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 here.

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?