Wednesday, July 16, 2008

Bariatric Obstetrics, Part 2 - This Guy is Objective?

Previously, we discussed the New York Times article called, "Too Fat and Pregnant," and the emerging concept of "Bariatric Obstetrics," obstetric practices which specialize in fat women (and not in a good way).

First we discussed how "Bariatric Obstetrics" ghettoizes fat women into a high-tech, high-intervention protocol without actually questioning whether such an approach actually improves outcomes. We also discussed how many fat women have found that they actually achieve better outcomes and more humane births by choosing the midwifery model of care, yet this push towards "Bariatric Obstetrics" might keep fat women from being able to choose that kind of care.

Today, we begin to look at the controversial concept of limiting weight gain in "obese" women in order to prevent complications, and the main doctor pushing this agenda.

Before we get to that, fairness impels us to note that not all of the New York Times article was bad. They discuss having equipment that fits the women they see, like large blood pressure cuffs and scales that accurately weigh large women (many of whom previously had to be taken down to be weighed on the loading dock scales). Would that more obstetric practices realized the importance of proper equipment for people of size.

In addition, proponents of "Bariatric Obstetrics" strongly promote the idea of exercise during pregnancy for all women, fat or thin. As long this is reasonably done, this is a good thing, as research clearly shows that regular exercise before and during pregnancy can lower the chances for gestational diabetes, pre-eclampsia, and other complications in women of all sizes. [But please note that doctors are johnny-come-latelies on this issue! Midwives have been promoting healthy movement as prevention for pregnant women for years.]

All well and good, even though the tone of the Times article was certainly
sensationalistic, emphasizing women having babies at "400, 500, even 600 pounds," when in fact these pregnancies are still unusual. But like the headless fat torsos in media releases, if they can emphasize the most "extreme" cases, then they can ratchet up the condemnation level in the public and the medical community.

But then the article turns into yet another media spin for limiting pregnancy weight gain in women of size. They quote Dr. Raul Artal (cue boo, hiss sound effect), who is trying to pressure the Institute of Medicine (IOM) into lowering the guidelines for acceptable weight gain during pregnancy, especially for obese women.

Dr. Artal did a study (a flawed study, but that's a topic for another post) that found less pre-eclampsia and cesareans among obese women who gained less weight in pregnancy, so now he's spinning this SAME study many different times in the press in order to create the illusion of a preponderance of evidence for little or no weight gain in women of size. He is manipulating the media to convince doctors everywhere (and the IOM) that the guidelines really need to be lowered. Sandy of Junkfood Science calls this "Science By Press Release," an analysis of which can be found

Dr. Artal has been promoting this same campaign to change the IOM guidelines for several years now. He seems to feel that with enough repetition, the message will create enormous pressure to change the IOM guidelines. So he keeps re-issuing the same old material in new ways, keeping it in the public eye, and more importantly, in the eyes of the doctors who influence the IOM, which is currently reviewing the evidence for these very guidelines.

But who is this guy, and what does he believe about fat women? Here's what Dr. Artal said in an earlier Associated Press article about limiting weight gain in pregnancy.

Although most doctors would never recommend dieting during pregnancy, Artal says he has no qualms about counseling overweight patients to eat less. "For them, less could still be the diet of another person for a whole week," he says.

[Amazing how this man is so psychic he knows without looking how much all these fat women are eating at all times. I'm always amazed when doctors insist they know what someone must be eating, based on their size alone.]

Do you really think that fat women are going to get respectful, dignified, fair treatment from this man? Do you really think he has the best interests of fat people at heart? Or he is so biased by his own fat-phobic assumptions about obesity that he can't possibly be objective about his own interventions?

The New York Times article does point out, "Some scientists warn that we still know little about the potential dangers of this approach," right before it shrugs off those concerns. Dr. Artal's guidelines are seen as a bit extreme by some doctors, yet few are speaking out against them.

This guy is now the Chairman of Obstetrics and Gynecology at St. Louis University in Missouri, and the director of the Bariatric Obstetrics Clinic there. So now he is spreading his message of fat-fear and extreme interventions to next generation of doctors everywhere.

Is this really the guy we want driving public and medical opinion about obesity in pregnancy? Where are the opposing voices in the medical and midwifery community, willing to speak out against this tripe?


Abigail Nussey said...

As someone who is considered "obese" by the Holy Arbitrary Panic-Mongering BMI chart, and as someone who is looking to one day get pregnant (not soon, but one day), I find trends like this extremely alarming.

This medicalization of normal body variance is just a thinly-veiled ruse to make fat people seem less "human" than other people. It has been shown again and again throughout history that groups who are medicalized (or told that they could be "cured" if only they reformed/got a lobotomy/etc), and more in general groups who are dehumanized, are later subjected to even greater ills by a majority who sees them as diseases, or aliens, or lab animals.

You might be right that it is ghettoizing fat women by inventing this field of medicine, but I'd go one step further. I'd argue that it is in fact a prelude to outright experimentation on a dehumanized class. Prelude? Scratch that. It *is* outright experimentation on a dehumanized class.

Wellroundedmama, I'm so glad you have this blog. I think the way fat pregnant women, fat children and fat parents are being treated is appalling, and I think it's also extremely illustrative. Once they seize our bodies and our children, we have effectively been dehumanized. It's been happening more and more: read practically anything Sandy writes over at

Thanks for the great post.

wriggles said...

You are right to criticise the extraordinary silence of the medical professions, even faced with potentially dangerous attitudes such as those held by this doctor.
All that it takes for evil to triumph is for the good to do nothing. This may not quite be 'evil' but we know that these kind of views have shown to be very corrupting, and the goodness of people seems no protector against this corruption.

When I became pregnant, I decided that it was not a good idea to diet as such, but I hit upon a strategy which was to eat only until I was no longer hungry, then a couple of bites more just for safety then stop.
I thought I was being very clever and reasonable, but by the time I was towards the latter 3rd of my pregnancy, I felt like I was eating all the time.
I don't think I gained that much, about 21 pounds. The point is, I don't know whether I would have gained more, less or the same if I'd not bothered.
He says that women who gain less weight during pregnancy have safer deliveries, he has not said why they put on less, were they on a carefully calorie controlled diet?
Did they just eat what they felt like, without fear or what?

Anonymous said...

This makes me so angry. I only gained 23 (at the time the reccomen pounds during my second pregnancy. There was no worry over less than normal amount of weight gain, because I was fat. With my first child I gained 40, but with my second only 23. I'd been sick throughout my pregnancy and didn't worry about not gaining as much weight because I was fat. I thought was probably a good thing. My first child had been 7 pounds 11 ounces at birth, my second was barely six pounds. She quickly lost weight to be under six pounds, and the nurses would sometimes get me mixed-up with the woman who had given birth to a preemie because my daughter was so small. She had colic for months and months and I blamed myself. I cannot tell you how much guilt I had over my daughter's size. My crunchy, thinner friends were gaining lots of weight while pregnant (one gained 50 with every one of her kids- and is came off on it's own after each one too) were having these mellow, healthy fat babies. Nobody was telling them she should gain less weight.

Anonymous said...

"For them, less could still be the diet of another person for a whole week," he says.

Wow. Just wow. I am so insulted by that that I can hardly come up with a coherent thought. He has no idea what I eat, given that my metabolism is so fucked up from years and years of (doctor-supported and encouraged) dieting that I can barely go over 1500 calories a day without gaining weight, even when I'm pregnant.

I had a baby less than 8 weeks ago and have already lost the 15 or so pounds that I gained during my pregnancy. I had a normal, vaginal birth with no pre-eclampsia, no GD, no high blood pressure, nothing. Did I mention that I'm 5'6 and weighed 302 pounds when I gave birth?

I had a traditional obstetrics model with a very fat-friendly practitioner, and I needed no interventions of any kind. It's amazing how assuming that bad things will happen can make bad things happen.

Thanks for this series. You're creating a very valuable resource for fat women.

Anonymous said...

Respond to anonymous.... I am about the same as you in weight and height, and I have had a few kids already, My husband and I have one together and we want one more, and I am trying to find a size friendly Doctor here in Oregon, so I posted a Blog on craigslist about it, and I am so depressed, from all the rude things people said in response to my blog, comments such as, why would you want to get pregnant when you already have kids, and your fat, also one saying I am just being selfish, that I should lose weight before trying to conceive again. It goes on, they said such cruel things. I had my thyroid partially removed and it is so hard to lose weight, and we want one more baby so I just want to have it, then concentrate on getting to a healthy weight after. I am 35 now, and plan for the next baby to be my last. I just dont know how to find a size friendly Doc in my area, just alot of heartless cruel people. Hopefully I get a response here that will lift my spirits back up, I love this site!! Thanks for listening....