Tara Schmidt: We have an episode on weight inclusivity and the hard thing is that if these people are doing anything, they’ll do anything to lose the weight or to become a candidate for their treatment. We have to switch them to a framework of, “Hey, I actually need you eating really well balanced.” Instead of doing these crazy fad diets and cutting out entire food groups.
I say, “Please can we bring some of those foods back in.” But how stressful and how scary to be going back and forth between this restrictive mindset and growing a human. [They’re thinking] “I don’t want to gain too much weight because I was successful.” It’s a lot.
Dr. Ali Ainsworth: Yeah, on top of everything else that we navigate in a day, it’s a lot. In terms of diet and exercise, I tell my patients, there is no perfect answer here. Whatever you’re going to do that is sustainable and isn’t going to be jarring. We come in and out of this, but let’s really make this a part of our life [is what I would suggest that they do.]
Tara Schmidt: How do you have that conversation? How do you bring up their weight or their diet? Do you simply say this is a risk factor and it may be impacting your ability to become pregnant?
Dr. Ali Ainsworth: I talk to every patient about it, regardless of their weight because society is in all of our heads. First to normalize a broader range of normal than many of us feel, and then I do say that at either extremes—and I tailor it to what I’m talking to—a negative association with both time to pregnancy, fertility treatment success, risks in pregnancy, and then there are times that I have to be pretty direct.
We do also have a BMI cut off. Sometimes acknowledging, this is not what you want to do right now, but if you could, if you were amenable to this, pausing attempts at fertility, to really focus on weight loss for a few months, to not only make this possible for us to do this together, but more successful, that’s really where our best time is spent. But it’s hard. It’s a hard conversation for me to have and certainly to hear.