Infertility is a heart breaking affair for anyone who wants to have a child. With the NHS now reporting that 1 in 7 couples have difficulty conceiving, infertility is more common that we realise. Thankfully most people in UK will be able to access fertility treatment via the NHS. However, some people are not deemed suitable for treatment, and one of the groups who may be denied access are those categorised as clinically obese.
Women with a BMI over 30 are routinely refused fertility treatment. Doctors advise them to lose weight before they can be referred to a specialist. There are a number of issues with this policy and some are tied in with the way society as a whole views fat people.
Let’s begin with the index used to measure if a person is obese. Body Mass Index (BMI) has been widely discredited. The index has a number of problems, including the fact that BMI does not differentiate between muscle & fat. Hence, people who are fit & have healthy body fat can be classified as obese. Another issue is that BMI does not recognise differences in body shape. It is well established that those who carry their weight around the middle (sometimes known as apple shaped) are at much higher risk of health complications than those who carry excess fat around their hips (pear shaped) 1. Thus women with very different shapes & risk factors can be labelled with the same BMI.
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Perhaps the biggest failing is that BMI does not always change with lifestyle alterations. A person may make significant changes to their health without necessarily losing large amounts of weight. Partaking in regular exercise and switching to a ‘healthy’ (but not calorie focused) diet will have a huge impact of a person’s well being. Sadly, BMI would not recognise these changes unless there is also weight loss. This can put women in the position of focusing on how much they weigh rather than how ‘healthy’ their lifestyle is.
Of course, there are also questions to be asked outside the clinical failings of BMI. It is important to note that there is no official policy on women who are underweight. Despite the fact that being of a lower weight can have a bigger impact on a woman’s fertility than being of a higher weight.
The medical community appear to jump to the conclusion that fat is always bad. A notion that is reflected in society as a whole and that causes plus size women to face wide spread discrimination. It is estimated that half of pregnancies in the UK have obese (in terms of BMI) mothers. Yet studies show that only 5% of admissions to neonatal units and 4% of preterm births could be avoided if all pregnant women had a ‘normal’ BMI at the start of pregnancy 2. The implications are clear: overweight women are regularly having healthy pregnancies & deliveries. Still the overwhelming message from the medical community is that obese women automatically have high risk pregnancies.
The most worrying part of this protocol is that women are often not even referred to a fertility specialist until they capitulate on the weight loss issue. This means that women who have specific medical problems interfering with conception are forced to delay interventions that could solve these problems. The bottom line is that women who are classified as obese get a raw deal. Underlying prejudices seem to be making an already distressing issue much harder for plus size women. Infertility can make women feel powerless and incompetent. When you are fat, those feelings are increased by the prevailing impression that your weight is to blame.