COMMENT:FAT AND FERTILE

Ever since palaeolithic artists carved those voluptuous Venus figures, fertility symbols have been fat. In these earliest representations of women, the female sexual features the breasts and mons pubis are ample and prominent, and the stomach and bu

This is appropriate, because female fertility is grounded in female fat. It is an increase in female fat especially the achievement of a critical weight which means the girl has stored enough calories to sustain a foetus that is the physiological trigger for menarche. And female fat plays a crucial role in conception and in sustaining a healthy pregnancy.

Problems around fertility are common in thin women. If you are too thin, you may not be menstruating, you may be menstruating but not ovulating, you may be menstruating and ovulating but will have difficulty conceiving, or you may manage to conceive but will have difficulty carrying a pregnancy to term.

Yet when underweight women go to their doctors with fertility problems they are rarely advised to put on weight. Doctors as well as lay people believe that slimness is healthy and sexy.

This belief in the link between slimness and health is in fact fallacious. Ironically, over the decade in which slimness has come to be so closely identified with health, a number of comprehensive research studies have established that, contrary to popular belief, the longest living people in the population are those who are slightly overweight according to current ideals. According to these studies, the very thin die soonest even when smokers and those with cancer have been excluded and people who gain 10 pounds with every decade actually improve their life expectancy (see Never Too Thin, Prentice Hall, 1989 for a summary of studies).

Yet thin women with fertility problems are given drugs, not dietary advice.

Recently a leading endocrinologist, Professor Howard Jacobs of University College and Middlesex School of Medicine, spoke out against the practice of prescribing ovulation inducing drugs to underweight women, which he described as “reprehensible”. He is quoted as saying, “Underweight women have five times the risk of producing an underweight baby. Amenorrhoea [cessation of periods] is clearly nature’s way of protecting babies against subnormal nutrition (Guardian, 28 June 1991).”

Infertility causes heartbreak for many women. How much of it is simply caused by being a little too thin? Naomi Wolf (The Beauty Myth, Chatto & Windus, 1990) talks of the “One Stone Solution” the belief that everything would be OK if only you could lose a stone in weight. How often is there a “One Stone Solution” to infertility gain a stone and get pregnant?

What happens once the woman has conceived? When I was researching my book on miscarriage, I knew about the links between low maternal weight and low birthweight, but I could find no investigation anywhere of what I had come to suspect that very thin women had more problems of all kinds in pregnancy.

Subsequently, I came across a study carried out for the London Institute of Child Health (People: The International Planned Parenthood Federation Review, Vol 15, no 1) that looked at the relationship between mother’s weight and the risk of “pregnancy wastage” miscarriage, stillbirth and neo natal death. The research was done in Bangladesh, Cameroon and Sierra Leone yet it has relevance for the many undernourished women in our affluent society.

It was found that, “underweight women were much more likely to lose their babies: of the women who weighted over 42 kg (93lb), only 7 per cent reported pregnancy wastage, whereas 43 per cent of women under this weight had experienced it.”

A woman can increase her chances of having a healthy baby sixfold by not being underweight.

Poor nutrition and poor weight gain in pregnancy may be associated with other problems, too. American gynaecologist Tom Brewer has argued that toxaemia, the most dangerous condition of pregnancy, is largely caused by malnutrition in the mother (What Every Pregnant Woman Should Know, Penguin, 1979). He advocates a high protein diet in pregnancy, including two pints of milk and two eggs a day. There are also many studies which suggest that various handicaps, including spina bifida, are associated with poor nutrition before conception and at the start of pregnancy (BMJ, vol 282: 1509-11, 1981).

If you eat a nourishing diet and are not underweight before conception, you give your pregnancy the best possible start. Yet women who are planning to get pregnant are never advised to put on weight and to eat especially well. Once you are pregnant, it is essential to the health of both mother and baby that you maintain a good weight gain. Yet many women are still told by their doctors that they have put on “too much” weight.

In his widely read advice manual Pregnancy (Pan 1975), Gordon Bourne insists that “the importance of control of weight gain in pregnancy cannot be too forcefully repeated”, because “the welfare of both the mother and her child are directly related to it.”

This advice is rooted in now out dated research from the 1930s, which suggested that excessive weight gain in pregnancy might cause toxaemia. Yet many GPs regularly repeat these out dated assertions, presumably because they fit so neatly with prejudices about the virtues of being slim.

Not all women, just most, diet to be sexually attractive. But if we are told in pregnancy that we are gaining too much weight, all women will pay heed, believing it’s for the good of the baby. Here we see our society’s horror of female fat carried to extraordinary and damaging lengths, when women are given the impossible injunction that even when they’re pregnant, they must stay slim.