Semin Reprod Med 2023; 41(03/04): 63-69
DOI: 10.1055/s-0043-1777016
Review Article

Weight Bias in Reproductive Medicine: A Curiously Unexplored Frontier

1   Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
,
1   Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
› Author Affiliations

Abstract

Obesity has been associated with a multitude of medical comorbidities, infertility, and adverse obstetric outcomes. Weight stigma and weight bias pervade not only the medical field but also education, employment, and activities of daily living. The experience of weight stigma has been shown to adversely impact not only the mental health of individuals with overweight or obesity but also worsen obesogenic behaviors, and medical comorbidities. This review frames the rise of weight stigma and weight bias within the context of the “obesity epidemic” and explores its associations with infertility and decreased access to health care and its subsequent impact on the lives of individuals. Furthermore, it explores the concepts of intrinsic and extrinsic weight stigma/bias and highlights the need for further examination and research into the impact of these factors on access to reproductive medicine and subsequent outcomes.



Publication History

Article published online:
22 November 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Li M, Gong W, Wang S, Li Z. Trends in body mass index, overweight and obesity among adults in the USA, the NHANES from 2003 to 2018: a repeat cross-sectional survey. BMJ Open 2022; 12 (12) e065425
  • 2 Cohen SS, Signorello LB, Cope EL. et al. Obesity and all-cause mortality among black adults and white adults. Am J Epidemiol 2012; 176 (05) 431-442
  • 3 Moura LANE, Pagotto V, Camargo Pereira C, de Oliveira C, Silveira EA. Does abdominal obesity increase all-cause, cardiovascular disease, and cancer mortality risks in older adults? A 10-year follow-up analysis. Nutrients 2022; 14 (20) 4315
  • 4 Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309 (01) 71-82
  • 5 Vitek W, Sun F, Hoeger KM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Reproductive Medicine Network. Short-term weight change and live birth among women with unexplained infertility and polycystic ovary syndrome undergoing ovulation induction. Fertil Steril 2020; 114 (05) 1032-1039
  • 6 Legro RS. Effects of obesity treatment on female reproduction: results do not match expectations. Fertil Steril 2017; 107 (04) 860-867
  • 7 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: united states, 2017-2018. NCHS Data Brief 2020; (360) 1-8
  • 8 Sun X, Yan AF, Shi Z. et al. Health consequences of obesity and projected future obesity health burden in China. Obesity (Silver Spring) 2022; 30 (09) 1724-1751
  • 9 Ogden CL, Fryar CD, Martin CB. et al. Trends in obesity prevalence by race and Hispanic origin-1999-2000 to 2017-2018. JAMA 2020; 324 (12) 1208-1210
  • 10 Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016; 315 (21) 2284-2291
  • 11 Gesink Law DC, Maclehose RF, Longnecker MP. Obesity and time to pregnancy. Hum Reprod 2007; 22 (02) 414-420
  • 12 Zhu L, Zhou B, Zhu X. et al. Association between body mass index and female infertility in the United States: data from National Health and Nutrition Examination Survey 2013-2018. Int J Gen Med 2022; 15: 1821-1831
  • 13 Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online 2011; 23 (04) 421-439
  • 14 Prunty A, Hahn A, O'Shea A, Edmonds S, Clark MK. Associations among enacted weight stigma, weight self-stigma, and multiple physical health outcomes, healthcare utilization, and selected health behaviors. Int J Obes 2023; 47 (01) 33-38
  • 15 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
  • 16 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
  • 17 Johnson RJ, Lanaspa MA, Fox JW. Upper Paleolithic figurines showing women with obesity may represent survival symbols of climatic change. Obesity (Silver Spring) 2021; 29 (01) 11-15
  • 18 Eknoyan G. Adolphe Quetelet (1796-1874) – the average man and indices of obesity. Nephrol Dial Transplant 2008; 23 (01) 47-51
  • 19 Flegal KM, Shepherd JA, Looker AC. et al. Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. Am J Clin Nutr 2009; 89 (02) 500-508
  • 20 Borga M, West J, Bell JD. et al. Advanced body composition assessment: from body mass index to body composition profiling. J Investig Med 2018; 66 (05) 1-9
  • 21 Pan WH, Yeh WT. How to define obesity? Evidence-based multiple action points for public awareness, screening, and treatment: an extension of Asian-Pacific recommendations. Asia Pac J Clin Nutr 2008; 17 (03) 370-374
  • 22 Westbury S, Oyebode O, van Rens T, Barber TM. Obesity stigma: causes, consequences, and potential solutions. Curr Obes Rep 2023; 12 (01) 10-23
  • 23 World Obesity Day. End Weight Stigma. 2018 . Accessed November 5, 2023 at: https://s3-eu-west-1.amazonaws.com/wof-files/WOD2018Toolkit.pdf
  • 24 Rubino F, Puhl RM, Cummings DE. et al. Joint international consensus statement for ending stigma of obesity. Nat Med 2020; 26 (04) 485-497
  • 25 Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res 2001; 9 (12) 788-805
  • 26 Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring) 2009; 17 (05) 941-964
  • 27 Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes 2008; 32 (06) 992-1000
  • 28 Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: a systematic review. J Adv Nurs 2018; 74 (05) 1030-1042
  • 29 Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev 2018; 19 (08) 1141-1163
  • 30 Wear D, Aultman JM, Varley JD, Zarconi J. Making fun of patients: medical students' perceptions and use of derogatory and cynical humor in clinical settings. Acad Med 2006; 81 (05) 454-462
  • 31 Campbell K, Engel H, Timperio A, Cooper C, Crawford D. Obesity management: Australian general practitioners' attitudes and practices. Obes Res 2000; 8 (06) 459-466
  • 32 Bocquier A, Verger P, Basdevant A. et al. Overweight and obesity: knowledge, attitudes, and practices of general practitioners in France. Obes Res 2005; 13 (04) 787-795
  • 33 Hebl MR, Xu J. Weighing the care: physicians' reactions to the size of a patient. Int J Obes Relat Metab Disord 2001; 25 (08) 1246-1252
  • 34 Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One 2012; 7 (11) e48448
  • 35 Tomiyama AJ, Finch LE, Belsky AC. et al. Weight bias in 2001 versus 2013: contradictory attitudes among obesity researchers and health professionals. Obesity (Silver Spring) 2015; 23 (01) 46-53
  • 36 Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African-American obese women. Int J Obes 2006; 30 (01) 147-155
  • 37 Carr D, Friedman MA. Is obesity stigmatizing? Body weight, perceived discrimination, and psychological well-being in the United States. J Health Soc Behav 2005; 46 (03) 244-259
  • 38 Gudzune KA, Bennett WL, Cooper LA, Bleich SN. Perceived judgment about weight can negatively influence weight loss: a cross-sectional study of overweight and obese patients. Prev Med 2014; 62: 103-107
  • 39 Tomiyama AJ. Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model. Appetite 2014; 82: 8-15
  • 40 Wu YK, Liu Y. Weight-related stigmatization and binge eating among overweight adults in Southern Taiwan. Asia Pac J Clin Nutr 2015; 24 (01) 118-127
  • 41 Pearl RL, Wadden TA, Hopkins CM. et al. Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity (Silver Spring) 2017; 25 (02) 317-322
  • 42 Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci 2015; 26 (11) 1803-1811
  • 43 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: 19
  • 44 Teede HJ, Tay CT, Laven JJE. et al. Recommendations from the 2023 International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome. J Clin Endocrinol Metab 2023; 108 (10) 2447-2469
  • 45 Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil Steril 2021; 116 (05) 1266-1285
  • 46 Einarsson S, Bergh C, Friberg B. et al. Weight reduction intervention for obese infertile women prior to IVF: a randomized controlled trial. Hum Reprod 2017; 32 (08) 1621-1630
  • 47 Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update 2009; 15 (02) 189-201
  • 48 Romanski PA, Farland LV, Tsen LC, Ginsburg ES, Lewis EI. Effect of class III and class IV obesity on oocyte retrieval complications and outcomes. Fertil Steril 2019; 111 (02) 294-301.e1