Wednesday, January 19, 2011

Belly Thoughts

So, for those of you who have been pregnant, how did you feel about your pregnant belly?  How did you feel during pregnancy?  After pregnancy, with the post-mummy tummy?  Years later?

I was reflecting the other day on my relationship to my belly, especially in regards to my pregnancies and births ─ how I've celebrated it in some ways, and how I've struggled with it in other ways. 

I thought about things that I expected to happen and how the reality did or didn't meet those expectations, things that surprised me, things that pleased me, and things that made me unhappy or which challenged my peace with my body. 

Thought I'd share some of those thoughts here.  Hope you will share your own experiences too.

Trigger Warning:  Frank talk about body ambivalence and negativity. Some folks may find this post challenging or triggering and may want to opt out.

Worrying About Shamu

My first pregnancy was a surprise.  I went from being told I would not be able to get pregnant without "help" to being pregnant a few months later without trying.  So I was totally not prepared to think about pregnancy bellies! 

I hate to say it now because it sounds so vain, but I was really worried about what I'd look like pregnant.  I was already a large person; I figured when I was pregnant I'd look like Shamu. 

Now, I don't mean that in a negative way; I was pretty at peace with my body pre-pregnancy, and I didn't really "fear" being huge in pregnancy.  But I was having a hard time picturing the giant basketball belly you see on skinny women added to my already sizable frame, you know?  And I wondered what I'd be wearing on that basketball belly (or if I could find anything to wear at all, considering that it wasn't easy to find clothes even when not pregnant).

I know a lot of other women of size wonder these things too, because the top post viewed on this blog (by a HUGE margin) is the one on plus-sized pregnancy photos.  There are so few pictures of women of size out in the media, let alone pregnant women of size.  (And fat pregnant women of color?  Nearly impossible to find. Gah!)

The most common search words people use when they find my blog has to do with this search for images of fat pregnant women.  Except the phrases are usually "overweight and pregnant photos" or "obese pregnant belly" or "obese pregnancy pictures" or "plus-size pregnancy belly pics" and things like that.  There is a tremendous desire for pictures of pregnant women of size because I think so many fat women have that "Oh-My-God-What-Am-I-Going-To-LOOK-Like" anxiety. 

The Shamu obsession, I call it.

The Not-Looking-Pregnant-Surprise

The ironic gotcha to all that worry is that once I was well into pregnancy, I was disappointed to realize that I didn't look pregnant at all. 

People kept looking at me and wondering where the pregnancy belly was, I could see it in their eyes.  Well, it was there ─ it just wasn't visible to the casual onlooker.  I have a big ole rack-o-doom and that tends to hide any belly popping out pretty well, plus my baby was facing my belly (occiput posterior) for much of the pregnancy, which means you "show" a lot less (cause the baby's behind is facing the other way!). 

I was so NOT showing in pregnancy that most people couldn't even tell I was pregnant until the baby was nearly born.  My classic story of this was when I had to move during my 8th month of pregnancy.  I showed up to my new doctor's office, told them I was transferring care there from another state ─ and they eyed me and asked me if I needed a pregnancy test!  I said, uh no, I'm 8 months pregnant already and if you need confirmation, you can come over here and feel her kicking!  They still looked dubious but took my word for it. I was so upset that they couldn't tell I was pregnant even at that point.

The only time anyone knew I was pregnant was just before I gave birth at 40 weeks.  I was in an elevator, going up to my last OB appointment, and a doctor on the elevator remarked on my pregnancy (he didn't know me; he was just being kind and making small talk).  I could have kissed him!!  Finally, FINALLY, someone saw I was pregnant.

So in the beginning, I was most worried about just how large I might get in pregnancy, only to have the ironic problem of no one even knowing I was pregnant most of the time.  Some fat women do look obviously pregnant, but some don't.  A lot depends on factors like the position of the baby, your shape ("pears" show more than "apples" or "hourglasses"), and your overall frame. 

If you are bothered by folks not knowing you are pregnant, the secret is to wear obvious maternity clothing, stand with your hand massaging your belly a lot, and talk a lot about your pregnancy.  That will make it clear to all but the most oblivious by-stander that it's not just fat but actual baby in there too.  (Sad we have to be so OBVIOUS about it, but hey, if it brings you peace of mind, go for it.)

The Hard-Belly-Surprise

The biggest thing that surprised me about my actual pregnant belly was that it was hard

I was used to my belly being a bit more on the soft and squishy side ─ not flabby but not rock-hard either.  But in pregnancy, my "bump" was quite hard and that really surprised me.

The not-so-lovely part of this was that the squishy parts then drooped down to the underside of the baby bump and I developed an "overhang" that I'd never had before.  Eywww.

Now, I'm generally a lot more self-accepting than most but even I had trouble being loving and accepting of the big belly droop that sent all my fat south for the winter.  Permanently

That was a not-so-pleasant surprise.

And it only got worse with each kid. 

Four of 'em.

The Postpartum-Belly Reality

I have to be frank about this ─ this belly droop thing has been hard to deal with.  Honestly, it's not a part of my body that I'm so at peace with anymore. 

Hard as it may be for some people to believe, I really was okay with my belly before babies.  It wasn't flat, it did have a bit of a roll, but nothing all that remarkable. I carried more of my weight in my boobs, hips, and legs.  I was okay with my belly.  I wasn't photographing it and sending it off to magazines, but I really didn't hate it and I really did enjoy the fact that my waist was so much smaller than my hips, giving me that va-va-va-voom hourglass vibe. 

But post-children ─ oy.  The va-va-va-voom factor?  It va-va-va-vrooomed off to another universe.  The belly droops down now in a way it never did before.  If I move in just the "right" way, I can hear the "slap-slap-slap" sound of my flesh hitting against itself.  It never did that before children!  Oh my gosh, I cannot tell you how much I absolutely loathe that.

And that hourglass figure?  Well, it's not a straight line but it's closer.  I gained a lot of abdominal fat in my pregnancies, and I dislike that for a number of reasons, both aesthetic and more importantly, because abdominal visceral fat is much more of a health risk.  I used to be very much a pear, or at least an hour-glassy pear with boobs.  Now I gained an apple to add to the pear with boobs, leaving me just fat all over.  That didn't make me very happy. I don't mind being fat, but I really liked actually having a shape.  Now, I feel more like a blob.

The extra abdominal fat certainly wasn't from gaining "too much" weight.  I gained a total of 5 lbs. net (lost 10 or so and then regained 15) on average with each child.  I bounced around a bit between each but ended up at about the same weight I started my first pregnancy.  However, you'd never know it from looking at me.  I look quite a bit heavier now than I did before my pregnancies.  And that sucks, I have to say.

It sucks not because I'm fat but because I look a lot fatter than I really am.  I basically am the same weight as 16+ years ago....but I sure look a lot heavier.  I'm not thrilled with that ─ but the real reason it sucks is because I know from the research that abdominal fat really is more risky. Even though I didn't gain "too much" and even though my eating habits actually improved from pre-pregnancy....I look more at risk, and probably am more at risk.  Damn.

The Lipedema Effect

As a side note of interest, I should point out that the bellyfat gain is probably due to lipedema (warning: not a fat-acceptance link).

People with lipedema (not the same as lymphedema) have a tendency to gain abnormal fat deposits in the lower body, especially the legs, but sometimes also in the abdomen or upper arms. They often gain a lot of these fat reserves during times of major hormonal changes, like puberty, pregnancy, menopause, etc.

My legs look just like the picture here, my legs got bigger symmetrically, I have the classic "cankles" with the ring overlap at the bottom yet my feet are not affected, and it is extremely painful to have any pressure on my legs, especially my lower legs.

While the lipedema fat gain did happen a bit, it was not too bad with the first few pregnancies. However, in the fourth pregnancy (in my 40s), the combination of pregnancy plus perimenopause plus postpartum thyroiditis did seem to add an awful lot of fat, both around my ankles and in the abdominal area.

So while I'm technically at the same weight I started my pregnancies out with, my fat levels have definitely increased, and that's been difficult to be at peace with.

Now, the belly droop thing is pretty common among women of size after pregnancy.  Fat women often experience this, regardless of how much weight they gained, how they gave birth, etc.  (Some get it without pregnancy too, especially if they've had a lot of drastic weight loss/regain in their lives.) 

But mine may be worse because of my 2 cesareans, because many women (fat or skinny) who have had cesareans find they have a post-cesarean "shelf" or "flap."  I'm sure some would be there anyhow without cesareans, but most cesarean moms really do see a marked increase on the belly flap-o-meter, and I'm sure being fat and having lipedema and having had cesareans only magnified that lovely effect.  [Another *#ing gift from my cesareans!]

So all in all, I've had some real challenges to my body acceptance after four children.

Belly Ambivalence

I take some comfort in knowing I'm not alone in my belly ambivalence, though.  A lot of women have droopy bellies postpartum, a ton of stretch marks, and a different overall shape than before. 

A change that drastic ─ well, it's just not that easy to come to terms with, no matter how much you love your body in general, or how much you adore your babies and wouldn't trade them for the world. So having a hard time coming to peace with your body afterwards is very normal, as you can see here:

Beware, though, this is not a body-acceptance or fat-acceptance site at all.  These women have all the self-hate of their bodies (and especially their fat bodies) that is so typical of women in our society.  Add in the wrinkly, saggy belly that is universal immediately postpartum, and the body hate talk there can be really strong at times.  So while the pictures at Shape of a Mother are great to see, you should know that the self-hate talk may be triggering for some. 

Personally, I still find the site useful, even though I find the self-loathing and pro-dieting talk frustrating. I try to remember that it does reflect the ambivalent feelings many women have about their bodies post-partum ─ magnifying whatever body image issues they already had pre-pregnancy ten-fold.  Plus I just don't know any other sites out there that have such honest pictures of postpartum bodies. So I value the absolute honestly of the pictures themselves enough to try and overlook the self-hate talk.

Here is the link to the category of pictures of pregnancy and post-pregnancy bellies in women of size:

[Again, be warned that there's lots of diet talk and WLS (weight loss surgery) discussion there.]

Belly Honor

No, it's not easy to stay at peace with your body (and especially your belly) during pregnancy and post-partum.  There are many challenges to body image, and the natural changes that come with pregnancy can exacerbate the body image issues of even the most self-accepting woman.

Still, it's important to honor the vital work that our bodies did, to love every bump and curve for the job it did bringing a new soul to the earth, growing a healthy being and helping it into this world, and nurturing that new life afterwards.

I guess my main message on this is that it's normal and okay to be a bit ambivalent about your body shape and condition after birth (even long after birth).  Don't hate on it, recognize the important work it did ─ but realize that it's totally normal to have some ambivalence about it too.

Acknowledge that, and then take some time to honor your belly anyway. 

To honor my belly despite my ambivalence, here are some shots of me several years ago in my last pregnancy.  I was "overdue" and impatient to have the baby, but I'd been down the Seduction to Induction Road before, knew how often it leads to a cesarean, and refused to get lured into that trap again.  So I was waiting....and waiting....and waiting...and waiting.  Baby didn't come until nearly 43 weeks by LMP (nearly 42 by adjusted dates).  Augh!

So to distract myself and to have some fun in those last few days, I put on my oldest, ugliest painting clothes, gave my kids a bunch of washable tempera paint, went out into the back yard, stuck out my belly, and gave them a new and unique painting canvas. 

They were young; the resulting artwork is probably not beautiful to anyone in the world except me, but we had a BLAST.   

I remember that belly-painting session with tremendous fondness.  I hope they do too. 

So I honor my belly, stretched out and saggy and droopy as it was (and still is), for all the work it did bringing my wonderful babies to me, like this one, below. [Yes, she is the one in-utero above.]

It was totally worth it, every bit of it.  

Enjoy. And find a way to honor your bellies, too.

*Art Docent HintsIf you enjoy a good mystery and want to try and deciper the painting, look for the picture of the baby they drew.  Look for the green head with a brownish arm sticking out to the side underneath (the rest of the body is a bit amorphous, I'm afraid). Also look for the word "baby" on the side.  There was an arrow below it, pointing to the baby, but it got obliterated by an overenthusiastic toddler.  Then they filled in the blank spaces with random colors and swirls. The final result was a bit Picasso-ish, but hey. 

**Fetal Position Postscript: For the curious, yes, in this picture my baby bump is really quite visible, but then my baby in this pregnancy was in the most optimal position for birth, which is anterior.  That means the little butt was sticking out in front, making a nice big bump to paint on.  In my first pregnancy, when I didn't look pregnant at all, baby was posterior and in that position the baby butt doesn't stick out and make much of a discernible bump.  The difference? I saw a pregnancy-trained chiropractor and got some adjustments.  That made my last pregnancy SO much more comfortable, and it helped baby to be anterior after 3 prior pregnancies with a posterior baby!  Trust me, that's a MUCH easier labor!

Thursday, January 13, 2011

About Time: Asking Fat Women About Their Experiences

This is one of those no-duh studies, but I thought it was interesting enough to pass along.  Here's the study abstract.  [emphasis mine]

Nyman VM et al.  Obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth.  Midwifery. 2008 Dec 17.

OBJECTIVE: To describe obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth.

DESIGN: A qualitative study using a phenomenological approach. Data were collected by means of interviews that were tape-recorded.

SETTING: The women's homes or at a hospital in western Sweden.

PARTICIPANTS: 10 women with body mass index greater than 30, three primiparous and seven multiparous, who had given birth at a hospital in western Sweden in the period between October 2006 and September 2007 were interviewed four to six weeks after childbirth.

FINDINGS: The meaning of being both obese and pregnant is living with a constant awareness of the body, and its constant exposure to the close observation and scrutiny of others. It involves negative emotions and experiences of discomfort. Feelings of discomfort increase as a result of humiliating treatment, whilst affirmative encounters alleviate discomfort and provide a sense of well-being.

CONCLUSION AND IMPLICATIONS FOR PRACTICE: Obese pregnant women are a vulnerable group because obesity is highly visible. Caregivers tend to focus on providing care to obese patients somatically, but are additionally in need of knowledge about care from the woman's point of view.

Many obese women have negative experiences of health care that they have to overcome.

It is necessary to individualise care for obese pregnant women, which involves taking time to give the women an opportunity to tell their own story.

Caregivers have to promote health but it has to be done honestly and respectfully.

In order to avoid judgmental attitudes and causing increased suffering for obese pregnant women, midwives and physicians need to be conscious of, reflect upon and verbalise their own attitudes and power

My Comments

I wish more doctors and midwives would reflect thoughtfully upon their attitudes, assumptions, and biases around "obesity," and realize just how much negative impact insensitive and fat-phobic care during pregnancy and birth can have.

AND if they'd only realize that "promoting health" doesn't necessarily have to mean promoting weight loss ─ that health can be promoted without dieting/weight loss being the keystone.

How much could outcomes be improved if they promoted Health At Every Size instead of weight loss as the goal?Sigh.

*Your comments?

Thursday, January 6, 2011

Score!! Winter Stuff in Extended Sizes

I've written before about the difficulties I've encountered finding good rain gear and winter coats in extended plus sizes.  It's a problem that frustrates me no end.  I'm a chronically cold person (even when my hypothyroidism is well-controlled), and I get cold far more easily than anyone around me.  I need good warm clothing, sweaters, raincoats, and winter coats. 

We discussed before that my best sources so far were Junonia (women's sizes to 4x, sometimes 5-6x), and sometimes Land's End (women's sizes to 3x, men's sizes to some 4-5x) and L.L. Bean (some women's sizes to 3x, men's sizes mostly to 2x but a few 3x).  I can sometimes get outstanding stuff in these companies, but not always. 

The quality at Junonia really varies; some stuff is great, and some stuff isn't, either in fit or in quality. I got a ski jacket from them that was a huge disappointment, and a fleece jacket that was only so-so. And while they have some of the QuickWik-type materials and some ski wear, the stuff I've gotten from them in these have not been of the quality my kids get at REI or other major sports labels.  There's really a noticeable difference in terms of high-tech gear that helps wick away moisture or helps hold in the heat etc.  And as I see my kids with the really good stuff, I think ─ why can't I have that stuff too?

Land's End and L.L. Bean usually have some good stuff, and I got a couple of really great moderate-cold coats from them last year.  I also got a great wool sweater (not scratchy at all) from L.L. Bean that I use for keeping warm inside.  But the problem is that LL Bean stuff typically only goes up to a 2x in men's. Both LL Bean and Land's End only go to 3x in women's (not quite big enough in the boobs for me).  So, not always the best match for me.

Well, now I have a new source: Columbia Sportswear.  I knew about this company before, but last time I checked they didn't have women's coats anywhere close to my size.  My husband bought me a men's extended size coat from them 12 years ago, but it wasn't that great.  So I never really considered shopping for myself there.

But recently, a friend of mine gave me a "friends and family" pass (major discounts!) to Columbia's online store. My oldest son needed a bigger ski jacket, so I was hoping to use the pass to get a really good ski jacket for him at a halfway decent price.

When I went online to shop, though, I discovered that Columbia now carries extended sizes.  Score!!!

As is so typical these days, they only carry women's sizes to a 3x, which is almost but not quite enough for me....BUT they had men's sizes to 4x and 5x at times.  Whoohooo!

While it ticks me off majorly that more accommodation is made for men of size than for women of size (i.e., men are "allowed" to be fatter than women, and "allowed" to have more functional and quality clothing in extended sizes), I had to take a deep breath and move on.  At least they had some stuff in 4x, and I hoped the men's 4x might fit me. (Men's plus sizes are shaped differently ─ bigger in the belly and smaller in the chest and hips than I am ─ so it wasn't a sure thing). 

Because I had this one-time pass for a major discount, I took a risk and ordered a whole BUNCH of things from in 4x, crossing my fingers that they would work.  

Well, I got my package this week and IT WORKED!!!  I am so stoked.  I got a moisture-wicking shirt for workouts, a couple of full-zip or half-zip light jackets/fleeces, a high-tech wicking half-zip for layering warmth, a rain jacket (with special lining for more warmth), a soft-shell jacket (fleece on the inside, waterproof on the outside), and a full-on ski parka. 

I tried them all on and they all worked.  And the quality was way better than the stuff I ordered via Junonia, Land's End, or L.L. Bean.  Whoohooo!

I almost bought a pair of hiking pants too, but I decided not to risk buying pants at this point.  Men and women's shapes are too different and I've not had good luck buying men's pants in the past, so I didn't want to waste money on something I couldn't try on in person. 

But to get such ultra-warm, high-quality coats in my size?  Freakin' awesome when you consider I've been looking for years for quality stuff like this. 

Oh, and my son?  Got an AMAZING ski jacket ($260 retail!) for $90, plus some fitness shirts, hiking shirts, rain pants, and ski pants.  All very high-quality materials and workmanship, and they will keep him well-equipped for skiing, snow caving, wilderness survival, fencing, and Boy Scout hikes. 

I'm way poor now but it was worth it!  All in all, an excellent find!  They don't go to 4-5x in everything, alas, and they are quite pricey without the discount pass ─ but they had quite a few choices in coats, at far better quality than most other sources. Worth the price if you are needing a really good winter coat.

Tuesday, January 4, 2011

Can Fat Prejudice Be Changed?

Weight bias among healthcare professionals is a significant problem ─ but how do you combat it? 

Here are a couple of recent studies that discuss that.  The first is a review of other studies, and the results are not very encouraging.  The second is a bit more encouraging. 

How do you think we can best combat the issue of weight bias/stigma among healthcare professionals?

Daníelsdóttir S, O'Brien KS, Ciao A. Anti-fat prejudice reduction: a review of published studies.  Obes Facts. 2010 Feb;3(1):47-58.   PMID: 20215795

Division of Psychiatry, Landspítali-University Hospital, Reykjavík, Iceland.


Prejudice against those who are perceived as 'fat' or obese (anti-fat prejudice) is rife, increasing, and associated with negative outcomes for those targeted for such treatment.

The present review sought to identify and describe published research on interventions to reduce anti-fat prejudice. A systematic search of relevant databases (e.g. PsychInfo, PubMed, Scopus) found 16 published studies that had sought to reduce anti-fat prejudice.

Most notable was the lack of research on interventions for reducing anti-fat prejudice. Methodological problems that limit the interpretability of results were identified in the majority of studies found. Interventions employing more rigorous experimental designs provided at best mixed evidence for effectiveness.

Although several studies reported changes in beliefs and knowledge about the causes of obesity, reductions in anti-fat prejudice did not typically accompany these changes. Anti-fat prejudice interventions adopting social norm- and social consensus-based approaches appear encouraging but are scarce.

The lack of prejudice reduction following most interventions suggests that psychological mechanisms other than, or additional to, those being manipulated may underpin anti-fat prejudice. New directions for researching anti-fat prejudice are suggested.

Given the strength of antipathy displayed toward those who are perceived as 'fat' or obese, research in this area is urgently required.

O'Brien KS, Puhl RM, Latner JD, Mir AS, Hunter JA. Reducing Anti-Fat Prejudice in Preservice Health Students: A Randomized Trial. Obesity (Silver Spring). 2010 Nov;18(11):2138-44.  PMID: 20395952

School of Psychological Sciences, University of Manchester, Manchester, UK.


Anti-fat sentiment is increasing, is prevalent in health professionals, and has health and social consequences. There is no evidence for effective obesity prejudice reduction techniques in health professionals. The present experiment sought to reduce implicit and explicit anti-fat prejudice in preservice health students.

Health promotion/public health bachelor degree program students (n = 159) were randomized to one of three tutorial conditions. One condition presented an obesity curriculum on the controllable reasons for obesity (i.e., diet/exercise). A prejudice reduction condition presented evidence on the uncontrollable reasons for obesity (i.e., genes/environment); whereas a neutral (control) curriculum focused on alcohol use in young people.

Measures of implicit and explicit anti-fat prejudice, beliefs about obese people, and dieting, were taken at baseline and postintervention. Repeated measures analyses showed decreases in two forms of implicit anti-fat prejudice (decreases of 27 and 12%) in the genes/environment condition relative to other conditions. The diet/exercise condition showed a 27% increase in one measure of implicit anti-fat prejudice. Reductions in explicit anti-fat prejudice were also seen in the genes/environment condition (P = 0.006).

No significant changes in beliefs about obese people or dieting control beliefs were found across conditions.

The present results show that anti-fat prejudice can be reduced or exacerbated depending on the causal information provided about obesity. The present results have implications for the training of health professionals, especially given their widespread negativity toward overweight and obesity.