Obesity Stigma as a Determinant of Poor Birth Outcomes in Women with High BMI: A Conceptual Framework

Abstract

Obesity stigma has been linked to poor health outcomes on an individual and population basis. However, little research has been conducted on the role of chronic or recent obesity stigma in the health disparities experienced by pregnant women with high body mass index. The purpose of this article is to discuss poor birth outcomes in this population from an integrated perinatal health framework perspective, incorporating obesity stigma as a social determinant. In studies of non-pregnant populations, obesity stigma has been associated with stress, unhealthy coping strategies, psychological disorders, and exacerbations of physical illness. This article examines the mechanisms by which obesity stigma influences health outcomes and suggests how they might apply to selected complications of pregnancy, including macrosomia, preterm birth and cesarean delivery. Given the rates of obesity and associated pregnancy complications in the United States, it is critical to examine the determinants of those problems from a life course and multiple determinants perspective. This paper offers a conceptual framework to guide exploratory research in this area, incorporating the construct of obesity stigma.

“I'm Just a Woman Having a Baby”: Negotiating and Resisting the Problematization of Pregnancy Fatness

“…However, this framing is not universally accepted as commonsense. Critical scholars writing from diverse epistemological positions have questioned both the "problem" of pregnancy fatness and the proposed solutions (Furber and McGowan, 2011;Lindhardt et al, 2013;Mulherin et al, 2013;DeJoy and Bittner, 2015). For scholars writing from a poststructural epistemological frame, contemporary knowledge about pregnancy fatness does not represent an objective truth or reality but rather historically and socially specific "truths, " constituted from multiple dominant gendered, biomedical, and neoliberal discourses about health, fatness, reproduction and mothering (Jette, 2006;Tolwinski, 2010;McNaughton, 2011;Warin et al, 2011Warin et al, , 2012Jette and Rail, 2013;Parker, 2014;Parker and Pausé, 2018).…”

A Qualitative Study of the Maternity Care Experiences of Women with Obesity: “More than Just a Number on the Scale”

“…Given emerging research on the psychological and physiologic effects of weight bias, obesity stigma may be a determinant of poor birth outcomes in women with BMI greater than 30 as both a distal and proximal risk factor for stress, discrimination, unhealthy coping mechanisms, and differential care . Therefore, to optimize care and outcomes for women who are obese, providers and researchers must understand the experiences that these women have with the health care system and how those experiences may affect them.…”

Thinking About People-First Language: Weight Bias, Stigma, and Discrimination, and Women's Reproductive Health

“…4−6 However, we as clinicians are less aware of the concept that obesity stigma may be an independent determinant of poor birth outcome. 7 As women's health providers, we need to be cognizant that our patients may have negative experiences related to our provision of care, from the sizes of the chairs in waiting areas to improperly sized medical equipment, difficulty with pregnancy and gynaecologic ultrasound image quality, and challenging pelvic examinations and Pap tests. Not surprisingly, labour and birth experiences, as well as gynaecologic procedures, provide challenges and sometimes frustrations to the care team because of the complexity around patient safety, positioning, fetal monitoring, and anaesthesia; in turn, those challenges and frustrations may be negatively perceived by our patients.…”