Begin the Conversation: Tip Sheet

Begin the Conversation About Weight and Pregnancy

As a healthcare provider, you know that a woman’s weight may affect her pregnancy, the birth, and, in the long term, her own and her child’s health. Some plus-size women worry that their providers will judge them for their weight or size.

Use the following ideas to communicate effectively with plus-size pregnant women and deliver respectful, high-quality prenatal care.

  1. 1. Remind yourself that:

    • Prenatal care is important for all moms-to-be—including those with overweight or obesity. A prenatal care appointment could make the difference between a healthy pregnancy and pregnancy complications. Patients who have a negative experience with a provider might forgo the prenatal care they know they need.
    • Psychological determinants of health play a role in obesity. Talk to your patients about the factors that can influence their eating habits, physical activity, and weight. These factors may come from both home and work environments and can include finances, interpersonal relationships, family, culture, genetics, and a variety of stressors.
    • Language matters. Some women respond better to certain terms. Choosing words carefully may keep women from feeling stigmatized or judged.
      • “Plus-size,” “women of size,” or “because of your size” instead of “obese”
      • “Eating habits” instead of “diet”
      • “Physical activity” instead of “exercise”
  2. 2. Use active listening and reflect on the patient’s thoughts, feelings, and experiences to learn about her challenges and identify ways to support her.

    • Example: “Tell me about your lifestyle. Are you physically active? How would you describe your eating habits?”
  3. 3. Explain body mass index (BMI) and how it relates to health.

    • Some patients may be unfamiliar with the term or misinformed about what it means. Explain that healthcare providers use BMI to determine whether someone has excess weight. It is one of many factors that providers use to assess health risks during pregnancy.
    • Work with each woman to create a healthy pregnancy plan specific to her needs. Explain that taking into account all of her risk factors, health history, and other concerns promotes the best pregnancy outcomes.
  4. 4. Consider bringing up weight within the context of specific symptoms or concerns.

    • Example: “You mentioned fatigue and aching knees. Would you like to talk about things you can try to help you feel better?” If she says no, respect her choice and postpone the conversation.
  5. 5. If the patient wants to discuss healthy behaviors, determine how ready she is by suggesting specific actions and helping her set achievable goals.

    • Example: “How likely are you to consider a couple of small lifestyle changes, like eating one more serving of fruit or vegetables each day? That kind of small change can make a difference.”
  6. 6. Discuss any potential barriers to healthy behaviors, and suggest manageable, specific actions to help address them.

    • Example: If the woman says she does not know how to eat healthy, refer her to a registered dietitian or nutritionist you know or to the Academy of Nutrition and Dietetics’ Find a Registered Dietitian Nutritionist external link online referral service.

Citations

  1. American College of Obstetricians and Gynecologists (ACOG). (2019). ACOG Committee Opinion No. 763: Ethical considerations for the care of patients with obesity. Obstetrics & Gynecology, 133(1), e90–e96. doi: 10.1097/AOG.0000000000003016
  2. ACOG. (2016). ACOG Obesity Toolkit external link. Retrieved February 25, 2019, from https://www.acog.org/About-ACOG/ACOG-Departments/Toolkits-for-Health-Care-Providers/Obesity-Toolkit external link
  3. Strategies to Overcome and Prevent (STOP) Obesity Alliance. (2014). Why Weight? A Guide to Discussing Obesity & Health with Your Patients. Retrieved February 25, 2019, from http://whyweightguide.org/ external link
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