Rebel Wilson’s fertility and weight has been in the media over the summer. Not that it’s any of our business, of course, but we know the media love a fat transformation story! They just love to reinforce the message that only thin bodies are worthy. Then their advertisers can flog us products led by our insecurities!
In 2020, while four in ten of us reportedly got bigger over lockdown, Rebel was consciously pursuing the opposite. In a recent Instagram Live, a fan asked why she decided to lose weight, and Rebel shared that it was because her doctor told her it would give her a much better chance of conceiving. But is this true?
When I was trying for a baby, I heard all the messages that because I’m fat, I’d struggle. Because I’d been on a long acting contraceptive for years, I’d struggle. Because I was over 30, I’d struggle. But that absolutely wasn’t the case for us; I got pregnant much quicker than I was honestly ready for!
Obviously, my experience alone is anecdotal. It does show that the negative messages us bigger people receive from professionals are not the cast iron facts they appear, though!
Is this just another example of weight stigma, fatphobia, misinformation and scaremongering?
I heard a LOT of things about my pregnancy from health professionals that turned out to not be strictly true… So as usual, I want to know what is the evidence here?
“I was actually a bit offended. I thought that even though I was bigger, I was pretty healthy”Rebel Wilson, Instagram Live, 28th July 2021
Big Birthas asked Nicola Salmon, fertility coach and author of Fat and Fertile, and The Fat Person’s Guide To Getting Pregnant, for her perspective.
“Rebel, you were right to be offended.
The doctors made assumptions about Rebel’s health and her fertility based on her body.
“When I was going through and looking into fertility stuff, the doctor was like, ‘Well, you’d have a much better chance if you were healthier,’”Rebel Wilson, Instagram Live, 28th July 2021
This is a dilemma that so many fat folks face. We are basically given a choice between “lose weight” or “grow your family”. When having a family feels like the most important goal in the world, it’s not even a choice.
This isn’t about Rebel’s decision to lose weight. As much as it hurts the fat community to lose an icon, Rebel should absolutely be able to make decisions about her body free from judgement and shame and that includes weight loss.
So were her doctors right? Will her weight loss improve her fertility?
The answer, as it most often is, it’s complicated!
What research IS there?
The research shows that it can take folks in higher weight bodies longer to get pregnant. But it’s not years longer, it’s one to two months (on average).
Overall, the probability of conceiving in a given cycle was reduced 8% for overweight women and 18% for obese women. This translated to a median one month longer for overweight women to become pregnant, and two months longer for obese women to become pregnantObesity and Time to Pregnancy, Law, Maclehose and Longnecker, 2007
For those who do take longer to become pregnant, this study found that people with a higher BMI take comparatively longer again. But still only nine months longer.
Cumulatively, this meant it took about three months longer before 75% of overweight women became pregnant and nine months longer before 75% of obese women became pregnantObesity and Time to Pregnancy, Law, Maclehose and Longnecker, 2007
While this research was published in 2007, it is based on analysis of data from 7,327 women in the late 1950’s/early 1960’s. There were significantly fewer people with higher BMIs, and very few with BMIs 40+, than we would see today. The data also did not include women who did not become pregnant. The researchers recognise that this could mean their results either over or under-estimate the link between BMI and fertility.
Doctors often claim losing just 5-10% of your body weight will magically increase your chances of getting pregnant. But there have been no studies that have shown that when you lose 5% of your body weight, your fertility increases by some measurable, linked amount.
What about better sleep, better nutrition, more exercise, and focusing on wellbeing?
What is actually happening is that when folks are told to lose weight, this often impacts the health promoting behaviours that they partake in. There’s a good chance that it’s these health promoting behaviours that impact our health and fertility, regardless of whether our weight goes up, goes down or stays the same when we do them, but the studies that do show an impact of weight loss never separate out that impact of weight loss vs the impact of the health-promoting behaviours. Studies also never take into account the impacts of weight stigma and weight cycling on our health.
The other huge piece of this puzzle is access. Fat folks are regularly denied access to routine fertility tests and treatments. They also put off going to see their doctor about reproductive issues due to the way that they are often treated by healthcare professionals.
The reality is that yes, Rebel, will absolutely have a better chance of getting pregnant in a smaller body. It’s not because she has less fat around her middle or is more healthy, it’s because she will be treated better by her doctors and get better access to healthcare.”
Thanks Nicola! It is so frustrating for bigger people struggling with fertility to be told to go away and lose weight, and only then, if you still can’t get pregnant, might anyone begin to look for an underlying cause.
Why can’t these sorts of investigations take place in parallel with trying to lose weight? It really feels like an unfair way of gatekeeping access to services. Especially when we know that age can also have an impact on fertility!
Would Rebel Wilson’s fertility and weight be treated similarly in the UK?
I don’t know if Rebel is pursuing fertility treatment in the US or in Australia, and their systems, particularly the USA, do differ from ours significantly. Generally it’s a given that Hollywood stars have access to expensive private doctors. Not that that’s any indication of a more evidence-based and less biased experience!
But here’s what the British Pregnancy Advisory Service report found in the UK. They looked into how CCG (Clinical Commissioning Groups) restrict access to NHS funded fertility services. They didn’t just look at BMI, but age, personal circumstance, geography, etc. But here’s what they had to say about BMI.
BPAS investigation into fertility services in the UK
BMI criteria exist across almost all CCGs in England, with 130 CCGs (96%) specifying a maximum female BMI… For male partners, 32 CCGs (24%) detail a maximum male BMI…
The denial of treatment based on either female or male BMI constitutes an extension beyond the NICE guidance, which only recommends that men and women “should be informed” of the risks to infertility associated with obesity or low body weight in women and obesity in men.
The extent to which IVF outcomes are impacted by a higher BMI is somewhat controversial: some studies have found that a higher BMI is associated with impaired ovarian responsiveness and/or an increased risk of miscarriage, preterm delivery, or certain conditions including gestational diabetes, but others have concluded that a higher BMI should not be a basis for treatment denial…
Certainly NICE does not recommend that fertility treatment is withheld on the basis of BMI, but only that women should be informed that female BMI should ideally be in the range 19–30 before commencing assisted reproduction, and that a female BMI outside this range is likely to reduce the chance of success.
Four CCG policies also require that BMI must be maintained for the previous 6 months before referral. The use of a minimum time period presents a further barrier to IVF access. The NICE guidance neither recommends the denial of fertility treatment based on BMI nor a minimum time period for BMI maintenance.
BPAS investigation into the IVF postcode lottery: an examination of CCG policy for the provision of fertility services, August 2020
What’s Been Your Experience Of Getting Pregnant?
I got pregnant much more quickly than anticipated. I also know several other larger folk who got pregnant swiftly and easily, despite our supposedly malfunctioning bodies. Which got me curious what other people’s experiences were.
So I asked the question in our Big Birthas Private Facebook Group.
Now, of course, this is a completely unscientific study. By definition, most people find Big Birthas while pregnant, so people who are struggling with fertility are less likely to have seen the question. The answer is also reliant on the individual’s own interpretation of what getting pregnant ‘quickly’ would look like.
There’s a good chance that due to the fact that many of us (incorrectly, as it turned out in my case!) would take AGES to get pregnant, even a statistically ‘average’ time could seem ‘quick’ to us.
But I still think the results are worth sharing. There were more than 100 responses received in less than an hour.
This was the result after 4 hours, with 89% of people seeing the post responding. (That’s quite frankly phenomenal, thanks everyone who took the time to poll and comment!) The data is displayed as a pie chart, obviously, because I’m fat and am therefore obsessed with pie*.
*sarcasm. I’m actually obsessed with cake.
Our Completely Unscientific Poll
As you can see, the Completely Unscientific Poll showed that the vast majority of us said we fell pregnant quickly. Or at least, quick by our standards. Now, while I’d suggest that the 11% answering that they were or had struggled with infertility is undoubtedly underreporting the true number, the substantial difference in the other two segments is rather remarkable… isn’t it?
Now, we know this isn’t the full picture. Several people responded to say that they didn’t have trouble falling pregnant, but they did struggle to stay pregnant. Others said that they had vastly different experiences in different pregnancies.
I’m no expert on fertility. And this quick poll proves nothing. But if you’re fat and worried you may struggle to conceive – you may be pleasantly surprised.
It’s also an excellent reminder that if you DON’T want to get pregnant, don’t neglect your contraception! Fat bodies can and do fall pregnant quickly too!
And one final word on Rebel Wilson’s fertility and weight journey… I wish her all the luck in the world. Now that doctors can no longer conveniently blame weight as the issue to the exclusion of everything else, they might actually get on with the business of helping her in a meaningful way…