Above is a CPAP sales and info booth in a major Midwest mall. CPAP machines treat sleep apnea, a brutal disorder on the rise thanks, in part, to American obesity. We are now so fat that dropping by the midway's CPAP booth is as mundane as hitting the Sunglass Hut and Orange Julius. We're fat. Not news. But all that blubber is a lifestyle choice. The consequence of living well. No regrets. So you may get sleep apnea; other than killing yourself early (which some argue is economically beneficial) or making flights to Houston even more uncomfortable, where's the harm? Well, for starters, a mountain of recent data shows being obese during pregnancy is as dangerous as being a pregnant alcoholic. And a one-two punch of IVF and the "fetal personhood" movement could easily make criminals of the pregnant fat.
The American College of Obstetricians and Gynecologists' position on obesity during pregnancy is that: "Obese women should be informed of the risks associated with maternal obesity, be screened for gestational diabetes, and be assessed for the need for supplements of vitamins and minerals, including folate. Obese women should be advised to gain less weight than other women." No more than 20 pounds-compared to 25 to 35 for women who were normal weight before pregnancy.
The consensus of the obstetricians I spoke with on the subject is that far too many pregnant women are dangerously overweight and that too many gain too much. One estimated that her average patient is now well over 200 pounds on delivery day (well beyond a Body Mass Index (BMI) of 25). She delivers babies for 300-pounders with regularity.
Traditionally, obstetrics was primarily concerned with underweight women not gaining enough weight during pregnancy. But the rising prevalence of obesity means the opposite is now the issue. Obesity creates a murderers' row of obstetrical miseries. For starters, obese patients take much more time to see. They have a frequent inability to follow diets and self care regimens. Many nod along with doctors' directions while in clinic, and do not follow them. Deliveries are messy and dangerous. There's the anecdote of a baby who almost drowned in the wall of fat of a severely overweight c-section patient.
Adipose tissue suffocation is just one-albeit rare-risk of maternal obesity. The most common is preeclampsia, a beastly hypertensive disorder. Studies of women who were obese before pregnancy, or gained too much weight during pregnancy, reveal a whole grab-bag of fetal development horrors.
A study by U.S. National Women's Health Information Center found that "babies too heavy at birth can suffer stuck shoulders and broken collar bones, and are prone to overweight or obesity and type 2 diabetes later in life. And a big baby poses risks for the mother, including vaginal tearing, bleeding and often the need for a C-section."
Obstetricians hate c-sectioning the obese because the procedure is more dangerous. Paradoxically, being obese drastically increases the chance of c-section. Obstetricians tell tales of cutting slabs off pregnant women. And almost all the obstetricians I spoke with have intentionally broken the collar bone of a gestational-diabetes-inflated baby with a risk of suffocating in the birth canal. Too many also have anecdotes about the obese pregnant involving, as they call it, "fetal demise" which in layman's terms is "dead baby."
Then there are the neural disorders. A recent Journal of the American Medical Association report noted that obese women are almost twice as likely to have a baby with neural tube defects: "...[T]he risk of spina bifida was more than twice as high for obese mothers-to-be, and the overall risk of neural tube defects was 87 per cent higher for obese mothers compared with women with normal weight."
Creighton University School of Medicine found that: "Babies born to obese women were at greater risk of death in their first year, and were also more likely to die in their first 28 days of life than infants born to normal-weight women." The latter researchers noted that their data set was old and "the prevalence of obesity and the average amount of weight women gain during pregnancy has increased."
An Edinburgh University analysis of 90,000 births between 1980 and 2005 found a spike in incidence of premature births tied to obesity. Other studies on obesity show it leads to substantive increases in cleft lip and cleft palate, hydrocephaly (the abnormal buildup of fluid in the brain), and limb abnormalities and just an incredible amount of other overwhelmingly depressing stuff.
It turns out that the question is wrong; it shouldn't be "What can't I eat when I'm pregnant?" but "What can't I eat before I get pregnant?"
But wait. Science! It turns out that human biology also makes it increasingly difficult to get pregnant the fatter a person gets. Nature recognizes the danger of a 400-pound woman carrying a child and quite often attempts to shut down the biological system that makes such a thing possible. (And it's noteworthy that biology works the same magic in men.)
But wait... Science! The recent parallel explosions of in vitro fertilization (IVF) and obesity aren't merely coincidental.
According to the Brandeis Fertility Center in New York, "over the past several years, IVF has been offered increasingly to patients with polycystic ovarian syndrome PCOS." PCOS is a tricky hormonal imbalance that is not always or solely a consequence of obesity; many believe it is on the rise as a result of a spike in obesity-related insulin resistance. So, as Dr. Vincent T. Brandeis, put it, "the advantage of IVF for patients with PCOS is a "higher success rate than just using fertility medication." (By the way, don't miss the Dr. Vincent Brandeis Gender/Sex Selection special; only $6,500.)
Shady Grove Fertility, with locations in Maryland, Virginia and Washington, D.C., has standards. It insists patients must have a BMI less than 40 before initiating an IVF cycle. Meanwhile, the CDC's National Center on Birth Defects and Developmental Disabilities found women classified as overweight during the early pregnancy (BMI over 25 but under 35) were found 15% more likely to give birth to a child with a congenital heart defect as a result of gestational diabetes and hypertension. For women classified as obese (BMI over 35) the risk rose to 30%. That "Shady Grove" sounds more like a funeral parlor than a fertility clinic might just be fate's dark sense of humor.
Family Beginnings, in its patient "education" section on obesity and IVF, presents a bunch of preposterously technical data:
Lashen et al (2) examined the effects of BMI (Obese>27.9) on IVF. They examined amount and duration of gonadotropins, number of follicles aspirated, egg number, number of embryos, peak estradiol, clinical pregnancy rate, miscarriage rate, implantation rate, and incidence of OHSS compared to controls with normal BMI. The only difference was a lower peak estradiol level.The section concludes, in the only segment a potential baby-wanting patient might ever hope to understand, "While diet and weight loss are encouraged, these data do offer some re-assurance to the obese patients...thus, it is quite reasonable to have PCOS patients undergoing IVF...."
When I emailed Family Beginnings posing as a couple where the potential child-bearer (my "wife") was overweight by 110 pounds (easily past any possible healthy BMI), the response from Family Beginnings' Dr. Donahue was: "Weight may plan a role with the amount of meds she would need. Also, if her insulin were high." He recommended I set up a phone consult.
For IVF clinics, the "risk" for obese patients is all about how likely the procedure is to be successful. Never once does any clinic I found online state outright the very real risks obesity might present to the child itself-though the IVF industry is well aware of those risks. Some see the obesity epidemic as a business boom, with some more willing to treat the obese than, say, lesbians. The lyrics of "It's such a shame" set to the back-beat of a cash register.
Buck up America, we are not alone. Even though the British Fertility Society recommends no woman with a BMI over 35 should ever receive IVF and that those with BMIs over 30 should delay treatment, the NHS recently declared obese women might be allowed IVF. Echoing increasing Brit obesity, Human Fertilisation and Embryology Authority data show IVF in the UK has hurtled to nearly 40,000 cases from under 15,000 in 1992. (Also adorably just like us, they like to deny IVF to their own lesbians.)
It must be noted that the obstetricians I spoke with, while having all sorts of colorful language to describe individual experiences with IVF physicians, insisted that it be made clear that most IVF practitioners provide valuable, necessary medical services for healthy, if often desperate, people. (It should also be noted (especially for physicians reading this) that the obstetricians repeatedly corrected me when blaming "obesity" when the harm is from things caused by obesity. What they mean: obesity doesn't cause birth defects; fetal pancreatic beta cell development caused by obesity may cause birth defects. But to keep this from going to 300,000 words and sending readers in search of fresh bear videos, I use "obesity.")
Now, combine our sticking it in nature's ear by enabling the morbidly obese to become pregnant with data clearly demonstrating how dangerous such obesity might be to a fetus with the "personhood" movement and you have got yourself a genuine possibility of prosecuting a fat pregnant woman with child abuse or child endangerment or even homicide.
Helmed by the organization Personhood USA, the "personhood" movement aims to "establish legal 'personhood' for pre-born children through peaceful activism, legislative efforts and ballot-access petition initiatives." Essentially, a "personhood" state law would make abortion a homicide. The movement has been alarmingly successful; while no actual personhood bills have been passed, they have made it all the way to state legislature votes and ballot initiatives. (North Dakota, Colorado).
The executive director of National Advocates for Pregnant Women, Lynn Paltrow, told me that the personhood movement is more than just an end-run around federal abortion laws. "The theory underlying personhood measures has already been used to reach and punish women with regard to non-drug and non-alcohol related issues," she said. "The measures would not only grant the 'unborn,' from the moment of fertilization, separate legal rights, but such measures would deprive pregnant women of their rights as full persons under the law." (See: Video: How Personhood USA & The Bills They Support Will Hurt ALL Pregnant Women)
Currently the United States does not criminalize pregnancy. That is to say, if you are pregnant and your personal behavior endangers the fetus, you will not be charged with a crime. Rare cases have occurred in Utah, South Carolina and Texas. Not only is such a criminal charge unconstitutional, it is counterproductive, threatening to deter the very women who most need obstetric care from seeking it.
Many, especially those in personhood-type or anti-abortion movements, do not see criminalization of the pregnant as a problem because they view such negligence in its most common forms, alcohol, smoking, or narcotics. And these fetal rights champions would never do any of those things while pregnant. But The Teratology Society paper Birth Defects Research Part A: Clinical and Molecular Teratology states: "Obesity should be classified as a pregnancy risk factor alongside smoking, drinking alcohol."
So, how would the same people, many of whom are certainly no slinky slims, feel about making obesity criminal child endangerment-or, if a fetus were to die from obesity-related complications, homicide?
To find out I called up Keith Mason, co-founder of Personhood USA, to get clarity about what declaring a fetus a "person" might mean for criminalizing the pregnant obese. Despite supporting my initial hypotheticals about criminalizing drug and alcohol use by the pregnant, Mason declined to answer a direct question about obesity. "I can't answer that because it's a hypothetical," he said. "It's like asking what would happen if a Martian came down and impregnated a woman on earth. Let's talk about real issues."
Mason admitted the question was a tough one, though, saying that some of his very family might be impacted by such an interpretation. But, he said we needed to get the personhood laws passed and "worry about the details later."
Sure, Keith.
Agreeing that some IVF providers are ethically bankrupt and that the criminalization of pregnancy is stupid does not dismiss society's responsibility on the issue. The threat to a potential child from obesity-related complications is no different than the one posed a generation ago by alcohol. We blow a gasket if a pregnant woman even looks at a glass of wine, a cigarette, sushi or a hot tub and openly debate the negligible harms of coffee and underwire bras. Yet: One can have "a glass" of wine; one cannot be diabetic for 15 minutes. The fact that obesity does not even rate on our often overboard collective contempt for the pregnant is preposterous. And it should be embarrassing. But it isn't and it won't be. More than anything, we are fat. And the ramifications of our children suffering for our inability to control ourselves is beyond contemplation by a nation that is getting fatter only slower than it is getting selfish.
Abe Sauer is The Awl's Associate Editor for Real People Issues.
Devastatingly well-researched, written and assembled--and just plain devastating. This could be pitched to a news-magazine show for a 2 or 3-parter: that's how current and urgent it feels.
Yeah, this is terrific. Wish you could have worked "Yo momma's so fat" into it a little more, though.
Choire said NO JOKES!
"slinky slims" may not be a "joke" but it did get a giggle out of me!
No Jokes policy was stupid bullshit. More jokes.
And I was going to put a great "momma so fat" joke here but then I read the rest of the comments and YIKES RUN FOR THE HILLS KIDS HERE COME THE LAW AND THEY ARE SO FAT THEY MAKE YOUR MOMMA LOOK JUST SORT OF BIG-BONED, so now I think I will just say, Edith, that's not funny in any way.
id rather be fat as a whale than like you.
Amazing and insightful article as always, Abe. I agree with Josh - you should publish it more generally. Just be prepared for the anti-fat label and vitriol once you do.
On a more general note, is there an Awl Complaints for Whiners Dept? There have been so many awesome entries today that my work productivity has sucked even more than usual. So, boo (and thanks).
I love this idea of a "fetal personhood movement" and have been reading about it for some time. To be honest, I think it's a terrific development for people who believe that the state cannot possibly be allowed to compel a woman to carry a pregnancy to term.
For those of us who know the forced-birth movement for what it is, i.e., as a desperate and demented bid to reduce women to nothing more than their uteruses, the issue of "personhood" raises a single important question: When does a woman become a person?
The fetal personhood movement strikes me as a rare misstep for the forced-birth movement, which has been so alarmingly successful in cordoning off abortion, the most common surgery performed in the U.S., from the realm of reasonable medical treatment.
And Abe, while I really enjoy your work, I can't possibly agree with your 'no fat chicks' meets forced-birth propaganda argument that "the threat to a potential child from obesity-related complications is no different than the one posed a generation ago by alcohol."
I don't know about other readers here, but I'm not particularly interested in what you think women, pregnant or otherwise, need to do with their bodies.
This piece of yours seems to me like a cheap and dilettantish foray into a controversy that you clearly haven't thought about very deeply. What's going on? Are you hard up for pageviews this month or something? Maybe you just need to hit the gym?
Indeed, the personhood movement is wildly interesting socially and legally. Just cal up Lynn Paltrow and ask her; she' will speak very knowledgeably about it. It is also its own 40,000 word piece.
If you really think that complications from obesity are not a threat akin to alcohol (for fetuses) you really need to look at the data and speak with some obstetricians. That is not MY opinion. It is that of many in the medical community.
And if you're right in your preposterous suggestion, then the above is the least efficient possible way to trawl for cheap pageviews.
Which suggestion of mine was preposterous? That your piece is a cheap bid for pageviews, a poorly-thought-out essay on which types of women 'deserve' to get pregnant, or that your silly conclusion equating obesity with alcoholism in pregnant women is just that, i.e., silly?
And of course this is your opinion! You journalists! Never taking credit where credit is due.
The pageviews bid part.
It is my opinion. One I seem to share with a good number of people who themselves know a little bit about it.
I truly don't think that obesity is a "threat" to fetuses that is in any way akin to alcoholism. I can't possibly know where you're coming from with this piece, but I feel almost certain that if you knew anything about fetal alcohol syndrome (FAS) you might not be so bold about your conclusions.
I also don't believe that you generated this piece based on your research.
You came up with your 'fat dangerous moms' idea by passing a sleep apnea kiosk in some Midwestern mall. Right? What do you have against fat people? Or moms? Again, I can't possibly know.
Nevertheless, you made your 'fat dangerous moms' idea into a thesis by looking for confirmation from all of the most easily contacted unimpeachable sources, i.e., certain medical organizations who told you pretty much what you wanted to hear.
Again, I'm a fan of your work. This particular piece just seems like it needs more thought and more work.
Well, those I spoke with would caution me to say "obesity" is not a treat akin to alcoholism. Obesity-related things like diabetes are. I actually generated this piece when I came across the personhood movement and heard about pregnant women being criminally charged (Utah and Yexas) for choices made while pregnant. From there it kind of snowballed and I talked with Lynn and she said she'd never heard of such a case but agreed it was possible under a personhood bill. I tried to include a preponderance of data that was not just my opinion. I really do appreciate your input but it is not malicious.
Abe, I don't mean to harangue you, but I don't think you need to concern yourself with anyone else's fetus, except perhaps your girlfriend's or your wife's. This is precisely the point at which you've gone terribly wrong in this essay.
There is, as you may know, a 4th Amendment right to privacy, at least until the next Republican president appoints a Supreme Court justice. That right entitles a woman to terminate a pregnancy, with some restrictions for late-term pregnancies.
You seem to think that you're entitled to speak at great length about women and what they should do with their fetuses.
But, in fact, you are not entitled to do so. Your job, when confronted by a particular fetus, is to defer to the woman who happens to be carrying that fetus inside her body and help her do whatever she wants to do about her pregnancy.
Hon, I'm not sure you're being really fair to Abe here.
What I took away from this article is not that ABE is the one championing the "personhood movement" and trying to dictate what I can & can't do with my body. But merely that those who DO advocate it may not have thought of all the possible ramifications of their activism. Viz:
"So, how would the same people, many of whom are certainly no slinky slims, feel about making obesity criminal child endangermentâ€"or, if a fetus were to die from obesity-related complications, homicide?"
Do I have it wrong?
Dot that is how I read it as well. That the person movement could possibly be hoisted with their own petard.
Good!
I'm generally loath to disagree with lawyergay, but I thought his vehemence here just seemed a bit misplaced.
Particular women can do what they like with their particular fetuses. But how is it invading anybody's privacy to say "Hey fatties and alcoholics, maybe don't get pregnant." My respect for a woman's right to do whatever with her body doesn't mean I have to agree with the actual shit she does with it. It's like being in favor of free speech, but disagreeing with what people say.
"a desperate and demented bid to reduce women to nothing more than their uteruses"
I am pro-abortion, but I am quite certain that most of my anti-abortion counterparts are not motivated by this view.
Mantooth: I think the general notion of anyone who is not a doctor or researcher creating a normative standard for someone else's pregnancy--whether that pregnancy is actual or prospective--is pretty much indefensible. And that's the thrust of Abe's piece: fat chicks who get pregnant nowadays are no better than the alcoholic moms of yore. Fat pregnant chicks = alcoholic pregnant chicks.
You've got to admit that that's ridiculous, and it isn't in any way supported by the medical establishment.
It amazes me how people--mostly men, but also women--with literally no skin in the game feel authorized to police women's bodies. That's all I'm objecting to here.
One thing should be noted: BMI is an inaccurate way of measuring individuals. It was always intended to measure populations. This is why someone with a 25 BMI is pretty thin.
Very true. BMI is hardly ideal for "real" use but it is what ALL studies use in their data sets so...
you've got serious thinking problems my friend. why dont you write an article on women who smoke? thats just as dangerous as being fat...why do you hate fat women? was your mom fat? did you get dumped by some fat girl? do you secretly like fatties and hate yourself for it so you say mean things about them? do you have low self esteem and making someone else feel bad about them selves make you feel better? well the only thing your making me is pissed.
This is a good point! That is all!
"One [obstetrician] estimated that her average patient is now well over 200 pounds on delivery day (well beyond a Body Mass Index (BMI) of 25)."
How is that shocking? I mean, 175 pounds for a non-pregnant, average-height woman is pretty standard, and not (necessarily) unhealthy.
Well, assuming that the average height for a woman is somewhere around 5'6" - 5'7" (?) that would be a bit, uh, hefty, no?
No. Curvy, yes, but you wouldn't describe the woman in that hypothetical as hefty if you met her.
Depends on the body fat percentage.
I remember reading somewhere that the average American woman is 5'4 and 160 pounds. This seems to make 'well over 200 pounds' larger than average, even taking into account 20-30 pounds of baby weight.
Haha that is pretty fat.
Does anyone else find it weird that anti-abortion activists don't seem to have a problem that scientists create life? Shouldn't that be on the same plane (if not an even bigger deal) to religious zealots than ending a life?
Always wondered the same thing.
I concur.
me too! especially after i read an article a few weeks ago where a woman received IVF and was later told they implanted the WRONG embryos in her uterus and the kids in there were NOT her and her husbands. that creeped me out for like days!
Yup. I, too, thought the exact same thing when I read this article the other day.
Well, the Roman Catholic Church is against abortion _and_ IVF.
Some of the loons in the Quiverful (Outbreed The Heathens) movement oppose adoption and IVF because they belive god wants you to have _your_ kids, or _no_ kids.
creating life and ending life are 2 totally different things...are all you people really this ignorant or are you trying to be cool?
Abe! So good.
PS:
Can we make Awl T-shirts that just read: "Sure, Keith." Many levels there.
Humbly recommend t-shirts that read "I'm not fat ... I read the Awl!"
Even though the last two days at the gym have left me with murderous soreness, this excellent piece is pushing me to go right back again.
I just got fired and this piece helped me rule out gorging myself on bonbons until I get all sugar-coma'd.
I do reserve the right to a few drinks tonight though.
(Sorry to hear that, and yes, you do.)
Haz if you are thin you should think about selling your eggs. Could get up to $30K.
Welcome to the funemployment line, it's not so bad really. The drinks taste better when they're so precious.
Also, regarding the whole impotence aside: while I never suffered from impotence, I can tell any other male fatasses out there that dropping my BMI by what doctors would professionally term "a fuckload" has turned me from a 38-year-old back into an 18-year-old.
It's actually almost a nuisance.
awesome to know! wish there were a before/after pics place on the awl! [and congrats! that's what we call a good kind of nuisance]
Abe --
Your article is very well-researched. But it is also dangerously patronizing. And very close to supporting eugenics?
It's not eugenics to suggest that people engaged in harmful behaviors and are unwilling to stop (very fat people, crack heads) should not get pregnant, as they will very likely harm their baby.
Also, it's sort of like reverse-eugenics to create a fertilization industry catering to people who are too fat to get pregnant naturally.
Yeah, but making decisions on who can and cannot bear children, or prohibiting certain people from using science to conceive, seriously concerns me. As does, in fairness, analogizing crackheads to the obese.
toadvine, I think you might be conflating Abe's position with that of the personhood movement.
Also, as a skinny, responsible drug user (not crack, though), I do not find analogizing drug use and obesity problematic. Just for the record.
Well, I don't mean to be. And believe me, I'm totally pro-drug. But it's really hard to talk about things like this without creating a serious "us vs. them" dichotomy, which ends up feeling patronizing at best, threatening and judgmental The attributed quotes and summation paragraph get very close to advocating for taking decision-making about procreation out of the hands of the people who would do the procreating. And that crosses over into threateningly judgmental.
I think you're extrapolating a bit. By my read, he's saying that obesity in pregnant women endangers the health and safety of their fetuses, similar to the use of alcohol, drugs, or cigarettes. Then he goes on to talk about the personhood movement, and ties them together by asking whether the success of such a movement would make it criminal for obese women to become pregnant (or vice versa) because of the harm it would do to the unborn person.
I see no argument for eugenics here.
Well, the article ends by taking the position that there are certain people who society should choose not to allow to procreate, and certainly should not encourage to procreate, and that those people can be readily identified by physical differences without regard to anything else about the person. Eugenics means selective breeding. It certainly seems to me that it is fair to read this article as a thinly veiled article for at least some form of eugenics.
This is a much better argument for eugenics than Abe's article:
http://whythefuckdoyouhaveakid.com/
I see the health insurance industry pouncing on this as a justification to deny prenatal and postnatal care in three...two...one...
You make a really critical error here in saying that PCOS is caused by obesity. Who are these "many" who believe this? Many women are overweight, or obsese, because of PCOS and many of these women are not diagnosed until they try to get pregnant. Obesity is not causing a rise in PCOS. PCOS causes weight gain and obesity. This seems crucial to your argument, but it's not true. You are taking a symptom of a disease and blaming it for a rise in the cause of the disease (and the symptom).
I KNEW the PCOS thing would be an issue which is why the statement is "PCOS is a tricky hormonal imbalance that is not always or solely a consequence of obesity; many believe it is on the rise as a result of a spike in obesity-related insulin resistance." "Many" being more than a bunch of outlier quacks. But PCOS and obesity as it relates to IVF are very much interrelated.
Who are they? I've never heard that from any reproductive endocrinologist or any research on PCOS. Of course obesity and infertility are correlated to PCOS. They are symptoms of PCOS. I just think it's wrong to compare the weight gain of PCOS--which is the RESULT of PCOS--with weight gain caused overeating, lack of exercise or whatever else. That weight gain can lead to health problems, though not always. It doesn't lead to PCOS. I don't think that "many" believe that.
All the research I have read says the cause of PCOS is unknown and whether it can cause obesity or obesity can cause it is also not understood. And that how obesity and PCOS are related exactly is a mystery. Though it is clear that one can have PCOS and NOT be obese. Do you know of a study that definitively answers this? And whatever PCOS' link to obesity, the end result (sometimes) is the obese with PCOS get IVF.
Here are some links:
http://www.ingentaconnect.com/content/bsc/cend/2001/00000055/00000004/art00004
http://womenshealth.suite101.com/article.cfm/polycystic_ovarian_syndrome_rapid_weight_gain
There's more. I've read nothing, anywhere, that suggests obesity or being overweight comes from PCOS.
And implying it does leads to this hysteria that all medical problems are part of some sort of moral failure, can be corrected (or at least blamed) through behavior and we should openly judge those who suffer.
Well, that second one was written by a freelance writer with a law degree so citing her as right and me as wrong is odd.
Doing a simple endocrinology search I find stuff like
http://www.alphagalileo.org/ViewItem.aspx?ItemId=56125&CultureCode=en which says "These data provide the first genetic evidence to corroborate the well documented association between these two conditions. Our future work will focus on elucidating the underlying mechanisms of polycystic ovary syndrome and its metabolic consequences with the hope of understanding how this common condition develops."
I'm just commenting so people believe that readers will put the time into long-form blogging. Also, I like this post.
Why isn't this post sponsored by Equinox?
Seconded. Awesome post.
I wonder how much of the increase in birth defects and other problems for babies born to overweight/obese women is really just a reflection of poverty (poor women tend to have sicker babies, and also tend to be heavier). Look at the diabetes map--its the same national pattern as children eligible for free school lunch, or people living below poverty line. maybe it's poorness that is killing babies, not fat ladies. would would keith say to that?
It is most assuredly poverty that is killing babies. And causing bade diets which also leads to obesity.
Christ, no one tell Broadsheet or Jezebel about this post or we'll never hear the end of it.
I was contemplating forwarding this to Kate Harding, but decided I didn't care that much.
Sorry, but I have to ask: Who is fucking/impregnating these obese women?
Drunk horny guys at last call.
Btw, Rod there is not much else to do in the upper midwest in then winter but drink and fuck.
Obese men.
Just one guy. One exhausted guy.
George Foreman.
that's why they're asking for IVF.
Now THIS is the comment I'd like to see sent to Jezebel!
(I really, really wouldn't, actually. I like it here way too much.)
People who are attracted to them, perhaps? I'd imagine that percentage of the population is roughly the same size as, for example, the percentage of people interested in fucking middle-aged gay men?
There's a goodly subset of men who are sexually attracted to heavier women, ranging from curvy to extremely obese. A lot of them are ashamed of that attraction, because society looks down on fat women and makes fun of guys who date them. It's akin to what goes on with ostensibly straight/deeply closeted guys, including their taunting the objects of their desire when they're hanging with their drinking buddies, only to awkwardly approach the fat woman later in hopes of hooking up.
There are, of course, secure men, who simply like hefty women and don't have complexes about it. But if I had to bet, I'd put you into the former category.
Pssst! Rod doesn't "do" ladies.
(And I think he was just being his usual incendiary/funny self.)
Oh, I dunno, the male equivalent of any woman who would sleep with an enormous douche bag who thinks that being physically attractive is the most important indicator of value in a person. You know, some one like that.
IS YOUR DICK SO SMALL YOU MUST BE LITTLE OTHER PEOPLE TO MAKE YOUR SELF FEEL BETTER?
Abe, is that West Acres?
Yes.
Definitely good points, and great research. But there's a lot going on here. PCOS and obesity aren't mutually inclusive by any means - really, all PCOS is is a hormonal imbalance whereby a woman produces too many "male" hormones. Most women with PCOS (which is a very very small percentage of women) are not obese.
Also, I'm generalizing here, but there is a huge correlation between obesity and income/social class. The fattest women tend to be the lowest wage earners - women make less anyway, plus fat women are discriminated against more than fat men in the workforce. IVF is ridiculously absurdly expensive, so much so that only the top echelon of the population can afford it. So I'm not sure that relating IVF to obesity is necessary -- at least, not right now, while IVF's pricetag remains so high.
Still, obesity is a disaster. On every possible health level. I just don't see how "oh they die sooner so it's actually good for everyone" is ever a good argument.
Yeah, this is a great column, but I kept waiting for the low-education/poverty paragraph that never came. It has to be mentioned -- the fat rich IVF recipients are not the ones nodding their heads dumbly at medical advice and then going home and stuffing Sour Patch kids up their vaginas or whatever. Poor people are!
OMG OMG OMG stuffing Sour Patch Kids up in their vaginas OMG OMG OMG. Too funny.
Also, yes this is a good point.
wouldn't that burn horribly?
Very good point. While I did not get too deep into the economics of obesity (so much out there elsewhere) or the economics of IVF, it certainly is not only the rich. Many are going deep in debt to finance IVF and some insurance co.'s cover a chunk.
http://www.pcoscommunity.com/showthread.php?t=12074
Of course, one of the consequences of that are IVF (and other pro fertility services) patients being more concerned with success (as they pay either way) and wanting to get their money's worth and thus an explosion of twins, triplets, Octomom etc.
But again, the economics angle is very important.
Not that it matters but this
fresh bear videos
takes you here
http://www.http.com//www.theawl.com/tag/bears
otherwise great article.
I read this on an empty stomach, with an empty uterus (albeit with both of them clanging equally for attention). They're both going to stay that way for at least a while longer. And I'd like to third NinetyNine's comment, too. Great piece, Abe.
Needs a "No Fat Chicks" tag
I haven't rad all the comments, but I'm surprised this statement:
"a mountain of recent data shows being obese during pregnancy is as dangerous as being a pregnant alcoholic"
didn't have a link backing it up.
This is not really peer reviewed journal. But here are some google searches if you want to compare the risks.
http://tinyurl.com/yzh8v8l
or
http://tinyurl.com/yzmrmdy
Bah! I am going to end up double posting this
This is not really peer reviewed journal. But here are some google searches if you want to compare the risks.
http://tinyurl.com/yzh8v8l
and
http://tinyurl.com/yzmrmdy
Was I the only one who read that as "CRAP store"?
Oh jesus. Several points:
1)"all that blubber is a lifestyle choice" - Not true. Obesity has as strong a genetic link as height -http://www.newsweek.com/id/215115/page/1
2) BMI is bullshit. People are starting to realize this, but it is a poor indicator of body fat and has no relation to overall health. Recently-conducted studies that are using BMI rather than body fat percentages are remarkably backwards.
3)"Obese" is not what most people think it is. You don't have to be reduced to rolling around walmart on a scooter to be classified as obese, or morbidly obese. Look: http://kateharding.net/bmi-illustrated/
4) Being obese is not the same as being unhealthy. A large percentage of overweight and obese people (as classified by BMI) eat healthily, work out, and have normal insulin and cholesterol levels.
5) As of when did The Awl give a shit about pregnant women? This article clearly took a ton of time and research, but in the end, what's your point? "Fat is bad"? We all know that, except its not. Being unhealthy is bad. And they're not the same thing.
/end soapbox.
That slideshow is very interesting--thanks.
Brilliant article.
As an incredibly well-researched obese mom of a gorgeous, healthy, active child, I have to say that while there is some truth in this article, it's unfortunately suffocating in a big fat layer of bullshit and alarmist language. The "developmental horrors" cited here -- "a murderers' row of obstetrical miseries" (seriously?) including pre-eclampsia and gestational diabetes -- are by NO means the sole province of the obese. "Cutting slabs off pregnant women?" What does that even mean? The author's language (a "300-pounder?") suggests a prejudice that makes it nearly impossible to read the article as a piece of reportage.
What the hell, Awl?
I agree the omission in an article like this of the correlation between education, income and obesity is pretty galling. The only real conclusion that can be drawn here is that upper-income educated white women should know better. But until you address the issue that an overwhelming percentage of people (maybe even the majority) are fat because that's all they can afford and/or that's all they know, you're just skipping around a socioeconomic nightmare going on out there. All sorts of crazy conclusions can be drawn; e.g., should there be some algorithm incorporating BMI, Education, and Income that determines whether a woman is entitled to an IVF or can have her pregnancy controlled by the State? Lord I hope not.
"The only real conclusion that can be drawn here is that upper-income educated white women should know better." Well, I'm a little bummed if that really is the only take-away. And I know the obesity + pregnancy point with the data about that, as expected, sucks all the air out of the room. But two important points that I hope are "real conclusions:" movements like the "personhood" one are a genuine danger to a women's right over her own body (with the obesity hypothetical being an extreme interpretation that might make those who would otherwise favor criminalizing pregnancy re: drugs etc. think differently); and that, more than white women, some IVF practitioners should, in your words, "know better."
Those are really important points, and I get it, but I don't know if your feedback is going to reflect it. But just to suck more air out of the room, there is this anecdote to think about. I worked my way through college and law school at a grocery store. And from that experience, I know you can buy just about anything other than liquor and tobacco with food stamps. But how do you ban the use of food stamps to purchase chewing gum or Coca-Cola, let alone Kraft Mac'n'Cheese or Spaghettios, two of the staples I observed to be in the food stamp diet? I just think there's a lot here to think about that focuses on the root causes of obesity, and that needs to be addressed along with the result of an obese person's pregnancy. Series! Parts 2-10. I'll read it.
AGREED! The root causes of what is clearly bad news for US health is... at least to part 5 of a series. The thing is, as it pertains to what I was looking at, type 2 diabetes does not discriminate or care about HOW it happened and, to your point, exactly what socioeconomic class do you think the first criminalization of a morbidly obese - fetal demise case under a personhood law would be found? Not suburbia.
The two points you mention above make total sense, and I completely agree with them. Its a pity that those valid conclusions get lost beneath all the passive aggressive fat bashing.
Bo there are other reasons why people choose to buy mac and cheese over apples. Even though there is no prep time apples have a much shorter shelf life. I am not saying mac and cheese and spaghettios are great nutritional choices but sometimes these are the only foods kids will eat and you can keep them in the pantry for years. I buy stuff at supermarkets I can't get at Trader Joe's or a farmer's market so you may have been seeing someone's edited version of their buying habits. p.s. I am not a parent, I make my own home made mac and cheese and Chef Boyrdee products should be outlawed.
1) There are (particularly in the part of the country under consideration in the post, although certainly not only in this part of the country) plenty of women (and men!) not under serious economic constraints who are still unhealthily overweight.
2) I realize that people are dumb -- believe me, I realize that -- but I'm somewhat skeptical about how big a role education plays here. For one, concepts like "Fast food and junk food are bad for you" and "Fruits and vegetables are good" are not high-level concepts; maybe I'm wrong, but I have a sneaking suspicion that you could quiz classes of first-graders from all over the country on this stuff and they'd probably tell you that apples and carrots are better for you than Taco Bell. For another, I know plenty of people who have a reasonably solid working knowledge of how to make healthy diet choices -- including myself -- who routinely opt not to nevertheless.
3) I appreciate that there are people who are unfairly classed as overweight who are healthy, and I appreciate that those people's situation deserves more attention and understanding. That said, I sometimes sense from those folks an unwillingness to acknowledge that dude, a lot of people are not overweight because of genetics. I'm not! It's because we eat too much crap.
To clarify those last couple of sentences: I'm overweight; it's not because of genetics. (As opposed to "I'm not overweight!")
You can buy a ton of Mac'n'Cheese for the price of a few apples. Think about it.
You can! But as I think I pretty explicitly indicated, I'm talking about the people, of whom there are plenty, who can afford the apples and go with the mac n' cheese anyway, to the exclusion of apples.
I agree that there is a large measure of personal choice in the matter; however, it is not just a matter of knowing what is healthy. It is a matter of behavior, because, as in your own case, knowing that an apple is healthy does not make you a healthy weight. Behavior is taught as well, and in the case of diet and exercise, the instruction most receive sends an opposing message. You can say that apples are healthier than mac and cheese all you want, but if kids are served boxed mac and cheese in lieu of apples day in and day out, they are going to reach for the mac and cheese or something like it on their own. School lunches are awful, and most people do not have any clue about what constitutes one portion of protein, starch, veggie, etc...People say that you should put half of your meal in a doggie bag when you eat out, but two things-1. Why the fuck should I have to put half of my meal in a fucking doggie bag. I have no fucking dog. 2. If you research the calories in many restaurant meals, you will find you have to put more than half away for your fucking obese dog if you want to stay within your calorie and sodium limits for the day. In our culture it is better to set people on an uphill battle and watch them fail (this is considered more valiant), than to make the best choice the easiest choice to make.
But I don't think that is the author's message. I wonder what the average BMI of those involved in the personhood movement is.
I don't think it has anything to do with valor. Culturally speaking, in the U.S. we simply have a history of putting the financial bottom line before other concerns -- we expect to get large portions at restaurants for our money; and restaurants, knowing this, provide large portions because they want to keep their customers happy.
The best book I've read on the subject is Mindless Eating, which more or less says that people eat too much and are drawn to high-calorie foods because we're wired to -- the present availability of food is an anomaly, historically speaking; evolution has built us to seek out food that will provide the most energy as quickly as possible, and to finish whatever portions are set out in front of us. It's a quick, really interesting read, with a lot of research to back it up, and it rings truer than any other reasoning I've run across.
I don't think that the reason I listed is the only reason, and I completely agree with your reply. I was going to add that they idea that we need to get the most for our money is what is doing us in. I also agree that we are wired to overeat, which is where personal will power must come in. Also, serious behavior modification is necessary. But people in other countries are just as wired to overeat as we are, yet many don't. I think that is where the culture part comes in. We have to condition ourselves to learn that there is more food out there. Many of us are not in danger of starving. To see the value in quality over quantity. To realize that getting more for our money is a tactic that costs us more in the end. I disagree about the valor part. We love the story arc of the uphill battle and the success of the underdog. It makes us feel good about ourselves. I see it play out with the food issue as well as health care and education.
Is that more of a diet book or like a pollan-type book?
Yeah, that's fair, although I'd describe it as our unconscious belief that salvation only comes through hard work -- and that conversely, imperfection is a result of laziness -- rather than valor. But I think we're talking about more or less the same thing.
I haven't gotten around to reading Pollan yet, but my guess is that tone-wise and style-wise, it's closer to a diet book. That said, it's most assuredly not an Atkins or Long Beachâ€"type thing. The authors have been doing eating research for the private and public sector for years, and the book is heavy on describing their experiments (which are the most interesting part); they don't get especially detailed with the science, but that's a function of their wanting to create a book readable by a large audience.
Their research has led them to a belief that willpower diets are usually going to fail -- because biology is working against you -- and instead, you're better off using mental tricks to change your behavior: Like, people suck, it turns out, at estimating portions, and in the case of liquids we measure them vertically. So if you typically drink out of wide glasses, you nearly always drink a lot more than you'd guess, because if you don't fill a glass at least halfway, it looks like there's not enough in it to drink. It sounds absurdly simple, but they've discovered that if you, say, switch to tall, narrow drinking glasses and smaller plates (which make smaller portions look bigger in proportion), you drink and eat a lot less.
Anyway, it's quick and highly readable, and by all accounts I've seen, the science is rigorous.
Yes, I guess precorrection then. Don't set yourself up for failure. Do they say anything about positive long-term results? Like 5-10 yrs down the road?
Maybe a little, but not much that I recall (although it's been awhile since I read it). Remember, it's not a diet book -- it's a science book, written in a light way. Their focus is more on understanding why people gain weight, with some corollary stuff on how to lose it, or at least how to eat less.
Causation: ur understanding it wrong.
It must be great to feel like you can come up with something meaningful to say about life's great conundrums by spending a few hours with Google and making a few prank phone calls. I don't know what the right solutions are to the moral problems associated with IVF and personhood, but I do know that dilettante males with no stake in the outcome have no place in the discussion about who should and shouldn't be having babies. I would have thought that so-called liberal men would have already learned this from the abortion issue, but apparently some men still feel like their opinions should count because they spent a few hours researching them.
Bucko, we all have a say as we all are effected by who gets born and who dies within any given time frame.
Kitten --
I'm going to go ahead and atrongly disagree with you. If you submit that "well have a say" in the procreative choices of anyone else currently living because we are all effected, then by that logic we all have a say in pretty much every single other thing that any single person ever does. And man -- I'm just not going there with you. From such well-intentioned ideas comes tyranny, whether that of right-wing religious bigots or left-wing healthy-living bigots.
First of all, there's a slippery slope fallacy going on: I don't think anyone here is suggesting that who can have babies be regulated. Abe is saying (as best I can tell) that there are people who think it should be, and that they are wrong, but that philosophically, it's not impossible to imagine weight being as much a criteria as alcohol or drug use in such beliefs. (But that, interestingly, the people pushing fetal personhood don't seem to want to go there, perhaps because then their beliefs would affect them.)
I'm a lot more concerned by the suggestion that because of someone's sex or background, they have no place in a conversation. No one has to agree with the post! But there is, historically, a pretty direct link between the idea that some people have no place in a discussion and tyranny.
(Bucko, toadvine, I realize I'm conflating your comments here. But while logic may play a role in how you receive someone's argument, it should play very little role in whether the person gets to make it in the first place. Nearly always, the person should get to.)
would a (dilettante or not) *female* with no stake in the outcome have a *place* in the discussion about who should and shouldn’t be having babies?
I am not sure how you can be female and not have a stake in the outcome of a "having babies" conversation. If its biologically impossible for you to reproduce, maybe. But even if you've decided you're never ever having kids, it's important that it's your choice, rather than one forced upon you. There's that whole "control over one's own body" issue.
I absolutely agree with cherrispryte and others about the "passive-aggressive fat-bashing." I think the style in which you chose to write this piece completely sabatoges any research you've done: both the well-founded research as well as the badly-correlated research. Frankly, it also makes me wonder whether or not you are overweight, and whether you think that's at all germane.
Your post is most interesting to me as an experiment in making an extremely complex issue inflammatory, cynically catchy and skimmable. I like reading the Awl and I've loved other pieces you've written for it, but this one fell miserably flat. More depressing proof that it's still completely unfeasible to do solid, in-depth reporting online that isn't attached to a print source...
Who is fucking obese women? This comment, more than anything Abe could say on his own behalf, illustrates what's wrong with this piece. I don't see what could possibly have motivated this piece besides hatred of fat people and a sense of entitlement to speak on behalf of women, which unless you have a uterus, you don't.
It's patently misogynistic to write a piece arguing that, while it's offensive to grant fetuses personhood status, if we DID, then fat women should be charged with child endangerment. Do you know what else is bad for your health? Being an angry asshole. Raises your blood pressure, makes you more of a dick to your spouse and potential kids.
Obesity is a public health issue. It is not a moral issue. Personal responsibility plays a role; but personal responsibility also plays a role in any number of imperfect choices human beings make: the choice to use too much electricity or natural resources, the choice to use drugs that contribute to violence in drug producing countries, the choice to buy clothing produced in sweatshops, the choice to drink out of a plastic water bottle or buy any new product, ever, that is not produced in your own backyard.
Fuck you for defending my children, Abe. This is the last post I will read on the Awl. I enjoyed the humor but the fat bashing has gotten very tired.
Abe, I thought this was an interesting piece with interesting research and an interesting angle.
So I guess I misunderstoond it completely!
What I thought you were giving us was a reductio ad absurdum of "fetal personhood" extremists, showing that if the fetus is a legal person, there are some strange consequences.
But, having read some of the comments, now I realize that it's much simpler than that. You just hate the fats and you want to be the Who Can Get Pregnant Czar. Right?
I'm the Hate Czar.
i dont know who the fuck you people are to write this garbage. I AM PLUS SIZE and im 20 weeks pregnant. my blood pressure and my cholesterol are excellent and i do not have gd. what gives you the right to sit here and judge people? your time will come. YOUR THE ONE WHO WILL STAND BEFORE GOD AND BE JUDGED. and you better start asking for forgiveness now cuz eternity is a long time to burn in hell. karma is a bitch. im big, beautiful and a better person than you'll ever be. i'd bet a million bucks your reading this laughing and talking shit but idc. your time will come.
I'm a regular Awl reader (with a low commenter number and everything!). This is a pseudocommentername because my work doesn't know I'm doing IVF.
I've been trying to get pregnant for almost two years, and am at the end of the fertility road. After two pregnancies in seven months (a tubal pregnancy requiring emergency surgery and a miscarriage), I gained weight. The giant doses of estrogen you inject during IUI/IVF make you moody and fat. During and after fertility treatment, they won't let you do much in the way of exercise, since you can cut off oxygen to your ovaries; even swimming was on the list of forbidden activities from my doctors. There's a lot of resting during IUI and IVF, as well as after a D&C. More to the point in my case, pregnancy loss, like any emotionally devastating event, can trigger depression. Comfort eating, lethargy, anhedonia, you name it.
I read this post as I was just starting my second-to-last IVF cycle, having spent all my savings and surrendered my body, time, and mind to what can be an extremely alienating and spirit-crushing process. Though plenty of overweight women have healthy children, some of the studies you cite are certainly frightening for those of us in fertility treatment.
All I want to say is that when I read phrases like "But all that blubber is a lifestyle choice. The consequence of living well. No regrets," "300-pounders," "which in layman's terms is 'dead baby,'" and "That 'Shady Grove' sounds more like a funeral parlor than a fertility clinic might just be fate's dark sense of humor," I can't believe I'm reading The Awl.
One note: thin/fit women get preeclampsia. It can happen to anyone--your sister, your cousin, your best pal. As can infertility. As can miscarriage. As can depression. As can--believe it or not--weight gain. Normal, healthy, sophisticated people fall into all kinds of circumstances, though we all find that hard to believe when we're on top of the world.
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