Navigating Anti-Fat Bias in Doula Care: How to Support All Bodies

1. Addressing Fear of Weight Gain

It’s not uncommon for clients, regardless of size, to express fears about gaining weight during pregnancy. Social pressures, along with concerns around conditions like gestational diabetes or delivering a “big baby,” can create anxiety. As doulas, we can be a voice of compassion and science-based information:

• Normalize weight gain: Remind clients that weight gain is a natural and necessary part of pregnancy. It supports the growing baby, placenta, amniotic fluid, and other essential changes in the body.
• Combat misinformation: Gestational diabetes and larger babies are often oversimplified as “weight issues” and blamed on body size creating shame. Provide clients with evidence-based information about these topics to dispel myths and ease concerns.
• Affirm client autonomy: Support clients in making choices about their own nutrition, exercise, and health, honoring that their bodies are unique and inherently worthy, without attaching value to any specific health status.
• Address anti-fat bias: Where does a clients’ fear of weight gain come from? Is it around health, appearance, or mobility? By understanding what their actual concerns are you can offer evidence-based reframes to help shift anti-fat beliefs.

2. Navigating “Bounce Back” Culture and Postpartum Dieting Pressures

The cultural pressure to “bounce back” post-birth is pervasive, often leading new parents to plan postpartum diets even before birth. For clients who express these desires, we can help them explore alternatives to restrictive practices and focus on recovery and wellness.

• Highlight the importance of healing: Postpartum recovery is about so much more than body shape. Encourage clients to shift focus from weight loss to restoring energy, bonding with their babies, and caring for themselves.
• Educate on lactation needs: Explain the impact of calorie deficits on lactation and energy levels. Undereating can reduce milk supply and make recovery harder for new parents. A well-fueled body is best for both parent and baby!
• Affirm their bodies as they are now: Validate your clients’ right to feel comfortable and confident in their postpartum bodies. Remind them that bodies are meant to change, grow, and adapt—especially through the monumental shifts of pregnancy and parenting.

3. Recognizing and Combating Anti-Fat Bias in Healthcare

Many of our clients experience biased care that can be dismissive or outright harmful. Anti-fat bias in healthcare settings often means that valid concerns are attributed to weight, that clients are treated with less respect and empathy or denied basic care. Here’s how doulas can help counteract this:

• Support informed consent: Help clients feel empowered to ask questions, seek explanations, and request care providers who respect their right to be informed about all decisions, regardless of their size.
• Be a buffer when possible: In cases where you can attend medical appointments, act as an advocate by helping clarify options and supporting your client’s needs and boundaries as well as pushing back when anti-fat bias occurs.
• Refer to size-inclusive providers: Build a referral list of providers who prioritize size-inclusive, respectful care. This can reduce the chance of clients encountering biases and can enhance their overall healthcare experience.

4. Navigating Hurtful Comments from Strangers

People in larger bodies are often on the receiving end of comments from strangers who feel entitled to comment on their size. Pregnant clients may experience remarks questioning whether they “look pregnant” or simply “look fat,” which tend to be annoying (at best) or distressing and reinforce anti-fat bias. While we can’t shield clients from these interactions, we can empower our clients to develop effective responses and coping strategies to navigate these challenges and grow their resilience.

• Validate and listen: Give your clients space to talk about how these comments make them feel, offering understanding and empathy.
• Discuss response strategies: For some clients, responding confidently may feel empowering. For others, ignoring comments is best. Help your clients explore what feels safest and most comfortable for them.
• Reinforce that anti-fat bias is a form of discrimination and that these comments are not acceptable no matter their body size.

5. Fertility and Anti-Fat Bias: Advocating for Fair Treatment

Clients may also encounter biases when navigating fertility care. Many are told they need to lose weight to conceive or are given misleading information about their chances of conception. As a doula, you can empower clients to access fair and respectful fertility care.

Creating a Safe Space for All Bodies

Providing size-inclusive care is more than a practice; it’s a mindset that actively challenges societal norms and biases. By validating and addressing each of these concerns, you help clients feel valued and cared for—regardless of body size. This not only enhances their experience of pregnancy, birth, and postpartum but also contributes to a more compassionate, inclusive world!

As doulas, our ultimate goal is to be a source of unwavering support. By offering size-inclusive care, we honour the diverse, beautiful ways bodies carry life and create families. Let’s be the difference our clients need to feel safe, seen, and celebrated.

Resources for Providing Size-Inclusive Care

For doulas committed to offering size-inclusive support, having the right resources at hand is essential. From evidence-based articles on pregnancy and postpartum health to directories of size-inclusive healthcare providers, these resources will help you build knowledge and support clients in ways that challenge anti-fat bias and affirm their unique experiences.

Fertility and Conception →

• Top 5 Myths about Fat People & Fertility
• When You’re Told You’re Too Fat to Get Pregnant
• 7 Ways to Live Whole Lives as Fertile Fat Folks
• The Challenge of Weight Stigma for Birthers in the Preconception Period

Pregnancy and Birth →

• Navigating Diet Culture’s Impact on Pregnancy and Parenting
• What to Know About Weight Gain During Pregnancy
• How to Cope If Pregnancy Is Messing With Your Body Image
• Pregnant and Told You Have a Large Baby? What You Need to Know
• How to avoid falling into the diet culture trap during pregnancy
• Learning to Reject Diet Culture, One Pregnancy at a Time
• Debunking myths about gestational diabetes
• Trauma-Informed Care and Consent

Postpartum →

• How to Deal with Negative Postpartum Body Image
• Embracing Your Postpartum Body
• Learning to Love Your Postpartum Body
• Postpartum is not a phase
• Self-compassion and body image in pregnancy and postpartum: A randomized pilot trial of a brief self-compassion meditation intervention
• Tackling Fatphobia in Lactation
• 3 Ways To Feel More Connected To Yourself

Diet Culture →

• Learning to Reject Diet Culture, One Pregnancy at a Time
• Rejecting Diet Culture Mentality
• How to Stop Obsessing Over Your Body and Eat Sanely in a Toxic Culture | Virginia Sole-Smith

Local (British Columbia) Size-Inclusive Practitioners  →

• CAYA Health Center — They often have workshops exploring the connection between food, body image, and relationships
• Local Health — We recommend seeing Jessica Hume and Janelle Fontaine!
• Clementine Natural Health
• Trikinetic
• New Tides
• Inclusive Therapists — Fat Liberation Approaches
• Weight-Inclusive Dietitians in Canada
• Good Fat Care — Connecting body-accepting health practitioners to people who need them
• Fat Community — Fat Club Vancouver Facebook Group