First Annual Turkey Awards

Happy Thanksgiving Day, everyone!

In honor of Turkey Day today, I decided to create the First Annual Turkey Awards, given in "honor" of fat-phobic healthcare provider "turkeys" everywhere.

A Turkey Award to Fat-Phobic OBs and Midwives, who harassed and humiliated and deserted clients of size this year. [And believe me, these are just a few of the more recent stories I've heard; I could fill a book with all the stories I've heard over the years.]

There's the doctor who told the supersized woman she was basically committing suicide by being pregnant at her size, and scared her to death with a long list of complications that was "going" to happen to her. Puhleeze. Distorting risk does not serve anyone. Discuss instead how to be proactive and lessen risks, not try to shame and scare someone out of procreating.

There's the doctor who met a fat woman at the beginning of pregnancy and insisted she give permission for a cesarean section before he would even agree to take her on as a client. There's no way you can tell who is going to "need" a cesarean at the beginning of pregnancy. He's already made the decision to slice and dice her, simply because of her size. That's bias, pure and simple. Most fat women can give birth vaginally....and if you look at the research, did so in the past, before the obesity hysteridemic made cesareans a foregone conclusion for women of size with many doctors.

There's the doctor who is denying the option for Vaginal Birth After Cesarean (VBAC) to a woman of size simply because of her weight. (More posts on this coming soon.) Rest assured, fat women CAN and DO have VBACs, including this well-rounded mama! However, it often means you have to step outside of the traditional medical model because the bias against fat women is so incredibly entrenched in obstetrics today.

But sometimes not even midwifery is safe either. I got an email just yesterday about a midwife who bailed on a VBAC mama at 36 weeks of pregnancy because of the woman's size and her past history of big babies (born vaginally, mind, with no shoulder dystocia). Now this mama with two prior VBACs is left with very few options, and is finding other midwives turning her down out of fear too. If that midwife had qualms about serving this woman because of her size, she should have brought them forth long ago. Dumping her at 36 weeks because of the political climate around women of size and around VBACs is simply unconscionable.

A Gigantic Turkey Award to Dr. Raul Artal and his colleagues, who are insisting that fat women starve themselves and LOSE weight in pregnancy, despite all the associated risks this can entail, and who are lobbying hard through an insidious media campaign for the weight gain guidelines to be drastically lowered for women of size. They are basically advocating that babies be put on diets before they are even born.

When you look at the studies they base their media blitz on, their conclusions don't hold water at all. Too bad the news media and the obstetric community are so gullible they don't examine the actual evidence with any kind of a discerning eye at all.

And finally, a Party-Pooper Turkey Award to the News Media Food Fascists, who just can't let us enjoy a Thanksgiving meal without guilt.

Yesterday's paper was filled with news about how there are more ER visits after the holiday, how we all should avoid overeating during the holidays, how we should all get up and take a walk after that turkey dinner, and in general lots of neurosis about just enjoying your food and your holiday.

For God's sake, people, it's just one meal, one day. I agree that a walk is a good idea, I agree that really stuffing yourself isn't a great idea, yadda yadda, but come on! If we didn't have such a restrictive, fearful approach to food on a daily basis, people wouldn't overindulge so excessively on a holiday!

Can't we hear a voice for moderation anywhere? Can't we just eat for once without having to "make up for it" with exercise afterwards? Can't we just enjoy good food without the media pushing us to feel guilty about it?

A little sanity and a little common sense, please. It's one day, one meal.

Enjoy yourself without having to stuff yourself, and let yourself savor your food without having to feel guilty.

Feedback Results

Thanks for all the feedback, readers.

I appreciated knowing that there was indeed an audience for my pregnancy-related fat-acceptance/HAES writing. I had been wondering if people felt the blog was a little too one-note and needed diversifying, but glad to know people are appreciating the unique niche I've carved out. Rest assured, I plan to keep writing extensively about pregnancy-related topics.

I do still plan to write also about general FA stuff; I have too many thoughts about fatness in the media and size bias in general to ignore. I've been so busy for so many years writing about pregnancy and birth and FA/HAES that I've had to suppress many of my other ruminations, and some of those are just bursting to get out. I'll also write about general medical stuff for fat folk, general birth stuff and birth politics, and maybe even the occasional fluff or cute kid/pet story.

One thing that was requested a lot that I hadn't gotten around to quite yet was to write more about fat parenting....that is, parenting as a fat person. Rest assured, that was definitely on my to-do list. It's a topic much on my mind as the fat mother of four kids who may or may not turn out to be fat also.

However, I have so much to say on the topic that I've had trouble dividing it up into smaller, more digestible bits. I need to narrow my focus and take things a little bit at a time.

So my question to you all is this: As a fat parent (or a future fat parent), what are your strongest concerns? What are you most worried about? What do you most want to hear about?

Of course, the focus doesn't have to be negative either. So I'd also ask....What has surprised you most about parenting as a fat person? What would you most want to share with other fat parents to help them, reassure them, and inspire them in their future parenting?

Tell Me What's On Your Mind

I just wanted to take a minute to take the pulse of my readers.

What would you most like to see me address in my blog? What are you most interested in?

Do you want me to blog about pregnancy and birth in women of size? Do you want to see less pregnancy stuff and more general fat-acceptance stuff? Or do you want me to blog about pregnancy and birth in general (not necessarily about women of size)? Do you want me to discuss parenting issues? Parenting as a fat person? Medical stuff that might affect fat folk? Birth politics in this country and around the world?

I don't have a good sense yet who is reading my blog. I'm guessing most of my readership is from the fatosphere because of the fatosphere feed, but I wonder how many birth activists/professionals may be reading it too. And of the FA folks that are reading this, how many are moms already? How many aren't but are reading about it for future use? How many read it despite not being particularly interested in birth and children-related issues? Do folks pass it over because they think it will ONLY be about birth-related stuff? Do I need to add more general interest stuff for the general fatosphere reader, or should I keep to mostly birth and parenting-related stuff?

Tell me about what you want to read about. I can't promise to address each and every topic suggested, and I do have to point out that I'm very busy with four kids and all our activities (there's LOTS!), so it could take a while for me to actually write something addressing a specific request, but I'd like some direction in how folks would like my blog to go. I promise to listen.

You can post comments directly to the blog, or if you'd rather request something more privately, you can email me at kmom "at" plus-size-pregnancy dot org. I can't promise to reply personally or in a real timely manner if I do reply, but I do read it all, always. And it really helps me keep a finger on the pulse of what is most urgently needed.

So speak up. Let me know what you are most interested in seeing and why. I may not get to everything (or it may take me a while to get back to it), but I'd really like to hear your thoughts.

What plans I do have:

I have plans to follow up with more specifics on weight gain in women of size in pregnancy, on preventing complications and being proactive in pregnancy in women of size, and general information about pregnancy (and adoption) for women of size. I have several ruminations about parenting and marriage and stuff brewing but they need to ferment a little more before I commit them to the internet.

I also like to comment on media-related stuff.......famous people of size, fat folks who have contributed positively to our world, the image of fat folk in movies and TV, that kind of thing. And then there's the really frivolous stuff----pop culture, my favorite movies, pet peeves, cute kid stories, my animals, etc. I could go on and on about those!

So that's what's on MY mind for this blog, but I want to know how best to prioritize it, what my readers most need and want to see, and whether there are any burning issues that I'm overlooking that really need to be addressed.

In Memory Of Mama Afrika

For some years I have been a fan of Miriam Makeba, also known as Mama Afrika. I was saddened to hear of her recent death, at the age of 76.

She was born in South Africa, spoke out against apartheid, and was exiled from her country because of it. Her passport was revoked in 1960 when she tried to return for her mother's funeral, and her citizenship was revoked in 1963 for speaking out to the U.N. about apartheid.

I came to her songs late in her career but was immediately captured by her joy, her passion, her energetic singing. She was a Grammy award-winning artist, and that honor was well-deserved. Check out her music if you get a chance.

You can read more about Miriam Makeba at:

• http://en.wikipedia.org/wiki/Miriam_Makeba


• http://www.miriammakeba.co.za/
  

Long-Term Effects of Fen/Phen

I'm sure many of you have heard already that a new study came out, linking Fen/Phen to an increased risk of heart valve damage, even years after its use.

When I first started having children, I joined a lovely email support group for women of size who were moms or were pursuing becoming a mom. As a size-acceptance activist and as a mom, it was a wonderful source of support for me, yet also a source of frustration because it was not a diet-free list.

It was a challenge to try and gently bring some HAES concepts to the list, while also remembering that the mission of the list was not size acceptance and that weight loss talk was not against the rules in this group. This has been very challenging to deal with sometimes, yet it was a group of women I grew to care about, so I wanted to stick around anyhow.

Thus, over the years, I have watched so many of the latest diet fads, drugs, and procedures come and go while on that group. Shortly after I first joined, the Fen/Phen craze was reaching its height, and quite a few of the moms on that list were trying it.

They had only the best reasons at heart: they wanted to improve their health so they would be there long-term for the baby, they wanted to lose weight so they could keep up with an active child, they wanted to set a "good example" for their kids, etc. Many struggled with the popular culture belief that because of their weight, they might not be around to see their children grow up. How sad that moms are so uniquely vulnerable to weight loss scare tactics like this.

So some of them turned to Fen/Phen. I knew it was a disaster in the making, but I couldn't do anything about it.

But now there's proof that there was reason for concern. A new study shows that Fen/Phen actually caused far more harm than benefit, that women were more affected than men, and that damage from the drug may not show up for years after taking it. From the press release:

One of the "fen/phen" drugs once widely prescribed to help fight obesity has been tied to heart valve damage that develops years after a person has stopped taking it, a new study reports.

In the new study, published Nov. 5 in the journal BMC Medicine, researchers looked at 5,743 people who had stopped using fenfluramine more than a decade earlier but had damaged heart valves up to seven years later.

"Valve problems were common in individuals exposed to fenfluramines, more frequent in females, and associated with duration of drug use in all valves assessed," research leader Charles Dahl, from the Central Utah Clinic, said in a news release issued by the journal's publisher.

"We found clear evidence for a strong, graded association between duration of exposure to fenfluramines and prevalence of aortic regurgitation and for mild or greater mitral and tricuspid regurgitation," Dahl said.

"This is probably a conservative estimate, as another study has shown that there exists a 17- to 34-fold excess of clinically apparent (presumably severe), valvular disease in persons who had used fenfluramines for four months or longer," the authors wrote.

I don't know if any of the moms on our list who took Fen/Phen all those years ago sustained damage; many of those moms are no longer on the list. I hope anyone who did take the drug (and especially anyone who took it for more than a month or two) gets their heart function tested periodically because this study shows that the damage may take years to show up.

But this is what is so scary for me in watching all the diet fads, weight loss drugs, and weight loss surgery trends come and go. So often the long-term effects of these interventions aren't clear at first, and so many seem to turn up unexpected complications later on, some even life-threatening.

Now the big trend on the list is weight loss surgery, usually gastric bypass. I understand why these moms choose the surgery, and I understand the kind of miraculous weight loss and health improvements it seems to offer...at first. But over time, the nutritional deficits begin to pile up, the unexpected side effects accumulate, and the quality of life declines.

Weight Loss Surgery (WLS) seems like such a miracle cure on the surface, but I fear the long-term results for many women are going to be far worse than the Fen/Phen fiasco. And like the Fen/Phen thing, it will probably take years to show up and will be difficult to track.

How many women will get exposed to these risks in the meantime before they discover just how risky WLS is in the long run?

Is Weight Relevant in a Crime Story?

I saw a small news story recently in a major regional paper about a man arrested for murder. They gave some details about the case, how the body was found, the man's history of mental illness, etc. Normal reporting stuff.

Then, at the end of the article, they noted that the man weighed more than 400 lbs. They gave his height and weight, taken from the jail records.

My immediate reaction was.....What does this have to do with the case? Why is it relevant to be reported?

If the man was on the loose and they were asking the public to look for him, well, okay. Seems relevant then to have posted a physical description of the suspect on the loose.

But the man had been taken into custody already. So what about his weight had any bearing at all on anything?

Again, if a suspected criminal is at large in the community, physical description certainly seems relevant. Occasionally there may be some cases where weight might be relevant, such as reporting details about a crime which involved a struggle with a significant discrepancy in size between the perpetrator and the victim, etc. [I remember seeing a report from a trial with a scenario like that and thinking, well okay, maybe it's relevant here.]

But most of the time, I don't see how a person's weight is relevant to the reporting of crime cases. And yet, I've noticed it seems to be fairly common practice to include it.....if the person is fat. And especially if they are supersized.

And that leads me to my next point, the non-uniform application of weight reporting. If you consider weight relevant to crime reporting, then report everyone's. But the only ones I see being included are the ones where the suspect is significantly fat.

Why is a person's "obesity" status relevant at all? Given the level of bias about obesity in most people, including this information prejudices the public's perception about the suspect before they've even gone to trial.

As far as I'm concerned, all it does is further demonize obese people in the public's eye.

I don't think most newspaper reporters and editors are doing it consciously or deliberately....they probably are just reporting any details they see as being out of the "ordinary."

But they need to consider what effect their reporting may have, both on public bias about obesity ("supersized people are often mentally ill and/or dangerous") and on whether that suspect can get a fair trial.

The bottom line is whether any particular detail about the suspect is really relevant to the case or not.

In this case, the two main aspects highlighted were the man's mental illness and his size. Mental illness is a tricky one.....sometimes it's relevant, sometimes not. You have to be careful not to demonize or overgeneralize about it. Yet in this case, the man's mental illness probably played a strong role in the murder, so it seems relevant in that regard.

On the other hand, his weight does not seem to have played any kind of role in the murder, at least from the information publicized so far. So why include it?

I just can't see that it was justified or relevant at all.

Actionable Response

Well, that's just a pattern that I've noticed in papers for a number of years now. I don't see it all that often, but I do see it frequently enough to see a pattern, one that seems completely unnoticed by the writers and editors.

It really frustrates me that no one at the paper sees a problem with it. Surely the writer (or at least the editor!) would see that such things have no relevance to the report and might even cause harm?

When I see examples like this, I always think to myself.....I need to cut this out of the paper and save a bunch of examples up of it, then write to the editor (or ombudsman) of the paper, give my examples, point out the pattern, and explain why it's a problem.

So I'll write down the item or cut it out.....and then I lose it before I have enough good examples to show a pattern. My life is extraordinarily busy and complex, and this has just slipped through the cracks, given the many other priorities in my life. Yet this jumped up again recently and it's been bothering me ever since.

Yes, I could write and complain about this one example (and I may still), but it really is more powerful to show a pattern. Editors respond more decisively if a pattern of bias or misreporting can be shown. So I'd urge the rest of the folks in the fatosphere to start watching news media for examples like this, collect them, and then write in to the editors and protest it.

In the meantime, I have an article to dig out of the recycle pile and hopefully a letter to the editor to write. Chances are no one will notice the problem if no one ever mentions it. Time to get my butt in gear.

Comments? Do you see stuff like that in your local papers? Do you point it out to the writers and editors? If so, what kind of response have you had?

Plus-Sized Maternity Clothing Manifesto

Thanks to everyone who commented on my previous post about maternity clothing in women of size. I just wanted to add a few more comments.

First, people tend to fall into 2 camps about maternity clothing in plus-sizes. Some would never spend that money for clothing you only wear for a few months, or want to spend as little as possible on it. Others fervently want to wear maternity-specific clothing instead of just larger sizes because it's fitted differently and they think you look/are perceived better as a fat person when you wear maternity-specific clothing.

I say there's room for both points of view. I personally really really wanted maternity clothes so people knew I was pregnant as well as fat. I didn't want to just look fatter....not that I had a problem with being fat, just that I wanted people to GET that fat people actually got pregnant too, you know? I also wanted them to know and get excited with me that there was a little baby inside there!! It's fun to share the joy.

But I am also quite pragmatic and had to consider things like finances very carefully because my husband was laid off from his job right after we found out we were pregnant. Even had I had access to all the online maternity fashion then, could I have afforded a lot of it, just for a few months? Probably not so much. But I would have gotten a few pieces....especially so I could look as professional as possible for my job while I had it.

Well, it's all moot because I didn't have any choice in that first pregnancy. As I mentioned before, I couldn't find ANY maternity clothing in my size at all. None. So I made do as best I could.

But now I've had four pregnancies, three after the internet became available, and my financial situation improved over time. So what did I do for the other three pregnancies?

Plus-Sized Maternity Clothing, Post-Internet

Frankly, I did a combination of both approaches. In each successive pregnancy, I bought a few specific maternity-related tops for the "beached whale" end-of-pregnancy phase, and I enjoyed the hell out of actually having maternity-specific clothing. Some of it was cuter than others (and I look at some of what is available now and lament it wasn't available then!), but still, even the less-flattering things beat the skanky "big men's tee" hands-down.

However, I didn't have enough money to buy an all-maternity wardrobe, so I also re-used the empire-waist tops and jumpers from the first pregnancy. I did buy one pair of maternity pants for the last couple of months, but for the most part, I just used non-maternity stretchy knit pants with an elastic waist and had a couple of different sizes available.

Babydoll, empire waist, and trapeze tops from mail-order clothing companies tend to work like maternity tops, so I ordered a couple more of these in bright, bold colors. And because by then I was at home with other kids and didn't have to have a professional wardrobe, I did use men's large potbelly-friendly t-shirts at times too (but only for schlepping around the house!).

So for the most part, because money was never easy with me not working outside the home, I mostly did without a lot of maternity-specific clothing. However, I have to say, I really really enjoyed having a few maternity-specific items by the last couple of months of pregnancy, stuff that really WAS designed for a pregnancy belly.

You really do look better with well-designed maternity-specific stuff, trust me. You deserve to have at least a few of these, even if you are pinching pennies.

Plus-Sized Maternity Only For Mid-Sized Fatties?

However, I do have to point out that most of the internet options I eventually found were for sizes 16-22, with a few 24s if you really searched hard. I usually wear size 24 or 26/28, so it was not so easy to find maternity wear in those sizes, even with the internet.

Again, it seems to go back to the belief that fat women don't have sex, especially larger-sized fat women.....the fashion industry might just be able to bring themselves to believe that middle-sized fat women actually had sex and could get pregnant, but not that larger-sized fat women have sex or could get pregnant. (Augh!)

So I have to send a shout-out to Charlotte at Baby Becoming. She was one of the first (and only) companies to specialize in maternity clothes for a wider variety of plus sizes. She had maternity clothes up to 5-7x. She also provided a lot of telephone and internet love and support for pregnant women of size. Alas, her website seems to be down and I'm not sure she's in business any longer, but the whole plus-size maternity industry owes her a giant word of thanks.

For supersized women (5x or more) who are pregnant, there aren't a lot of maternity-specific options out there anymore. One thing that works for some women is to order from companies that specialize in supersized clothing, and order styles (like empire-waist dresses etc.) that tend to work with pregnancy bellies. Since most supersized women carry a little smaller anyhow, this usually works.....but I would still advocate that maternity companies consider adding a couple of items on the larger end of sizing, or that companies that specialize in supersizes add a couple of maternity-specific items to their lines as well. Supersized women deserve cute maternity clothes too!

A Few Sample Plus-Size Maternity Companies

I also have to send kudos to J.C. Penney, whose mail-0rder catalogue carried plus-size maternity long before most other companies did. They were the very first place I found plus-sized maternity wear, and I actually could have bought maternity clothes from them in that first pregnancy, had I only known they carried them back then.

Another plus is that they do tend to be fairly reasonably priced compared to many companies, although on the downside, their stylings tend to be a bit bland. But overall, this is a wide-reaching, good option for women of size, and they were one of the first companies to really reach out to this market niche. Bravo to them for recognizing and meeting this need.

One piece of good news is that some companies that didn't carry plus-size maternity in the past now seem to be carrying it....companies like Motherhood Maternity, Old Navy, etc. Yay!! More choice is good! And some of the stuff I see now is reasonably cute too, instead of the usual old caftan and tent options.

Lane Bryant now has online ordering for maternity-specific clothing, and some of it is even relatively cute. Although I have many issues with Lane Bryant as a company, it does remain a very accessible option for many women. So there's that choice as well.

One place to start searching for plus-size maternity clothes is http://www.plusmommaternity.com/, because they search a bunch of different companies for clothes suitable for pregnant big moms, and then list them (complete with pictures and links) all at one site. That's pretty handy. However, I was disappointed to notice most sizes still only go up to about a 3x. Sometimes they list a piece as going up to larger sizes, but when you follow the link, the only sizes available are much smaller. Hopefully, the size range that is regularly available will get expanded over time....but unfortunately, that's up to the various designers and retailers, not the websites that organize the information. All we can do is keep reminding the designers and retailers that there is a maternity market in larger sizes.

Maternity Wardrobe on a Budget

These companies are all well and great, but what if you are really short on cash? A maternity-specific wardrobe can cost a pretty penny. What do you do if you don't have many pennies?

Again, most women of size don't have to have an elaborate maternity-related wardrobe. A few key maternity shirts and pants for those last beached-whale months are helpful, but for most of the pregnancy, you can really get by without a lot of maternity stuff.

Of course, a lot depends on your particular build. Women who are on the smaller side of plus-sized tend to need a lot more maternity stuff, whereas supersized women tend not to need much maternity stuff at all. Women who are apple-shaped tend to need more maternity stuff because they already have more in the middle, so they need a maternity cut to allow for a pregnancy belly too. Women who are busty on top tend not to need as much maternity stuff because they already buy a bit bigger up-top, so then there's more room for expanding baby bellies underneath.

So you never know what you are going to need for sure; you may be surprised at how much you can "get by" with regular clothes you already own if you need to save money. I do think it's a good idea to have a few key maternity-related pieces to fall back on; a few maternity tops for near the end, maybe some maternity pants or skirts (especially for those on the smaller side of large). But if you need to save pennies, remember that a few key items are often enough to get by.

A really good option for getting some cheap maternity-specific clothing in plus-sizes is eBay. A lot of plus-sized women put their maternity clothing up for sale there, so it's a great way to get a bunch of pregnancy clothing cheaply.

And let me just put in a plug for donating your maternity clothing after you are sure you are done having children. You can sell it on eBay if you need the cash, but please, consider giving at least some of that plus-sized clothing to charities that serve women in need. They are chronically short of plus-sized maternity clothing, and often write to me via my website, looking for donations.

So please, sell on eBay if you wish to recoup some of your costs, but also consider donating a couple of things to these charities (some contact info available on my website). About half of pregnancies in this country are unplanned; imagine how hard it must be for really poor women of size to cope with an unexpected pregnancy and the accompanying maternity clothing needs. Pretty daunting stuff. Please consider helping out our less-advantaged sisters.

Women of Size in Other Countries

Here in United States, we now have some choices for plus-size maternity clothes. However, women of size in other countries often face very limited choices, as we did here not that long ago.

I do have sections on my maternity clothing FAQs that cover non-USA countries, although at this time it mostly covers only the UK, Australia, New Zealand, and Canada. Frankly, even this information is older now, so I'm sure that much of it needs updating anyhow. I would encourage women from these and other countries to email me via my website about choices available in your area (either new or updated info).

I'd also point out that there are a few companies that do utilize mail-order to various countries around the world, if you have the money to pursue that. And there is also information on my site about sewing your own maternity clothes, if sewing is among your skills.

Final Thoughts

It's fantastic that we live in the age of the internet and have so many more choices in plus-size clothing than we did before. One of the fashion categories that has particularly benefitted has been plus-sized maternity clothing.....and it's about damn time!

Even so, maternity lines and designers still seem to be ignorant that women over 3x get pregnant and need maternity clothing too. And although there is some stuff available in 4x or more, it's hard to find and choices are limited. Let's get more stuff available for women of all sizes! And cute stuff too, not just tents, thank you very much.

Do be aware that if you are on a budget, as a plus-sized woman you are not as likely to need as much maternity-specific clothing as an average-sized woman. You really don't have to spend a lot of money for maternity clothes if you don't want to or cannot afford to.

Depending on your body type and build, you may even be able to get by with very little specialty clothing during pregnancy.....if that's how you prefer to handle it. But being able to get by with less maternity clothing doesn't mean it shouldn't be available at all. The plus-size maternity option should be there for those who want it!

Also remember that even if you're on a budget, there are always options like consignment shops and eBay to help you find what you need for a lot cheaper than buying new. There are also many patterns available online for those who sew.

Finally, even if you can't afford much maternity wear, do try to find a few pieces (maternity-specific or not) that are bright and colorful and make you feel good about yourself. Don't hide in dark colors and tents, but find some pieces that make you look and feel fabulous.

Pregnancy changes your body in so many ways, and it's often also a time of big emotional changes too; pregnancy is challenging to the self-concept of most woman, regardless of size. Therefore, it's so important to do little things for yourself that help you feel good.

The top choices on my pregnancy "treat yourself" list are nice maternity clothing choices, pregnancy massages (even if it's only from your partner!), and long warm soaks in the tub. Ahhhh!

Indulge yourself!! Pamper yourself!! And start it off with clothing that makes you feel good.

Fashion Newsflash: Fat Women Actually Have Sex!

I read with some amusement the recent press release about a study finding that fat women actually do have sex.

Gasp!!! Who'da thunk it??!!??

They don't come right out and say it directly, but some of the subtext of the press release seems to be amazement that fat women are actually having sex, or perhaps even more amazingly to them, that there are men out there that want to have sex with fat women.

It's that same kind of reasoning that's been behind so many delays in the fashion industry for plus-sized women. They just don't seem to believe that fat chicks actually go on dates, go to the prom, get married, or have babies.

Bottom line, they seem to have difficulty believing that fat women have sex at all. Surprise!

The Plus-Size Fashion Vacuum

Because I'm middle-aged and grew up before the age of the internet, this plus-sized fashion vacuum hit me particularly hard, as I'm sure it did many others in the pre-internet days. [You young whippersnappers, you need to appreciate the wonders of having the internet as a resource!]

When I was in high school, I had a heck of a time finding nice clothes in my size, even though I was closer to "normal" sizes then (size 16 generally, sometimes an 18 or a 14).

My mom had to sew many of my clothes for me because most stores stopped then at size 12 or 14, and of the ones that went to a size 16......well, I just didn't fit their silhouette very well (too much of an hourglass instead of an apple).

I realize now it was a great act of love for her to sew for me like that (and what a blessing for me that she did know how to sew!), but her tastes and mine were not that close so it didn't always feel like a blessing. I really really wanted more fashionable clothes, stuff without polyester and elastic waists, you know?

I remember my shock and total disbelief my junior year when I actually found a prom-suitable gown in my size. I was thrilled. The clothing store employees kept throwing open the dressing room curtain to see if I was shoplifting because I stood there sooooo long, staring at myself in disbelief in the mirror. It was so beautiful, and I looked so good in it! You better believe I bought it!

Then I gained a bunch of weight in college (combination of undiagnosed hypothyroidism and PCOS, in which a strong weight gain in early adulthood is all too common) and it got even harder to find clothes in my size. I often resorted to running around in men's overalls because that's about all I could find in my size and non-existent price range. (They made clothing in larger sizes for MEN, but not for women, of course....but that's a whole 'nuther discussion!)

Yet imagine.....I still somehow managed to find a man anyhow, and we fell in love, overalls and all.

When Mr. WellRounded and I decided to get married, I went out to try and find a wedding gown......but there were none to be found in my size. Not ANYWHERE. Not in small towns, not in big towns, not even in a major metropolitan area.

I could go to a bridal store and hold up a dress against me and guess that it might look good on me and cross my fingers that when they were done it would fit me reasonably well......but I'd have to take a giant flying leap of faith and order it, pay for it, and then pray it actually worked. That seemed rather risky to me.

So I nixed that idea and contemplated getting married in my overalls. He loved me already in them, why not get married in 'em? Sadly, it looked like it might come down to that.

Finally, I decided, what the hell, it's my wedding, it's worth going into debt a bit. I hired my own seamstress, designed my own dress (neo-Victorian, thank you very much), and had it custom-made for me. I was back to having someone sew for me again, but at least this time I was calling the shots.

It worked out well but I was still ticked that I couldn't find anything in the stores, that I couldn't try out any designs ahead of time to see what worked best on my body, and that the fashion industry completely dismissed the needs of women of size at such an important moment of their lives. How dare they!?!

But the hardest part was yet to come.

The Plus-Sized Maternity Clothing Vacuum

Fast forward a few years, and Mr. WellRounded and I decided to have children. Took about a second to get pregnant despite dire predictions to the contrary (that's a whole 'nuther story too!).

So sooner than I began expecting, I went out looking for maternity clothes in my size....only to find that NONE existed. In fact, some clerks were openly hostile about having me in their maternity store at all. I remember going into a couple of them, only to have a clerk precipitously rush over to me and inform me that they didn't carry anything in "that" size in their store. When I asked them where I should go instead, they shrugged their shoulders and suggested buying a size larger in the plus-size stores.

They were really in a rush to get me out of their store; I think they didn't want to scare away the skinny women who might not want to be associated with a store selling "fat" clothes.

There was one clerk in one store that assured me that they had my size. Oh, my hopes were so high! I was beginning to panic about possibly needing to go naked during my pregnancy, and while I was pretty self-accepting, I wasn't too sure how the people at my job would feel about that!

She proudly hauled out one thing in an "XL" size (which generally fits about a 16/18, which I had long since left behind in teenagehood). Of course, it wasn't anywhere near suitable. She just assumed that an XL would fit anyone who was plus-sized. Ummmm, no!! There are different sizes of plus! So once again, I was without choices.

The long and the short of it is that I went through my entire first pregnancy without maternity clothes. None, zero, zip, zilch, nada.

How did I manage? Well, I did the only thing I could do. I went to the plus-sized stores (where I was already at the top of the size range, or close) and found the loosest clothes I could dig up, bought a few empire-waisted jumpers or trapeze tops, and then relied on loose-fitting tops and sweat pants with drawstrings I could loosen. Not the most professional-looking clothes for my job, but what else could I do? I had no other options.

By the end of the month eight, I was down to wearing 2-3 outfits, over and over and over again, each week the same exact clothes in order because I had so few choices. I was just lucky that I didn't have to work my last month (due to moving) because by then almost nothing fit....certainly nothing professional-looking. It was sweats and the biggest men's potbelly-friendly t-shirts I could find. It was really embarrassing.

That at least got me by to some degree for clothing, but I was really panicked about what I was going to do for nursing bras once the baby arrived. I could hardly find a regular bra in my cup size; how would I find one in an even larger cup size? With accessible flaps? OMG, I was really sweating that one.

I was lucky; a midwife at my doctor's practice had recently come across a brand-new business a few hundred miles away that specialized in hard-to-find nursing bra sizes. She had some flyers at the office and gave me one just before I moved. I was able to get some nursing bras in my size...miracle of miracles!.....just before I gave birth. Again it was by faith that the size would be right, because we had to do it all by mail....but at least I finally found something.

However, the humiliation of having to go through my entire pregnancy without maternity clothes really stayed with me. I knew I couldn't have been the only other plus-sized woman to have a baby in the history of the universe. Why wasn't someone, somewhere, addressing this?

I really caught on fire to try and change things and spread the word about the needs of plus-sized pregnant women.

It was shortly after this that the internet really started taking off, and I actually began to find a few companies here and there that did carry maternity clothes in my size. So I put together a FAQ on finding plus-sized maternity and nursing clothing.

I became active on the fat-acceptance bulletin boards, and would forward my FAQ when someone asked about maternity clothing for women of size. Within a short while, that got turned into my website, http://www.plus-size-pregnancy.org/, along with other information about being pregnant at larger sizes, and my particular niche of fat acceptance activism was born.

The plus-size maternity and nursing clothes FAQs are still there on my site, updated periodically (another update is due soon). Google makes it much easier to find such information these days, but it's still a good place to begin for someone just starting their maternity clothes search, or for women of size looking for more unusual maternity-related products like pregnancy support belts, birth balls that support larger sizes, nursing pillows that work for well-endowed women, nursing bras in unusual cup/band sizes, that sort of thing.

[I should probably mention that it's merely a clearinghouse for information on various vendors; I don't sell anything on the site whatsoever and I don't get kickbacks from any of the vendors in order to be listed there. It's a totally non-profit site.]

Still A Long Ways To Go

But while the internet has made a HUGE difference in finding clothing in larger sizes (including specialty stuff like wedding, costumes, and maternity), it still amazes me how many designer lines still don't design for us.

I think it all comes back to this idea that fat women don't have sex. Some folks in the fashion industry really seem to believe that fat women don't date, don't get married, and don't have babies.

Well, newsflash, designers!!! Fat women do date, we do get married, and we DO have babies. Yes, it's true.........fat women DO have sex!!!

Research even confirms this now, so maybe you can finally start believing it.

It's about time you designers and clothing store managers get on the stick and get more plus-sized choices out there.....for "regular" clothing, for fancy dress, for business wear, for weddings, for costumes, for athletic wear, and yes, for MATERNITY too!!!

Yes, fat women have babies too. And fancy that, we'd even like to have the option for maternity clothes for that time as well.

[Invitation to comments: If you have had a baby, how did YOU solve the maternity clothing issue? Was this pre- or post-internet?]

Note: It may take a couple of days for the comments to appear, but I'm very interested in your own experiences. Please do share.

Putting the Baby on a Diet Before It's Even Born

Two of the most important questions in the "fat women should gain less weight in pregnancy" movement are:

1. Exactly what means should be used to achieve that smaller weight gain (i.e. do they recommend hypocaloric diets to obese women in pregnancy)


2. What will providers do to enforce a particular weight gain if a fat woman starts to gain more than allowed despite normal nutrition

The answers to these questions are very important.

Normal Eating vs. Hypocaloric Diets

When advising their obese patients to aim for a smaller weight gain in pregnancy, some care providers simply mean "Eat healthy and normally, exercise regularly, and if you don't gain much weight, that's fine."

There's nothing wrong with this approach. As we have established, many larger women don't gain as much weight in pregnancy regardless of what they eat. It's not outside the range of normal. As long as they are eating healthfully and not restricting calories, whatever they gain (or don't gain) is fine.

[Of course, part of the problem with some doctors is their assumption that fat women OBVIOUSLY eat poorly so therefore eating healthy must represent a major change in intake and lifestyle and so they won't gain much weight at all. I can't tell you how much those assumptions irritate me. But I digress.]

But when some doctors advise gaining less weight in pregnancy, they mean manipulating their clients' food intake in order to achieve a lower weight gain. They're not just talking about eating healthfully and normally, they basically mean prescribing hypocaloric diets in pregnancy.

And if their clients start to gain more than what is "allowed," some doctors use scorched-earth techniques to limit that gain.

This is why the movement to limit weight gain in pregnant obese women is most alarming. This is the course of action that is dangerous and must be questioned.

What Is Normal Caloric Intake in Pregnancy?

Of course, a discussion of all this depends on what you think is a normal caloric intake in pregnancy.

Most sources just say it's 200-300 calories beyond your normal intake in the 2nd and 3rd trimester. Many don't specify a total number, but simply note that 200-300 calories extra is all you need and that doesn't take much extra food.

The sources that specify caloric intake say slightly different things:

• The National Institute of Diabetes and Digestive and Kidney Diseases says that normal pregnancy caloric intake can vary from 1900-2500 calories, depending on your activity level, height, and energy needs
  
• The RDA/DRI for pregnancy is usually cited as 2400-2500 calories in books


• The American Dietetic Association says that most pregnant women need 2200-2900 calories during pregnancy

So even "official" sources differ somewhat in the total calories needed during pregnancy but let's assume around 2400 calories; a bit less if you are not very active.

Calorie Intake for Obese Pregnant Women

But if women of average size are "supposed" to eat somewhere around 2400 calories, give or take a bit, how many are fat women supposed to have?

Well, few sources will tie themselves to recommending that fat women only eat "x" calories in pregnancy....most just strongly imply that fat women should be eating far less than the norm.

What happens most often is that doctors and pregnancy books tell women they should NOT gain much weight in pregnancy.....and then they leave it up to the mother to deduce how to achieve such a limited gain.

So even if a care provider doesn't directly say, "Eat only xxxx calories," the advice to strongly limit weight gain indirectly is going to lead to hypocaloric intakes in many women.

Some sources are not afraid to come right out and recommend caloric restriction to women of size. For example, fat women with diabetes or gestational diabetes are routinely advised to restrict their calories because borderline starvation has been shown to lower blood sugar. So there are some studies that show that women have slightly lower blood sugar if they are given hypocaloric diets.....but is this really harmless to the baby?

The degree to which obese pregnant women with diabetes or GD should be restricted is controversial. Many programs limit obese women to somewhere around 1400-1600 calories. Some have limited women to as few as 1000-1200 calories.

Non-obese pregnant women with diabetes/GD, on the other hand, usually are given at least 2000 calories and often more like 2400-2500.

Please note---that's 500 - 1000 calores less per day!

My question is....why would it take fat pregnant women less calories to grow a baby than average-sized women? Isn't the actual caloric/energy cost of growing a healthy baby going to be similar among women of all sizes?

Sure, obese women have fat stores already and so we don't need extra calories for building up fat stores. So I could buy a few less calories per day.....but 500-1000 less calories per day?

That is a lot more than the difference between a bit of extra fat stores or not. With that kind of restriction it's difficult to believe the mother is getting all of what she optimally needs nutritionally.

But it's not just GD mothers that are getting hypocaloric advice. Although such drastic cuts are by no means universally advised, it's still not uncommon for women of size to be given hypocaloric diets in pregnancy.

Here's a website....from a registered dietician no less!.....that recommends that obese women select her 1500-1700 calorie plan, while overweight women get to whoop it up on her 1800-2000 calorie plan. Whooohooo.

And it really isn't all that uncommon for obese women to be told to limit her calorie intake to somewhere in the 1500-1800 calorie range.

Real-Life Dietary Advice

But is this kind of restriction just the result of a few raving lunatics here and there, or is this kind of advice really common?

Here is a sampling of just a few of the emails I've seen over the years, documenting reduced caloric diet advice during pregnancy:

• When I was pregnant with my first, [the doctor] had me on a 1800 calorie diet
• My [relative] will be having her baby [soon]. They just tested her a few weeks ago and she says her sugar is "borderline." They put her on a 1500 calorie diet.
• [At 22 weeks pregnant], the OB told me I probably had gestational diabetes. [He] suggested I go on a 1500 calorie diabetic diet.
• While [pregnant] with *twins*, the nutritionist put me on an *1800* calorie diet
• At our first meeting the nutritionist very patronizingly recommended we all eat as much aspartame as possible before introducing us to our new diet, one that I would later calculate to add up to roughly 1300 calories per day.
• My fat-phobic OB...put me on an 1000-1100 calorie a day diet with baby #4

Although 1500 and 1800 calorie diets in pregnancy are most common, I have read studies (yes, recent ones!) where they had PREGNANT fat women on 1200 calorie diets! It's not common but unbelievably, it does still happen.

WHAT are they thinking?

The Scorched-Earth Approach

And the further question is, if women gain more weight than their doctor tells them they may gain....what then?

[Note: Some of these stories have been mentioned before, but they bear repeating in this context.]

Is she going to be harassed every time she gets weighed at the doctor's?

• Although my OB is a decent man, he constantly hammers me about my weight (I've lost 3 lbs. during this pregnancy so far), and I am scared to death to step on the scales at my appointments

Is she going to be sent to Weight Watchers or Jenny Craig in an effort to keep her weight gain down?

• [The nurse-midwives at the birth center] sent me to Weight Watchers and told me not to gain weight or they wouldn't be able to keep me.
• After meeting with the OB nurse, she said that I could go back to WW.
• I am 9 weeks pregnant and [my midwife] said I need to go on a diet. She said I can go back to Jenny Craig, like I was doing before I was pregnant.

Is she told to diet during the last trimester of pregnancy when the baby is really developing neurologically?

• I was told not to gain any more weight when I reached about 7½ months with my first 2 pregnancies. So I’d try to starve (and not succeed) during the 8th & 9th month when my little guys were trying to grow their brains
• I have gained 18 pounds so far..[the doctor] had a fit. She told me...I had better lose weight. I asked, "Do you mean not gain any more?" and she said, "NO, you need to LOSE weight.”
• [The doctor] said I mustn't gain more than 20 lbs., 15 was even better, because I was overweight. If I gained more, he'd put me on a diet...I left the doctor when I was 5 months pregnant. [My] cousin stayed, and obeyed. When she reached her weight limit he [did] put her on a diet.

Is she going to be told to go to extremes in order to limit weight gain?

• [The OB told me, while pregnant with twins, to drink Slim-Fast in order to keep down my weight gain.]

This is one of the most critical questions. What interventions are going to be used to curtail or prevent an "excessive" weight gain? And how can we be sure they are not doing more harm than good?

Conclusion

Let's be fair. Most doctors these days do not advise fat women to diet during pregnancy, but there is a movement afoot return to this, and some doctors (and even some midwives) are advising reduced caloric diets.

Furthermore, the common advice for obese women to gain minimally during pregnancy means that many of them will adopt reduced calorie diets during pregnancy in order to achieve that goal.

And if the Institute of Medicine (IOM) revises its weight gain guidelines (as they are currently considering doing), many doctors (and even midwives) will see this as a justification to put more and more obese women on reduced calorie diets.

And this sort of thing has the potential for far-reaching consequences.

You know that the obesity hysteridemic in this country is way out of control when they are, in effect, promoting putting the baby on a diet before it's even born.

Next: The potential effects of fetal undernutrition

A Little Historical Perspective on Weight Gain in Pregnancy

Preventing Pre-Eclampsia and Big Babies

Years ago, doctors regularly advised women to strictly limit their weight gain in pregnancy. They viewed this as a way to prevent pre-eclampsia (high blood pressure issues in pregnancy) because one of the symptoms of pre-eclampsia is a high weight gain from retaining fluids.

They decided that the large weight gain must be causing the pre-eclampsia, and therefore, preventing a large weight gain would help prevent pre-eclampsia.

They also wanted to prevent women from having large babies, so they strongly counseled women of all sizes to limit weight gain in order to get a smaller baby.

[Not only did they restrict weight gain, they also advised women to smoke to keep down their weight gain and fetal size, or to use diuretics to prevent fluid retention, both of which were later discovered to cause serious problems in pregnancy. Doh!]

All this was in the name of a worthy goal----preventing pre-eclampsia, which can be a very serious complication of pregnancy, and which is potentially deadly to both mother and baby. Their hearts were in the right place, but their methods were ill-considered and extreme.

Furthermore, the safety of this approach had not been established before it was adopted, as is unfortunately common in obstetrics. (Think of all the babies damaged when their mothers' doctors prescribed DES.)

Unforseen Consequences: Underweight Babies

What they found out later was that these extreme approaches actually CAUSED more harm then they averted. Many babies were born too small or very stressed; some no doubt died as a result of these interventions.

We also know that babies born underweight or "small-for-gestational age" (SGA) have more health problems later in life so the consequences of restricted fetal growth go far beyond problems at birth.

This is why the Institue of Medicine (IOM) adopted new weight gain guidelines in 1990, raising the recommended weight gains in pregnancy. They noted years of research that showed that low weight-gain in pregnancy caused an increase in SGA babies....in women of all sizes.

They also noted that in the 70s, when weight gain restrictions began easing up, there was a strong reduction in the occurrence of SGA babies.

So they raised the guidelines, and then began the big job of trying to get doctors to believe in this new system of weight gain guidelines. It was a difficult job.

Current IOM Weight Gain Guidelines

The old weight gain recommendations vary by source and by decade to some extent, but generally they fell somewhere between 10-20 lbs. By the 1970s, several organizations set a desirable range of around 20-25 lbs. or so.

The IOM raised these guidelines...but not across the board. They differentiated weight gain recommendations by BMI. Their guidelines were:

• "Underweight" women: 28 - 40 lb. weight gain
• "Normal" Weight women: 25 - 35 lb. weight gain
• "Overweight" women: 15 - 25 lb. weight gain
• "Obese" women: at least 15 lb. weight gain

The reason they had different weight goals by BMI was because weight gain's effect on fetal size varies by pre-pregnancy BMI.

The highest risk for SGA babies was in underweight women who didn't gain enough weight in pregnancy. Research clearly shows that gaining more weight can prevent many SGA babies in this group, so they raised the upper limit in this group to 40 lbs.

The effect of greater weight gain in preventing SGA babies is less pronounced as maternal size goes up; thus they felt that smaller gains were justifiable in the other groups. Still, women of "normal" size were now allowed to gain up to 35 lbs., which was a little more lenient than in the past.

The effect of weight gain on SGA babies is least strong in overweight and obese women, so therefore they felt only a small weight gain was appropriate in this group.

However, they did note that very small weight gains/losses caused increases in SGA babies across the board, even in obese women, and therefore they were not comfortable in recommending <15>This has been very controversial; many doctors still believed that obese women should gain little or nothing in pregnancy. They believed a larger gain in fat women would lead to a stronger risk of....ta da!!....pre-eclampsia. And big babies. And cesareans. And would result in more obesity after the pregnancy because of retained weight. So they've been chafing under these "guidelines" ever since.

Pressure to Revise the Weight Gain Guidelines

This chafing over guidelines has reached fever pitch now as a result of the obesity hysteridemic. More and more are pressing for lower weight gain goals.

Recently, a number of doctors have banded together to pressure the IOM to revise its guidelines on weight gain in pregnancy, and in particular to lower the guidelines for obese women.

They are hawking the same old concept again, namely: Large women have a higher risk for pre-eclampsia and big babies, so if we prevent a large weight gain in them, we'll lower the risk for pre-eclampsia and get smaller babies!! And prevent further obesity afterwards!!

Know what guidelines they are proposing for obese women?

• Class I obese women (BMI 30-34.9): 10 - 25 lbs. gain
• Class II obese women (BMI 35-39.9): 0 - 9 lbs. gain
• Class III obese women (BMI >40): 0 - 9 lbs. loss

That's right, they are proposing that some fat women BE REQUIRED TO LOSE WEIGHT DURING PREGNANCY.

Alas, their P.R. campaign is working; the IOM has begun meetings to discuss revising weight gain guidelines again.


Coming Soon: Deconstructing the research being used to justify lowering these cutoffs.

Suicide by Pregnancy?

I recently received yet another story of tremendous size bigotry from an OB, who basically tried to scare this poor woman to death about being pregnant at her size, and who more or less told her she had committed suicide by daring to be pregnant at her size.

I can't tell you how much stories like these infuriate me; NO ONE should have to put up with this kind of bullsh*t treatment. People in the healthcare professions should be ASHAMED that this kind of medical bullying occurs. Yet sadly, it is all too common with women of size, especially in obstetrics.

I have permission to quote her email; I have edited it slightly.

I am 31 years old and I weigh 400 pounds. The last time I was pregnant, which sadly ended in miscarriage, I weighed 350 pounds...I've overcome as best as I can and I want to try for a baby again.

My current OBGYN says he can get me and my baby safely through pregnancy, and that he has lots of history with obese women and pregnancy. I want to believe him, but I worry because of what another doctor told me.... and because of what I've been brainwashed for years to believe.

Anyway, when I was pregnant, I went to a doctor who CONDEMNED me the moment I walked into the office. He told me that I wasn't going to make it alive through my pregnancy and that they would "have to take drastic measures to try save me before they would even attempt to save my baby" etc.

He kept saying I shouldn't have gotten pregnant, that I had in a sense, committed suicide! He told me that my heart was going to give out, or that I was going to stroke out while attempting to push my LARGE baby out, therefore I was going to have a c-section. He told me that I was going to have massive blood clots in my legs and severe pre-eclampsia.

I left his office completely panicked and in tears. I was shaking so bad I could hardly walk and all he did was look at me and said in a cold voice with no emotion at all, "It's really scary, isn't it."

I regretted all the years of trying and numerous fertility treatments (I have PCOS) to get pregnant. It was 4 days later that I lost my very much-loved baby. I believe it was a good part due to the stress and fear that he caused me.

I'm sorry; this kind of treatment is INEXCUSABLE.

Yes, statistically there are more risks in pregnancy with obesity, and yes, these risks probably do go up somewhat as BMI increases, but at NO point do they reach 100% or even remotely close. Being at increased risk for a problem does not mean you will inevitably experience it, and in the meantime there are proactive things you can do to lessen your risks for problems. Even if you do experience a problem, most of the time there are treatments that will help. Most of the time things are fine.

Let me say it once again. MOST women of size have healthy babies just fine.

"Even" in the 400 lb. size range, I know of a NUMBER of women who have had healthy pregnancies and babies. Most in that size range are not "allowed" to labor (or the doctors induce their labor early and then they end up with a cesarean) so the cesarean rate in this group is very high....but I DO know women of that size range who have had vaginal births too. None that I have known have died or even come close. None have stroked out during labor or birth; none have had heart attacks or any of the other dire things this doctor said would surely come to pass.

The largest-sized woman I have come upon so far in case reports in the medical literature was around 500 lbs. She did NOT experience gestational diabetes, she did NOT experience blood pressure issues, she did NOT have blood clots, or any of the other terrors this doctor would have said she obviously would get. The only complication she had was asthma, and she and baby were just fine. As is so common with obstetrics, they did pressure her to have a cesarean, and surgery on a person of that size is more difficult and challenging.....but it went just fine. There were no complications at all.

Although certainly there is more risk for complications, it is NOT a bygone conclusion that bad things will happen, even in women of very large sizes.

Medical bullying is a blight upon the profession. That's not to say that doctors and midwives cannot share that obese women are at increased risk for some complications; they would not be doing their jobs adequately if they didn't share these possible concerns. However, HOW you discuss these things makes all the difference in the world.

You can present possible risks without implying that they no doubt will happen; it's important to present the risks in proper perspective. The truth is that they do NOT happen to the majority of women of size, and the worst-case scenario very rarely happens. You can also present them in a neutral way, without the judgment and harshness and condemnation so often used on women of size.

Furthermore, you can present ways to be proactive that can help lessen the risks for complications. Excellent nutrition (not dieting) and regular exercise go a long way towards lessening the risks, and for women at particular risk, there are other options too, such as using metformin prophylactically or considering low-dose aspirin (with medical supervision). These are all things that can be discussed calmly and reasonably, without having to resort to hyperbole and scare tactics.

The kind of over-the-top BULLYING shown above is a total exaggeration of the risks, and basically amounts to trying to scare women of size out of having babies rather than giving her reasonable counseling about possible risks. It is a unique and insidious form of bullying and eugenics and IT MUST STOP.

My Own Experience With Hypothyroidism

Previously, I wrote about hypothyroidism issues in pregnancy in general. Now I want to write a little bit about my own experiences with hypothyroidism. It's a widely varied journey, but one with lessons for others who think they might have thyroid issues, so I want to share it.

Hypothyroidism Begins with a Roar

When I was younger, everyone always considered me "overweight" and I had lots of pressure to diet, but I wasn't really "obese" at that point. Then the PCOS and hypothyroidism really hit.

Starting at about age 16, I began skipping periods. Scared me to death, but it didn't happen that often and I knew periods could be variable, so I figured I was just one of those people who was a bit irregular.

Then around age 17 I began gaining weight and lots of it. I had been on a diet recently so I just figured it was re-gain (and I'm sure some of it was). Looking back now, though, I think much of it was also the big gain that often accompanies the double-whammy of PCOS and hypothyroidism.

Between 17 and 21, I gained about 100 lbs. That's right, a hundred pounds. [Wow, it's upsetting even writing that; I can still hardly wrap my mind around it.] It happened without changing any of my food habits or anything else significantly. It was devastating. But I couldn't seem to stop it, no matter what I did........and I did a lot.

I fought it with everything I could think of. I cut back on food......but I kept gaining. I thought maybe it was dorm food, so I moved out of the dorm and started cooking for myself.....but still kept gaining. I went to Weight Watchers again......but kept battling crazy fluctuations of weight. I signed up for a college fitness class and spent an extreme semester exercising like crazy.....yet I gained 25 lbs. in that semester alone, WHILE doing all that exercise and being on Weight Watchers. (And no, that was definitely not muscle gain.) The coach thought I was lying and that I must be a binge eater....but I wasn't.

Dealing with Doctors: Round One

During this time period, I went to the doctor a couple of times and they tested my thyroid levels. I was told they were always "normal" or "a little on the low/borderline side, but nothing that needs treatment." So we concluded that thyroid wasn't an issue for me, despite the tremendous weight gain I was experiencing.

Now, of course, I wish I had the exact results from those tests to look at. Back then, the ranges considered "normal" were much wider, and I suspect strongly that I fell into a gray area, where TSH tests are within normal limits as they were defined then but would now be considered abnormal by many endocrinologists.

[So lesson #1: Always get your exact test results and know the range the lab used to define "normal," and then keep those results so you can track them over time.]

I finally got so desperate about the weight gain that I signed up with a radical commercial diet center. 500 calories a day, plus vitamin/mineral supplements. Seriously. I did that for 6 months. I lost 50 lbs. all right, but it was NOT a "good" or "healthy" loss. I'm lucky I didn't seriously damage my body. That was the turnaround that began my fat-acceptance journey.

I ended that diet for many reasons, but in particular because by the end of 6 months, I began gaining weight on 500 calories per day. Yes, GAINING weight on 500 calories a day.

That's when I realized that the whole "calories in/calories out" mantra was full of crap, and that there must be something more to all this. The math didn't add up; there must be more variables than doctors realized.

I also began realizing that the whole dieting thing was taking me places mentally and emotionally that I didn't want to go, and I felt for my own health and sanity I had to stop. So I did. (Smartest thing I ever did.)

For the time being, I gave up on seeing doctors and concluded I must not have any thyroid issues. I knew something was going on, but figured that yo-yo dieting had screwed everything up. I gave up on trying to find answers and tried to concentrate on stabilizing my weight.

Dealing with Doctors: Round Two

Fast forward a few years. I was married and working at a career, but seeing more and more signs of problems. I was skipping periods again, I had many other symptoms that were bothering me, and I was constantly fighting my weight. I finally decided I had to go consult an endocrinologist because I just knew something was wrong.

We had just moved to a new town so we picked an endocrinologist from the phone book. I went there and filled out all the paperwork, extensively describing my symptoms and history. The doctor didn't even really look at it. He was very disdainful, very dismissive. He didn't take my concerns seriously at all.

He told me I was just looking for an excuse for being fat.

I was devastated and didn't go back to a doctor for several years. I continued to skip periods and to experience other worsening symptoms, but I couldn't see going back to a doctor and being dismissed like that again. So I only kept getting worse.

[Lesson #2: Don't give up if you can't find a doctor who will take your concerns seriously; don't let a fat-phobic doctor keep you from getting the care that you need. Find a new doctor!]

Dealing with Doctors: Round Three

Finally a friend gave me a book about thyroid issues. I read it and went, wow, that's me. I got a basal body thermometer and starting taking my basal body temps (BBTs) and sure enough, they were in the basement, and I had so many of the other symptoms they listed too.

This friend recommended a doctor to me who was trained in complementary medicine as well as traditional medicine, and who might be more inclined to listen to what I said. I was dubious.....complementary medicine?......but decided to give it a shot.

This doctor was SUCH a breath of fresh air. He was so nice, and he really listened to me. He didn't discount what I said just because I was fat and therefore "must" be lying about food. He asked me lots of questions and took a lot of time with me. He wasn't a whacked-out hippie; he knew his science and used traditional treatments, but he also kept an open mind to the possibility that traditional views of medicine might be missing some things. He was a gem.

My blood tests were nominally in the "normal" range. However, he said that my symptoms certainly pointed to hypothyroidism and he took all the BBT data I brought seriously. He suggested a "trial of meds"----putting me on a low dose of thyroid meds (Armour thyroid) for a short period of time to see what happened, re-doing the blood tests, and then re-evaluating at that point.

WOW, what a difference. I felt SO much better, so quickly. I had energy again, my periods became regular again, my weight dropped without any change of habits, my skin was no longer like a lizard's.....I felt like a new person.

We tested my levels again after a few weeks on the thyroid meds, and my levels were much better within the normal range instead of at the edges of normal. He felt that if I truly didn't have hypothyroidism, the meds would have made my TSH levels go into the abnormal range, when what they actually did was get them into a better range. So he felt that this (plus the symptom improvement) merited a diagnosis of hypothyroidism. We continued my medication.

Dealing with Doctors: Round Four

A few years later, my insurance changed and this doctor was no longer "in-network." So I switched to an internist closer to home, thinking it wouldn't make that much difference.

Unfortunately, he insisted I switch to Synthryoid instead of Armour Thyroid for meds, and I never quite had the same level of benefit again. But I guess I should count my blessings that he kept me on some form of thyroid meds; some doctors might have taken me off them completely.

[Lesson #3: Not all doctors are equally knowledgeable and willing to work with you on your thyroid issues. It's worth it to hold out for a good one.]

My Experiences with Pregnancy and Thyroid Issues

After that, we moved and I began my family. I am so relieved that I didn't start a family before my hypothyroidism was discovered and treated....who knows how things would have gone without it!

I think having my thyroid levels normalized helped me conceive without any problems (despite my age and size) and it helped me keep my pregnancies normal. We tested my levels periodically in my pregnancies and they never went haywire at all, so I was lucky in that way.

However, after baby #4, I did experience postpartum thyroiditis. I never experienced the hyPERthyroidism that often accompanies this, but boy howdy, did I experience the hypo part! I gained a lot of weight postpartum (normally I lose weight postpartum while breastfeeding), I was exhausted, I was cold all the time, and my skin started looking lizardy again. Yet even with all my years of experience with hypothyroidism, I didn't recognize that my thyroid had gone whacko until many many months later, in retrospect. I just failed to see the patterns.

[Lesson #4: A history of thyroid issues means you may be particular vulnerable to thyroid wackiness during vulnerable times such as pregnancy, postpartum, menopause, and advanced age.]

I'd had my thyroid levels tested at about 4 months postpartum, as part of my yearly thyroid tests. My TSH came back higher than usual, but still well within normal so they didn't adjust my dosage. Now, we don't know how much it fluctuated before and after that; my personal opinion is that it was probably bouncing all over the place and we just didn't know it because we only tested once.

[Lesson #5: If you suspect your thyroid is out of whack, you may need to test multiple times over a short period of time to catch the variations.]

Fine-Tuning Thyroid Meds

Over the years, with much experimentation, I have found that I feel best when my TSH levels are between 1.0 and 1.5, and any even small deviation over that really affects how I feel, the stability of my weight, and skin etc. symptoms. So even though my TSH postpartum had come back "normal," it wasn't normal for me and where I feel best.

[Lesson #6: Some people are exquisitely sensitive to even small changes in TSH levels, and even when levels test "normal," they may not be optimal for that person.]

I also found that I feel better with a combo of both T4 and T3 meds; if I take only Armour, my TSH may be fine but my T3 numbers are too high. If I take only T4 meds (Synthroid and its equivalents), I don't feel as well. It's a combo of a little of both that seems to keep me closest to normal. Makes for twice the prescription co-pay, but it's worth it.

[Lesson #7: Many people feel better when using alternatives to Synthroid, or combos of T3 and T4 meds. However, it's important to track not only your TSH but also your T3 and T4 numbers, as these may be out of whack even when the TSH is fine.]

After going on thyroid meds, I never skipped a period again. EVER. Many of the skin problems I'd experienced (cystic acne, boils etc.) lessened significantly. I was no longer gaining weight uncontrollably. Keeping a stable weight was still a struggle, but not a losing struggle anymore. And I just felt so much better, in so many ways.

Now, I have to be honest.....I didn't experience a total resolution of all my symptoms. I still have some of them.....even after fiddling with my dosage, even after getting meds with both T3 and T4 in them, even after doing all the things I'm "supposed" to do.

There may still be something out there to try yet, or there may be some other problem complicating full resolution......but I also have to concede the possibility that hypothyroidism may be more complex than we think, and even with thyroid meds my symptoms may never be fully resolved. I hope doctors will keep researching hypothyroidism and its implications because there are a lot of people out there like me that experience help but not full resolution of symptoms with treatment.

But the improvement I have experienced has been remarkable in so many ways that I am grateful that I persevered in getting diagnosed and treated. It has absolutely been worth the time and trouble.

[Lesson #8: Not everyone gets full remission of symptoms even with best current treatment, but perhaps as they learn more about hypothyroidism and its co-morbidities, treatment will get even more effective. Partial remission of symptoms is far better than no remission at all.]

Hypothyroidism Needs to be Taken More Seriously

My experience (and the similar experience of many others) tells me that many symptomatic people with "borderline" TSH readings actually benefit significantly from treatment to optimize their thyroid levels, yet there is a great deal of resistance to this in the medical community.

Although more study is needed, some research does seem to indicate that people of size and those with PCOS do tend to have thyroid issues (especially the "borderline" kind) more frequently. People in these categories should have their thyroid levels tested regularly throughout their life, as a precaution, and especially before pregnancy.

Yet it's still so hard to get doctors to take "borderline" TSH readings and symptoms seriously, or to get newer diagnostic standards widely accepted by most doctors and labs. Far too many people are still being told they are "fine" when they are not, or are not being tested at all.

This is a story that is so common among people of size. We tell doctors over and over that something is wrong, that something is "off" and we just don't feel right. And over and over, we are not taken seriously, or it's all blamed on being fat.

The tremendous resistance to our experiences and concerns seems to come from the belief among some healthcare professionals that fat people are "just looking for an excuse for being fat" and you can't really trust what they say. And that if they'd just get off their butts and lose weight, all these issues would be resolved.

For a while, there was some headway on this problem, but now I see the pendulum swinging back again towards blaming and closed minds. If you protest that something else besides "calorie math" must be going on, they think you are making excuses for yourself, lying about what you actually eat, or are simply in denial.

Healthcare professionals simply MUST start stepping outside the paradigm that obesity itself is the main cause of all problems in fat people, and that weight loss is the only way to really deal with these issues.

They must consider the possibility that obesity may sometimes simply be a symptom of other issues, instead of the cause of them. They must recognize that permanent weight loss is difficult and not just a matter of willpower. They must start recognizing that this focus on weight loss at all costs often causes more problems than it fixes. And they must start looking for ways to improve symptoms and quality of life in people of size that don't necessarily involve weight loss as the "fix."

And they simply must lose the judgmental attitudes that fat people are always simply looking for an excuse for being fat.

Final Advice to Those with Hypothyroidism

If you suspect you may have hypothyroidism, or if you have already been diagnosed and are working with a healthcare professional, inform yourself as much as possible about thyroid issues. Find a healthcare professional who listens to your concerns, will work with you to find the best possible meds and dosage, and keep reading the research.

There are good, decent healthcare professionals out there that will take your concerns seriously; it's really worth finding them. But the first step is informing yourself and becoming an advocate for your own needs.