“But many fail even though they are very anxious to get pregnant and have a healthy pregnancy,” she said. “This is the new reality, and obstetricians have to be aware of that and know how to treat patients with weight issues.”

The committee report emphasizes that “obese patients should not be viewed differently from other patient populations that require additional care or who have increased risks of adverse medical outcomes.” Obese patients should be cared for “in a nonjudgmental manner,” it says, adding that it is unethical for doctors to refuse care within the scope of their expertise “solely because the patient is obese.”

Obstetricians should discuss the medical risks associated with obesity with their patients and “avoid blaming the patient for her increased weight,” the committee says. Any doctor who feels unable to provide effective care for an obese patient should seek a consultation or refer the woman to another doctor.

Obesity rates are highest among women “of lower socioeconomic status,” the report notes, and many obese women lack “access to healthy food choices and opportunities for regular exercise that would help them maintain a normal weight.”

Nonetheless, obese women who want to have a baby should not abandon all efforts to lose weight. Obstetricians who lack expertise in weight management can refer patients to dietitians who specialize in treating weight problems without relying on gimmicks or crash diets, which have their own health risks.

Weight loss is best attempted before a pregnancy. Last year, the college’s committee on obstetric practice advised obstetricians to “provide education about possible complications and encourage obese patients to undertake a weight-reduction program, including diet, exercise, and behavior modification, before attempting pregnancy.”

An obese woman who becomes pregnant should aim to gain less weight than would a normal-weight woman. The Institute of Medicine suggests a pregnancy weight gain of 15 to 25 pounds for overweight women and 11 to 20 pounds for obese women.

Although women should not try to lose weight during pregnancy, “a woman who weighs 300 pounds shouldn’t gain at all,” Dr. Klipstein said. “This is not harmful to the fetus.”

Dr. Klipstein also noted that obesity produces physiological changes that can affect pregnancy, starting with irregular ovulation that can result in infertility.

Obese women are more likely to have problems processing blood sugar, which raises the risk of birth defects and miscarriage. There is also a greater likelihood that their baby will be too large for a vaginal delivery, requiring a cesarean delivery that has its own risks involving anesthesia and surgery.

The babies of obese women are more likely to develop neural tube defects — spina bifida and anencephaly — and to suffer birth injuries like shoulder dystocia, which may occur when the infant is very large.

High blood pressure, more common in obesity, can result in pre-eclampsia during pregnancy, which can damage the mother’s kidneys and cause fetal complications like low birth weight, prematurity and stillbirth.

It is also harder to obtain reliable images on a sonogram when the woman is obese. This can delay detection of fetal or pregnancy abnormalities that require careful monitoring or medical intervention.

Many of those who struggle with weight didn’t always struggle. For example, when she was younger, Liz Hronek was was very athletic and active. She even swam competitively and played soccer. But then a doctor put her on a diet anyway – and her life spiraled from there.

“It was traumatizing,” Hronek told PEOPLE in the 2019 Half Their Size issue. “I didn’t value anything about myself. I just felt like a piece of crap.”

That diet actually had the opposite effect for the young Hronek, who then started to gain weight, and continued to for the next decade. By college, she was 300 lbs., and she had given up on herself, eating meals like creamy pastas and too much soda from the dining hall or drive-thru fast food.

But then an unexpected delivery happened… quite literally. She was sitting in class one day when she suddenly “thought I peed my pants.” Turned out her water broke, she gave birth to her daughter the next day.

“I had a belly, but I didn’t get a baby belly,” she explains. “They said that my daughter’s knees were tucked up under my ribs, and that’s why I probably didn’t feel any kicking or moving.”

The unexpected mom now had a life she was responsible for other than her own and moved in with her dad so he could help her out while she cared for her daughter.

“I had this little baby and I didn’t know how I was going to take care of her, so I would just go to food for comfort,” she says.

Finding Inspiration

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A post shared by Liz Hronek • Body Empowerment (@themissfitboss) on Jan 2, 2019 at 6:37pm PST

But finally, Hronek realized she needed to be stronger and healthier so she could play with her daughter and chase after her when she needed to. This wasn’t like when she was forced into diets, but this time, she was doing it for herself.

“I got to the realization that I’m kind of important,” she says. “Everybody has a purpose, and so do I. And so being able to just switch my mindset from, I’m doing this because I hate myself, to I’m doing this because I have purpose. I wanted to make sure that I reached my full potential.”

Hronek started following a low-carb, high-protein diet in Jan. 2008 and lost 50 lbs. From there, she started working with a personal trainer, and dropped another 101 lbs. and even started to enter bodybuilding competitions and became certified as a personal trainer and now runs a coaching program called Miss Fit Boss in North Carolina that also includes nutrition planning.

“I felt inspired to go do more and make a massive impact,” she says. “I have one-on-one, face-to-face clients, but the coaching that I do is all online. We have a community where I share nutrition plans, workout plans, recipes and restaurant guides.”

Having lost over half her size herself, Hronek feels relatable to her clients.

“If there’s something that they’re struggling with, I’m right there, so we can talk it through,” she says.

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A post shared by Liz Hronek • Body Empowerment (@themissfitboss) on Oct 19, 2018 at 11:18am PDT

Now she’s taking everything she learned to support her now-13-year-old daughter, and another daughter born four years ago, about appreciating their bodies and living healthfully.

“I think her seeing me committed to my health without obsessing over it helps her to realize that even though she sees some things that she doesn’t like in the mirror, it doesn’t mean that she’s any better or worse of a person,” Hronek says.

More Life Transformation stories:

  • 5 Powerful Habits That Will Change Your Life
  • 5 Simple Habits that Can Add 12 to 14 Years to Your Life
  • 5 Foolproof Tips For Leaving Your Comfort Zone Once And For All

300 pounds and pregnant

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