When Pregnancy, Diabetes, and Stigma Intersect

“I remember just breaking down into tears,” says Safeera Hussainy about her diagnosis of gestational diabetes. This pharmacist and women’s health researcher from Melbourne eventually found empowerment. But new research suggests that this is not the usual case when pregnancy, diabetes, and stigma intersect. Weight stigma itself – even more than BMI – seems to predict the onset of gestational diabetes. This is a yet another example suggesting that the stigma linked to obesity can be worse for health than obesity alone.

First of Its Kind Research

Taniya S.Nagpal, Janet Tomiyama, and Angela Incollingo Rodriguez published this research in Primary Care Diabetes last Friday. This was a study of 358 postpartum women with an average BMI of 32.7. As the first study ever of weight stigma and gestational diabetes it may have important implications for pregnancy care. But of course, there’s much more to learn here.

The link between pre-pregnancy BMI and gestational diabetes has solid documentation. This study found evidence to support that link. However, Nagpal et al found that experiences of weight stigma had an even stronger relationship with the risk for gestational diabetes than BMI.

The study has its limitations because it uses a convenience sample, recruited online and it uses self-reported data. So it’s likely, for example, that BMI data suffers from biased reporting. This is why follow-up research will be so important.

The Lived Experience

The lived experience of weight stigma is unrelenting. Add pregnancy and gestational diabetes and the impact of stigma becomes worse. Qualitative research by Judith Parsons tells us that this is a distressing experience to say the least:

“While most women were grateful for the intensive support they received during pregnancy, the costs to their personal autonomy were high. Women described feeling valued solely as a means to produce a healthy infant, and felt chastised if they failed to adhere to the behaviours required to achieve this. This sometimes had an enduring impact to the potential detriment of women’s long-term psychological and physical health.”

We Can Do Better

We are failing in providing care for people living with obesity. Instead, the culture and healthcare providers merely offer blame, shame, and DIY strategies for dealing with it. Prior research has shown that weight stigma causes other harms to the mental and physical health of mothers – both during and after pregnancy.

The Royal College of Obstetricians and Gynecologists updated their guidelines in 2018 for the care of women with obesity in pregnancy. Notably – and shamefully – this guidance does not even acknowledge that weight stigma is a problem for women’s health. In fact, the guidance for pre-pregnancy care focuses almost entirely on measuring BMI “to encourage women to optimize their weight before pregnancy.”

But simply telling women that they’re fat and instructing them to lose weight is both inadequate and harmful. Good obesity care requires shared decision-making and possibly referral to providers who understand obesity and how to care for it.

This approach of the Royal College reflects the pervasive bias that obesity is a condition of choice and that DIY weight loss is the answer. From this false narrative, stigma flourishes.

The truth is that when obesity is a problem for health, it is a biological problem. Patients need sound care for this condition, just as they do for any other medical condition. If we respect these patients, health systems will provide this care. Only then will the harm of weight stigma begin to fade.

Click here for the Nagpal study and here for the study by Parsons et al.

Pregnant Woman, painting by Otto Dix / WikiArt

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July 22, 2021