Three steps for fat folks to get pregnant
If you’re fat and want to get pregnant, you will, inevitably, be told to lose weight. Everyone will feel like they have a right to comment on your body. Whether it’s your health care provider, your partner, your friends, your family, your co-workers, or strangers overhearing your conversations - someone will always “helpfully” suggest that losing weight is the answer to any fertility problems. Many will even claim that you *have to* lose weight before you even start trying to grow your family.
As a culture, we’ve been taught to believe that fat people can’t, or worse — shouldn’t — get pregnant.
This message has spread for a number of reasons. It hasn’t been helped by a plethora of research that shows that people in bigger bodies take longer to get pregnant and are likely to face higher risks of complications. However, most of these studies all have the same flaw: they’ve been conducted with an underlying assumption that being fat is bad. When you correct the weight stigma (stigma that fat folks face due to their size) at the heart of much of this research, you start to see that it’s not fatness that’s responsible for many of the problems higher weight people face.
When those fatphobic beliefs are internalised, meaning that fat people also believe them to be true, they may avoid seeking help with their fertility, especially when it proves to be difficult. For all the research out there on weight and fertility, there is no research specifically investigating the access that fat people have to fertility support. However, a study looking at how body weight impacted routine gynaecological and breast checks found that an increase in BMI led to a decrease in accessing preventative healthcare. It’s perhaps not surprising that, in general, going to the doctor is a fraught and often stigmatising experience for many fat people. Doctors are quick to prescribe weight loss for everything from mental health problems to dental work. Fat people seeking to get pregnant have reason to fear being stigmatised because of their body size. They might even blame themselves for any fertility issues they encounter and feel too ashamed to go to the doctor for help.
I have spoken with hundreds of fat people who express the belief that it’s their fault that they can’t get pregnant or access support to get pregnant. They believe that if they could just lose weight, it would solve all their fertility problems, and they could grow their family with ease.
In a way, sadly, they are right. Straight sized or thin people have an easier time accessing fertility tests and treatments to support them in getting pregnant. Fat people find themselves shamed into losing weight because many specialists will not help someone with a BMI (an outdated and misleading measurement) that categorises them as “overweight” or “obese”.
Even if they share that they are in eating disorder recovery or explain that their weight is related to a condition like PCOS, they often aren’t believed. Let me be clear: pushing weight loss as a solution to someone who has just told you they are in recovery from an eating disorder is irresponsible and downright dangerous. These experiences make them feel like failures and discourage them from going back for help.
The truth is that fertility issues cannot be solved by prescribing weight loss. Countless studies show any form of intentional weight loss is usually short-lived. No weight loss studies show long-term results beyond 2-5 years because, after that, the majority of participants regain the weight they lost and often more. (I recommend reading Just Eat It by Laura Thomas, PhD, RNutr and Anti-Diet by Christy Harrison, MPH, RD for more information on this topic.) In other words, whether done for fertility reasons or not, long-term, sustained, “healthy” weight loss is not in our control and, therefore, is not a reasonable solution to a problem.
Often people are told that losing 5-10% of their body weight will have a positive impact on their fertility. Again, there are no studies — let me repeat that: NO STUDIES — that show a causative relationship between a loss in weight and an increase in fertility.
For every additional year that fat people are denied appropriate tests and treatment, the probability of a successful outcome — that is, the probability that they’ll get pregnant — decreases by 3.5%. The delays that medical providers cause with their beliefs about fat bodies directly impact people’s fertility outcomes.
So if you are a fat person who wants to get pregnant, what can you do?
The same advice that every other person trying to get pregnant applies to fat people, too. Supporting yourself and looking after your health — regardless of your weight — will go a long way in maintaining a healthy pregnancy.
Remember: people of all body shapes and sizes and levels of “health” encounter fertility issues and also have healthy, happy pregnancies. Whether you struggle to get pregnant or get pregnant right away, your body size is not to blame.
Skip the scales and instead focus on low-impact, daily health habits that make you feel good in your body. Research shows that it’s these health-promoting behaviors (which differ from person to person!) that have the most impact on our overall health, rather than any weight that your body might lose. You might find you lose weight, you might not, but the point is that the behaviors matter more than the weight itself.
These habits can include:
Get enough sleep and rest. In our hustle culture, we are made to feel like we need to be constantly doing something, whether that’s working, socialising or starting up our own side hustle! Rest is a valid use for our time. Take downtime away from your phone and make sure you are getting the sleep you need (whether that’s 7 hours or 10!).
Eat foods that make you feel good and give you plenty of energy. Intuitive eating is my absolute favorite way to re-create a great relationship with food.
Stay hydrated.
Move your body in a way that feels good. Doing some form of movement that gets your heart rate up has been shown to reduce risk markers of a number of chronic illnesses.
2. Support your mental health. We know that living in a fat body and experiencing weight stigma from all areas of life can have a negative impact on mental health, so it’s important to take care of your mental health. Trust that your body knows what it’s doing and is capable of getting pregnant.
3. Advocate for appropriate and respectful healthcare. If you do need to access additional support to get pregnant, and you are able, find a health care practitioner who doesn’t have BMI restrictions about who they will help. Ask your local fat friends for recommendations or ask in fat facebook groups.
If you can’t change doctors, advocate for your right to access the services you need. You might need to be difficult or pushy and ask hard questions. If your doctor continues to push weight loss on you as a solution, you are well within your right to ask your doctor for the specific evidence that shows a connection between weight loss and increased fertility (it doesn’t exist). Then ask what they would recommend to someone in a smaller body and keep asking until you get the help that you need.
When it comes to getting pregnant, your weight is not the problem. No matter the size of your body, you are worthy of becoming a parent and of getting all the help you need to get there.
Nicola Salmon (she/her) is a fat-positive fertility coach and author of “Fat and Fertile”.
She helps fat folks navigate getting pregnant in a weight-obsessed world and advocates for change in how fat people are treated whilst accessing help with their fertility.
Nicola uses her unique FAT+ve framework to support people in finding their own version of health without diets, advocate for their bodies, relearn how to trust their body and believe in their ability to get pregnant. Find out more about Nicola and her work by following her on instagram and visiting her website nicolasalmon.co.uk