Reproductive Health Embodied

A Social Science Perspective on Eating Disorders, Obesity, and

PregnancyAndrea LaMarre, MSc.PhD CandidateVanier Scholar (CIHR)Department of Family Relations and Applied NutritionUniversity of Guelph

Agenda• Introduction• Taking a Social Science Perspective• Eating Disorders: Key Features• Eating Disorders in Pregnancy• Obesity – Biomedical and Critical Perspectives• Weight Stigma• Obesity & Weight Stigma in Pregnancy

Introduction: about me• PhD candidate• Primary research on

eating disorder recovery• Project manager for

“Reproducing Stigma” (U Manitoba)

• Daughter of a biomedical science prof

• Feminist• Wanderlust

Taking a social Science Perspective• Why should you care?– Medical school– Human impact– Critical thinking– Challenging objectivity

About Eating Disorders

About Eating Disorders• Anorexia Nervosa (AN) – Restricting subtype– Binge-purge subtype– Atypical

• Bulimia Nervosa (BN)• Binge Eating Disorder (BED)• Other Specified Feeding and Eating Disorder

(OSFED)

About eating disorders• Eating disorders in popular

culture– Assumptions & stereotypes– Barriers to diagnosis,

treatment– Important of honouring lived

experience

About eating disorders

• Complex intertwining of biological, social, and environmental factors

About Eating Disorders• Low recovery rates• Difficult to treat• Social sanctioning of many eating-disorder-related

behaviours

About Eating Disorders• Medical complications– Cardiac– Metabolic– Endocrine– Gastrointestinal– Neurological– Dental

Eating disorders in Pregnancy

• Women with eating disorders can & do get pregnant– Absent menses ≠ uniformly

anovulatory• Eating disorders may

_____ pregnancy– Pre-exist– Be precipitated by– Follow

Eating disorders in pregnancyRecognition• Little/no weight gain or weight loss• Restriction, skipping/avoiding meals• Fear of weight gain• Engaging in extreme exercise • Chronic fatigue• Dizziness, headaches, blacking out• Difficulty concentrating• Social isolation/avoidance• Increased depression/anxiety

Eating disorders in pregnancy

Complications• Pre-eclampsia• Preterm labour• Low birth weight in baby• Cardiac irregularities• Stillbirth/fetal death• Gestational diabetes• Miscarriage• Respiratory difficulties• Abnormal fetal growth• Cesearean birth• Difficulture breastfeeding

Eating disorders in pregnancy

• Monitoring of bodies: increased scrutiny• Triggering long-dormant eating disorders• Post-partum depression– 1/3 – 2/3 of cases

• Genetic links + hormonal changes

Eating disorders in pregnancyManagement• Multi-disciplinary care (doctors, psychologists,

dietitians, etc.)• Recommending delaying pregnancy until significant

recovery is achieved • Acute or long-term hospitalization may be required

in some situations

Eating disorders and fertility• People seeking fertility care may also have eating

disorders• Higher prevalence of ovulatory disorder in women

with severe eating disorders– May be less likely to present for assistive reproductive

technology; fear dismissal/stigma

“Obesity”• More complex than a number• Not the opposite of an eating disorder• The flaws of BMI

Reproducing stigma?

Reproducing Stigma?• 2011: fertility specialists debate whether to deny

services to women classified as obese• May present these women as unfit potential

mothers• Stigma itself may exacerbate health issues (Budd et al.,

2009; Erdman Farrell, 2011; Wray & Dreery, 2008)

Reproducing stigma?• Complex links between obesity & health: focus on

health (e.g. physical fitness, etc.), not size• Obesity stigma– Harrassment– Denial of healthcare services– Questioning of parenting abilities– Exacerbated amongst otherwise marginalized people

Reproducing stigma?• Barriers to women in larger bodies seeking

reproductive health care:– Being told to lose weight prior to full health screening

• Cited risks for maternal & infant health:– Gestational diabetes– Pre-eclampsia– Child health outcomes including future obesity, heart

disease, and diabetes

Reproducing stigma?“A lot of people who look like you have treated me like crap”– Participant in Reproducing Stigma study

1. Dignity and respect2. Collective, compassionate care3. Recognizing the body size ≠ health

Thank you!Questions?