What Weighs the Most? A Study Among Childbearing Women With Obesity in Norway

Abstract

What weighs the most? A study among childbearing women with obesity in Norway Difficult childhood experiences lead to increased vulnerability for developing pre-pregnancy obesity in a normal population of Norwegian women. In a qualitative study, in-depth interviews with 14 women with pre-pregnancy obesity found that unmet essential needs, vulnerable transition phases and the experience of being subjected to a critical eye affect social relationships and the relationship with food. Inadequate emotional investment on the part of parents results in insecure relationships with parents but also with peers and is perceived as a significant cause of weight gain in some women. Body shaming has been a significant part of the childhood experience for several women and some have experienced it from both parents and peers. This was described as causing an emotional hunger, with energy-dense foods being used to regulate emotions. Women who described their childhood experiences as positive linked their own weight development to hereditary disposition, vulnerable transition phases, injuries and illness or illness on the part of close relatives. However, these women also described using food to reduce stress and regulate emotions. Pre-pregnancy obesity was found to lead to increased vulnerability in encounters with maternity care. For women with positive childhood experiences or a positive body image, this vulnerability was expressed in being identified as different and categorised as having a high-risk pregnancy due to weight. These women explained that they changed healthcare professionals or submitted complaints about their maternity care if weight-related subjects were handled in a stigmatising manner. Women who spoke about difficult childhood experiences relating to body shaming, bullying or self-perceived differences expected their weight to be subject to criticism. They had a tendency to raise weight-related subjects before healthcare professionals did in order to avoid uncomfortable conversations that would trigger a sense of shame. The results of the thesis show that several women received follow-up care for weight-related issues, as subjects such as weight, risk and lifestyle are routinely part of maternity care for women with pre-pregnancy obesity. However, women would, to a greater degree, prefer for such follow-up to be offered and strengthened post-partum. As the framework for the thesis, I have taken a closer look at the prevalence of obesity from a national and global perspective. Causes of developing obesity are linked to difficult childhood experiences and possible mechanisms of action are discussed using recognized stress theory and a socio-economic model of weight development across generations. The place for weight-related follow-up in maternity care is explained by looking at the associations between pre-pregnancy obesity and the risk of complications during and after pregnancy for the women and their children. In conclusion, obesity is linked to the platform of knowledge related to stigma and shame. A mixed method design was used in order to achieve the goals of the thesis. The associations between difficult childhood experiences and weight before pregnancy was initially estimated in a selection of 6679 HUNT participants. An extended understanding of the underlying cause of difficult childhood experiences was examined using in-depth interviews with 14 women with pre-pregnancy obesity, 3-12 months after childbirth. During the same in-depth interviews, we also examined how the women felt that their weight influenced the maternity care they received.