5 Questions with Anna Whelan, MD, FACOG

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Welcome to another installment of the 5 Questions With… series where we learn a bit about experts in the field. Previous interviewees include Dr. Lesley Williams, Mikey Mercedes, Aaron Flores, Dr. Gregory Dodell, Lisa Du Breuil, Dr. Asher Larmie, members of Medical Students for Size Inclusivity, Chrissy King, Jessica Jones, Leslie Jordan Garcia, Dr. Mara Gordon, and Dr. Whitney Trotter.

Today I am honored to bring you five questions with the amazing Dr. Anna Whelan!

1. Tell us a bit about yourself and your work

I am Dr. Anna Whelan MD FACOG, a board certified OBGYN and Maternal-Fetal Medicine subspecialist. I am physician-scientist and my clinical time focuses on care for pregnant people with pregnancies complicated by maternal or fetal conditions ranging from maternal diabetes, heart disease, and autoimmune disease to fetal genetic and anatomic differences. My research focuses on how the experience of pregnancy and delivery impacts mental health, particularly for patients with "high-risk" pregnancies. Over the past few years I have been working on a project to improve the experience of pregnancy for individuals in larger bodies by targeting the internal and external experience of weight stigma in prenatal care.

2. How did learn about the concept of weight-inclusive, body affirming care?

I became aware of weight-inclusive care during my own personal recovery from an eating disorder. I was in medical school at the time and was horrified and severely triggered by the incredible fatphobia I witnessed (both implied and explicit). It was then that I discovered the Health at Every Size(R) principles in their previous iteration.

I wish I could say that I stood up when seeing medical fatphobia during my medical training, but fear of retaliation kept me from using my voice. Towards the end of my fellowship training, I had some fantastic mentors who encouraged me to pursue my interest in weight inclusive obstetric care through my research. This has led me to gain a deeper understanding of the data (or really lack thereof) around weight-centered (traditional) obstetric care. It has also led me to meet and collaborate with amazing individuals including Ragen Chastain and Dr. Lisa Erlanger.

3. How have you/do you apply those concepts to your work?

As a Maternal-Fetal Medicine Physician I often have individuals referred to me for consultations or transfers of care due to their body size. When I meet with these individuals, my first goal is to make them feel heard and safe. I will state that unless they want to talk about their weight, I will not bring it up or discuss it as I have better tools to assess health and wellbeing in pregnancy including blood pressure, heart rate, labs and ultrasound. If a patient asks about the risks to the pregnancy because of their BMI I will review the existing data with the caveat that correlation does not equal causation and the effect sizes of the increase in risk are not clinically significant.

Routine weighing of obstetric patients started in the 1940s due to high concern for malnutrition after WW2 to help identify people at risk for adverse outcomes due to malnutrition. Increased body weight and increased gestational weight gain have been associated in population level studies with slight increases in adverse outcomes including fetal anatomic abnormalities and stillbirth. However, these population level studies that lead to the nationally utilized Institute of Medicine guidelines state themselves: these studies did not account for maternal or placental genetics, the built environment and societal factors which can impact weight gain in pregnancy. Thus, I do not recommend routine weighing of obstetric patients (there are always exceptions to the rule including individuals with a history of heart failure or severe nausea and vomiting of pregnancy - Hyperemesis Gravidarum, to name a few).

My patients will therefore not receive information on suggested weight gain and will instead be asked about their ability to take in nutrition, their energy levels and their satiety. We discuss the benefits of activity in pregnancy as way to decrease the risks of gestational diabetes and improve strength for labor and delivery. We will assess fetal growth by maternal physical exam and by ultrasound (as maternal weight is a terrible way to assess fetal weight).

Lastly, and perhaps most importantly, I affirm that if they do develop a complication of pregnancy such as gestational diabetes or pre-eclampsia, it is not their fault nor was it caused by their body size. These conditions are impacted by many factors including age, family history (genetics), systemic racism, placental hormones and genetics, and weight and thus it's not correct or fair to blame weight for these complications.

4. What’s one thing that you wish people who are still working from a weight-focused paradigm could learn/know?

I wish that they would understand the truly shoddy research behind weight focused medicine. I wish they would realize how much harm the field of OBGYN has on patients in larger bodies. I wish that they were quicker to question the GLP1 research and stop allowing indication creep without randomized clinical trials. For example, my colleagues are thinking about recommending these medications pre-pregnancy for decreasing the risk of preeclampsia and gestational diabetes, for infertility and for menopause. These medications are not magic cure all. We also need to focus on address access to care, systemic racism, food insecurity, pollution and climate change (among other factors) which have all been shown to negatively impact maternal and fetal health.

5. How and where do we find you and your work?

I am the Chair of Education for the Association of Weight and Size Inclusive Medicine. Please check out our website awsim.org to learn more. My research can be found on PubMed. I wish I was better with social media but have not been active in a while @the.pregnancy.doc

Bonus – anything else you’d like to say

I am so grateful for the education and support I have received from the experts such as Ragen who have been leading the charge on weight inclusive medicine. I also want to thank all of the individuals who have participated in my research on weight stigma in obstetrics, you are the fire that drives me forward!

To those individuals just starting in the weight inclusive space, keep speaking up, I am so grateful that the next generation of physicians started Medical Students for Size Inclusivity. It gives me great hope for the future.

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’