Is Denial of IVF Therapy for Obese Women Really Discrimination?

In the UK, fertility treatment is free under their health care system. However, experts are now suggesting that obese women should be denied access to in vitro fertilization unless they lose weight. The reasoning behind this are the high health risks associated with the treatment if the patient is severely overweight. The British Fertility Society suggests that these women may receive free IVF after losing weight. A BMI over 36, which is severely obese, would disqualify a woman from receiving the therapy.

From Yahoo News:

"Obese women are less likely to get pregnant and more likely to encounter health problems. It makes sense to address obesity before seeking fertility treatment," Richard Kennedy of the BFS told the BBC.

In response to this, some "fat-activists" are taking this as tacit discrimination. The fat acceptance blog Big Fat Blog responded thusly:

Just awesome: the British Fertility Society is suggesting that women with a BMI over 36 be denied any kind of free fertility treatment, and those with a BMI over 29 be required to diet and exercise before receiving treatment.

This recommendation is discrimination, pure and simple. What the hell, really? Fat people are told they can't adopt and told they can't get pregnant (from both societal and medical angles); let's just add in some more. For people who want to get pregnant, this is a slap in the face. And it speaks a little more to social engineering, methinks - don't even allow fat people to breed, because, well, their kids might be fat. And you know what that means.

How can they get away with this?

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While it may be discrimination in a pay-for-treatment health care system, socialized health care has not only the right but (I believe) the mandate to administer that care in a financially- and health-conscious way. If a certain treatment endangers the mother, as well as the potential child, that treatment should not be administered. While fat acceptance is all well and good for the self esteem of countless people, addressing the cause of the medical epidemic caused by obesity will result in palpable health improvements in the overweight. A few months back when I was taking a Histology of Disease class, I was amazed at how many diseases are either directly or indirectly caused by obesity. It cripples life span, damages the heart and liver, increases the risk of a host of neurological disorders from stroke to Alzheimer's....the list when on and on. Perhaps the only comparably lifestyle quality which was as detrimental was smoking, and an excellent case could be made that obesity was worse. In light of the health risks, is it acceptable that precious medical resources, tax dollars, time, etc be spent helping an obese woman obtain a risky pregnancy?

Now to me, the most productive thing to do to relieve soaring medical costs caused by an increasingly obese population is to help those who suffer from obesity lose weight. I'm not saying its easy, it isn't. But, the health payoffs for the individual and for society are so huge that I'm baffled that it hasn't been a priority in America yet.

A size-acceptance organization in the UKL (the ISAA UK) has also come out against the recent IVF recommendation:

The United Kingdom Branch of the International Size Acceptance Association (ISAA UK) strongly condemns the decision by the UK's National Health System (NHS) to ban fertility treatments for obese women. ISAA UK has determined that they systematic denial of fertility treatment to women with a BMI of 36 or more is akin to blackmail.

"Because the NHS has poorly managed its funding, it is trying to make up for it by denying service to groups of people it deems 'unworthy.' It is essentially saying two things to the public: lose weight in order to have children and fat women aren't worth helping," said Fatima Parker, President of ISAA UK. "At the same time, it is further showing its bias against the obese because it will allow fertility treatment for smokers, who have a much higher proven health risk to mother and child than the obese."

I agree that women should not smoke during their pregnancies, and that IVF therapy should be conditional upon the smoking cessation during the pregnancy. However, the point remains that obesity is also a health risk to a developing fetus.

According to a study published in Pediatrics in 2004, maternal obesity in pregnancy more than doubles a child's risk of obesity at 2 to 4 years age.

Twenty-four percent of children in the study whose mothers were obese during the first trimester of pregnancy were obese by age 4, compared with nine percent of those whose mothers were of normal weight during the first trimester. Looked at another way, obesity occurred in almost 1 in 4 of the children born to obese mothers, compared to fewer than 1 in 10 of those born to mothers of normal weight. Previous research has shown that many obese preschoolers continue to have weight problems in adolescence and beyond.

A 2005 Swedish study found that obese women faced a significantly higher number of birth complications, preeclampsia, stillbirth, fetal distress, and early neonatal death. the risk is so great that obese women should automatically be assigned to the care of a high-risk pregnancy expert.

The findings stemmed from a study of 3,500 pregnancies of women considered to be morbidly obese, each with a body mass index (BMI) over 40. Another 13,000 women with a BMI between 35.1 and 40 were also part of the study. Both groups were compared with pregnant women considered to be of normal weight, meaning they had BMIs ranging from 19.8 to 26. Cedergren advises obese women to try to lose weight before conception, even if the effect is minimal. Lowering BMI by just a few points lowers the risk of problems, she said. In the study, women with BMIs between 35.1 and 40 had far fewer complications than the more obese participants.

And according to a CDC study published in Pediatrics in 2003, obese women are 3x a likely to have a baby born with spina bifida and defects in the infant's abdominal wall. They were twice as likely to give birth to a baby which had a severe heart defect.

As to whether the denial of IVF is discrimination, I would say no insofar as other complication risk factors are also restricted (drug abuse, smoking, diabetes, etc).

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Good topic! The problem with the more militant fat activists is that they cannot or will not distinguish between the unnecessary discrimination and ridicule of overweight people and the medical realities of being overweight, and classify any talk of health problems linked to obesity as "fat hate" or "fatphobia."

It's not that they merely believe that IVF should be available to very obese women in spite of the greatly increased risk to both mother and fetus; it's that they refuse to even acknowledge that such risks exist. Like Bible literalists who ignorantly scorn evolution, think that biologists are driven by an inherent dislike of God, and buy into each others' lies, fat activists are convinced that the data pertaining to the health risks related to obesity are manufactured by shady researchers who are bribed by the diet and pharmaceutical industries and that the government itself (especially the CDC) is ever plotting to marginalize the overweight.

Being a fan of the psychology of mass delusions, I wrote fairly extensively about BFB a couple of years ago on one of my blogs of yore, and although I said nothing about fat people's appearance and so on -- only pointed out that they were in medical denial -- they in response assailed me as if I'd insulted someone's mother or worse. (It didn't help that a skinny marathoner was making the observations I did.) Heck, one of them even called me "leathery" and ugly! ;o) (In truth I don't blame her because she mistakenly attributed comments to me that were actually from someone else, but no matter.)

It would all be kind of funny if it weren't for the fact that given current trends, there will be exactly four non-overweight people in America by Thanksgiving, 2008 (and zero the day after).

Sad. Refusing to change seems to be a cop out. And that comes from a chubby guy.

A tox class I took several years ago went over the case of workers in a battery plant. Female employees were barred from working in the areas where lead was handled. These jobs had the highest environmental risks along with the highest pay. The women won the right to work the lead handling jobs, and the predicted outcome of toxic effects in the children they had after the job change began to show. Even if a medical guideline appears discriminitory, it can be a good idea.

"While it may be discrimination in a pay-for-treatment health care system, socialized health care has not only the right but (I believe) the mandate to administer that care in a financially- and health-conscious way."

Wouldn't it be the opposite ? Since fat people pay taxes they can claim that some type of injustice has been committed if they are denied treatment under a socialized system.**

On the other hand private clinics have a right to deny service to whomever they want, just like any other private enterprise.

** Their claims would be misguided, because Britain operates on the basis of 'parliamentry supremacy' which means that the legislative branch of the government can pretty much do whatever it wants.

I don't know how can we move pass "health risk" argument.

It's funny, you can eat yourself to death, but if you jump off a bridge - "he took the coward's way out".

BMI is a good enough measure for populations of people, but it's not a good enough measure for individuals making this potentially a very unfair measure.

If you have two people with the same BMI - one could have a much higher proportion of body fat than the other. Someone with a very dense body can also have a high BMI.

This does not matter when you are measuring over a population and need a "good enough" estimate, but when you are using it to decide who gets to have kids and who doesn't, it's a different thing entirely.

IF the baby and mother's health and NOT discrimination and cost savings is their real objective, there are many other factors they should be taking into account including blood pressure, CV fitness, smoking etc, and a visual assessment of obesity.

....Or put like that, doesn't it seem much more like what it is - society getting to decide who gets to breed?

"BMI is a good enough measure for populations of people, but it's not a good enough measure for individuals making this potentially a very unfair measure."

True, but this applies much more strongly in the lower ranges of "overweight," e.g., BMIs of 25 to 30; a BMI of 36 is high enough to pretty much rule out hypermuscularity being an important factor, especially in a woman. That's 220 pounds or more at an average (5' 5") height.

Shelley -- check your junk comments folder, I left one yesterday that was filtered out, probably because it included a number of links.

No more of these useless eaters. While it is now "voluntary," with this technology, should they even allow defective babies to be born?

We will yet have our master race!

From New York Times, Sat, 02 Sep 2006 10:10 AM PDT

Seeking Healthy Children, Couples Cull Embryos

http://www.nytimes.com/2006/09/03/health/03gene.html?ref=us

"Already, it is possible to test embryos for an inherited form of deafness or a mild skin condition, or for a predisposition to arthritis or obesity. Some clinics test for gender. As scientists learn more about the genetic basis for inherited traits, and as people learn more about their genetic makeup, the embryo screening menu and its array of ethical dilemmas are only expected to grow.

Don't studies show, that children raised in one parent homes are more likely to have social problems, committ crimes, and be burdens on society? Maybe they could also deny IVF to barren single women or lesbians?

Also, is it in the public interest that anyone have more children, so much that we need to spend on advanced technology to procreate?

OK, here's some straight talk from a fat chick. I was a heavy gal (at a size 20) when I had my last baby. I am heavier now (morbidly obese and going in for bariatric surgery in a couple of months). Let's bypass all the reaons why I am now this weight, because it really isn't relevant to the topic at hand and, my doctor and I have a good handle on it now. I wanted to say something about this denial of IVF issue.

Here are the problems I am having personally as a result of my obesity that make it tough for me to be a good baby carrier: Prediabetes, shortness of breath (thank goodness, no heart condition), recurrent bladder infections, overproduction of estrogen (from the fat), low-normal thyroid, iron-deficiency anemia, oversensitivity to heat, headaches, and swollen ankles. I would not only be putting myself at risk, but even if I didn't feel any effects, the hormonal problems alone would hurt my baby. I can't even see myself successfully delivering; what if something went wrong and they wanted to do a Caesarian and my belly fat got in the way?

Fat chicks who think they ought to be mothers are just like diabetics whining for candy.

By anonymous fat girl (not verified) on 03 Sep 2006 #permalink

Don't studies show, that children raised in one parent homes are more likely to have social problems, committ crimes, and be burdens on society? Maybe they could also deny IVF to barren single women or lesbians?

No. Studies show that children raised in dysfunctional homes are more likely to have social problems etc. One parent homes can be much more functional than two parent homes.

By Kristjan Wager (not verified) on 06 Sep 2006 #permalink