Do fat cells cry out for surgery?
I came across this study titled “Obesity prevalence and its impact on maternal and neonatal outcomes in pregnant women: a systematic review.” (Almutairi et al., 2024) that cracked me up. In their results they state:
“The studies reviewed highlight a strong association between maternal obesity and increased rates of caesarean delivery. Across various obesity classes, higher GWG (gestational weight gain) is consistently linked to elevated odds of caesarean section, with the risk notably increasing in more severe obesity cases. While several studies demonstrate a statistically significant relationship between obesity and caesarean rates, particularly among women with extreme obesity and substantial GWG, others suggest that lower weight gain may help mitigate this risk. Additionally, the presence of maternal comorbidities, such as pre-existing thyroid disease, further elevates caesarean rates among obese women. Overall, these findings emphasise the critical need for managing weight gain during pregnancy to reduce the risk of cesarean delivery in obese patients.”
It's as if the fat cells themselves are crying out for surgery! Somehow the mere fact of carrying more weight has become a primary risk factor for surgery while we know that structural weight stigma in healthcare settings create significant problems for larger bodied women. The results of a recent systematic review (Tran et al., 2025) revealed structural weight stigma in healthcare presented across:
institutional policies that are weight-centric and often placed women in larger bodies on “high-risk” pathways
the lack of government funding and insurance coverage for weight-related services
uncertainty amongst healthcare professions regarding their roles and responsibilities
stigmatising physical environments
lack of appropriately sized equipment
There’s nothing like a blood pressure cuff that’s too small to suddenly diagnose hypertension. (Maxwell et al., 1982 ~ yeah, we’ve known about this for that long)
What’s absolutely stunning is that if the woman manages to starve her pregnancy and gain very little weight or even lose weight, her “risk” of a caesarean reduces. How does the number on a scale translate into a surgeon being less likely to call for surgery? Was she a good girl? Did she please the surgeon with her attention to starving her pregnancy?
While the surgeon might be happier with her limited weight gain, the baby isn’t so lucky. Inadequate weight gain in obese women (any pregnancy) increases preterm birth, low birth weight, and stillbirth. (Class, 2021). But no doubt the increase in those adverse outcomes is still just a part of carrying more weight in their eyes.
The study concludes with “This study underscores the substantial impact of obesity on pregnancy outcomes.” No mention of the woman carrying the larger body or the practitioners who drive this nonsense or the structural issues that promote and most likely ensure worse outcomes. It’s just a “condition” that needs to be managed.
If we ask more questions, we might discover that the obese woman has a long history of anti-depressant use. Antidepressants are “obesogenic” meaning they are a medication that causes weight gain. (Fiedorowicz et al., 2021)
When did her usage begin? Quite likely just after she was prescribed oral contraceptives. (Johansson et al.,2023).
What we have is an industry that pathologises our female experience, medicates it, then tries to manage the consequences through nonsensical interventions that keep them in a perpetual state of cognitive dissonance and power.
We really can do better ours