an overall sensitivity to fertility issues. As I understand it both of you had no trouble conceiving and did not utilize IVF or other medical fertility interventions - you can really feel that in how the conversation progresses and meanders from actual fertility issues into grievances about being judged for being fat as mothers (only if you're lucky enough to birth one! Isn't this the fertility episode?) Nicola's website bio even talks about just how easy it was to get pregnant, despite being warned that it would be hard. That is not true for all women (of any size). Undergoing IVF is a major undertaking that subjects women to endless injections and the side effects of hormones taken over time, huge body changes, huge expense, psychic stress, often travel, especially now as laws in the US have made it more difficult. Women go through these procedures and protocols for months on end only to learn they have to try again, if they can afford it financially and mentally. So much infertility is still unexplained and doctors will take the "kitchen-sink" approach giving women a cocktail of estrogen, progesterone, blood thinners, steroids and yes, probably some kind of diet advice. And women who really want to be mothers jump into this despite it being extremely taxing. And they do it all over again when it doesn't work out. I wish you had put your conversation in broader context and shown the same sensitivity you demand when it comes to discussing anti-fat bias.
I am deeply disturbed that there are women not pursuing fertility treatment bc of fears or limitations placed on them based on their size. But you made it sound like they'll just be turned away from something that is otherwise easy for women with lower BMIs and that weight and conditions like PCOS should not be factored into any protocol. If you've ever had a friend doing IVF (of any size) she is likely taking a regiment of vitamins and watching what she is eating and just "trying everything" bc honestly, the medical community does not always have all the answers and if you only have a few chances at it financially and emotionally, you are likely going to want to try any and everything that will increase your odds.
Once when I was dangerously depressed my therapist strongly suggested that I stop reading the heavy laden literary works I love so much and find something light. She told me to go to my favorite reading place, sit with the book and read. I chose Winnie-the-Pooh, bought a round trip ticket to NYC, sat and read cover to cover from WDC to NYC and back. By the time I was home my depression had markedly lifted. No, I wasn't cured. But Pooh rewired some neurotransmitters in just the right way. I gave my copy, a vintage copy no longer available, to my twin godsons when they were in hospital, 1 day old. Their father began reading it to them that night.
I just wanted to say that my mom has a bigger body and always did. Not once did her body ever prevent her from taking care of my sister and I, giving us everything we needed, playing with us, taking us fun places, or just being an all round great mom. It is so enraging and upsetting and ableist when people say such things. My mom is in her 70s now and remains an example of living her best life. I have been so very lucky.
I avoided fertility treatments when I was having trouble with pregnancy losses (miscarriages and an ectopic pregnancy), partly because none of my ob doctors suggested it, partly because I didn't want to be told to lose weight, and very much because I had known someone while she was going through fertility treatment who found it so mentally and emotionally difficult to go through the egg placement, waiting to see if it would take, etc., which I felt I had already gone through with the miscarriages. I didn't think I could handle the psychological aspects. When I finally got pregnant and didn't have a miscarriage, overall my doctors didn't bring up my weight, but I did realize that they seemed to assume I would contract gestational diabetes at some point. They seemed surprised when I didn’t.
Thank you so much for sharing this conversation! I am 26 weeks pregnant, and considered "obese" according to western medicine. And while fertility thankfully wasn't an issue for me, navigating the healthcare system and its' biases has been SO EXHAUSTING. Why are there only slim women with perfect basketball bumps in the brochures and apps? Where are all the other kinds of body representation? It really does feel isolating. I've had colleagues tell me "Oh, I didn't even know you were pregnant!" just because my body happens to be larger and I'm carrying the pregnancy weight discretely. It feels shameful sometimes, to not look like the "typical" pregnant person. I've also had some health challenges that unfortunately play right into the medical community's opinions about fat pregnancy (chronic hypertension, gestational diabetes). I have NEVER had these issues prior to getting pregnant, so it feels like my body is doing pregnancy wrong. It's also been so hard to find plus sized maternity clothes, and the ones I do find are sized so strangely. I just try to keep telling myself that this condition is temporary, and I'm doing it for my daughter, who is thankfully healthy so far. But it is hard, and these things take some of the joy out of what should be an exciting time for our growing family.
Raising a glass for the supportive docs out here: When I was considering having a second kid, I told my doc I was worried because my body grew considerably with my first kid’s early years and stayed that way. What if my body size affected the baby? She was unfazed. She said something like, “If you want to get pregnant, I see no medical reason not to try. We’ll watch and see what happens and take care of you.” I decided not to get pregnant, but she was great.
I think we also forget HOW MUCH other privilege intersects here. When we couldn’t get pregnant the old fashioned way, I went to the best fertility center in the state which was covered by my Cadillac level insurance at a max cost of $4K/year. (It was actually free to me because I’d had my gallbladder out that year.) No one at ANY time ever asked me to “consider losing weight” or “lose weight first” despite my BMI hovering around 40 for all of this. Instead I have had dozens of medical providers check my thyroid levels. Because they presume the rich white lady with an Ivy League degree and the very important law job knows not to eat whatever food they feel like demonizing that day. And when IVF worked, even my OB/GYN never told me not to gain weight. (I’m sure it did help that I didn’t gain much weight pregnant.) which is how you KNOW all these “medical” positions are BS and bias. Because they don’t apply when you have money.
Thank you for covering this! I could have used this discussion 12 years ago when we started our fertility journey because I often felt like a lesser woman, having PCOS to the extreme of not menstruating ever, and going through so many failed transfers and early losses. When I finally did get pregnant with a viable pregnancy, I had mild hypertension going into it that hadn't gotten better with weight loss (thank you, genetics) and while I was monitoring it, I still ended up with superimposed pre-eclampsia, ending in a c section at 30 weeks with twins. The entire time I was pregnant, I was anxious over another potential loss, overly sensitive of how people looked at me, and constantly compared myself to my best friend who was also pregnant at the time and had that cute baby bump I was so envious for...anyway, thank you again for highlighting this topic and helping to normalize fat people in the world.
Thank you for covering this- I did not struggle with infertility but the immediate healthcare bias when pregnant while fat is so frustrating- very first appointment I was being told to gain 20-25 lbs because I was already over the BMI of 30. And like I was sitting there saying well I’m having trouble eating anything except cereal and fruit and being praised for not gaining weight in the first 8 weeks?! Thankfully my pregnancies went fairly smoothly but I was stressed about weight gain and looking back with my ED history I definitely feel like I should have done blind weights at least. My oldest measured small and the fixation on his weight as a newborn was also really exhausting. The whole healthcare industry focus on weight is exhausting.
My closest experience with infertility is my twin sister, and she has always been straight size. There was a lot of frustration for her on the other side of Oh you seek so physically healthy, we are sure we can help you and yet her IUI treatments were unsuccessful. And despite me being deemed as a high risk pregnancy because I had high blood pressure and my mom had preeclampsia, I got pregnant in 4-6 months with both my kids. And to me just goes back to please don’t completely eliminate fat people from the treatment protocols! I have never felt like my body held me back from anything I wanted to do with my kids and they have certainly never seemed concerned about my body size. Those roller coasters at Disney were somewhat tough but also sitting next to a 5 yo and expecting the bar to hit at the right place on both of us is probably already unrealistic!
Ugh, yes. So frustrating the way that my fertility specialist seemed almost biased the other way with us- like y’all are young and healthy (at the time we entered treatment I was 29, and he was 32, we ended up spontaneously conceiving and had our daughter when I was 31 and he was 34), we should easily be able to help you get pregnant again. Also frustrating because the fact that I had had a miscarriage after getting pregnant the first cycle I went off birth control meant that it made it seem like I shouldn’t have had as much trouble as I did conceiving again.
Lizzy, I am always annoyed on your behalf by the weird stress on weight gain for those with slightly higher BMIs. It’s such an annoying thing to harp on.
Thanks for doing this episode! I used Nicola’s resources when I was navigating fertility treatments and they were very helpful. Even just to normalize my situation.
I experienced the most of the“greatest hits” of fatphobia in infertility. Being told to lose 100+lbs before even attempting to get pregnant, was told my best bet to have a baby was to go to a weight loss clinic (spoiler: what I actually needed was IVF and a surgery to remove a cyst), denied IVF care because of my BMI, driving out of state for a clinic that would take me, suggested to get WLS even though research has shown that IVF is less successful after WLS, told I had to do my egg retrievals without anesthesia, the list goes on and on and on.
It took all the resilience and profound privilege (healthcare literacy, amazing insurance coverage, money, whiteness etc) I could muster to get me through the process. But I have two daughters due to the fertility care I was able to access despite all the bullshit.
Thank you for promoting this conversation!
I was very interested by this headline and very surprised by the tone of the conversation that seemed to lack an overall sensitivity to fertility issues. As I understand it both of you had no trouble conceiving and did not utilize IVF or other medical fertility interventions - you can really feel that in how the conversation progresses and meanders from actual fertility issues into grievances about being judged for being fat as mothers (only if you're lucky enough to birth one! Isn't this the fertility episode?) Nicola's website bio even talks about just how easy it was to get pregnant, despite being warned that it would be hard. That is not true for all women (of any size). Undergoing IVF is a major undertaking that subjects women to endless injections and the side effects of hormones taken over time, huge body changes, huge expense, psychic stress, often travel, especially now as laws in the US have made it more difficult. Women go through these procedures and protocols for months on end only to learn they have to try again, if they can afford it financially and mentally. So much infertility is still unexplained and doctors will take the "kitchen-sink" approach giving women a cocktail of estrogen, progesterone, blood thinners, steroids and yes, probably some kind of diet advice. And women who really want to be mothers jump into this despite it being extremely taxing. And they do it all over again when it doesn't work out. I wish you had put your conversation in broader context and shown the same sensitivity you demand when it comes to discussing anti-fat bias.
I am deeply disturbed that there are women not pursuing fertility treatment bc of fears or limitations placed on them based on their size. But you made it sound like they'll just be turned away from something that is otherwise easy for women with lower BMIs and that weight and conditions like PCOS should not be factored into any protocol. If you've ever had a friend doing IVF (of any size) she is likely taking a regiment of vitamins and watching what she is eating and just "trying everything" bc honestly, the medical community does not always have all the answers and if you only have a few chances at it financially and emotionally, you are likely going to want to try any and everything that will increase your odds.
Once when I was dangerously depressed my therapist strongly suggested that I stop reading the heavy laden literary works I love so much and find something light. She told me to go to my favorite reading place, sit with the book and read. I chose Winnie-the-Pooh, bought a round trip ticket to NYC, sat and read cover to cover from WDC to NYC and back. By the time I was home my depression had markedly lifted. No, I wasn't cured. But Pooh rewired some neurotransmitters in just the right way. I gave my copy, a vintage copy no longer available, to my twin godsons when they were in hospital, 1 day old. Their father began reading it to them that night.
I just wanted to say that my mom has a bigger body and always did. Not once did her body ever prevent her from taking care of my sister and I, giving us everything we needed, playing with us, taking us fun places, or just being an all round great mom. It is so enraging and upsetting and ableist when people say such things. My mom is in her 70s now and remains an example of living her best life. I have been so very lucky.
I avoided fertility treatments when I was having trouble with pregnancy losses (miscarriages and an ectopic pregnancy), partly because none of my ob doctors suggested it, partly because I didn't want to be told to lose weight, and very much because I had known someone while she was going through fertility treatment who found it so mentally and emotionally difficult to go through the egg placement, waiting to see if it would take, etc., which I felt I had already gone through with the miscarriages. I didn't think I could handle the psychological aspects. When I finally got pregnant and didn't have a miscarriage, overall my doctors didn't bring up my weight, but I did realize that they seemed to assume I would contract gestational diabetes at some point. They seemed surprised when I didn’t.