1. Killion, Molly M. MS, RN, CNS

Article Content

Discussing weight management with patients can be a challenging or even uncomfortable conversation for many healthcare providers. Although obesity is a medical condition, it is often accompanied by a bias that can negatively affect patients through disrespectful behavior, blaming, or inadequate care during pregnancy complicated by obesity (American College of Obstetricians and Gynecologists [ACOG], 2019). Obesity has potential for comorbidities including diabetes, hypertension, cardiovascular disease, and stroke (ACOG). Every woman with obesity during pregnancy will not have negative outcomes; however, there is an increased risk of complications specific to pregnancy including gestational diabetes, preeclampsia, prematurity, and stillbirth that may require heightened care and attention (ACOG).


Obesity is defined as a prepregnancy body mass index (BMI) of greater than 30 and then is further separated into grades 1 to 3 with grade 3 being a BMI over 40, a group which has more than tripled since 1970 and continues to rise (Bodnar & Himes, 2019). The Institute of Medicine published weight gain goals in pregnancy in 2009 that recommended that all women with obesity gain 11 to 20 lb, yet recent studies have suggested that goals should be further subcategorized for grades of obesity and women with grade 3 obesity should aim to gain no weight during pregnancy (Bodnar & Himes). The American Medical Association recently published guidelines for recommendations for physical activity that encouraged pregnant women to participate in at least 150 minutes of moderate-intensity aerobic activities each week through pregnancy and the postpartum period (Piercy et al., 2018). Given this information, pregnant women with obesity may need additional resources to aid them in healthy nutrition and exercise appropriate to their body and their pregnancy.


Suggestions on how to facilitate an open dialogue with women to discuss weight and lifestyle are offered by ACOG (2019) including: creating healthy behaviors as a goal for all women by calculating prepregnancy BMI and tracking weight gain to avoid stigmatizing those who may struggle with meeting these goals and to ease in making the conversation a part of normal prenatal care; avoidance of terms that define the patient as their condition instead of the condition that is a part of who they are as a whole person ("patient with obesity" is preferred over "obese patient"); treating obesity as a medical condition and giving it the focus and care required, which sometimes means referrals to other disciplines or specialists; using empathy to understand that diet and weight may be a difficult topic for the patient as well. It is unethical to refuse to care for a pregnant woman based on an arbitrary BMI cutoff; rather standard obstetrical care should be provided with referrals to specialists when or if needed (ACOG).


Obesity is a medical condition that many clinicians treat as an issue of lack of self-control, such as overeating and not exercising, and is often highly stigmatized (ACOG, 2019). When clinicians are practicing with this often-unrecognized bias, women with obesity may not get the medical care they need or compassionate care they deserve. Women who feel they have been treated with bias or disrespect based on their weight may delay or avoid seeking appropriate care (ACOG). All clinicians, including nurses, should use self-reflection to examine areas of bias and make sure this does not inhibit excellent, nonjudgmental, and respectful patient care (ACOG).




American College of Obstetricians and Gynecologists. (2019). Ethical considerations for the care of patients with obesity (Committee Opinion No. 763). Obstetrics and Gynecology, 133(1), e90-e96. [Context Link]


Bodnar L. M., Himes K. P. (2019). Maternal nutrition. In R. Resnik, C. J. Lockwood, T. R. Moore, M. F. Greene, J. A. Copel, & R. M. Silver (Eds.), Creasy and Resnik's Maternal-fetal medicine principles and practice (pp. 181-189). Philadelphia, PA: Elsevier. [Context Link]


Piercy K. L., Troiano R. P., Ballard R. M., Carlson S. A., Fulton J. E., Galuska D. A., ..., Olson R. D. (2018). The physical activity guidelines for Americans. Journal of the American Medical Association, 320(19), 2020-2028. [Context Link]