Weight Stigma across the Preconception, Pregnancy, and Postpartum Periods: A Narrative Review and Conceptual Model

Abstract

Weight stigma is a pervasive issue promoting significant adverse health and psychosocial consequences. Preconception, pregnant, and postpartum women are particularly vulnerable to weight stigma, which can directly impact their health and that of the next generation. Of note, weight stigma affects women living with obesity who are already at risk for developing gestational diabetes and experiencing associated stigmas. This narrative review aimed to examine the literature on weight stigma across the preconception, pregnancy, and postpartum periods, specifically to (1) synthesize the evidence using a socioecological lens; (2) develop a conceptual model of weight stigma tailored to women across this life phase; and (3) provide recommendations for future research. To date, weight stigma research across the preconception, pregnancy, and postpartum periods has focused predominately on pregnancy and antenatal care. The drivers and facilitators of this stigma are pervasive, occurring across various contexts and settings. Manifestations of weight stigma include decreased reproductive healthcare quality, mental health symptoms, poorer health behaviors, and adverse pregnancy outcomes. Future research should further investigate the experiences of women preconception and postpartum, and health/social impacts beyond healthcare. The model herein will guide such research to ultimately identify opportunities for stigma reduction and improve multigenerational health and well-being outcomes.

Keywords

weight stigma - weight bias - preconception - pregnancy - postpartum

Publikationsverlauf

Artikel online veröffentlicht:
16. März 2021

• References

• 1 Brewis A, SturtzSreetharan C, Wutich A. Obesity stigma as a globalizing health challenge. Global Health 2018; 14 (01) 20
• 2 Prunty A, Clark MK, Hahn A, Edmonds S, O'Shea A. Enacted weight stigma and weight self stigma prevalence among 3821 adults. Obes Res Clin Pract 2020; 14 (05) 421-427
• 3 Seacat JD, Dougal SC, Roy D. A daily diary assessment of female weight stigmatization. J Health Psychol 2016; 21 (02) 228-240
• 4 Sutin AR, Terracciano A. Perceived weight discrimination and obesity. PLoS One 2013; 8 (07) e70048
• 5 Tomiyama AJ, Carr D, Granberg EM. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 2018; 16 (01) 123
• 6 Brewis AA. Stigma and the perpetuation of obesity. Soc Sci Med 2014; 118: 152-158
• 7 Fikkan JL, Rothblum ED. Is fat a feminist issue? Exploring the gendered nature of weight bias. Sex Roles 2012; 66 (09) 575-592
• 8 Hill B, Hall J, Skouteris H, Currie S. Defining preconception: exploring the concept of a preconception population. BMC Pregnancy Childbirth 2020; 20 (01) 280
• 9 Lim S, Hill B, Pirotta S, O'Reilly S, Moran L. What are the most effective behavioural strategies in changing postpartum women's physical activity and healthy eating behaviours? A systematic review and meta-analysis. J Clin Med 2020; 9 (01) 237
• 10 Corder K, Winpenny EM, Foubister C. et al. Becoming a parent: a systematic review and meta-analysis of changes in BMI, diet, and physical activity. Obes Rev 2020; 21 (04) e12959
• 11 Hill B, Bergmeier H, McPhie S. et al. Is parity a risk factor for excessive weight gain during pregnancy and postpartum weight retention? A systematic review and meta-analysis. Obes Rev 2017; 18 (07) 755-764
• 12 Institute of Medicine and National Research Council. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: National Academies Press; 2009
• 13 McIntyre HD, Gibbons KS, Flenady VJ, Callaway LK. Overweight and obesity in Australian mothers: epidemic or endemic?. Med J Aust 2012; 196 (03) 184-188
• 14 Ward P, McPhail D. Fat shame and blame in reproductive care: implications for ethical health care interactions. Womens Reprod Health (Phila) 2019; 6 (04) 225-241
• 15 Incollingo Rodriguez AC, Smieszek SM, Nippert KE, Tomiyama AJ. Pregnant and postpartum women's experiences of weight stigma in healthcare. BMC Pregnancy Childbirth 2020; 20 (01) 499
• 16 Yao D, Chang Q, Wu Q-J. et al. Relationship between maternal central obesity and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of cohort studies. J Diabetes Res 2020; 2020: 6303820
• 17 Liu NF, Brown AS, Folias AE. et al. Stigma in people with type 1 or type 2 diabetes. Clin Diabetes 2017; 35 (01) 27-34
• 18 Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming weight bias in the management of patients with diabetes and obesity. Clin Diabetes 2016; 34 (01) 44-50
• 19 Incollingo Rodriguez AC, Dunkel Schetter C, Tomiyama AJ. Weight stigma among pregnant and postpartum women: a new context of stigmatization. Stigma Health 2020; 5 (02) 209-216
• 20 Skouteris H. Pregnancy: physical and body image changes. In: Cash TF. ed. Encyclopedia of Body Image and Human Appearance. London: Elsevier; 2012: 664-668
• 21 Bombak AE, McPhail D, Ward P. Reproducing stigma: interpreting “overweight” and “obese” women's experiences of weight-based discrimination in reproductive healthcare. Soc Sci Med 2016; 166: 94-101
• 22 Atkinson L. Fear of inducing guilt or shame affects midwives' communication about body weight with pregnant women. Evid Based Nurs 2018; 21 (04) 106-106
• 23 Dieterich R, Demirci J. Communication practices of healthcare professionals when caring for overweight/obese pregnant women: a scoping review. Patient Educ Couns 2020; 103 (10) 1902-1912
• 24 Dieterich R, Demirci J, Danford C. Weight stigma related to pregnancy: a concept analysis. ANS Adv Nurs Sci 2020; 43 (02) 190-199
• 25 Nagpal TS, Liu RH, Gaudet L, Cook JL, Adamo KB. Summarizing recommendations to eliminate weight stigma in prenatal health care settings: a scoping review. Patient Educ Couns 2020; 103 (11) 2214-2223
• 26 Olander EK, Scamell M. Teaching students about maternal obesity without creating obesity stigma. Nurse Educ Today 2016; 42: 59-61
• 27 DeJoy SB, Bittner K. Obesity stigma as a determinant of poor birth outcomes in women with high BMI: a conceptual framework. Matern Child Health J 2015; 19 (04) 693-699
• 28 Kriebs JM. Obesity in pregnancy: addressing risks to improve outcomes. J Perinat Neonatal Nurs 2014; 28 (01) 32-40 , quiz E1–E2
• 29 McPhail D, Rountree-James M, Whetter I. Addressing gaps in physician knowledge regarding transgender health and healthcare through medical education. Can Med Educ J 2016; 7 (02) e70-e78
• 30 Stangl AL, Earnshaw VA, Logie CH. et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med 2019; 17 (01) 31
• 31 Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol 1977; 32 (07) 513-531
• 32 Hill B. Expanding our understanding and use of the ecological systems theory model for the prevention of maternal obesity: a new socioecological framework. Obes Rev 2020; ; (epub ahead of print)
• 33 Hanson M, Barker M, Dodd JM. et al. Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol 2017; 5 (01) 65-76
• 34 Parker G, Pausé C. Productive but not constructive: the work of shame in the affective governance of fat pregnancy. Fem Psychol 2019; 29 (02) 250-268
• 35 Johnson M, Campbell F, Messina J, Preston L, Buckley Woods H, Goyder E. Weight management during pregnancy: a systematic review of qualitative evidence. Midwifery 2013; 29 (12) 1287-1296
• 36 National Institute for Health and Care Excellence, Weight Management Before, During, and After Pregnancy (PH27). UK: National Institute for Health and Care Excellence; 2010
• 37 Department of Health. Clinical Practice Guidelines: Pregnancy Care; Canberra: 2018
• 38 Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. "…or else I close my ears" How women with obesity want to be approached and treated regarding gestational weight management: a qualitative interview study. PLoS One 2019; 14 (09) e0222543
• 39 Maxwell C, Sharma A. Thinking about people-first language: weight bias, stigma, and discrimination, and women's reproductive health. J Obstet Gynaecol Can 2019; 41 (11) 1533-1534
• 40 Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, Gerbert B. Preventing excessive weight gain in pregnancy: how do prenatal care providers approach counseling?. J Womens Health (Larchmt) 2010; 19 (04) 807-814
• 41 Nippert KE, Tomiyama AJ, Smieszek SM, Incollingo Rodriguez AC. The media as a source of weight stigma for pregnant and postpartum women. Obesity (Silver Spring) 2021; 21 (01) 226-232
• 42 Mulherin K, Miller YD, Barlow FK, Diedrichs PC, Thompson R. Weight stigma in maternity care: women's experiences and care providers' attitudes. BMC Pregnancy Childbirth 2013; 13 (01) 19
• 43 Faucher MA, Mirabito AM. Pregnant women with obesity have unique perceptions about gestational weight gain, exercise, and support for behavior change. J Midwifery Womens Health 2020; 65 (04) 529-537
• 44 Incollingo Rodriguez AC, Dunkel Schetter C, Brewis A, Tomiyama AJ. The psychological burden of baby weight: pregnancy, weight stigma, and maternal health. Soc Sci Med 2019; 235: 112401
• 45 Incollingo Rodriguez AC, Tomiyama AJ, Guardino CM, Dunkel Schetter C. Association of weight discrimination during pregnancy and postpartum with maternal postpartum health. Health Psychol 2019; 38 (03) 226-237
• 46 Dutton GR, Lewis TT, Durant N. et al. Perceived weight discrimination in the CARDIA study: differences by race, sex, and weight status. Obesity (Silver Spring) 2014; 22 (02) 530-536
• 47 Furber CM, McGowan L. A qualitative study of the experiences of women who are obese and pregnant in the UK. Midwifery 2011; 27 (04) 437-444
• 48 LaMarre A, Rice C, Cook K, Friedman M. Fat reproductive justice: Navigating the boundaries of reproductive health care. J Soc Issues 2020; 76 (02) 338-362
• 49 Hawke M. Anti-fat bias, weight stigma and vulnerability: issues identified in maternity care. Australian Midwifery News. 2018: 54-55
• 50 Brown J, Alwan NA, West J. et al. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 2017; 5 (05) CD011970
• 51 Parsons J, Sparrow K, Ismail K, Hunt K, Rogers H, Forbes A. Experiences of gestational diabetes and gestational diabetes care: a focus group and interview study. BMC Pregnancy Childbirth 2018; 18 (01) 25
• 52 Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. Shame and avoidance as barriers in midwives' communication about body weight with pregnant women: a qualitative interview study. Midwifery 2018; 63: 1-7
• 53 Washington Cole KO, Gudzune KA, Bleich SN. et al. Providing prenatal care to pregnant women with overweight or obesity: differences in provider communication and ratings of the patient-provider relationship by patient body weight. Patient Educ Couns 2017; 100 (06) 1103-1110
• 54 Parker G. Shamed into health? Fat pregnant women's views on obesity management strategies in maternity care. Womens Studies J 2017; 31 (01) 22-33
• 55 DeJoy SB, Bittner K, Mandel D. A qualitative study of the maternity care experiences of women with obesity: more than just a number on the scale. J Midwifery Womens Health 2016; 61 (02) 217-223
• 56 Dennis C-L, McQueen K. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics 2009; 123 (04) e736-e751
• 57 Milgrom J, Holt C. Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial. Trials 2014; 15: 385
• 58 O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol 2013; 9: 379-407
• 59 Hill B, Skouteris H, McCabe M, Fuller-Tyszkiewicz M. Body image and gestational weight gain: a prospective study. J Midwifery Womens Health 2013; 58 (02) 189-194
• 60 de Jager E, Broadbent J, Fuller-Tyszkiewicz M, Nagle C, McPhie S, Skouteris H. A longitudinal study of the effect of psychosocial factors on exclusive breastfeeding duration. Midwifery 2015; 31 (01) 103-111
• 61 Fuller-Tyszkiewicz M, Skouteris H, Watson BE, Hill B. Body dissatisfaction during pregnancy: a systematic review of cross-sectional and prospective correlates. J Health Psychol 2013; 18 (11) 1411-1421
• 62 Wazqar DT, Evans MK. Socio-cultural aspects of self-management in gestational diabetes. J Diabetes Nurs 2012; 16 (02) 62-66
• 63 Torloni MR, Betrán AP, Horta BL. et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009; 10 (02) 194-203