Dealing with infertility can be a scary and unpredictable journey. What starts out as an exciting new chapter can quickly start to feel confusing and overwhelming. Why isn’t it happening for me? You make an appointment with your doctor, hoping for helpful advice. Sadly, many women are met with something decidedly different. You have to lose weight for fertility. Or worse, you have to lose weight before we can even work with you. It can be a crushing directive that leaves many women feeling like they have no other choice. After all, the doctor must know what is best, right?
Health at Every Size has gained traction in many aspects of healthcare. If you’re unfamiliar, HAES promotes the idea that bodies can be healthy at lots of different sizes, not just the ones that fit neatly into the “normal” section of the BMI chart. We learn more and more every day about how weight likely doesn’t cause all the health problems we’ve been warned about for years. Associations between “overweight” and “obese” body weights (according to the BMI chart) and chronic disease are just that– associations. Male pattern baldness is associated with heart disease, but that doesn’t mean that hair loss causes heart attacks.
Fertility, however, is one aspect of healthcare where HAES voices are still relatively silent. Women are still being told by their doctors that being “overweight” or “obese” is causing their fertility problems. Worse, many of these women are being turned away from receiving any kind of care until they lose X amount of pounds. These women, filled with desperation and urgency, are left with limited options: Lose the weight or let go of the idea of being a mom. But when there’s an abundance of research showing that dieting for weight loss doesn’t work for upwards of 98% of people– and may even result in weight gain in the long term– how is prescribing weight loss in any capacity (but especially for improving fertility) considered evidence-based medicine?
The answer is it’s not. Yet the literature about fertility and weight loss is incredibly deceiving. Study after study concludes that risk of infertility increases with BMI, however, many of these studies imply correlation, not causation. Clinical trials that do attempt to establish causation produce mixed results: sometimes weight loss leads to better fertility outcomes, but in many cases it does not. Some of the strongest research suggests that postponing fertility treatments for overweight women in order to conduct weight loss interventions does not result in higher pregnancy rates; The only certain impact this delay has is to make an incredibly stressful and anxiety-filled period even longer.
How to navigate fertility in a larger body without weight loss or dieting
All women in larger bodies struggling with infertility who have been told they have to lose weight to get pregnant deserve to know that they have other, healthier options. Not only does the research not conclusively show that weight loss improves fertility, we know that diets can negatively impact a healthy relationship with food and your body. When fertility is affected by a spectrum of factors like stress, sleep, nutrition, movement, and even genetics, dieting may ultimately be working against you. We recommend trying a few of these tips to make navigating your infertility in a larger body more focused on self care and less focused on the number on the scale.
Nourish your body without giving up your favorite foods.
Fertility diets have become extremely popular. And while recommendations to eat more fruits, vegetables, whole grains, and protein-rich plants are not inherently bad, adopting an ‘eat this, not that’ approach can quickly spiral into a diet-focused mentality. You shouldn’t cut out your favorite foods that bring you joy and comfort during this time. We’ve written about fertility nutrition in a two-part blog series, which you can find here [INSERT LINK].
Listen to what your body has to say about what feels good and what doesn’t
You don’t owe it to anyone to do more, more, more in an effort to “fix” your infertility, especially if it comes at the cost of your physical and mental health. We discuss the idea of intuitive eating with many of our mamas-to-be because the mindfulness they learn to apply to their diets can be applied to other areas of your life as well. Move your body in ways that feel good and not like punishment; choose to take an afternoon nap instead of taking on another project when you’re feeling tired. Find ways to relax and relieve stress like yoga or journaling. Tuning into your body and its signals takes some time and practice, but it can be an extremely rewarding process.
There are women with fertility stories similar to yours that end in success! Find them and follow them.
You are not alone. It can be incredibly uplifting and encouraging to read about and connect with other women who have struggled with infertility in a larger body who went on to have happy, healthy pregnancies. Whether it’s with friends and family, or with strangers online, surround yourself with body positivity and weight-inclusive fertility talk. Check out #fatfertilitymatters on social media for more body-positive fertility warriors like yourself!
Mother, fertility coach, and author of “Fat and Fertile,” Nicola Salmon is a great online resource for women struggling with infertility in a larger body. Nicola offers a free “Fat Girls Guide to Getting Pregnant” on her website. She also offers fertility coaching that takes the focus away from weight and weight loss and puts it back on you and your physical and mental health. You can listen to Nicola discuss what she calls “fat positive fertility” on various podcasts with HAES dietitians Julie Duffy Dillon and Heather Caplan, and educator and author Robyn Birkin.
As your dietitians, we are also here to support you on your journey as a member of your HAES healthcare team. We don’t believe in restrictive diets, nor will we ever judge your health by your weight or your BMI. We understand that everyone’s fertility story is different, and that no one approach will work for everyone, which is why we spend so much time getting to know you, your lifestyle, and your goals. Getting pregnant without weight loss is possible, and we’re here to support you every step of the way.
Kaitlin Williams Eckstein, MPH, RD, LD
Fertility Specialist Dietitian
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