An open letter to Dr Eva Orsmond

Obesity experts object to Dr Eva Orsmond’s comments that “pregnant women allowing themselves to be overweight is criminal”

Dear Dr Eva Orsmond:

We are a group of scientists, clinicians, and other experts with decades of experience treating, preventing, and trying to better understand the causes of obesity. We have written this letter to raise a number of objections to your comments published in an Irish Examiner (online) article titled “Pregnant women allowing themselves to be overweight is criminal — Dr Eva”, on July 25, 2018.

Before outlining these objections, we would like to be clear that we agree that obesity during pregnancy is an important challenge that demands our attention. Research suggests that around 10% of Irish women are dealing with obesity at the start of their pregnancy (having a body mass index greater than 30 kg/m2), that a majority of women gain an excess amount of weight during the pregnancy, and that maternal obesity is linked to more immediate obstetric challenges, as well as longer-term impacts for the mother and child. Further, we are happy to assume you don’t literally think pregnant women should be “criminalized” for being overweight. We know that healthy weight loss is challenging, even with the best support, so it would be ridiculous for someone trying to help people lose weight to then threaten them with criminal action should they fail.

However, your hyperbole is not without harms. For example, there is a substantial body of research demonstrating the stigma that people with obesity face, which includes pregnant women who may receive poorer care as a consequence. Blaming and stigmatising individuals may actually make it harder to achieve and maintain a healthy body size (e.g. 1, 2, 3).

Further, the suggestion that women somehow “allow themselves” to be overweight is at odds with a vast body of research pointing to environmental factors as the key drivers of obesity risk. Thus your advice that people with obesity need “to simply overhaul their lifestyle, eating habits, being overweight and lack of exercise” is entirely unhelpful. The reality is that many drivers of obesity remain frustratingly out of our control, making lifestyle changes anything but simple for most people. These drivers of course include fetal exposures, which you highlight. It is thus ironic that you would blame an overweight pregnant woman for the risks posed to the fetus developing inside of her, while completely ignoring the role of these factors may have played in her own weight status.

Your exaggeration of these risks is also problematic. Evidence suggests that any negative health consequences in the offspring due to maternal body size during pregnancy are largely limited to high levels of obesity. We recognize that this perspective is at odds with how this issue is commonly portrayed in the media. This confusion arises for a number of reasons, including scientific research focusing on mothers’ weight and health behaviours during pregnancy (rather than fathers’ health or factors occurring after birth, like childhood diet), how overweight and obesity are measured, the difficulty in separating correlation from causation in scientific studies, and the oversimplified, sensationalist reporting of complex scientific findings in the media (your article in the Irish Examiner being a prime example). By exaggerating these risks, we are concerned that you are adding to the substantial social pressures that are already placed on pregnant women, and we ask you to please consider the long history of harms that result from “blaming the mother”.

In the absence of any useful advice in the article, we would encourage women to discuss with their doctor or midwife how much weight they should be gaining over their pregnancy. Importantly, women should not try to lose weight during their pregnancy. The HSE provides leaflets on healthy eating during pregnancy which are available online or from their doctor or nurse. The Irish Nutrition and Dietetic Institute also provides information for pregnant women on healthy weight, healthy eating, and physical activity during pregnancy. There are also guidelines for health professionals on weight management and obesity in pregnancy.

Finally, we would like to highlight your clear conflict of interest, as headlines like this are surely good for business. We are disappointed this wasn’t noted by the Irish Examiner, who instead seemed to be more interested in providing advertising for your clinic than fulfilling any journalistic responsibility. We hope that the Irish Examiner, and other media outlets, will in the future avoid publishing such sensational, stigmatising views, and to please follow existing reporting guidelines for articles about obesity.

Sincerely,

(In reverse alphabetical order)

Dr Judy Anne Swift, RNutr CPsychol AFBPsS
Associate Professor of Behavioural Nutrition
Division of Nutritional Sciences, University of Nottingham

Hazel Ann Smith, BSc(Hons) MSc
Research Coordinator for the Paediatric Intensive Care Unit, Our Lady’s Children’s Hospital, Crumlin
Adjunct Lecturer in Paediatrics, Trinity College Dublin

Dr Gemma C Sharp, PhD
Lecturer
MRC Integrative Epidemiology Unit, University of Bristol

Dr. Michelle Queally, PhD
Health Economist 
School of Business and Economics, National University of Ireland, Galway.

Professor Sarah Redsell, PhD, BSc (Hons), CPschol, RHV, RGN.
Professor of Public Health
Anglia Ruskin University

Dr Jean O’Connell, MB PhD MRCPI
Consultant Endocrinologist, Blackrock Clinic & St Columcille’s Hospital Weight Management Service
Chair, Association for the Study of Obesity on the Island of Ireland

Dr. Grace O’Malley, PhD
StAR Research Lecturer
Division of Population Health Sciences, Royal College of Surgeons in Ireland

Dr Karen Matvienko-Sikar, PhD
Postdoctoral Research Fellow
School of Public Health, University College Cork

Professor Deborah Lawlor, PhD
Professor of Epidemiology
MRC Integrative Epidemiology Unit, University of Bristol

Professor Louise Kenny, MBChB (hons), MRCOG, PhD
Pro-Vice-Chancellor
Faculty of Health and Life Sciences, University of Liverpool.

Professor Patricia Kearney, MBBCh, PhD, MPH, FRCPI
Professor of Epidemiology
School of Public Health, University College Cork

Dr Janas Harrington, PhD
Senior Lecturer
School of Public Health, University College Cork

Marita Hennessy, MA
SPHeRE Programme PhD Scholar,
Health Behaviour Change Research Group, School of Psychology, NUI Galway
Communications Lead, Association for the Study of Obesity on the Island of Ireland

Professor Francis Finucane, MSc MD FRCPI
Consultant Endocrinologist, Galway University Hospitals
Honorary Personal Professor in Medicine, NUI Galway

Dr Darren L Dahly, PhD
Senior Lecturer in Research Methods
School of Public Health, University College Cork
Associate Editor, Journal of the Developmental Origins of Health and Disease

Professor Jacqueline Blissett, Ph.D.
Chair in Childhood Eating Behaviour
Department of Psychology, School of Life and Health Sciences, Aston University