9th Turkey Awards: Obesity Eugenics Media Campaigns

A fairly recent article in an Australian newspaper ─ October 2016 ─ had the inflammatory headline, "Call to stop obese women from having babies." The picture below it featured a woman with a slight double chin and said, "Experts warn obese women should not have children."

Well, here we go again with the Obesity Eugenics Wars. This incredibly discriminatory movement is the winner of not one but two Turkey Awards. It's time to call these egregious practices out.

If you aren't familiar with them, the Turkey Awards are the "prizes" I hand out to highlight fat-phobic treatment of people of size from care providers, biased attitudes or studies from researchers, or troubling trends in the care of fat pregnant women these days.

In past years of the Turkey Awards, we've talked about:

• #1: fat-phobic care providers
• #2: scare-mongering and shaming tactics
• #3: jumping to conclusions about risks
• #4: scorched earth tactics
• #5: prenatal weight gain extremism
• #6: fat-phobic attitudes around treatment of PolyCystic Ovarian Syndrome(PCOS)
• #7: astronomically high cesarean rates in women of size
• #8: weight bias in the treatment of lipedema 

I haven't done a Turkey Award in quite a while, so I'm doing two years in a row now. To make it easier to read, I'm splitting one giant post up into two. Today's post is about attention to the Obesity Eugenics Media Campaign and its impact on women. In the future, we will highlight the egregious lack of access to fertility treatment for high BMI women and how this plays into Obesity Eugenics.

Obesity Eugenics: The Media Campaign

Headline from 2016 Australian news article

There has been a concerted public health campaign in recent years to vilify fat pregnant women, scare them away from pregnancy via risk hyperbole, and present only negative stories about fat pregnancy in the media.

This is because many doctors seem to believe that fat people have no business having children. Here's a recent comment from one OB:

Obese women shouldn't even get pregnant. 

This is a common opinion among some healthcare providers. While having a miscarriage, one women of size was scolded for being upset. She was told:

Why are you crying? It’s not like you lost anything. A woman your size has no business being pregnant anyway.

The caption under the picture for the above news headline is

Experts warn obese women should not have children. 

Although these experts justify their actions by saying it's for the sake of the children to get around criticism, that's baloney. This is nothing more than weight bias, pure and simple, combined with the arrogant belief that doctors should be the gatekeepers to who is allowed to reproduce. 

And that is completely unacceptable.

Objective Reporting?

Article from the New York Times, 2015

There have been a series of media articles in recent years designed to discourage obese women from having children unless they reach a "normal" BMI first. These articles have hardly been objective. They use scary headlines, cite worst-case scenarios, use emotionally manipulative language, and rarely represent any other point of view.

Because of our society's dogged belief that obesity is all about willful sloth and gluttony, communication about pregnancy in people of size has taken on an ominous moral overtone. The implication is that if the mother would only show a little self control, she could stop irresponsibly putting her baby at risk. Some imply that obesity during pregnancy is equivalent to child abuse.

Some articles portray fat mothers as despicable food addicts, akin to drug addicts and alcoholics, endangering their babies with their addiction. In the U.K., National Health Services health chief Jonathan Sher recommended in 2016 that certain women should be advised not to have children:

He wrote that “health professionals, pharmacists and community workers” should all take part in giving the advice to these groups of women, who include the obese, drug addicts, domestic violence victims, and women who suffer from depression.

Lovely. So now fat people are looked at the same as drug addicts? A 2015 article trumpets that it's time to "make obesity the new pregnancy taboo."

Well, we are certainly well on our way towards doing that. Look at the titles of a number of recent articles or books about obesity and pregnancy.

• 10 Scary Reasons to Fight Obesity Before Pregnancy  (2011)
• Pregnant, Obese, and in Danger  (New York Times, 2015)
• Obese Mums-to-be Risking Their Own and Their Babies' Health (The Mirror, UK, 2012)
• Obese and Pregnant: Bad for Mother and Baby (Real Clear Science blog, 2015)
• Growing Obesity Increases Perils of Childbearing (New York Times, 2010)
• Obesity: A Ticking Time Bomb for Reproductive Health (ebook, Elsevier, 2013)
• Call to Stop Obese Women from Having Babies  (The New Daily, 2016)
• Don't Have Babies, Health Chief Tells Addicts and Obese (Metro News, 2016)
• Don't Call It Fat-Shaming - There are Good Reasons Obese Women Shouldn't Get Pregnant - The Spectator, 2017

These are not the titles of objective pieces. These articles don't just raise awareness about risks. These articles have an obvious overt agenda, and that is to strongly discourage fat women from having children at all.

These articles are not meant to inform, but rather to scare, shame, and intimidate women of size. They're meant to promote a climate of hostility towards high BMI women among healthcare providers and society in general. It's meant to paint people of size as irresponsible and out of control. It's fat-shaming and scare-mongering, pure and simple.

Often, these articles feature an apocryphal story of an obese woman with severe complications as a cautionary tale. This is often a woman of color, accelerating the stigma even further. These stories imply that fat women are all at equal risk for such a dire outcome, and that anyone who dares to be Pregnant While Fat is the ultimate Bad Mother. Or as one blogger puts it, "fat is the new crack" in bad-mother blaming.

Anyone reading these articles might well conclude that virtually no fat woman has EVER had a healthy pregnancy or a healthy baby, that the ONLY way to have a healthy pregnancy is to lose vast quantities of weight first, and that the vast majority of fat women experience MAJOR complications and bear only deformed or doomed babies. And that simply doesn't jibe with the experiences of most fat mothers.

Exaggerated Scare Tactics

Article from The Spectator, 2017

One of the main ways the media and some doctors discourage childbearing in fat women is by using exaggerated scare tactics. We've talked about scare tactic hyperbole before in our 2nd Annual Turkey Awards on Scaremongering and Shaming Tactics. But of course, this tactic is still alive and kicking, as demonstrated in the above articles.

This is where "experts" get to pretend that they only have the best interests of women and children at heart when they publish inflammatory articles like these. It's not weight bias, oh no! After all, pregnancy while obese has risks, right?

The 2017 article article above claims it's not stigma, it's just their concern for you. In other words, it's the medical version of Health Concern Trolling.

Don't call it fat shaming ─ there are good reasons obese women shouldn't get pregnant. Some will say that this is ‘fat shaming’, but it’s just what we do in the medical profession; the identification of risk and its amelioration. We can’t sacrifice the health of mothers and babies on the altar of political correctness.

The article then goes on to recite in scary language how obese women have higher risks for various poor outcomes, without giving any context to those risks, and without acknowledging that only fat people are targeted in this way.

Yes, women of size have increased risks of some outcomes, such as gestational diabetes, blood pressure issues, certain birth defects, and stillbirth. It serves no one to pretend otherwise, and I believe firmly that women of size should understand the potential risks. I write about these potential risks so that women of size can come from an educated and empowered point of view, and decide for themselves what to do about them.

However, it is important to have context to any discussion of risk. 

For example, a recent 2015 article is a meta-analysis of the risks of obesity and pregnancy. Again, as so many of these scare tactic articles do, it distorts risks by using relative risk ratios without any actual numerical risks. This makes the risks sound far more grave and life-threatening than they are.

For example, past research has suggested that obese women have an increased risk for certain birth defects such as Neural Tube Defects (NTDs). Scare-mongering articles always highlight the birth defects risk in particular in media campaigns because it holds so much emotional resonance. Fat women are giving birth to deformed babies! If they weren't so selfish, these birth defects could be prevented!

It's true that obese women have an increased risk for NTDs; some studies have found 2-4 times the risk for Neural Tube Defects (NTDs) in obese and very  obese women. Sounds scary, doesn't it? Yet rarely do the articles mention that double or even quadruple a very small risk (about 1-2 per thousand) is still a very small risk. Do the math. Even if there is an increased risk, less than 1% of obese women will probably have a baby with a NTD.

Expressing it in relative risk (Two times the risk! Four times the risk!) makes it sound scarier and provides a juicier sound bite for the media. But what high BMI people really need to know is what the absolute numerical risk is and what they can do to lower their risk for a NTD. [Answer: To lower the risk for NTDs be sure your blood sugar is normal before pregnancy, stays normal during pregnancy, and possibly take a higher dose of folic acid before and during early pregnancy.]

Gestational diabetes (GD) is another risk that is frequently mentioned in these articles. The risk for GD is about 3-5% among the general population, but it increases to around 15% or so in high BMI women. This is definitely a substantial increase and a potential cause for concern because it may lead to other complications.

However, reverse the statistics and you realize that about 85% of high BMI women do NOT get gestational diabetes. The risk is definitely increased but it is hardly overwhelming. Do you come away from articles on obesity and pregnancy with the impression that more than three-fourths of very fat women will NOT be diagnosed with gestational diabetes? Nor do most articles point out that even if someone develops GD, it is a very manageable condition. Most people with GD are able to control it and have healthy babies.

Yes, women of size are at increased risk for some complications, but being at increased risk does not mean that complications will happen. Many women of size have healthy pregnancies and healthy babies, a fact conveniently ignored by these media articles. They only feature stories of scary complications in order to frighten people of size out of considering pregnancy. You don't scare people away from pregnancy with stories of normal pregnancies and good outcomes.

Nor should facing potential risk disqualify you from motherhood. All kinds of women are at increased risk for complications due to various factors (age, family history, racial or ethnic status, various health conditions) but are rarely told that they have "no business being pregnant." Their risk status is acknowledged and counseling toward risk mitigation is given. The same can be done for women of size.

In dealing with women with risk factors, the focus should be on helping them have the healthiest pregnancy possible, while acknowledging possible complications ─ not trying to keep them from ever having a baby.

It's deeming people with some types of risk factors (like type 1 diabetes) as worthy of having babies despite the risks, and people with other types of risk factors (obesity) as unworthy of having babies. This suggests a bias and stigma, a real implication of a eugenics agenda, even if it is an unconscious one.

Many caregivers recognize that plenty of people of size will have perfectly fine pregnancies and healthy babies despite their size. They also know that in those who do experience complications, the emphasis should be on kind and empathetic care in helping that person towards the best possible outcome, not on scolding and judgment. Even complicated pregnancies can often have good outcomes with supportive care.

It is NOT an irresponsible act to have a baby at a larger size. Yet many of these alarmist articles imply that it is. It's NOT up to doctors to decide which patients with which risk factors should procreate. Rather, it is up to the couple to look at their particular risks and make an informed decision about having children or not. 

Reasonable risk counseling is appropriate, medical bullying through risk hyperbole is not.

It's not that we cannot discuss possible risks. Of course we can; that's an important part of the healthcare conversation. However, public health discussions about weight have gone from discussing possible risks, to making sweeping generalizations and exaggerations of risk in the public's mind, to scapegoating, scaremongering, and suspension of basic rights by healthcare professionals.

What these experts fail to realize is that weight stigma in public health campaigns often backfires and leads to worse outcomes, not better ones. Stigma affects health negatively. Increasing stigma for people of size does not improve outcomes.

When media coverage quotes "experts" who criticize women of size in inflammatory language for even considering pregnancy at a larger size, when it refuses to acknowledge that many women of size DO have healthy pregnancies and babies at higher weights, when it distorts risk, when it makes sweeping behavioral generalizations, and when it attempts to keep plus-size people from procreation through guilt and dire predictions, that IS indeed fat shaming.

Just Lose Weight First?

Headline from 2012 article in The Mirror

Some doctors are very supportive of people of size, but others are uncompromising and rigid about weight. They believe that no one should get pregnant unless they are at a "normal" BMI. From a 2017 article from the U.K.:

It is imperative that women should be discouraged from trying to get pregnant until they have attended to any excess weight.

These doctors just don't get it. Being fat and wanting children poses a difficult set of choices, and that it's not always as simple as "eat better and exercise and you'll magically lose weight and be healthy enough for a pregnancy."

Getting to so-called "ideal" weight is simply not a realistic goal for most fat people before pregnancy. Even when eating well and exercising regularly, many people of size stay fat. Even the fall-back stance of "lose just 5-10% of your weight" can have negative outcomes in real life too, as it often triggers a rebound to a weight greater than the starting point.

Doctors want simple answers, but there are none. The fact is that nearly all fat people have tried repeatedly to lose weight, and rarely is it lost permanently. Frankly, if there really were an easy, foolproof way to lose weight permanently, we'd all be skinny. It's NOT just a matter of willpower, and research shows that long-term weight loss is very unlikely.

Most fat people have lost weight time after time, only to see it come back over time. Many of us end up fatter after a weight loss attempt than before we began it. In fact, for many of us, yo-yo dieting is what actually put us in the "morbidly obese" category in the first place. For others, strong genetic and hormonal factors may be at work, making reaching that "ideal" weight statistically extremely unlikely.

When faced with people like this, doctors often suggest bariatric surgery. Weight loss surgery does reduce BMI, but research shows significant trade-offs. There are reduced risks for gestational diabetes and large babies, but also increased risks of prematurity, too-small babies, and possibly neonatal mortality. Nutrient deficits are common and there is an increased risk for intestinal hernias; pregnancies after bariatric surgery must be monitored closely. There are no easy answers here.

Many people stop weight loss attempts because they recognize that all the yoyo-ing is hurting their health far more than it is helping it. When they do this, they are not "giving up" or "letting themselves go" but instead focusing on healthy habits instead of weight loss as a measure of health. These habits often do not lead to significant weight loss, but people are still healthier by simply emphasizing good habits and weight stability.  This approach is called "Health At Every Size" (HAES).

For some, the decision to have a pregnancy at a larger size is one chosen once we recognize that long-term weight loss is not likely to happen and if we wait to reach that "ideal" weight range, we may never have a baby.

Don't think that experts don't realize that. They do. Either they are deliberately deluding themselves about the long-term success of weight loss, or they are subtly trying to take fat people out of the reproductive pool.

Another factor to consider is that dieting before pregnancy may deplete the body's stores of vital nutrients (particularly iron), just at the time they are needed most. Many "morbidly obese" people have significant micronutrient deficiencies already; repeated dieting may be part of that. Some consciously choose not to restrict intake or undergo malabsorptive surgeries before deciding to have a baby because of this concern. We do this out of love, not out of selfishness.

Some people of size do choose to try and lose some weight before pregnancy; not necessarily down to "ideal weight" but at least a little bit in hopes of lowering risks. Everyone is an adult and gets to make their own choices. There is some research that it might improve some outcomes modestly. But is that the effect of actual weight loss or an effect of a change in habits?

On the other hand, weight loss before pregnancy can also backfire, even modest amounts. Many of these women find that once pregnant, the body rebounds with a vengeance, gaining far more weight than "should" be gained in pregnancy as the body tries to store fat for the starvation period it thinks it is in. And gaining a great deal of weight in pregnancy is not ideal for anyone, mother or baby.

There is also some research that suggests that dieting behaviors or weight loss product use just before or around the time of conception increases the risk for birth defects. So while losing even "just a few pounds" before pregnancy may seem prudent, it could have unforeseen consequences too.

The bottom line is that there are no simple solutions. The best thing a person of size can do is to focus on improving health habits before pregnancy. This doesn't have to center on weight loss. For example, regular exercise is one of the most powerful things people of all sizes can do to improve their health before pregnancy. Checking that you have normal blood sugar and blood pressure before conceiving is a very important way to improve outcomes. Starting a prenatal vitamin and extra folic acid before conception is also a good idea. Emphasizing good nutrition can also be helpful, regardless of whether it results in weight loss.

Some people of size choose not to wait till we are "ideal weight" before having kids because we know that there are risks to getting older too. Age decreases fertility and increases some pregnancy risks. We may decide that it's better to act sooner than later. 

Some of us believe that having a child at our present weight makes more sense than putting off pregnancy for years in an effort to lose weight. It's better than gambling on losing weight and then trying to keep the resultant pregnancy weight gain to "acceptable" levels, or to start out a pregnancy nutritionally-compromised from recent weight loss attempts or bariatric surgery.

Having a child at a higher weight does not mean we are ignorant about nutrition and exercise, that we are recklessly exposing children to potential risk because we are too lazy or stupid to "eat right." Many of us have very normal eating habits and do not fit the stereotypes of junk food, overconsumption, and gluttony.

Ultimately, the final choice about whether or not to lose weight before pregnancy is up to each individual. Some may decide to, and that's their choice. However, choosing not to lose weight first doesn't mean we are ignorant, uncaring, or unhealthy. Instead, for many of us, it may represent what we think is our best chance for a healthy pregnancy and baby. This is not an act of selfishness but an act of love, hard as that may be for some critics to understand.

Researchers need to STOP trying to scare and shame fat women out of reproducing and pretending that they only have the noblest of intentions at heart. They need to STOP implying that fat women are irresponsible for considering reproducing, or that the only safe way for a fat woman to have a baby is if she loses weight first. The fact is that many fat women have healthy pregnancies and babies without losing weight. Experts need to study those women and see what can be learned from them.

Intersectional Stigma

Headline from The New York Times, 2010

These media articles don't just stigmatize fatness; they often reflect other societal stigmas. This is intersectional eugenics, where women of color who are also women of size or disabled in some way are being stigmatized even more.

In the New York Times article above, the cautionary apocryphal story about obesity in pregnancy is a woman of color. Of course, it's an extreme story. The woman, in her 30s, was already diabetic with kidney issues when she became pregnant. She gained a lot of weight in pregnancy, had a stroke, and her baby was born prematurely. She is pictured mournfully sitting by her extremely small son, touching his tiny feet, in the Neonatal Intensive Care Unit (NICU), and looking regretful.

Imagine what happens when people with multiple marginalized social identities present for pregnancy care. Stigma increases even more. And it's no mistake that people with multiple stigmas are used as the "bad examples" in media articles, especially in the U.S. It's an unconscious desire to increase the "othering" of people of size in the minds of the public.

Weight stigma in pregnancy is already considerable. Caregivers report being repulsed and having less respect for people of size, along with concern on how to deal with fat pregnant women. They often assume that fat people lack "necessary skills, awareness, or motivation to manage their weight." They may view people who have become pregnant at a higher weight as irresponsible. One article notes:

Weight stigma is widespread in healthcare and can lead to anxiety, stress, depression, low self-esteem and negative body image. It can be particularly harmful during pregnancy, when women are at an increased risk of developing mental health issues and their bodies are being scrutinized more than usual. And discussions about things like how extra weight can put the baby at risk can lead to intense feelings of guilt when not handled properly.

Various racial groups, particularly African-Americans, also often experience great stigma in pregnancy. This may help explain why they have a higher risk for some poor outcomes. An excellent 2017 article from National Public Radio (NPR) explored black maternal health in pregnancy and found that blacks had far higher rates of maternal death during and after birth. The NPR article summarized (my emphasis):

According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women's health...In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.

According to the NPR article, the difference in maternal mortality between blacks and whites is not attributable to education, socioeconomic status, or access to healthcare. African-American women with every advantage still have poorer outcomes in general. Much of this is due to the stress of long-term exposure to racism and stigma.

What has been surprising recently is the discovery that black women are particularly vulnerable after the birth. More than half of maternal deaths occur postpartum, and people who experienced high blood pressure or cesareans are particularly vulnerable. Black women have higher rates of both blood pressure issues and cesareans. Add in chronic stress from racism and care models that chronically neglect women after birth and you have a recipe for poor outcomes.

The intersection of race and weight leads to even more stigma. The NPR article related the story of a young black Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. Getting providers to listen and take your concerns seriously is difficult, especially if you are a person of color and size.

That's why it's even more shameful when articles about the dangers of obesity and pregnancy feature women of color as their bad-mother examples; it multiplies stigma. As Abigail Saguy and Kjerstin Guys of UCLA note, articles that feature a cautionary example of a poor person of color "reinforces social stereotypes of fat people, ethnic minorities, and the poor as out of control and lazy...In the contemporary United States, body size intersects with other dimensions of inequality."

Most researchers and care providers do not consciously wish to stigmatize women of color or women of size. They want to improve outcomes, which is a good goal. But some are tone deaf. They refuse to understand that the public health campaigns they are waging around obesity and pregnancy are far MORE stigmatizing and have begun to venture into the eugenics realm.

Direct Pressure for Sterilization or Termination 

Article from The Daily Mail, 2016

The attempt to limit who can procreate doesn't just stop with scary media campaigns, hyperbole about risk, and pressure to get to a "normal" BMI first. Pressure for sterilization or termination (abortion) is another way that providers try to limit family size in high-BMI women.

We should be clear that most providers don't do this. However, it is real and it has happened. And that is inexcusable.

In the U.K. story behind the above headline, pressure for sterilization was direct and over the top. Her 5th pregnancy was a surprise pregnancy with twins, conceived despite being on birth control (which may be less effective in larger women). She was diagnosed with gestational diabetes during the pregnancy, not an uncommon finding in twin pregnancies. She was told in no uncertain terms that another pregnancy could kill her and that she needed to strongly consider sterilization:

'At 31 weeks pregnant the consultant sat me down and was blunt. Firstly he said the diabetes could cause the girls to grow quite large so I would need a C-section. And then he said another pregnancy would most likely kill me as even if I weren't pregnant, I was at a high risk of becoming a diabetic, ending up in a wheelchair and having a heart attack. As such doctors suggested I should not become pregnant again and I could be sterilised during the C-section.

And indeed, that's what this mother chose to do. The doctor was sufficiently scary in his predictions that she permanently ended her childbearing.

Sometimes the pressure is subtle, as in refusing to remove birth control devices. One Canadian woman recounted the story of her doctor who refused to remove her IUD because he felt it would be a "disaster" for her to become pregnant. Although this is not permanent irreversible sterilization, it is a de facto sterilization.

Other fat women have been pressured to have their tubes tied when they have babies. Gina Marie's story from my website shared the tale of a woman who was pressured for sterilization during labor. This is an ethical violation; ethics guidelines state that women should never be pressured for sterilization when particularly vulnerable, such as during labor. But it happened to Gina Marie anyway.

Her labor was induced early due to fear of a big baby, and not surprisingly, she ended up with a cesarean. The OB was very vocal about how she shouldn't be having children at her size, and pressured her to agree to have her tubes tied during the cesarean. When she would not agree to having her tubes tied, they tried to frighten her by exaggerating the risk of complications during the cesarean and asking her and her partner about her funeral plans during consent for the cesarean. Then they punished her by doing a classical cesarean (a giant incision, up and down, far more risky than a side-to-side incision), blaming it on her obesity, and telling her that her uterus would "explode" if she had any more pregnancies. She never did. In this case they did not succeed in directly sterilizing her but they did succeed in a de facto steriilization.

Although most care providers will not go this far or be this coercive, there is subtle pressure towards sterilization for fat women. We know there is a long and shameful history of forced sterilizations or sterilizations without consent in the United States. This is just the latest version of that, dressed up as "concern" for your health. Eugenics policies were often directed at women of color, poor women, and "disabled" women because medical authorities thought they should not be reproducing.

Although forced sterilization was not systematically applied to fat women across the board, there have certainly been stories of strong pressure for sterilization and even abortion. A number of women have written to me over the years and shared some of their stories. Care providers (or even family members) have implied that it's far too dangerous to be fat and pregnant, that they must terminate the pregnancy in order to save their own lives. Or they imply that the baby is sure to have health problems, birth defects, or be stillborn. Here are a few of the stories:

• "I also was told I could not have kids. Then when I got pregnant I was told by various doctors for various reasons that I should abort."
• "[The doctor] even suggested that we consider having an abortion because the likelihood was great that [problems with the baby were] going to happen....We had 2 weeks to decide about the abortion because legally you have up to 24 weeks to abort the baby." 
• "[The doctor said:] 'No fat woman can ever have a healthy pregnancy. Besides, if you did get pregnant, I'd order you to have an abortion. But that's a moot point anyway, because you're too fat to get pregnant.' "

Another story of a fat person pressured for abortion can be found on the blog, First Do No Harm:

The doctor walked in holding my chart. The first thing she said was, “We all know you don’t want to be here.” ... She continued, “Thirty six years old and a third baby. Hmm. We all know your eggs aren’t any good any more.” [The OB] spoke on and on about why it probably wasn’t a good idea for me to have the baby and that time was running short for me to terminate the pregnancy. I finally held my hand up and said, “I am not terminating the pregnancy. Let’s just move on from there.”

Sometimes the pressure for abortion is not quite as direct. The potential for death for mother or baby is emphasized and the parents are left to fill in the dots as to what their next action should be. Sometimes providers imply that fat women will die if they try to carry a pregnancy to term, that having a baby is committing "suicide by pregnancy."  They hope that the women will be too scared to continue the pregnancy or try to conceive in the first place. Or they imply that the baby is likely to be deformed or die.

• "I went to see a doctor today...He basically made me feel my baby is a death sentence...In his "honest opinion" I am going to die during labor/delivery or recovery."
• "I used to go to a really Fat phobic doctor; he was so awful he told me that I couldn't even consider the idea of having another baby or I would die for sure (due to my weight)."
• "[My doctor] was appalled when she heard I was not on any form of BCP [birth control pills] and said that "at your age and with your size" that either the baby or I would die."
• "According to him I'm probably going to die of a heart attack sometime during my pregnancy or shortly after."
• A reproductive endocrinologist refused to help a high BMI woman get pregnant, saying it would be unethical to do so. He says if she did somehow manage to get pregnant, "The baby would only have a 5% chance of survival."

One of the very first stories I heard years ago when I started my website was the woman who was told that she would "die on the table" while giving birth. Others have been told that they would surely have a heart attack during pregnancy or shortly after, or that they were "85% likely to die on the table" during the birth.

Although these doctors didn't directly pressure the women to have an abortion, statements implying that death is practically inevitable for a fat mother or baby are certainly going to be interpreted as pressure to terminate a pregnancy. Here is a story of a woman in the U.K. who was so frightened by the "obesity risk" talk" from her care providers that she was strongly considering termination of the pregnancy.

Please please please, can someone help me. I am 10 weeks pregnant and currently have a BMI of 35...I have had my first midwife appointment today and was told that more than 50 percent of maternal deaths in pregnancy and childbirth are obese mothers and that I will have to have special monitoring and won't be allowed to have a natural birth at the birth centre and will have to be under consultant care and be constantly monitored throughout labour (meaning no water birth, no moving around, no getting into positive positions to birth). 

I am so scared and disappointed, I feel like I am an unfit mother already and feel that the drs think I do not care about the health of my unborn baby. Now I know that this will not go down well with some people but I am considering a termination so that I can lose more weight before carrying a child (I have currently lost 70 pounds).

Here is another similar story. The woman was so scared by all the death talk around obesity and pregnancy that she was considering ending her pregnancy, even though she'd already had one successful pregnancy and healthy baby. She was particularly afraid of the risk for a blood clot (DVT).

I am pg with my 2nd child. With my first I was overweight with a BMI of 37 but had a textbook perfect pregnancy with low blood pressure, blood sugar etc and a small baby, natural birth no issues etc and everything was hunky dory. 

Fast forward 2 years and I have since suffered anxiety and depression, mostly directed towards my health. I have become a hypochondriac which is mental torture some days. I have gained a weight since I had my dd...I am so upset and disgusted with myself , I have beat myself up all day about this. I have done a lot of research the past few days and there's a lot of scary articles about how maternal death and infant death is linked to obesity, how overweight women have a much bigger chance of dying during pregnancy etc, developing DVTs (which is one of my massive hypochondriac fears).

I am terrified I am going to die during this pregnancy because of my weight that I am considering not going ahead with the pregnancy. I am losing sleep and every ache or pain I am worrying about a DVT. It has been mental torture so far and another 8 months of this seems unbearable.

Again, this speaks to the importance of presenting risk realistically. It's true that obesity is a risk factor for DVT, but the actual chances of having a blood clot are pretty small, even in a "morbidly obese" pregnant woman. Many women of similar size (including me) have had pregnancies without blood clots, but these are not the stories being promoted by the media or shared by the doctors.

Furthermore, if she is really worried about a clot, she could speak to her provider about taking a low-dose aspirin prophylactically. Some providers do this regularly with obese women; while no research on its benefit for obese women has been done, it is a choice that can be considered if she is really worried or has a strong family history of clots. She also needs treatment for her anxiety so she can deal with her fears.

Doctors may not intend to be actively promoting eugenics but they cannot overlook what the real-world effects are of discriminatory scare tactics. And shamefully, some are fully aware of these effects and employ them deliberately.

Eugenics Towards People of Size

Headline from Metro.co.uk 2016

How many women of size have had their family size limited, directly or indirectly, through medical bullying? How many people of size have decided not to have children because of the over-the-top public health campaigns against obesity and pregnancy? How many have put off pregnancy until they get to a "normal" BMI, only to find that day never comes? How many have faced pressure for sterilization or de facto sterilization? How many have considered ending their pregnancies because their doctors told them they might die? How many have been pressured to abort a wanted pregnancy because of their size?

There is more than a whiff of eugenics in these latest media campaigns, whether providers mean it to be that way or not. Some researchers have suggested that such stories "hint at so-called soft eugenic practices to keep obese women from reproducing."

From a National Post article from 2016 by Sharon Kirkey:

Canadian researchers say that amid a flurry of press about the dangers of excess fat during pregnancy, overweight and obese women are being made to feel they’re “disgusting” or “bad mothers” for putting their fetuses at risk.... 

Doctors have legitimate reasons to warn women of the complications related to excess maternal weight, they acknowledge. However, much of the obesity “risk talk” is sensationalized, moralizing and shouldn’t position heavy women as “always-already diseased and dangerous to their child,” they write in the latest issue of Social Science & Medicine. Larger women, they argue, can have perfectly healthy, incident-free pregnancies and births. 

“We’re certainly not trying to say that any of the healthcare providers that are referred to in the study is actually a eugenicist,” co-first-author, Andrea Bombak, an assistant professor at Central Michigan University said in an interview. 

“What we’re trying to say is that anytime we refuse care in these areas, or potentially limit people’s care, we could be unintentionally and inadvertently echoing some of these histories that we’ve seen in the past about who is it that society would prefer to reproduce — and who they would prefer to not have reproduce,” she said... 

Many women had positive experiences. But many others also described being made to feel as if they were “disgusting” or unfit to be mothers. 

Bravo to these researchers for calling out the hyperbole and stigma in these media articles and public health campaigns. It's time for others to take up their call.

When obese women are counseled about pregnancy risks with scare tactics and judgment, when newspaper articles use hyperbole to scare high-BMI women away from pregnancy, when obesity in pregnancy is viewed as child abuse or treated as the equivalent of drug addiction, and when women are pressured towards sterilization or termination because of their size ─ then it cannot be denied that these things begin to cross over into the repulsive realm of eugenics. 

Reproductive Policing is WRONG

Article from National Post, 2016, found here

Sadly, some medical professionals would like to prevent ALL fat women from having babies if they could. Remember the media article that states starkly that "Obese women should not have children"? This comes directly from a public health campaign started in the U.K. and endorsed by leading "experts."

Most of the time these days it's considered wrong to question a woman's basic right to motherhood, even in a mother at risk for complications. Yet reproductive policing and shaming does not seem to be equally applied among groups considered at risk for complications. It seems to be focused mostly on obese people, and worse yet, this practice is widely defended in medical circles.

Many doctors want to be the gatekeeper of who gets to procreate and who does not, and many of them particularly want to keep fat women from procreating so they don't pass along their fat genes to the next generation. A 2015 article reveals the real concern about obesity and pregnancy ─ that it will lead to more  fat people:

The kicker of all these consequences is that obesity begets obesity. "Maternal obesity is the most significant factor leading to obesity in offspring and, coupled with excess weight gain in pregnancy, also results in long-term obesity for women," the reviewers write.

Although doctors tell themselves they are just looking out for their patients, the underlying agenda here is about ridding the world of fat people. What better way than to prevent as many fat pregnancies as you can?

Because medical providers have have been taught that obesity only occurs because of sloth and gluttony, many care providers see fat people unworthy of procreating. They use whatever means they can to discourage fat women from having a family. This far exceeds their mandate as physicians, and worse, it smacks of eugenics.

Sorry, but NO ONE has the right to forbid reproduction. The government, medical authorities ─ history has shown time and again that these people should NOT be the gatekeepers of reproduction. Whether to have a baby is a decision for the woman and her partner to make and no one else.

Yes, women of size have higher risks in pregnancy as a group. So do many other groups. Fat people should not be singled out. People of size should be counseled (with compassion, not scare tactics) about their risk status and possible complications, and they should given information about how to mitigate or manage those risks. Whether or not they experience complications, they should be always be treated with dignity, respect, and support.

The ability to reproduce is one of the basic rights of people in society; the state and/or medical caregivers have NO business trying to govern that.

People should never be subject to shaming or scolding for the simple act of wanting to have a family. That principle applies just as much to people of size as to those in any other group.

Thankfully, many care providers are supportive of women of size, but the fact that some resort to extreme tactics to prevent or discourage people of size from reproducing is a terrible stain on the medical profession. This is a unique and insidious form of obesity eugenics and IT MUST STOP.

Blame the Mothers: Fat Children Equals Child Abuse?

I thought these research abstracts, published recently, deserved to be displayed together for sheer irony.

The first shows the parent-blaming inherent in the "childhood obesity epidemic" public health campaigns.

The second points out the unfair nature of this parent-blaming and the sexist, mother-blaming nature of most of the media messages around public health campaigns against child obesity.

The third helps refute the common idea that fat kids eat excessively and that fatness is always related to the amount of calories consumed.

Unfortunately, it is only the first message only that is being communicated to the public these days. Here's the typical take-away message that many people get from childhood obesity public health campaigns:

If a child is fat, it's THE PARENTS' FAULT, and they are bad parents to have "let" their child get that way (and it's especially the mother's fault because it's her job to see that everyone is healthy).   

Parents of fat children have failed in their duties as a parent, and perhaps their child should even be taken from them. 

If a child is "morbidly obese," then the parent has allowed him to become that way, and that is a form of child abuse. 

Like the attitudes behind this lawyer's comment:

The idea here is that a minor who is morbidly obese has an unacceptable amount of health risks due to, basically, the gross negligence of their parents...they have to be taught to lead a healthy lifestyle, which they obviously haven’t been taught yet thus far.

"Gross negligence of their parents"?  Because no child could possibly be morbidly obese unless their parent was force-feeding them huge amounts of junk, right?

The state will step in and stop parents who won’t feed their kids. Why shouldn't the state step in and stop parents who keep shoveling food down their kids’ throats?

"Shoveling food down their kids' throats"? Really?  Because children can only be obese if they are consuming huge amounts of calories?  Because their parents are lazy or ignorant and don't know anything about feeding "healthy" food?  Because all that's needed for fat kids to slim down is to unplug the TV/computer and exercise a little restraint at the dinner table, right?

The societal pressure on parents of fat children is tremendous.  Look at some of these quotes from people about the stories on removing fat children from parental custody.

-I get extremely frustrated when I see an obese child. I mean, REALLY frustrated. I immediately look to the parent to see why this child is overweight. Is the parent obese as well? Is it just carelessness? Does the parent not see it? Does the child have a thyroid problem? Can they not afford healthier food? All these questions run through my mind, and yes, in that very moment I do want to snatch the child away from the parent. I want to bring the child into my home and introduce them to REAL food, that nourishes their growing body....

-I get sooooo angry when I see obese kids too. I literally want to punch the parents in the face and tell them to wake up!!   

This idea that parents are solely responsible for making a child fat and that this is tantamount to bad parenting and child abuse drives so much of the discussion around "childhood obesity" hysteria these days, yet this perception is fundamentally flawed.

A fat child does not equal child abuse.

Let's say it again:

A FAT CHILD DOES NOT EQUAL CHILD ABUSE.  

Yet there are a number of health and social care professionals that seem to believe it does:

Does allowing a child to become morbidly obese qualify as child abuse? Some health and social care professionals believe it is a question that needs to be considered more seriously... 

"It is my view that child obesity should be treated as a form of child mistreatment, as any type of under-feeding is," says Joanna Nicolas, a child protection consultant who has been a social worker for 17 years. 

"If a child is obese it is a form of abuse because of the physical impact on the child, the implications for their future health and the psychological impact," she told Radio 4's The Report.

This is parent-blaming at its worst. It is a reflection of negative public health discussion that views obesity as a entirely voluntary state, caused by bad habits, laziness, and/or ignorance about nutrition, and a condition that is supposedly easily modifiable by reasonable behavior.

Yet if obesity were so easy to prevent and/or treat, why hasn't been it taken care of by now? Why don't the many obesity intervention programs out there result in more permanent weight loss? Why do most weight loss intervention studies tellingly not include long-term follow-up? Why do study after study show only a small number of people losing weight and keeping it off long-term? Why do many people who initially lose weight end up heavier in the long-term after dieting? Are that many people really that weak-willed and ignorant?

Why do many super-obese people who have SURGERY to restrict their stomachs and re-route their intestines still remain clinically obese, even after losing lots of weight? Why do they often remain fat to some degree (and even regain lots of weight after a couple of years) despite being unable to eat a lot of food or absorb many nutrients from the food they do eat?

Could it be that fatness is related to factors other than just intake and output?

The only way healthcare and social professionals can explain the tremendous statistical failure of diet programs is by blaming fat people themselves.  In their view, it can't be the fault of the diet/lifestyle programs, it can't possibly be from some metabolic difference, nor can it be because there are strong biological mechanisms for defense of body weight.

No, it must be fat people's own intransigence, laziness, ignorance, lack of self-discipline, or unwillingness to change habits that is behind their continued fatness.

In other words, it has to be fat people's fault because these healthcare folks NEED it to be their fault.  They need to believe in a paradigm where it's fat people's fault because otherwise, it questions everything they believe in and the very nature of their own body privilege.

And because this is the narrative that society wants to hear, this is the message they are given, over and over again in the media.  Read the stories featured in the media and see how rare it is to see a message that doesn't conform to this paradigm. As Abigail Saguy discussed in her excellent article for the Washington Post:

The way we talk about fatness as a medical issue and a public health crisis brought on largely by reckless personal choices may be worsening anti-fat prejudice and related health problems.

Well, it certainly is worsening the prejudice and pressure that parents of fat children experience.  If the trend keeps going the way that it is in some areas, there will be more and more blame put onto the parents of fat children, and more efforts to take fat children away from their parents in order to "save" them.

And that is just incredibly frustrating and alarming to the parents of fat children everywhere.


References

J Law Med. 2012 Sep;20(1):124-51. Childhood obesity, parental duties of care and strategies for intervention. Nolan EJ.   PMID: 23156652

Childhood obesity is an increasingly serious issue which causes significant health problems among children. There are numerous causes of childhood obesity. However, the ultimate responsibility for the problems and costs associated with an obese child should be attributed to that child's parents. Parents owe a duty of care to their child and, when their child is obese, have arguably breached that duty. However, if parents were required to pay their child damages, this would arguably be problematic and of little utility. Rather, intervention strategies should be implemented which seek to treat and prevent childhood obesity and to address the identified causes of childhood obesity.

Appetite. 2012 Nov 24. pii: S0195-6663(12)00448-5. doi: 10.1016/j.appet.2012.11.005. [Epub ahead of print] "Fat is your fault": Gatekeepers to health, attributions of responsibility and the portrayal of gender in the Irish media representation of obesity. Brún AD, McCarthy M, McKenzie K, McGloin A.  PMID: 23186694

We investigated the representation of obesity in the Irish media by conducting an inductive thematic analysis on newspaper articles (n=346) published in 2005, 2007 and 2009 sampled from six major publications. The study analysed the media's construction of gender in discussions of obesity and associated attributions of blame. Three dominant themes are discussed: the caricatured portrayal of gender, women as caregivers for others, and emotive parent-blaming for childhood obesity. Men were portrayed as a homogenous group; unaware and unconcerned about weight and health issues. Dieting and engaging in preventative health behaviours were portrayed as activities exclusively within the female domain and women were depicted as responsible for encouraging men to be healthy. Parents, specifically mothers, attracted much blame for childhood obesity and media messages aimed to shame and disgrace parents of obese children through use of emotive and evocative language. This portrayal was broadly consistent across media types and served to reinforce traditional gender roles by positioning women as primarily responsible for health. This analysis offers the first qualitative investigation into the Irish media discourse on obesity and indicates a rather traditional take on gender roles in diet and nutrition.

Pediatrics. 2012 Oct;130(4):e936-42. doi: 10.1542/peds.2012-0605. Epub 2012 Sep 10.
Self-reported energy intake by age in overweight and healthy-weight children in NHANES, 2001-2008. Skinner AC, Steiner MJ, Perrin EM.  PMID: 22966024

...METHODS: We examined dietary reports of children ages 1 to 17 years by using the National Health and Nutrition Examination Survey, 2001-2008 (N=12648)... CONCLUSIONS: In a nationally representative cross-sectional sample, overweight and obese girls older than 7 years and boys older than 10 years reported consuming fewer daily calories than their healthy-weight peers....

Politics and Weight: Risk Hyperbole

NJ Governor Chris Christie

The recent nonsense over whether Governor Chris Christie should be elected President "at his weight" is yet another example of size profiling (making medical judgments about a person's health and habits based only on weight) and the ridiculous risk hyperbole around obesity.

The blog, First Do No Harm, highlighted this, as have Paul Campos and others.

For those who have been in a vacuum, here's what happened.  Dr. Connie Mariano, former White House physician, made the following comments about Chris Christie on CNN:

“I like Chris Christie a lot, I want him to run, I just want him to lose weight.” 

“I’m a physician more than a Democrat or a Republican, and I worry about this man dying in office. I worry that he may have a heart attack, he may have a stroke…it’s almost like a time bomb waiting to happen unless he addresses those issues before he runs for office.”

This is the metaphor doctors love when size-profiling fat people..."a time bomb waiting to happen."  As if we are walking corpses, waiting to keel over at any second at the least stress or difficulty.

It's that kind of nonsensical hyperbole around the risks of fatness that cause so much of the weight stigmatization and weight discrimination today. Yes, there are risks associated with having a high BMI, but these risks get inflated in people's minds until they think of us as about to stroke out and die at any second.

Like the countries who won't let fat folks adopt children because they think fat people won't live long enough to raise the children.  Or fat women being pressured to abort their babies because "it's just too dangerous" to carry a baby at their weight.  Or fat women being told that they will no doubt have a heart attack and die during labor.

Christie responded:

“You know, I find it fascinating that a doctor in Arizona who’s never met me, never examined me, never reviewed my medical history or records, knows nothing about my family history, could make a medical diagnosis from 2,400 miles away. She must be a genius. She should probably be the Surgeon General of the United States, I suspect, because she must be a genius. I think this is just another hack who wants 5 minutes on TV.” 

“And it’s completely irresponsible. Completely irresponsible. My children saw that last night. And she sat there on TV and said ‘I’m afraid he’s going to die in office.’ I have four children between 9 and 19. And my 12 year old son comes in last night and says, ‘Dad are you going to die?’ This is irresponsible stuff. And people who have a medical license, who have the privilege of having a medical license, should in my view conduct themselves more responsibly than that. If she wants to get on a plane to come here to New Jersey, and ask me if she wants to examine me and review my medical history, I’ll have a conversation with her about that. But until that time she should shut up.”

Bravo to Christie for fighting back, but this doctor is far from the only person questioning whether his weight should keep him from being president. Barbara Walters also asked it, and so have quite a few others.  And many others are thinking it, even as some rush to declare that no, it's not an automatic disqualifier.

So let's take a look at the question.  Is a fat man in his 50s a walking time bomb?  Is he going to keel over at any moment if he works at a stressful job?  Should weight be considered more strongly than other risk factors?

Risk Factors Viewed Unequally

It is fair to ask whether a candidate's medical history might impact their ability to do the job. However, not all risk factors seem to be considered equally when the press ask this question. The fact that weight is more of a concern for them than many other risk factors just shows the distorted sense of risk we have developed around weight.

One of those distorted risks is the prediction that a fat person is going to keel over dead at any moment.  Yet the First Do No Harm article pointed out that "a 50 year old 'morbidly obese' man with no comorbidities...who doesn't drink or smoke, and is reasonably fit is fairly unlikely to die before 62, the age Christie would be when he leaves office if he runs and wins in 2016."

Paul Campos points out that the weight critics are ignoring the fact that age is a far more potent risk factor for death in office than weight, yet we routinely consider electing older politicians to office:

In January of 2017 Christie will be 54, while the current Democratic frontrunner for her party’s presidential nomination, Hillary Clinton, will be 69. It is true that, compared to “normal weight” people such as Clinton, very obese people like Christie have, all other things being equal, an elevated mortality risk. Specifically, the most recent, detailed, and sophisticated study of the question, published last month in the Journal of the American Medical Association, found that people as heavy as Christie have a 29% increase in mortality risk, compared to otherwise similar people of normal weight. 

Now 29% may sound like a significant elevation in risk, but let’s compare it to another factor — one which has a vastly more powerful effect than body weight: age. 

All other things being equal, government actuarial tables reveal that the odds that a 69-year-old woman will die between January of 2017 and January of 2021 are 115% higher than the odds a 54-year-old man will die during that four-year time period. In other words, age poses almost exactly four times greater a mortality risk to Hillary Clinton than weight does to Chris Christie, in regard to the chances that either would die during their first presidential term.

So older age is a stronger risk factor in the next election's potential candidates than weight, yet weight is the one getting the attention. That says a lot about the media spin put on obesity.

What about other risk factors?  How much attention do those get?

Others have pointed out that President Obama smoked until recently, and that is a very significant risk factor for heart disease and stroke.  Some people gave him a hard time about the smoking, but for the most part that risk factor was overlooked.

John McCain had a history of skin cancer when he ran for president.  He also would have been one of the oldest presidents, had he been elected.  Although these issues were raised in the campaign, the public did not seem to see his age or his prior cancer as serious considerations and he came close to winning.

John Kerry had a history of prostate cancer when he ran for president.  So did Bob Dole, who was another one of our oldest candidates.  Again, although mentioned occasionally, the issue of their prior cancer seemed to gather little attention during the campaigns.

Pre-existing health conditions, history of potentially life-threatening disease, and smoking are certainly legitimate risk factors, but the fact that weight gets far more focus as a risk factor is more a reflection of our risk hyperbole around obesity than anything else.

What about the pressures of the office on someone with a significant medical risk factor or condition?

John F. Kennedy is a president who took office with significant health issues, although these were not made known until after he died.  He suffered from Addison's Disease and was under major medical treatment while in office, yet somehow managed to deal with the pressures of the office.

Lyndon Johnson was a former heavy smoker who had had a major heart attack several years before being elected vice-president in 1961.  He became president in 1963 when Kennedy was assassinated. He survived eight years as vice-president and president during extremely turbulent, war-filled, and stressful times.

And don't forget that Dick Cheney, a man with a history of already having had THREE heart attacks (plus a coronary artery bypass operation) was elected to the VP office in 2000, a heartbeat away from president. He then had another heart attack, a stent placed, angioplasty, and placement of a defibrillator, and people still elected him to a second term as VP in 2004. He managed to survive eight years of being one of the most involved vice-presidents ever, during years of terrorism and wars, despite an extremely extensive history of heart troubles.

Yes, it's incredibly stressful to be President or Vice-President, but by no means is it a death sentence, even for those with serious pre-existing conditions.

As for a fat person's ability to handle stress, don't forget that Christie has been the governor of New Jersey for quite a while ─ a position hardly free of stress ─ and has done fine so far.  As he himself pointed out, during Hurricane Sandy and its recovery efforts he was putting in incredibly long hours and was under enormous stress.  Yet he did fine.  Although no one has a crystal ball, likely he would be fine while president too.

A History of Fat Presidents

Grover Cleveland,
22nd and 24th President

Of course, Dr. Mariano completely ignores that there already HAVE been fat presidents and they didn't die in office.

If fat folks were really that much of a walking time bomb, shouldn't we have seen those fat presidents keel over right and left?

So the question becomes, who have been our fat presidents, what were their BMIs, and how did they fare in office?

Well, it's not easy to find a reliable source of presidential BMIs (and even more difficult to verify them), so you have to apply some caveats to these numbers. And Presidents' weights may have fluctuated while in office, so the BMIs reported below may have varied, higher or lower, over time. But here's what one source gives for presidential BMIs.

According to this source, our "overweight" (BMI 25-30) presidents have been:

• Dwight Eisenhower (BMI of 25.3)
• George Washington (25.5)
• James Monroe (25.6)
• Gerald Ford (25.7)
• George W. Bush (25.9)
• Lyndon Johnson (26.0)
• Rutherford B. Hayes (26.0)
• Harry Truman (26.3)
• James Polk (26.4)
• James Buchanan (26.9)
• John Quincy Adams (27.2)
• Herbert Hoover (27.7) 
• Bill Clinton (28.3)
• Chester Arthur (28.7)

That's fourteen presidents who were officially in what we now call the "overweight" BMI category.  Guess it wasn't all that uncommon for people to be "overweight" even in the good old days, eh? And really, this list goes to show just how silly the BMI cutoffs are, as many people would not have guessed that some of the above presidents were in the "overweight" category at all.

There are fewer "obese" (BMI 30+) presidents, it's true. Certainly, weight prejudice and looks bias played a role in politics, even in the old days, so you have to wonder whether Chris Christie's chances of being elected will be influenced by his weight ─ not so much because of his health, but because of people's biases about his weight and his looks.

However, it's too strong for Dr. Mariano to suggest that the stresses of the presidency would almost surely kill a fat person. If that were true, most of these fat presidents should have died in office:

• Teddy Roosevelt (BMI of 30.2)
• Zachary Taylor (30.2)
• William McKinley (31.1)
• Grover Cleveland (34.6)
• William Howard Taft (42.3)

Okay, William McKinley died in office, but he was assassinated, so no relationship to his weight.  Oh, and he was assassinated in his second term, so he lived through his first term just fine.

Zachary Taylor died in office, but the cause was a severe case of gastroenteritis.  This could have come from food poisoning, cholera, a bad virus, or a bacterial infection. Again, it was not related to weight.

What about the others, you ask?

President Theodore Roosevelt and family, 1903

Teddy Roosevelt succeeded to the presidency after McKinley was assassinated.  He had a long prior history of childhood ailments (including heart issues and asthma) and malaria from his time in Cuba, but was a vigorous devotee of exercise. He thrived during nearly 8 years of the presidency, and ran for the presidency again several years later. He lost only because he split the votes from the Republicans by running on a third-party ticket.

Roosevelt was known for his high energy and voracious intelligence and is regarded by many as one of the best presidents of all time. He was rough and tough; he was shot by a would-be assassin in his third election, but went on to deliver his speech anyhow. He did die relatively young after his presidency (age 60, heart attack), but this was likely brought on by complications from the previous malaria and an extremely serious infection he had acquired on a South American trip.

Grover Cleveland, our second fattest president, was elected twice. He is the only president who was elected to two non-consecutive terms. He won in 1884, won the popular vote but narrowly lost the electoral vote in 1888, and re-won the presidency fully in 1892.

Cleveland served during a stressful time of significant labor unrest and a serious economic depression. Despite this, he survived two terms as president, with four years in between. Hardly the ticking time bomb Dr. Mariano predicts.

William Howard Taft,
Official White House Portrait

Of course, our fattest president was William Howard Taft (BMI of 42.3). Reports differ on his exact weight, but it was over 300 lbs. during his presidency.  He was a big yo-yoer and his weight went up while president, so I would guess that his BMI well exceeded 42.3 during his presidency.  Yet he survived his term just fine and lived for many years afterwards.

I'm sure a troll would point out that Taft supposedly got stuck in the bathtub at the White House, a story repeated again and again as if true, although its veracity is questionable. It's likely an urban legend, one of those stories people want to be true to confirm their own biases and so keep repeating, regardless of any actual truth to the story.

It is true that Taft had some health issues while in office, in particular high blood pressure and severe sleep apnea, neither of which had effective medical treatments then.  And there is no doubt that Taft fell into the Class III "morbidly obese" category ─ yet he somehow managed to survive four years of presidency.

Also note that Taft had been U.S. Solicitor General, Governor General of the Philippines, and Secretary of War before he became President, and he went on to become Chief Justice of the Supreme Court a few years after his presidency, a position he held for nine years. None of these were low-stress positions, yet somehow he managed to survive many years of this high stress, all while morbidly obese with health issues.

In fact, our two fattest presidents both had good life spans, especially considering the time period in which they lived.  Grover Cleveland died at 71, and William Howard Taft died at 72. They hardly keeled over at an early age from their weight.

It's also worth noting that Taft likely would have won a second term, except that Teddy Roosevelt ran against him, splitting the votes of his party and making it possible for Democrat Woodrow Wilson to win instead.  Notice that it was Wilson, with a "healthy" BMI of 23, who was the one who had a series of strokes while in the White House, not Taft with a BMI that was almost twice as high. Obviously, BMI is not necessarily a good indicator of health.

None of this predicts how Chris Christie would do, of course. His health may well be different than these men; in fact, one concern for him would be his frequent yo-yo dieting rather than just his BMI alone. He also has asthma to consider. But the point is that BMI is not a good surrogate for health, and that several fat folks have survived the presidency just fine.

But Would We Elect a Fat Person?

The question now is not whether we can elect a fat person president.  Obviously, we can and we have in the past. The question is whether we would elect a significantly fat person president in this age of obesity risk hyperbole and weight stigma.

In one major news magazine poll, the majority of responders felt that Christie's weight should be a major issue.  The comments showed that many people still equate fatness with laziness, a weak character, low self-esteem, a lack of control, and "time bomb" health status.

For example, here are some comments (trigger warning: insert major Sanity Watchers' points!) from readers of one article about whether a fat man could get elected president:

• Fatness is gluttony. The last thing we need right now or even in the future is a person who cannot control their appetite controlling our government spending!
• ...The question that is important is "Why is that person over weight?" Is it a symptom of something like lack of self control, low sense self worth, or just plain laziness? Those are questions that shouldn't be ignored for fear of upsetting the gods of political correctness for these questions can tell us a lot about what kind of person we're dealing with when the cameras are off.
• ...People perceive fat people as lazy and unmotivated. People will think that a fat president can't take care of his body. If they can't take care of their body then how are they going to be able to handle taking care of the country? 
• A person who does not have the self control to lose weight would not be my choice for President. The President must be health conscious in order to set a good example for our already overweight populace, especially our young people.
• The stress of the job of being President is overwhelming in itself. Add obesity to this equation and the job becomes almost physically impossible, and a massive liability to our nation.
• It is not really a question of fat or not fat, it is a question of what the media will push as a perception of body mass as a symbol for the politics and policies of the candidate. I, for one, will get tired very quickly of the fat jokes that will flood the airwaves once a corpulent candidate is nominated. 

Sadly, I despair whether a fat person could ever get elected in this modern media age.  The Health Police are too unrelenting in their condemnation to let it go, as evidenced by Dr. Mariano lecturing Chris Christie, who isn't even a candidate yet for an election that is still four years away.  

This is one of the outcomes of public health campaigns about obesity; they reinforce all the old stereotypes about obese people...as if the ONLY way you can be fat is if you are an out-of-control glutton, as if all fat people are lazy and unmotivated, as if obesity is always the result of low self-esteem and emotional eating as compensation, as if all you have to do to lose weight and keep it off is to put down the fork and go for a little walk.   

Sigh. No matter how many times you say that it's more complicated than that, people won't believe you, largely because they want to believe that it's your fault, that weight is completely within one's own control if you just try hard enough. They need to believe that if they personally are not fat, it is because they are virtuous and in control of their eating, not because they lucked out in the genetics department.  

The one encouraging thing in all of this is that there is some sympathetic backlash to some of these weight-related attacks on Christie. When his opponent tried to use Christie's weight against him in the last New Jersey governor's election, Christie was able to spin that against the opponent, and the opponent's weight jabs actually worked against him. And a lot of people now feel sorry for Christie after Dr. Mariano's insensitive comments.  

However, this sympathy will only last so long.  The moment that Christie does something unpopular, out will come the unrelenting fat jokes.  Out will come the editorial cartoons lampooning his weight, or using his size as a negative metaphor in a political cartoon.  Yes, Christie has been able to turn some of these jokes to his favor by making his own fat jokes about himself first (see the recent Letterman show), but this only goes so far.  If he decides to campaign for president, the mean-spirited fat jokes will start flying fast and furious, and the sympathetic bounce will quickly disappear.  

Yes, there were other fat candidates this last election, but if they had gotten very far in the polls, you know their size would have been used against them sooner or later, and you know that the fat jokes would have been everywhere.  

And we can only imagine what the reaction would have been if the candidates had been fat women. You can bet that Hillary Clinton, Michele Bachmann, Sarah Palin, Elizabeth Warren, or any other potential female candidate would never have gotten very far if they had been fat.  And of the political women who have been speculated about as presidential candidates in 2016, you'll notice that not one is fat.

If the world is ambivalent about a fat male politician, it's even less welcoming to the thought of a fat female politician.  And that's even more frustrating.

Final Thoughts

Yes, it's legitimate up to a point to raise questions about a candidate's health when they are running for office, but these health concerns have to be put into perspective.

Pre-existing medical conditions are a potential concern, but history has shown that many presidents with health conditions have done just fine in office. Just how strongly a pre-existing condition has to be considered will depend on the condition.

But history has also clearly shown that fatness alone doesn't mean you're going to keel over from the pressures of the office.  We've had fat presidents before, even very fat presidents, and they've been fine.  It's time to do away with this whole "too fat for a stressful job" idea.

While we can look closely at a candidate's health, we have to ask ourselves hard questions about our own biases when doing so.  It's very telling that in all of these media discussions, other risk factors like age, smoking, and prior significant medical conditions were considered a relatively minor concern and largely overlooked. In contrast, Christie's weight is considered a major concern by many.

Why does weight get such disproportionate attention as a risk factor? Frankly, it's more a reflection of obesity hyperbole than it is the reality of imminent risk. 

The Health Police see a fat candidate as yet another chance to beat the drum about the dangers of obeeeeesity in order to scare people into radical weight loss. The fact that some voters take this so seriously that they would automatically discard a politician only because of weight is yet another demonstration of the danger of these well-meaning but misguided public health campaigns.

I say, vote for a candidate or not based on your opinion of his/her politics and leave weight out of the picture.  If Chris Christie decides to run for president next time, then ask him pertinent questions about his health, just as all candidates should be asked those same questions.  But don't jump to conclusions about his health or what that will mean for his job based on the scale alone, don't make assumptions about his habits or his medical future based only on his weight, and stop throwing around the "time bomb" metaphor.  That is just risk hyperbole, nothing more, and it's just plain irresponsible and unfair.

*Post-Script:  Comments are welcome, but this is not the place for political debates or slurs on opposition candidates, whatever your political persuasion. Inappropriate or unkind comments about politics or weight etc. will not be published. Keep any discussion polite and limited to the intersection of weight and politics, please.