About nutrition
One thing that hurts me and excites me when I’m in one of the online nutritionist / therapist groups I belong to is seeking the recommendation of an OB-GYN or fertility drug doctor. .. Fat women (I use fat women as a neutral descriptor, for example, short, tall, thin, etc.) tell you that you need to lose weight before you become pregnant. ..
The recommendations to lose weight to improve the chances of a successful and healthy pregnancy are widespread, but there is no rigorous evidence to support it. So why are so many professionals, medical societies, public health programs, and treatment centers promoting weight loss before starting fertility treatment? The answer is a combination of weight bias and epidemiological studies, Association Between “obesity” and infertility. However, causality is not the same as causality.
“Health providers know that obesity is associated with greater complications during pregnancy. Fertility providers are also aware of the link between obesity and reduced fertility. Time can be double that of women with elevated BMI [body mass index]”Angela Sire, a Seattle Reproductive Medicine physician and founding partner, said. “From these historical studies, doctors hypothesized that if a woman could lose weight, she could improve her pregnancy and time to birth. They lost weight without knowing if it really helped. I recommended. “
Recent Randomized Controlled Trials — A type of study that can show cause and effect found that weight loss did not help. According to the results of the FIT-PLESE trial published at PLOS Medicine in January, 379 women with a BMI of 30 or higher and unexplained infertility (which cannot be explained because women ovulate normally), 16 It included a weekly intensive weight loss intervention. Low-calorie diets, physical activity (increasing up to 10,000 steps per day), and drugs that reduce fat absorption were not better at improving fertility or fertility than simply increasing physical activity interventions. .. This was despite the fact that women with weight loss intervention lost about 7% of their starting weight. The authors conclude that there is no strong evidence to recommend weight loss before pregnancy in women with unexplained infertility with a BMI in the “obesity” range.
“Changing existing doctrine requires such a well-designed study,” said Thyer, which is surprising to many providers as it disproves long-standing beliefs about weight loss and fertility. did. “Now I can confidently say that there is no evidence that weight loss improves the pregnancy of overweight women with obesity or ovulatory infertility.”
The research may have been amazing, but it has a company. In a 2016 randomized controlled trial published in the New England Journal of Medicine, infertile women (women who ovulate regularly and women who do not) who received similar interventions, including a low-calorie diet, It turns out that there are fewer healthy births than women who do not, and try to lose weight.
Judy Simon, a registered dietitian who owns Mind Body Nutrition, said: “But if you decide to eat a calorie-restricted diet, you’re more likely to lack important nutrients that optimize fertility and pregnancy. I have women with an average or low BMI. , Surprised to be subject to IVF [in vitro fertilization]Still, she has an eating disorder and may be undernourished. In fact, women who go to fertility clinics are more likely to have past or present eating disorders. Weight is not equal to health, especially when considering nutrition and lifestyle habits. “
Thyer said that if weight loss can help a particular patient for a particular purpose, it should be approached with compassion and ideally expert guidance. “Patients can be discouraged, discouraged, and disappear for years if weight loss is recommended without instructions,” she said. “And we know that as a woman gets older, her fertility also declines. Unfortunately, I’ve seen her in my practice where this happened.”
For over a decade, Simon and Thyer, who have been talking about “Checking for Weight Bias at the Door: How to Become a Body-Affirming Healthcare Provider” at the Seattle Reproductive Symposium in May, focus on the Food for Fertility class. I have provided it. Learn about eating abilities, such as planning meals and cooking together, and changing your lifestyle in a collaborative group environment. “Many of the participants who were preparing for in vitro fertilization actually became pregnant naturally after eating regularly and feeling confident in their bodies,” Simon said. Not all focused on weight loss.
“We do not withhold female infertility treatment because of BMI,” Thyer said. “We recommend that all women optimize their lifestyle before pregnancy. It is plant-positive, all foods, fertile diets, daily regular activities, Aiming to reduce the use of substances such as alcohol, tobacco and cannabis, aim for a restful and restorative sleep, a loving and supportive network of friends and family on the path to pregnancy, reducing stress. To maintain. “
Some providers may recommend weight loss based on outdated information, Thyer said. “Thankfully, the trend is changing. Many healthcare providers now recognize that weight loss alone may not help the fertility of most patients with high BMI. We also recognize that restricted diets are unhealthy and can fail over time, and weight circulation is worse than maintaining your current weight. “
Simon said there are BMI patients over the age of 55 who have been rejected by the fertility clinic. “Fortunately they found other help,” she said, and when dealing with infertility is already stressful and women feel guilty and shameful about their size, it’s their mentality. He added that it could be detrimental to his health. “I have had great success in working with fat women who support themselves before and after pregnancy. I support them claiming themselves and their size. increase.”
