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Mom Files Rights Complaint Alleging Hospital ‘Fat Shaming’

A high body mass index shouldn’t be the sole determinant of risk for pregnancies, says Sara Lindberg.
Sara Lindberg
Sara Lindberg, 38, holds her two-year-old daughter Ellee in the family’s backyard in Maple Ridge, BC.

Thirty-one weeks pregnant with her first child, Sara Lindberg thought her consultation with an obstetrician at Ridge Meadows Hospital would bring her some peace of mind about giving birth in the thick of the first pandemic wave in 2020.

She had done painstaking research to find a hospital that was 10 minutes from her new home in Maple Ridge and would offer the best skin-to-skin contact support for  her and her baby.

Lindberg, who is fat, had a smooth  pregnancy. When she developed gestational diabetes in her second  trimester, her midwife team wasn’t worried because she was not diabetic or otherwise in poor health. She did need insulin, and welcomed the  chance to meet with an obstetrician about it.

However, like many prior prenatal  appointments, Lindberg said the consultation with the hospital’s head obstetrician, Dr. Rick Mentz, left her feeling like a victim of “just  fat shaming.”

The doctor “basically told me I was there because I was ‘obese,’” she said.

Many fat people consider the term “obese,” which originates from the Latin phrase meaning “to eat oneself sick,” offensive because it pathologizes their bodies’ sizes. The fat justice movement is reclaiming the term “fat” as a descriptor  like “tall,” rather than an insult.

Lindberg remembers Mentz calculating her body mass index in front of her, and then informing her it made her too “high risk” to deliver at Ridge Meadows.

The BMI is a single number determined using someone’s weight divided by their height squared. It has, in recent years, been challenged and discredited as a reliable indicator of an individual’s health.

But as a result of her BMI, Lindberg had to scramble to find new prenatal care nine weeks before she was due. Her midwives only had privileges to deliver at Ridge Meadows.

On the way back home with her husband, Lindberg clutched a handout on fatness and pregnancy she was given that she says implied her body was a danger to her baby. She cried. And cried.

“It was probably one of the worst days of  my life,” Lindberg said. Now, more than two years after delivering her healthy daughter Ellee with no complications at Royal Columbian Hospital in New Westminster,  Lindberg is pursuing a human rights complaint against Mentz and the Fraser Health authority alleging weight discrimination deprived her of the same standard of care afforded to people with lower BMIs.

“If I truly was so high risk, why wasn’t  there urgency to ensure I had care providers?” she asked in a statement  to the tribunal.

Lindberg has learned that women with lower BMIs were allowed to deliver at Ridge Meadows, despite being deemed “high risk” because of other health conditions like diabetes. And she said she has been in touch with women with high BMIs who had similarly  been denied delivery at the hospital.

“Having a birth like that made me feel like my body could do this,” said Lindberg. “It was very affirming for me.”

At Ridge Meadows, which is categorized as a  “low risk” maternal hospital, a BMI higher than 40 automatically meant a person couldn’t  give birth there. At the time of her pregnancy, Lindberg’s BMI was 41. In 2021, the benchmark was changed to 45, which would have allowed her  to deliver in the hospital.

Lindberg wants to see BMI benchmarks  removed from hospital policies entirely so that other fat people are not  deprived of essential care in their own communities. 

“BMI is a very outdated way to assess  someone’s health,” Lindberg said. “There are much more comprehensive  ways of assessing risk and I really feel like we need to take a lot of  these discriminatory policies out of health care.”

There are BMI limits and  cutoffs for other types of health services in B.C., such as  gender-affirming surgeries and organ transplants. But Lindberg argues the BMI should not be the sole determinant of risk for pregnancies.

When asked by The Tyee what, if any, BMI  limits are in place for people giving birth in hospitals, all five B.C.  health authorities said there is no universal standard. Rather, risk is  determined by individual hospitals and on a case-by-case basis, and  patients with higher BMIs, as per guidance from the Society of  Obstetrics and Gynaecology and the British Columbia College of Nurses  and Midwives, may have their care transferred to other hospitals to  prevent adverse outcomes.

At Ridge Meadows, the BMI limit was established by Mentz and other hospital supervisors, according to an explanatory letter Mentz sent to Lindberg in February 2021. 

There is evidence that shows correlation  between higher BMI and increased risks of pregnancy complications, such as inductions or the need for a caesarean section, Mentz wrote in the  letter.

Mentz also noted that should a C-section or induction be required, calling staff back after they go home at 11 p.m. could cause a dangerous delay. 

“We can deal with the majority of  emergencies that walk through our door,” wrote Mentz. “The difference  however in obstetrics is, we can identify patients during the antepartum  period who have the potential to develop serious complications, and we  feel it would be dangerous to not inform them of these potential  complications and have them deliver at our site.”

The Fraser Health authority declined to  comment while the Human Rights Tribunal case is ongoing and did not make Mentz available for interview with the Tyee.

Good health at any size

The BMI was first developed in the 1830s by  a Belgian scientist seeking to understand the characteristics of the  “average” white man. It doesn’t account for bone density, weight  distribution, muscle mass or many other factors that describe someone’s  body more accurately than just its size.

According to Patty Thille, an assistant professor at the University of Manitoba, BMI calculations — which don’t account for how genetics,  poverty and intergenerational trauma impact body size and composition —  have been used to justify eugenicist policies and to pathologize Black,  Indigenous and racialized people’s bodies.

Its use continues to disproportionately prevent racialized people from accessing necessary medical care, Thille said.

“It’s a very strongly held cultural belief  that weight is some transparent measure of health, and specifically body  fatness,” said Thille, who specializes in weight discrimination in  health care. “But the BMI tells you nothing about someone’s health  status.” 

While the BMI was never intended to be used  as an indicator of an individual’s health, its use as a measure of  health and life expectancy proliferated in medicine — and for insurance  purposes — throughout the 20th century.

There is also a misconception that weight  is simply the result of individual behaviour and is easy for someone to  change. But studies have shown that significant weight loss is not  sustainable long-term for the vast majority of people, and that weight  cycling and constant dieting damages an individual’s metabolism, making  it more likely for them to gain back the weight — and more.

Dr. Katarina Wind, a family medicine resident physician in Vancouver, doesn’t calculate her patients’ BMI  anymore. She is a proponent of good health at every size, noting how  many fat people have died of treatable conditions like cancer when  doctors dismissed their ailments and told them to “lose weight.”

“If we start thinking of weight as  something that’s non-modifiable, like someone’s height, then we can  start thinking about it properly and starting to treat them  differently,” Wind said.

Much of the evidence she learned in medical  school, Wind said, is “tainted” by the assumption that being fat is  inherently unhealthy or reflects individual failings.

In recent years, mainstream medical organizations like the Canadian Medical Association have recognized that the BMI is a poor predictor of health.

Lindberg’s claims echo what academic  research is starting to show and other fat women have long said about  their experiences with reproductive health care: that “mother blame” is  prevalent and they face stigma at nearly every stage of their pregnancy that deters them from seeking care in the first place.

Weight stigma expert Dana Solomon said  while there is evidence of correlation between BMI and more difficult  pregnancy outcomes such as caesarean sections, that doesn’t mean BMI and  complications are causally linked.

Poverty, nutrition, housing, trauma,  genetics, hormone and metabolic conditions all impact someone’s BMI, as  well as their likelihood of having pregnancy complications, Solomon  said. Low-income and Black, Indigenous and racialized people,  particularly in the United States where much of the research is, also  don’t have as much access to proactive care that would prevent  complications down the road.

“When you control for those factors, the  [BMI and complications] correlation really recedes,” said Solomon, who  is a researcher at the University of British Columbia’s Birth Place Lab.

Solomon cited a recent study that suggests when fat people have their care managed correctly during pregnancy, there is virtually no difference in C-section rates.

Solomon pointed out that weight stigma and discrimination in pregnancy itself increases the risk of complications and birth interventions,  and deters people from seeking care. That can lead to missed or  incorrect diagnoses, which cascade to inattentive care or increased  interventions such as C-sections when not needed. Weight stigma also increases rates of postpartum depression and makes fat people hesitant to seek health care for even minor issues, she added.

In addition, some hospitals may not have  the staffing levels or right equipment to be able to safely care for fat  people, which Solomon said is no excuse. 

“It’s like saying, ‘We don’t have a ramp, so we won’t treat people who use wheelchairs.’”

“Fat people are treated badly by  health-care professionals and all these things get more prevalent the  bigger you are,” said Solomon. “It affects people’s health on so many  different levels, like access to care, types of interventions you’re  able to get, how people talk to you and how they treat you. It’s  systemic and creates individual harms.”

Weight stigma — not the weight — is the  real issue, Solomon said, which perpetuates the idea that people are fat  as a result of poor individual choices and are therefore undeserving of  proper care.

Blaming and shaming worsens anxiety, depression
Lindberg has always had a larger body. She grew up active, playing basketball and hiking, and her body stayed the same size. 

She has hypothyroidism and polycystic ovary  syndrome, two conditions that slow her metabolism and affect how her  body processes nutrients and holds onto dietary fats. Her ability to  exercise has also been reduced as she heals from a car accident.

Since delivering Ellee, Lindberg has dealt  with postpartum anxiety and depression, which she feels has been  worsened by the blaming and shaming she experienced.

“It’s incredibly ableist to blame me for my size,” she said. “There is very little I can do to control my weight.”

Lindberg also questions why concerns about  the number of staff needed to lift her, if required, were used as  justification to deny her care at Ridge Meadows.

“It’s as if somehow my life and the life of  my baby meant less than the hypothetical thin women they would have to  treat as well,” she says.

After an unsuccessful mediation with Fraser Health and Mentz, Lindberg is continuing her claim with the Human Rights Tribunal.

This process has made it difficult to seek  health care for herself and for Ellee at Ridge Meadows. After the active  toddler bonked her head, Lindberg felt on edge taking her to the  emergency room to get checked out. 

She and her husband also wonder if they are willing to experience more stigma should they choose to have another child.

The hospital’s policy felt like an attempt  to shame and blame her into losing weight,  said Lindberg. “But it  actually increases our risks by disrupting our care,” she said.

“I hope other women don’t have to go through this.”