Effective communication

Weight and obesity are sensitive issues. It's important that health professionals are able to find the right language to work constructively with pregnant women.

Health care professionals in the UK and internationally have described their difficulties when discussing obesity with patients. Obesity is a sensitive subject, associated with social stigma. Discussions need to be handled sensitively and supportively to avoid jeopardising patient relationships and reinforcing stigma.

Health care professionals have been described as being ambivalent, insulting, demeaning, discriminating, judgemental, blame-inducing, highly insensitive, patronising and derogatory when dealing with obesity.

• Previous negative experiences with health care professionals relating to weight can lead to avoiding or delaying seeking health care.
• Women avoid confronting health care professionals about humiliating treatment for fear of jeopardising their maternity care.

Barriers to effective communication

Barriers to discussing obesity include:

• difficulty initiating the discussion
• awkwardness and embarrassment (on both sides)
• the health care professional's own body size (including being overweight, with low patient confidence in the advice given, and not being overweight and appearing to have no empathy)
• difficulty avoiding reinforcing social stigma
• personal prejudices
• dealing with complaints
• lack of training and knowledge
• lack of time
• lack of support services available to work with obese pregnant women.

Think about the barriers which apply to you and prepare strategies in advance to deal with them.

Initiating the discussion

All pregnant women should have their weight and height measured, and their BMI calculated at booking, which provides an ideal opportunity to initiate the discussion.

Time constraints

Addressing a woman’s weight gradually throughout the pregnancy will help to spread the workload, allow time for building trust, and make it easier for her to process the information.

Lack of support services

Find out what services are available in the local community that pregnant women can join, particularly any free or subsidised services.

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Terminology

The language used to discuss obesity can make a big difference to women. Although the term obese is clinically accurate, it is often described as being offensive. There are ways of using terminology to reduce the likelihood of upsetting women and harming your relationship. 

One alternative is to talk about weight, rather than using the word 'obese'. For example, when measuring height and weight, and calculating the BMI at booking you could say 'your BMI shows your weight is outside the ideal range' rather than 'your BMI shows you are obese'.

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Understanding obesity

It is important to remember the complexity and inequalities associated with obesity when offering lifestyle advice. For example, women living in areas of high deprivation might not have easy access to fresh fruit and vegetables, so you may need to advise stocking up on dried, frozen or tinned as alternatives.

Similarly some women may not have the finances to pay for structured activities such as swimming, or they may struggle with the idea of exposing themselves in places like gyms or pools. It might be more appropriate to encourage them to get off the bus a stop earlier, or use stairs rather than lifts and escalators in their day to day activities.

Don’t be judgemental about a woman's weight, put any prejudices that you may have aside, and don’t presume that you already know about their diet quality or level of physical activity because of their size. Factors that are considered important to build and maintain a trusting relationship include being listened to, believed, and health care professionals showing empathy, compassion, awareness of stigma, and respect.

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She might say..... you could say....

How much weight should I gain during pregnancy?

In the absence of UK evidence-based guidelines, a practical way to answer this question is on an individual basis. This could include:

• involving women in setting their own goals rather than dictating what you would like them to achieve
• changing the focus of goal setting from weight gain to include improvements in the nutritional content of the diet or physical activity levels
• discussing the information currently available so they can make an informed decision about their own weight gain goals if that is what they want to focus on.

Should I lose weight while I am pregnant?

You should not advise women to try to lose weight when pregnant as there is not enough evidence to show safety for the baby.

I’ve gained more weight that I wanted to.

If women don’t manage to achieve their goals they might feel guilt or as though they have failed. Re-assure them and remind them that:

• it is OK to gain weight during pregnancy

• women gain weight at different rates as their body changes

• weight gained is not just fat but also the baby growing, placenta and fluids.

You could initiate a discussion to allow them to reflect on why they think they have gained more than they had planned. Give encouragement and praise for other accomplished goals, such as improvements in nutrition and physical activity levels. Offer continued encouragement to motivate women to stick to a healthy balanced diet and an appropriate level of physical activity.

Is exercise safe for my baby?

Advise women that it is safe to exercise during pregnancy and can actually benefit them and the baby to do at least 30 minutes a day of moderate intensity activity.

If they were regular exercisers beforehand then they can carry on as normal (as long as the type of activity is not contra-indicated during pregnancy – see Physical activity).

If they were not regularly active previously then advise them to build up gradually, and discuss how to build activity into their daily life.

How much more do I need to eat to make sure my baby is growing?

It is a common misconception that women need to ‘eat for two’ during pregnancy. A woman’s nutritional requirements do not change in the first two trimesters of pregnancy, and only increase by 200 caloriesa day in the last trimester.

My mum (partner, aunt, grandmother etc) keeps telling me to take it easy and not to worry about my weight as I’m eating for two now.

Family and friends with good intentions (and the media) can often give misleading and conflicting advice about nutritional requirements and the safety of being active in pregnancy.

Advise women to show their family and friends the information about nutritional requirements and physical activity safety. Suggest ways that they can get encouragement from family and friends, such as participating in social activities that they can join in with. Suggest alternatives to buying food-based ‘treats’ for the family to avoid temptation.

I eat when I feel stressed or bored.

There is an association with obesity, depression, and binge eating to control stress. Work together to find alternative ways to handle these situations, such as going for a walk or a swim.

I can't help snacking.

This might be a particular problem with pregnancy, especially if suffering from indigestion and not being able to manage full meals. Advise women to be aware of when they want to snack, and prepare in advance with slow energy release alternatives. For example, keeping a cereal bar or banana in their handbag so they don’t have to buy food (and be tempted to unhealthy options) while out and about. 

Healthy diets are too expensive.

There are ways to have a cheap healthy diet. For example, fruit and vegetables do not always have to be fresh: dried, frozen, and tinned are just as good (tinned fruit in juice, and vegetables with no added salt and sugar). Is there a food co-op locally?

I’m too tired by the time I get home from work to do any exercise.

Being active doesn’t have to involve structured activity. How does she get to work? Can she walk all or part of the way by getting off the bus early or parking her car a bit further away? What does she do in her lunch break? Can she go out for a walk, even if only for 10 minutes.

What can I do after I have the baby?

Does she already have children? Can she walk them to school or go to the park with them after work? Continuity of weight related advice and support following pregnancy is important for the long term and to help women reduce their weight for future pregnancies.

Help women to plan ahead by finding out about local services:

• Are there existing services which women can join in pregnancy and continue with after they have had the baby?
• Are there any baby-friendly groups in their local children’s centre, leisure centres, or council services?
• Are the services free or are they entitled to a subsidised fee?

Provide advice on physical activity:

• Women who have had an uncomplicated pregnancy and delivery can start walking, stretching, and doing pelvic floor exercises immediately.
• Women who have had complications or a lower segment caesarean section need to check with a health care professional when they can start activities (likely to be after their 6-8 week check), and will need to resume activities gradually.Can I lose weight by breastfeeding?Gradual weight loss through following a healthy diet and being physically active does not affect the quality of the breast milk, the ability to breastfeed, or fetal growth.
  However, obese women might struggle to get started and maintain breastfeeding, and may require support both antenatally and postnatally.

To find out more about our Managing your weight in pregnancy campaign visit our Health Campaigns section
For more expert information, call the Tommy’s PregnancyLine on 0800 0147 800 or email info@tommys.org.

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Also in this section

• Obesity management guide - overview
• Weight and nutrition
• Physical activity
• Effective communication

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Download the Obesity Management guide

The author of the Obesity Management guide is Dr Nicola Heslehurst.

You can download a PDF version of the full Obesity Management Guide, which includes references and more detailed information.