"I avoided going to all doctors for two years because I was so embarrassed about being overweight when I had to get undressed. I even skipped mammograms." —S.P.
But did you know it's getting worse? In 2021, the National Center for Health Statistics reported that more than 70 percent of adolescents said they had been bullied about their weight in the past year, and a 2019 survey found that 56 percent of adults also reported that they had been body-bullied, usually by friends or family.1
And "weight shaming" extends to those who are underweight as well as those who are overweight.
"I'd never tell someone they are too heavy. So why do people think it's OK to tell me that I'm too skinny or that they hate me because I can eat desserts?" —M.H.
Unfortunately, we often internalize the comments others make to us about our bodies and start to say the same things to ourselves. We tell ourselves that we're unhealthy and that it's our fault for being heavy or thin, but the truth about body weight is often very different.
Weighing In on Fertility:
These body size fictions do not only affect self-esteem, mood, body image, and quality of life. I know from my patients that body size can also impact fertility journeys—and not just medically.
"Every time I tried to discuss our problem conceiving, my family doctor would tell me to lose weight and then come back. Finally, I went to a fertility specialist, and she tested my husband, and the problem was his." —K.K.
"My infertility was called 'unexplained' for over a year until my therapist helped me gain weight without feeling out of control. I only gained 8 pounds, but I finally became pregnant when I did." —P. Z.
There are, of course, very real physiological fertility factors that can be associated with body size.
But these are general statistics about weight and may not be the answer to a particular individual's fertility problem. To determine the degree to which a low or high body weight may be causing or contributing to someone's fertility problem, medical exams and appropriate tests are needed.
Unfortunately, says Victoria Ozadovsky, a postpartum certified doula and a patient care advocate at Progyny, because the impact of weight on fertility can be overestimated, some patients with larger bodies find that access to those exams and tests are not available to them, and they are not getting the comprehensive care they need.
While the effects on fertility of being overweight can be overestimated, the effects of being underweight can be underestimated. When that happens, low body weight patients may not get the guidance they need to increase their weight as part of fertility treatment.
Ozadovsky encourages patients to advocate for themselves if they encounter weight discrimination or medically unsound barriers to their health care. Second opinions can be a first-rate idea.
What to Do When the Target Is You:
Janet Choi, chief medical officer of Progyny, reminds patients: "Weight and, more importantly, how it fits into your overall health—whether to promote fertility, health, pregnancy, longevity—should never be other people's business but your own (and your doctor's)."
Finally, remind yourself, as we all know but often forget, that human bodies come in all shapes and sizes. And beyond our bodies, there is also our mind and our heart. If you need help with your body, mind, or heart, reach out for medical support for your body, mental health support for your mind, and group support for your heart. Groups will not only reassure you that your experience with weight stigma is common, but it will also give you an opportunity to talk with those who really understand, gather tips and suggestions, hear yourself out loud, increase your sense of belonging, and, best of all, help others.
References
1) Body Dissatisfaction, Importance of Appearance, and Body Appreciation n Men and Women Over the Lifespan, National Institutes of Health. Published online 2019 Dec 17. Doi: 10.3389/fpsyt.2019.00864 Hannah L. Quetta, 1 , * Andrea S. Hartmann, 1 Rainer Düsing, 2 Ulrike Buhlmann, 3 and Silja Vocks 1
2) Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis.AU, Kramer CK, Zinman B, et.al.,Ann Intern Med. 2013 Dec;159(11):758-69. PubMed
3) Body-mass index and cause-specific mortality in 900 000 adults: analyses of 57 prospective studies , Whitlock, G., Lewington, S., Sherliker, P., Clarke, et.al.,. (2009).. The Lancet, 373(9669), 1083–1096.
4) Medicare's search for effective obesity treatments: diets are not the answer , Mann, T., Tomiyama, A. J., Westling, E., Lew, A.-M., Samuels, B., & Chatman, J. (2007. European Heart Journal, 31(6), 737–746.
5) Genetic architecture of human thinness compared to severe obesity, Fernando Riveros-McKay ,Vanisha Mistry ,Rebecca Bounds,et.al., Jan 24, 2019, https://doi.org/10.1371/journal.pgen.1007603
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