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Fat Obstetrics

On June 10, 2010, the Unnecesarean blog, had  a critique of an article about fat women in birth. The post, written by ANaturalAdvocate, is called “Do Overweight Women Need Separate High-Risk Hospitals?” and refers to the New York Times article, “Growing Obesity Increases Perils of Childbearing.” 

The blog article, henceforth called the “critique,” picks out bits and pieces of the (NYT) article, moulding it in a way that highlights (in her eyes) the horrors of fat phobia in the birth world. 

The gist of the article is that women are getting fatter and fatter and, because of that, labor & deliver floors are having to change how things work. Bigger gowns, sturdier and physically bigger L&D beds and operating room tables are becoming necessary, different/longer GYN equipment is being bought… all to accommodate the obese obstetric patient. 

(A note about terms: I am a fat woman who uses the term “fat” to describe myself and use it as an adjective and noun (depending on context), not as a pejorative. I will alternately use the terms “obese,” “large,” “bigger,” “large-sized,” “super-sized [over 300 pounds {or so} or over a 50 BMI],” and possibly others. However, I am offended by the term “morbidly obese” so will refrain from using it. I apologize if any of these words offends you, but these are the descriptions/adjectives I am comfortable with and choose to use.)  

Interestingly, it seems each blogger translates the article very differently. ANaturalAdvocate spends an inordinate amount of time discussing the Body Mass Index (BMI) and its shortcomings. The Well-Rounded Mama says, in her post, “Exaggerating the Risks Again,” that the article is, “hyperventilating about the risks of ‘obesity’ in pregnancy. And it includes the typical distortions, exaggerations, and apocryphal personal stories as part of the usual tactics to scare fat women into either drastic measures to lose weight before pregnancy, into draconian interventions during pregnancy, or to scare them out of even contemplating pregnancy at all.” I, on the other hand, read that fat is taking on a life of its own in the obstetric world… and we can no longer ignore it. Even if it is a smaller portion than WRM believes, it is a growing (bigger each day) population that must be acknowledged and addressed. 

You would have to have your head in the sand not to notice how fat Americans (and those who eat the S[tandard]A[merican]D[iet] diet) are becoming. Look around! I’m seeing toddlers weighing almost 100 pounds, grade school kids with diabetes and teens with blood pressure issues. I was the fat girl in junior and high school… at 130 pounds! Now, the fat girl weighs a whole, whole lot more. “Childhood obesity has more than tripled in the past 30 years. The prevalence of obesity among children aged 6 to 11 years increased from 6.5% in 1980 to 19.6% in 2008. The prevalence of obesity among adolescents aged 12 to 19 years increased from 5.0% to 18.1%.” What are we turning into? 

All of us could go on and on about the causes of obesity and the precipitous climb in the complications associated with it, but, one thing all of us are aware of: there is no one cause –and no one answer to fixing the problem. 

WRM says, “Some folks really are fat because they eat poorly and don't get enough exercise, and some folks really are fat because they have an eating disorder.  But research clearly shows that fatness also has a very strong genetic component.  Some people have underlying hormonal or metabolic disturbances (like PCOS) that create a propensity to being fat and great difficulty in losing weight.  Environmental factors (easy access to highly processed foods, less opportunities for exercise) plays a role for some people, yet many thinner people eat highly processed foods and get little exercise but are not fat.” 

I squint trying to see what her point is. To me, all of those statements roll into one reality: People are fat. Whether the food causes the hormonal imbalance that causes the PCOS that causes the weight gain that causes the fat… or whether the heredity makes the woman have a propensity to getting diabetes and she’s one of the (financially) poor minorities and eats the cheapest food our country offers; fast and fattening –and she gains a few extra pounds that her pancreas cannot handle and she lives for 15 years with Insulin Resistance before she gets pregnant and, even though she passes her GTT, has a serious case of over-stressed pancreas and, undetected, steps into the realm of diabetic complications. 

WHO CARES WHERE IT COMES FROM?!? We know how to fix it. Say it with me.

That’s right. Diet & Exercise.

If I know this… if I write this… why am I still fat? Because the answer to “Diet & Exercise” comes with a thousand parenthetical asides. 

-(But, the ghrelin makes people hungry, especially if they’ve lost weight before.)

-(The Dopamine receptors don’t work properly and are fed by food, making it a delightful feeling to eat again and again.)

-(Because we live in a world with remote control televisions instead of migrating twice a year as our bodies are meant to do.)

-(Because the poorest of the poor are relegated to eating the shittiest of the food choices.)

-(It’s not safe to walk where I live and I don’t have money for gas to go somewhere else or money for a gym membership.)

-(People at the office bring fattening foods and I can’t help myself.)

-(Food is delicious; healthy food tastes like crap.)

-(My grandmother lived through the depression and forced me to finish what was on my plate and I hear her yelling at me with every meal.)

-(Eating makes me high.)

-(I’ve tried to lose weight a thousand times and it never lasts.)

-(My thyroid is out of whack.)

-(I have PCOS and it makes it too hard to lose weight.)

-(I hate to exercise)

-(My whole family is Hispanic/African-American/Asian/Native American and it’s normal for my family to get diabetes.)

-(and on and on and on and on and on) 

Eating today has become biochemical warfare. 

Sometimes I feel like I fit into every one of those categories above, including the so on, so on, so on one. 

If I can’t even get my own food issues under control, how can I sit here writing about pregnant women getting theirs in order? 

Because I believe we all have to work together to support each other in this. I believe the only way for fat pregnant women to get the midwifery, holistic care we natural, birthy people think they deserve is to offer it ourselves

Before sharing my ideas about what to do, I want to talk a little more about why we must create our own solutions. 

Do you know what the body looks like inside when the person is fat? Do you know there are great globs of yellow fat… just like fat on a steak, but softer and yellower… coating the organs, the intestines, the uterus and clinging to the underside of the bottom layer of skin? Do you know that vaginas in very fat women are full, as if they are swollen, more challenging to find a cervix because fat in the tissues “drops” the flesh downward, hiding it? Did you know that the fat inside the body is called “Visceral Fat” and that it is not an inert mass like the fat you can grab/pinch on the body (subcutaneous fat), but an alive collection of matter that secretes many hormones, including leptin and resistin

"Visceral Fat  

Visceral body fat is one of the two types of body fat. Visceral fat sits underneath the muscles and borders vital organs. This tucked-away location makes it possible to be fairly slender and still carry an excess amount of fat. Visceral fat is metabolized by the liver and transforms into blood cholesterol, making it the most potentially harmful to your health. Your diet and degree of exercise affect your amount of visceral fat.

Subcutaneous Fat 

Subcutaneous fat lies beneath the outermost layer of skin (epidermis) and serves as a shield. It is located nearly everywhere on the body but may be thickest in the abdomen, thighs and underarms. A certain amount of subcutaneous fat is vital to survival. For example, it keeps you warm when it's cold outside. An excess of subcutaneous fat is a sign of being overweight.”

Visceral fat and its hormones don’t just sit there. It secretes chemicals into the system, chemicals linked to changes in the endocrine system, including causing PolyCystic Ovary Syndrome (PCOS), diabetes, heart disease and some forms of cancer. “Meanwhile, when fat reaches the digestive system it breaks down in the liver. As it does this, toxins are released into the bloodstream. These can seriously damage organs such as the liver, causing fatty liver disease. This can lead to inflammation, the formation of scar tissue and eventually cirrhosis. It is also a risk factor for cardiovascular disease.”

Did you tune out? Isn’t this part so flipping boring? Like some text book or a newspaper article that we’ve read a million times and just skim over saying, “blah blah blah.” All that crap we couldn’t care less about?

Instead, let’s look at what visceral fat looks like inside the body.

This is an MRI scan of an “averaged-sized man who is 6-foot-2, weighs 174 pounds and…” has a BMI of 21.7. The visceral fat is in yellow. Subcutaneous fat is green and the muscles are red.

This is a better example, also an MRI. Muscles are in red, bones are white, organs are black and fat is yellow.

This is a woman who weighs 119 pounds.

Here is a woman weighing 245 pounds.

You can easily see both the subcutaneous and visceral fat. Note the visceral fat surrounding the body's organs. The visceral fat is not just sitting there, but is actively infiltrating the organs with a mad variety of hormones and chemicals.

I don't know how anyone can sit there and tell me a fat person is healthy. The fat person might not have labs that are abnormal at the moment, but, moment by moment, those organs are being transformed into liver disease, cancers, diabetes, thyroid problems, heart disease and more.

Because I get an enormous amount of flack every time I say the vagina is fat, please take a gander at the fat around this one woman's (non-pregnant) uterus. Fat has weight and the weight presses down, pushing the tissues inward; vagina included.

Before you say, "But this is just one example," let me share with you another three photos of MRIs, the first is a normal amount of visceral fat, the second, a moderate amount and the third, a large amount of fat.



In this last MRI, the blue is the liver, red, kidneys, green, the spleen and pancreas. The white is the visceral fat.


I show and say all of this because I am so, so frustrated by everyone screaming, “FAT PHOBIC” whenever someone brings up the issues caused by fat. Of course I acknowledge fat phobia in our culture. I experience it almost every day, but that doesn’t mean we should ignore what is happening in our own, pretty isolated, natural birth community. Instead of pointing fingers outside, blaming the press, the rising cesarean rate, the insurance industry, the people who make bigger beds, the bariatric surgery people, the diet pill companies, why don’t we just hunker down and DO something for and with each other? Can’t we just admit there is a problem and we do have to figure out how to take care of our own? Simply having “fat positive” websites isn’t enough. It’s fine and dandy to feel great about yourself at any size, but really, does that eliminate the truth about what our fat is doing to our bodies? 

I propose that we develop groups for each other, places where we can talk, cook with each other, learning new ways to eat fresher and cleaner, places where we can walk with each other, encouraging each other during our pre-pregnancy, pregnancy and post-pregnancy times. I want a place that doesn’t make fat a bad word, that is filled with women who accept the reality of being unhealthy/fat/obese/super-sized and who want to do something about it. The groups of women can have diabetics, gestational diabetics, women with no medical problems at all, women who feel they can do more for their babies during the pregnancy… a place where there is zero judgment about fat and health, but a common commitment to working with each other – the only goal, to feel better, to get visceral fat out of our bodies (without dieting!) and be ready to parent our babies as gloriously healthy as possible. I haven’t come up with a name yet… I don’t want it to be “health,” “thin,” lose weight,”… words like that; I’m still experimenting. 

I’ll start. I’ll gather together women, even if it is one or two, and start some sort of group where we commit to being stronger and more alive by using food as energy and increasing even that with movement (exercise). 

I’ll start. I’ll start with myself.