In 2014, the National Institutes of Health (NIH) reported that more than 1 million pregnant women in the United States were obese. The Centers for Disease Control and Prevention (CDC) distilled this number further and found disparities among the demographics of women included in this statistic. By race, Black, Latinx, and Native American women have the highest rates of obesity while white and Asian women have the lowest. By income, women with a college education and those who can afford health care out of pocket have the lowest instances of maternal obesity.

Additionally, women who have had four or more children are more likely to struggle with obesity. This is significant in that pharmaceutical birth control is largely inaccessible and unaffordable for women who are financially disadvantaged. Given a look at the numbers, it’s quite simple to infer that maternal obesity is much deeper than a moral failing on behalf of the patient. It is not a moral failing at all. Systemic and socioeconomic factors create the circumstances that lead to maternal obesity, and the condition itself cannot be discussed without dissecting the root problem — as obesity is merely a symptom.

What Causes Obesity?

Several factors play into the development of the medical condition known as obesity. Obesity is a state in which a person’s body fat is considered far too high in relation to height and is considered a medical condition due to adverse health issues it causes. These complications include hypertension, type 2 diabetes, arthritis, and high cholesterol. Obesity has also been linked to hypothyroidism, hormone imbalances, gut microbe imbalances, depression, and eating disorders. Furthermore, weight gain is a side effect of many pharmaceuticals used to treat chronic conditions, including insulin, antidepressants, antipsychotics, beta blockers, and epilepsy medicines. Even doing things that are good for health, such as tobacco cessation, can cause rapid weight gain.

Apart from physical health and genetics, socioeconomic factors contribute to the development of obesity. Food insecurity is among the biggest health concern for those who reside in low-income areas. Neighborhoods outside of wealthy areas often lack grocery stores and farmer’s markets that provide affordable, fresh and whole foods. This leaves individuals of low economic status resigned to foods that are high in fat, sugar, and sodium. Additionally, people along the low-income threshold often work long hours that demand strenuous manual labor, thus it’s difficult to prepare a freshly cooked meal at the end of the evening.

Obesity is often viewed by society as a personal failure or act of laziness or apathy, but the truth is there are multiple factors that lead to excessive weight gain. These factors should be identified and strategically addressed before issuing a mandate to lose weight.

Obese While Pregnant

Excessive gestational weight gain puts pregnant people at risk of developing type 2 diabetes, preeclampsia, and heart disease. Other risks include miscarriage and stillbirth, sleep apnea, and increased chance of having a C-section, according to Mayo Clinic. For the baby, gestational obesity might put the infant at risk of birth defects, childhood asthma, and childhood obesity.

Oftentimes, women who are obese during pregnancy were obese before they conceived. However, clinical research shows that it is unsafe to lose weight while pregnant, and there is no evidence that losing weight while pregnant will reduce the chance of complications. Therefore, it is important that people are given the tools to maintain their health both before and after pregnancy.

Black women and women with low incomes who aren’t obese have increased risk of pregnancy complications, due to medical racism and lack of affordable health care. Obesity simply compounds these risks. In a study done by the NIH, 19% of participants admitted they avoid regular doctor visits due to the weight bias and stigma by their providers. Similarly, people of color often face a lack of trust for health care providers.

Preventive Care

Pregnant woman should talk with their health care provider about what physical activity is safe to maintain and what foods are best – and most accessible – to nourish their bodies and manage weight. Rather than focus squarely on weight loss (which can be dangerous while pregnant), expectant parents should be encouraged to make tangible changes to their overall lifestyle. Lifestyle changes within the first trimester can lower the possibility of elevated blood glucose (sugar), according to the NIH.

Health care bias and body-shaming patients makes already marginalized individuals more reluctant to step foot into a clinical setting. Naturally, this only makes health outcomes worse.

Self-care and community support, that centers health equity, are both imperative to the success of parents and their ability to raise healthy children. Health equity – removing every barrier to ensure [all] people receive quality health care regardless or race, gender, and socioeconomic status – is a social justice issue. It determines the well-being of future generations, and its long-term impact could fortify this country’s crumbling health infrastructure.