Why Aren't Docs Giving Obese Pregnant Women Accurate Advice?
Talks aren't tailored to their needs
It's no secret that women gain weight during their pregnancies—some obviously more than others, but still usually under the careful counsel of their physicians. However, according to a recent study by the Penn State College of Medicine, when the mother-to-be was already overweight or obese prior to being blessed with a bundle of joy, many doctors fail to provide the right advice for their specific needs—or any advice regarding their weight at all.
After interviewing two dozen overweight and obese new moms after the births of their first children, researchers found that the majority—87.5 percent—gained an amount of weight during their pregnancies that exceeded recommendations. In fact, half were incorrectly told to gain an amount that was more than they should have, with health care providers likely using guidelines for normal-weight women and not adjusting their advice accordingly. (According to Penn State medical experts, normal-weight women are advised to gain 25 to 35 pounds during a pregnancy, overweight women should gain 15 to 25 pounds, while obese women should gain less than 20 pounds.)
Golda Poretsky, holistic health counselor and founder of Body Love Wellness, believes the doctors' poor guidance is due to their own biases.
"Larger women often have a very difficult time dealing with health professionals," said Poretsky. "They often have issues that go untreated because doctors see them and prescribe weight loss before even looking for other causes. I've worked with women who were told to lose weight while pregnant even though restricting food is dangerous for them. And a recent study showed that health professionals have a strong bias against larger people, stereotyping them as lazy and noncompliant, so it's not surprising that they're getting bad advice."
Additionally, nutritionist and holistic health expert Julie E. says physicians often fail to relate to their patients—ironically, even when they themselves are out of shape, too. ("How many fit doctors do you know?," she asked.)
"The main reason doctors do not counsel these women correctly is that many of them are men and really cannot truly relate to being female and all that comes along with that, like emotional eating, body image, etc.," said Julie. "And medical doctors simply are not trained in nutrition or fitness. They aren't really qualified to have that conversation."
Indeed, according to Penn State College of Medicine's findings, the aforementioned "conversation" wasn't had at all with some of the women it surveyed, with nine not receiving any special weight-gain instruction from their health care providers. None of the surveyed women were told how long to exercise, or that the intensity of such exercise should be moderate to vigorous for them.
"The obstetrical, or medical, model of care specializes in surgery and the pathology of birth," said Larson. "And so the educational curriculum for obstetricians often fails to thoroughly cover the topics of exercise and nutrition, and of the importance of understanding the woman as a whole person. The average Ob/Gyn prenatal appointment is approximately 15 minutes; that's insufficient time for the doctor to get to know the pregnant woman and address her questions and concerns."
Lamaze-certified childbirth educator and prenatal yoga instructor Deena Blumenfeld, owner of Shining Light Prenatal Education, agrees, but also says most doctors are just being friendly, even if to a fault.
"Prenatal visits are in the range of 5 to 10 minutes and many pregnant women will see a nurse for a portion of that time and then her OB only very briefly," said Blumenfeld. "Time constraints restrict the OB's ability to discuss weight gain and exercise with the mother. Another reason is the doctor is being polite. No one likes to hear they are fat, or have gained too much weight. It may simply be a way of keeping the mother happy, by not mentioning her weight at all."
But Dr. Jeanne Conry, incoming president of the American Congress of Obstetricians and Gynecologists, begs to differ.
"We're worrying about preterm labor, obesity and hypertension," Conry told SFGate.com in response to a different study that criticized how well obstetricians and gynecologists inform their patients of potential dangers to their fetuses. "Obesity trumps almost everything. We put our time and energy there and don't dwell on some of the other things we should be aware of."
Regardless of what is really happening behind the doors of doctors' offices, Penn State College of Medicine reports that all pregnant women need to stay or become active for the healthiest pregnancies, with federal physical activity guidelines recommending 150 minutes per week of moderate-intensity exercise in healthy pregnant women, even previously inactive ones.