I had already planned an entry on pregnancy after Weight Loss Surgery (WLS) to address the recent study purporting to show that WLS made pregnancy in fat women safer.
However, Sandy from Junkfood Science beat me to it. And really, there's no need to re-invent the wheel when someone else has already done it far more completely than I'd ever have time for. So if you want to read about the weaknesses of this study and how there really are still significant concerns about pregnancy after WLS, be sure and go read Sandy's entry.
But while Sandy has done the heavy lifting on this one, let me just add some comments.
First of all, let's not vilify people who have had this surgery. I am strongly against WLS but I also understand what drives many people to do it. Several friends of mine have done it, despite my strongly expressed concerns over the potential consequences. I empathize with their reasons, even while I disagree with how they are going about addressing their concerns.....but ultimately it is their body and they have the final say about what they do with it. I just pray now that the nutritional repercussions are not too severe because I truly love my friends and I want the best for them.
To be fair, let's also point out that many women have had seemingly successful pregnancies after WLS. Their babies seem to have been born healthy and fine, with no major obvious issues. For their sake, I am glad their babies seem to be fine, and I genuinely rejoice with them for their new little ones.
I have to be honest, though, and say that I fear what impact this might have on the baby long-term that we are not able to see now. Just because a baby is born with no obvious problems does not mean that it was not affected. The doctors seem far too content to say, 'Look, no obvious birth defects or problems at birth; see, pregnancy after WLS is perfectly safe!!' Actually, we know no such thing.
In fact, one of the important points this review missed was that there is an increased rate of small-for-gestational-age (SGA) and/or IUGR (intra-uterine growth retardation) babies in some of the research. I've seen studies where the abstract proudly announces that outcomes were more "normalized" among the women with WLS, that no bad outcomes resulted from the pregnancies after WLS in the study.
Yet, when you look closer, hidden in the full text is the finding, carefully shrugged off, that there was a higher rate of SGA and/or IUGR babies in the women who'd had WLS before pregnancy. And we know that these babies have higher rates of all kinds of health problems. Yet this issue gets hardly any press.
Another problem is whether or not the outcomes of pregnancies after WLS are being selectively reported. I have heard anecdotal reports of poor outcomes from women who are on WLS support boards, as well as from doulas and midwives who have worked with pregnancies after WLS. While many women have seemingly done well, there are also quite a few miscarriages happening, as well as some babies with birth defects.....yet few if any of these stories are being documented in the research that I've read.
That certainly suggests the possibility that poor outcomes of pregnancies after WLS are being under-reported. What kind of accountability is there for making sure that all outcomes of pregnancy after WLS are being recorded and reported? Is it simply a matter of poor tracking after WLS? Or is that women who have poor outcomes are not reporting them to their WLS surgeons? Or could it be that some WLS surgeons are selectively reporting to feature only the best outcomes?
One of my biggest concerns about this whole issue is that the people who are responsible for doing the research and reporting about it are the ones with the biggest economic interest in it. It's like asking the tobacco industry to be the sole group investigating and reporting on the effects of cigarettes. Or asking the pharmaceutical industry to sponser all the research about a certain drug and report these findings without any oversight or independent investigation to confirm or repudiate their findings.
Research on WLS is mostly done by WLS doctors. On the surface, this is logical, as they are the ones in the trenches every day, seeing patients, and the ones with the data in their files to pull from. But WLS is a profoundly profitable industry these days; greed (and prejudice about "saving" fat people from themselves) makes it easy for data to get distorted or selectively reported.
Frankly, in WLS research, far too much data conveniently gets "lost" to follow-up, and there is little or no accountability from outside, independent agencies. There needs to be far more independent oversight and investigation from people outside both the weight loss and the weight loss surgery industries.
Another thing that really bothers me about WLS (especially Gastric Bypass) is the aggressive marketing of it to childbearing-aged women, as if no fat woman on earth could possibly have a healthy pregnancy or baby without losing weight first. While it's true that there are risks associated with 'obesity' and pregnancy, it's also true that the MAJORITY of fat women have healthy babies just fine, and that prevention of complications in this group does not have to involve weight loss or dietary restriction.
It's not an either/or proposition....but you'd never know that from the marketing on some WLS websites. A lot of fat women are having WLS because they have been convinced that WLS may be their only way to have a pregnancy or a healthy baby, and that's simply not true.
Furthermore, aggressively marketing WLS to childbearing-aged women as the "best" way to ensure a healthy pregnancy and baby while we still know so little about the long-term effects of malabsorptive procedures on the baby seems horribly unethical to me. The long-term nutritional effects of WLS can be so devastating for the mother; how do we really KNOW it's going to affect a baby, both short-term and long-term?
Malabsorptive procedures bypass parts of the digestive system that absorb certain nutrients. At first, the woman's own body reserves are enough to sustain her, and the massive amounts of supplements taken after WLS help make up the difference. For some, that's enough.....but for many it is not. Most women of childbearing age face significant nutrient deficits after several years, once their own reserves are used up and they stop absorbing the supplements as well.
If a woman is not able to absorb enough iron, B12, calcium, vitamin D, folic acid, etc. after WLS to keep up her own levels long-term, how in the world is she going to be able to lay down sufficient quantities of this for a growing, developing baby? What are the possible long-term effects this could have on babies?
I realize that most women who have babies after WLS get pregnant within 1-3 years or so, while they still have some nutritional reserves. And this is probably what has saved the babies of these pregnancies so far....they are able to draw on the mother's nutritional reserves to absorb sufficient stores for their own development....but are they really receiving optimal amounts of these nutrients?
For example, after WLS, many women have so much trouble absorbing enough calcium and vitamin D that osteoporosis and/or rickets is a real risk later on. It takes years for most people to get to this kind of deficit, but it's a process of malabsorption that takes place gradually over time. So even if pregnancy takes place within a couple of years after WLS, are babies in these pregnancies truly absorbing enough during a pregnancy for their bones to be fully mineralized properly? Will they pay a price later on in life? Frankly, I have yet to see anyone properly examine that question in research but it certainly is one of my concerns.
Yes, vitamin supplements help compensate for the gut's decreased ability to absorb these nutrients, but many women become nutritionally compromised, even while taking supplements. If they can't support their own bodies' needs over time, even while on supplements, are they really able to fully support a baby's needs? What kind of long-term effects will there be from compromised access to B12, iron, vitamin D, calcium, vitamin A, etc.? I just don't think we know this yet.....and no one seems to be asking the question at all.
I wonder if what we've got here is akin to babies born during times of famine. Yes, even on a famine diet of significantly reduced calories and nutrients, many babies are born "okay" and seem like they are fine. It's a tribute to the remarkable adaptability of the fetus in utero that babies survive even under the least desirable of conditions, like famine. And yet, research clearly shows that babies born during times of famine are affected by that lack of nutrients; more develop diabetes, hypertension, obesity, and a host of other issues.
Of course, pregnancy after WLS is not exactly the same as pregnancy during a true famine. Women after WLS get more calories and probably more variety of foods than women during a famine. On the other hand, women in famine still have their full digestive and absorption capabilities, so they can at least make better use of the calories and nutrients they are getting. So, obviously, pregnancy during famine and pregnancy after WLS are not exactly the same thing, and it's difficult to draw too many broad conclusions.
Yet it's also clear that pregnancy during famine is not entirely a benign thing, and animal models clearly show that deprivation during pregnancy can have long-term consequences for offspring. Doesn't pregnancy after WLS have the potential for similar consequences? Seems like a logical concern, yet the WLS industry is completely shrugging these potential concerns off.
As far as I know, there are NO long-term studies of the offspring of WLS pregnancies. They can hardly manage to document decent percentages of WLS pregnancies for study as it is now (see Sandy's piece); there doesn't seem to be anything in place for long-term foll0w-up of the children of these WLS pregnancies years later.
So the question remains.....are we creating more long-term problems than we are solving? Will we face an epidemic of other health problems in these children 30, 40, or 50 years down the road? Is ANYONE even trying to investigate this? And who is overseeing the surgeons with their hands in the monetary goody jars?
I have great empathy for people considering WLS. Although I sincerely believe they are making a choice that often worsens health over the long run, I understand some of the reasons why many of them consider it. Although it's a choice I'd never make, it's their body, their choice.
However, I do not believe that a "safer pregnancy" or a "healthier baby" should be one of those reasons. The research on this topic is far too spotty in quality, too subject to selective reporting, too lacking in long-term follow-up, and too prone to bias because it's done by those with a vested economic interest in promoting it.
Monday, December 15, 2008
Friday, December 5, 2008
Finding a Size-Friendly Pediatrician
One topic that keeps getting requested in the comments is parenting as a fat person. That was on my to-do list anyhow, but the requests just moved up some of my plans for what to post and when. Believe me, this stuff is significantly on MY mind too.
I thought I'd start with the importance of finding a size-friendly pediatrician/family doctor.
Once you have that baby, then what? The pressure for limiting weight gain doesn't stop with pregnancy; once the baby is born, many docs measure that baby within an inch of its life and soon start getting concerned if your baby is larger than average or is gaining "too quickly." Soon the lectures and "suggestions" begin.
Obviously, all doctors are not created equal. Some pediatricians are truly wonderful and very supportive, regardless of size. We're not condemning all doctors by any means. But with all the new pressure on doctors about the "childhood obesity epidemic," many doctors are really ramping up the harassment factor if they even think your child might be larger than average.
Oftentimes, it goes back to the old assumption that if you are fat, you obviously overeat and/or eat the "wrong" foods, and therefore no doubt will be teaching that poor lifestyle to your child as well. So there may be extra lectures about "healthy" eating and exercise, extra measuring of the child, and extra monitoring for problems.
Any sign of the child being above the 85th percentile may be seen as having a fat (or an imminently fat) child, with pressure to keep that weight down. Weight loss and "fat camp" suggestions for older kids may even follow from some docs.
But often, the first signs of pressure come early, during breastfeeding.
Overfeeding and Breastfeeding Worries
Sometimes the "weight" pressure starts almost immediately. Doctors may be concerned that a fat parent will "overfeed" the baby, so sometimes there may be pressure not to nurse "too much"---to limit the baby to a certain number of minutes per breast, to space out feedings so as not to feed "too often," and to strictly avoid "comfort nursing" when the baby is upset or just tired.
This concern is a reflection of some doctors' lack of knowledge about breastfeeding. Overfeeding is more of a concern with bottle-feeding; babies do tend to consume more when feeding from bottles and don't self-regulate as well. The mechanism of sucking from a bottle is completely different than that of suckling from the breast; babies can't really control very easily what they get from a bottle, but they can from the breast.
Breastfeeding babies can self-regulate. When they have enough, they'll stop nursing and go to sleep, or they continue to suckle a little but it's non-nutritive suckling. They're not really getting much breastmilk (or calories) at all at that point. But to an outsider who doesn't understand breastfeeding very well (as many pediatricians don't), this may look like "overfeeding," and they may pressure the mother to limit nursing.
To experienced parents, this sounds like nonsense---as it totally does to me now---but I remember worrying about this a little with my first. Newborns just seem to nurse and nurse and nurse without stopping sometimes....I remember feeling a little worred I might overfeed my baby and make her fat. I remember thinking maybe I should nurse a little less often, or to detach her and not let her fall asleep nursing.
Now, understand that I was a new mom, and there was no information about pregnancy and parenting for women of size then. My first pregnancy and birth had been very traumatic, and as a result, I was not at all confident in my parenting at that point. I really began doubting myself and my every decision.
And alas, cultural conditioning kicked in in a major way at that point. All my long involvement in fat acceptance organizations seemed to have been for naught, and most of my fat acceptance went out the window. I was consumed by fear that I might make my child fat. I knew she had the genetics for it and there was nothing I could do about that, but I was truly scared that I might somehow make it worse. So I began obsessing a bit about how much, how often, etc. I "should" nurse.
A combination of a very interventive birth, delayed/infrequent nursing at first, plus lots of bottles from the hospital led to breastfeeding problems. It took several months, but in the end, we were lucky.... breastfeeding worked out fine. And once she was finally nursing well, I was loathe to stop her. And I knew frequent nursing was important for building up my supply. So I started ignoring those cautions not to nurse "too long" or "too frequently." Once I did that, breastfeeding went much easier, her growth was fine, and I relaxed a little bit more about how often/how long/how much.
But in the beginning, the stuff I was reading made me worry about whether her long nursings were "overfeeding" her. So there were some times when I would stop nursing before she really wanted to stop, or make her wait just a little longer between feedings...simply because I was afraid of overfeeding her.
I wonder how many other fat mothers have done the same.
What Does a Good Pediatrician Look Like?
I was fortunate....I lucked into a great pediatrician. I was impressed by her calmness, her rational approach to things, her respectful approach in talking to me, and her willingness to take into account my own views and concerns. And so far, she has not pressured me about my children's weight at all.
My first child was a butterball in her first year. Cheeks from here to forever, lots of cute dimply folds, definitely not a tiny delicate child by any means. Yet the doctor never expressed any concerns. She could see that the baby was developing and moving well, walking at 9 months....so obviously butterball status was not keeping her from being active. She was extremely supportive of breastfeeding, didn't want me to rush solids, and never lectured me about food.
She did measure my kids and chart their growth carefully, but she never mentioned trying to get them down further on the growth charts. She was mostly looking at the overall trend of their growth curve, tracking it to see that it remained relatively steady.
Over the years she has been supportive of all of my kids, whatever their size and shape. She knows that kids go through some bulking up just before they do a growth spurt; she never said a word as my two elder kids went up a little on the growth charts just before they hit puberty. My third child is hitting the pre-puberty butterball stage now, so we'll see how supportive she stays at his next appointment....but so far she has always been supportive and positive.
She does ask questions about an active lifestyle (which I'm fine with, because I understand the importance of exercise, whatever your size) but she doesn't harp on it a lot...because she knows my kids get plenty of activity through soccer, swimming, yoga, etc. She knows we limit TV and computer time reasonably and that we make sure the kids get outdoor time.
So far, she's been a truly awesome pediatrician because she seems to get that kids come in all sizes and shapes and it's their habits that matter more than their percentile on a chart. She asks questions and offers opinions but gets that the parent makes the ultimate decisions about the child's care, and that includes the child's feeding and activities, etc.
We'll see how she is as my kids get older, and we'll see if she remains supportive if any of them develop into significantly large kids instead of borderline kids....but so far, I have to say I've been as lucky as can be.
Finding a Size-Friendly Pediatrician
But I hear stories online, and not all of them are so supportive. Some of them are downright scary. And so much begins with the kind of feedback the parent of size gets from the pediatrician or family doctor.
That's why it's so important to find a pediatrician that is truly size-friendly. You can start by asking open-ended questions about their philosophies. Don't ask them leading questions; ask open-ended questions and then let them talk. You'll get a better sense of their views and protocols if they don't know what answer you are looking for.
For example, you might point out to them that obviously they are dealing with a parent who is larger than average. Ask them what their concerns are about that for the child and how that might influence their care of your child. Then let them talk and see what they say. A pediatrician who seems worried or obsessed about weight size will betray that; one who is accepting and calm will get that across too.
If you feel you need to, follow up with specific what-ifs....what if my child measures above the 85th percentile in their grade school years? What if they measure above the 95th percentile? What are their recommendations for frequency of nursing, for starting solids, for juice and milk intake etc. if the child is larger than average? Do they ever recommend dieting? These are the sorts of questions that will help you discern their underlying attitudes about weight and size.
Conclusion
I think most doctors that work with young children have developed a modicum of sensitivity about weight issues. Most won't harass or harangue the child or parent who is larger than average. There may be some hints here and there, but most aren't over-the-top about their concerns and show some sensitivity in how they approach things. There are even some who are truly "on board" with HAES as a philsophy and support it enthusiastically in their practice.
On the other hand, there certainly are horror stories out there about pediatricians and family doctors, and you simply can't assume respectful treatment anymore. With the obesity hysteridemic (and its particular focus on children), more and more pressure will be placed on these doctors to weigh, measure, "educate," and admonish.
So ask questions, write letters, interview potential doctors.....and never EVER settle for less than fantastic, size-friendly care......for either yourself or your children.
What have YOUR experiences been with pediatricians? Have they been mostly positive or negative or a little of both? What hints do you have for other parents-to-be in dealing with this issue?
I thought I'd start with the importance of finding a size-friendly pediatrician/family doctor.
Once you have that baby, then what? The pressure for limiting weight gain doesn't stop with pregnancy; once the baby is born, many docs measure that baby within an inch of its life and soon start getting concerned if your baby is larger than average or is gaining "too quickly." Soon the lectures and "suggestions" begin.
Obviously, all doctors are not created equal. Some pediatricians are truly wonderful and very supportive, regardless of size. We're not condemning all doctors by any means. But with all the new pressure on doctors about the "childhood obesity epidemic," many doctors are really ramping up the harassment factor if they even think your child might be larger than average.
Oftentimes, it goes back to the old assumption that if you are fat, you obviously overeat and/or eat the "wrong" foods, and therefore no doubt will be teaching that poor lifestyle to your child as well. So there may be extra lectures about "healthy" eating and exercise, extra measuring of the child, and extra monitoring for problems.
Any sign of the child being above the 85th percentile may be seen as having a fat (or an imminently fat) child, with pressure to keep that weight down. Weight loss and "fat camp" suggestions for older kids may even follow from some docs.
But often, the first signs of pressure come early, during breastfeeding.
Overfeeding and Breastfeeding Worries
Sometimes the "weight" pressure starts almost immediately. Doctors may be concerned that a fat parent will "overfeed" the baby, so sometimes there may be pressure not to nurse "too much"---to limit the baby to a certain number of minutes per breast, to space out feedings so as not to feed "too often," and to strictly avoid "comfort nursing" when the baby is upset or just tired.
This concern is a reflection of some doctors' lack of knowledge about breastfeeding. Overfeeding is more of a concern with bottle-feeding; babies do tend to consume more when feeding from bottles and don't self-regulate as well. The mechanism of sucking from a bottle is completely different than that of suckling from the breast; babies can't really control very easily what they get from a bottle, but they can from the breast.
Breastfeeding babies can self-regulate. When they have enough, they'll stop nursing and go to sleep, or they continue to suckle a little but it's non-nutritive suckling. They're not really getting much breastmilk (or calories) at all at that point. But to an outsider who doesn't understand breastfeeding very well (as many pediatricians don't), this may look like "overfeeding," and they may pressure the mother to limit nursing.
To experienced parents, this sounds like nonsense---as it totally does to me now---but I remember worrying about this a little with my first. Newborns just seem to nurse and nurse and nurse without stopping sometimes....I remember feeling a little worred I might overfeed my baby and make her fat. I remember thinking maybe I should nurse a little less often, or to detach her and not let her fall asleep nursing.
Now, understand that I was a new mom, and there was no information about pregnancy and parenting for women of size then. My first pregnancy and birth had been very traumatic, and as a result, I was not at all confident in my parenting at that point. I really began doubting myself and my every decision.
And alas, cultural conditioning kicked in in a major way at that point. All my long involvement in fat acceptance organizations seemed to have been for naught, and most of my fat acceptance went out the window. I was consumed by fear that I might make my child fat. I knew she had the genetics for it and there was nothing I could do about that, but I was truly scared that I might somehow make it worse. So I began obsessing a bit about how much, how often, etc. I "should" nurse.
A combination of a very interventive birth, delayed/infrequent nursing at first, plus lots of bottles from the hospital led to breastfeeding problems. It took several months, but in the end, we were lucky.... breastfeeding worked out fine. And once she was finally nursing well, I was loathe to stop her. And I knew frequent nursing was important for building up my supply. So I started ignoring those cautions not to nurse "too long" or "too frequently." Once I did that, breastfeeding went much easier, her growth was fine, and I relaxed a little bit more about how often/how long/how much.
But in the beginning, the stuff I was reading made me worry about whether her long nursings were "overfeeding" her. So there were some times when I would stop nursing before she really wanted to stop, or make her wait just a little longer between feedings...simply because I was afraid of overfeeding her.
I wonder how many other fat mothers have done the same.
What Does a Good Pediatrician Look Like?
I was fortunate....I lucked into a great pediatrician. I was impressed by her calmness, her rational approach to things, her respectful approach in talking to me, and her willingness to take into account my own views and concerns. And so far, she has not pressured me about my children's weight at all.
My first child was a butterball in her first year. Cheeks from here to forever, lots of cute dimply folds, definitely not a tiny delicate child by any means. Yet the doctor never expressed any concerns. She could see that the baby was developing and moving well, walking at 9 months....so obviously butterball status was not keeping her from being active. She was extremely supportive of breastfeeding, didn't want me to rush solids, and never lectured me about food.
She did measure my kids and chart their growth carefully, but she never mentioned trying to get them down further on the growth charts. She was mostly looking at the overall trend of their growth curve, tracking it to see that it remained relatively steady.
Over the years she has been supportive of all of my kids, whatever their size and shape. She knows that kids go through some bulking up just before they do a growth spurt; she never said a word as my two elder kids went up a little on the growth charts just before they hit puberty. My third child is hitting the pre-puberty butterball stage now, so we'll see how supportive she stays at his next appointment....but so far she has always been supportive and positive.
She does ask questions about an active lifestyle (which I'm fine with, because I understand the importance of exercise, whatever your size) but she doesn't harp on it a lot...because she knows my kids get plenty of activity through soccer, swimming, yoga, etc. She knows we limit TV and computer time reasonably and that we make sure the kids get outdoor time.
So far, she's been a truly awesome pediatrician because she seems to get that kids come in all sizes and shapes and it's their habits that matter more than their percentile on a chart. She asks questions and offers opinions but gets that the parent makes the ultimate decisions about the child's care, and that includes the child's feeding and activities, etc.
We'll see how she is as my kids get older, and we'll see if she remains supportive if any of them develop into significantly large kids instead of borderline kids....but so far, I have to say I've been as lucky as can be.
Finding a Size-Friendly Pediatrician
But I hear stories online, and not all of them are so supportive. Some of them are downright scary. And so much begins with the kind of feedback the parent of size gets from the pediatrician or family doctor.
That's why it's so important to find a pediatrician that is truly size-friendly. You can start by asking open-ended questions about their philosophies. Don't ask them leading questions; ask open-ended questions and then let them talk. You'll get a better sense of their views and protocols if they don't know what answer you are looking for.
For example, you might point out to them that obviously they are dealing with a parent who is larger than average. Ask them what their concerns are about that for the child and how that might influence their care of your child. Then let them talk and see what they say. A pediatrician who seems worried or obsessed about weight size will betray that; one who is accepting and calm will get that across too.
If you feel you need to, follow up with specific what-ifs....what if my child measures above the 85th percentile in their grade school years? What if they measure above the 95th percentile? What are their recommendations for frequency of nursing, for starting solids, for juice and milk intake etc. if the child is larger than average? Do they ever recommend dieting? These are the sorts of questions that will help you discern their underlying attitudes about weight and size.
Conclusion
I think most doctors that work with young children have developed a modicum of sensitivity about weight issues. Most won't harass or harangue the child or parent who is larger than average. There may be some hints here and there, but most aren't over-the-top about their concerns and show some sensitivity in how they approach things. There are even some who are truly "on board" with HAES as a philsophy and support it enthusiastically in their practice.
On the other hand, there certainly are horror stories out there about pediatricians and family doctors, and you simply can't assume respectful treatment anymore. With the obesity hysteridemic (and its particular focus on children), more and more pressure will be placed on these doctors to weigh, measure, "educate," and admonish.
So ask questions, write letters, interview potential doctors.....and never EVER settle for less than fantastic, size-friendly care......for either yourself or your children.
What have YOUR experiences been with pediatricians? Have they been mostly positive or negative or a little of both? What hints do you have for other parents-to-be in dealing with this issue?
Thursday, November 27, 2008
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.
Monday, November 24, 2008
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?
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?
Thursday, November 20, 2008
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.
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.
Wednesday, November 19, 2008
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:
Tuesday, November 18, 2008
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:
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?
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?
Monday, November 10, 2008
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?
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?
Saturday, November 8, 2008
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.
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.
Sunday, November 2, 2008
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.
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.
Thursday, October 9, 2008
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:
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.
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.
- Exactly what means should be used to achieve that smaller weight gain (i.e. do they recommend hypocaloric diets to obese women in pregnancy)
- What will providers do to enforce a particular weight gain if a fat woman starts to gain more than allowed despite normal nutrition
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
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
Monday, October 6, 2008
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
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.
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
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.
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