The WOMBS Framework: A review and new theoretical model for investigating pregnancy‐related weight stigma and its intergenerational implications

Abstract

Summary As the growing weight stigma literature has developed, one critically relevant and vulnerable population has received little consideration—pregnant and postpartum women. Because weight fluctuations are inherent to this life phase, and rates of prepregnancy overweight and obesity are already high, this gap is problematic. More recently, however, there has been a rising interest in pregnancy‐related weight stigma and its consequences. This paper therefore sought to (a) review the emerging research on pregnancy‐related weight stigma phenomenology and (b) integrate this existing evidence to present a novel theoretical framework for studying pregnancy‐related weight stigma. The Weight gain, Obesity, Maternal‐child Biobehavioral pathways, and Stigma (WOMBS) Framework proposes psychophysiological mechanisms linking pregnancy‐related weight stigmatization to increased risk of weight gain and, in turn, downstream childhood obesity risk. This WOMBS Framework highlights pregnant and postpartum women as a theoretically unique at‐risk population for whom this social stigma engages maternal physiology and transfers obesity risk to the child via social and physiological mechanisms. The WOMBS Framework provides a novel and useful tool to guide the emerging pregnancy‐related weight stigma research and, ultimately, support stigma‐reduction efforts in this critical context.

Exploring weight bias internalization in pregnancy

“…A prominent environment where pregnant individuals who have higher weight or obesity report experiencing weight stigma is in healthcare [ 1 , 13 , 39 ]. Causal factors of weight stigma in healthcare have included receiving judgement about excessive weight gain, getting generic advice about being physically activity and eating well, and sensing healthcare provider discomfort when having weight-related conversations [ 39 ].…”

“…Furthermore, there is a correlation between frequency of weight stigmatizing experiences in pregnancy and maternal body mass index (BMI), suggesting pregnant individuals who have higher weights or obesity are at greater risk of weight stigma and potential associated complications [ 11 ]. Negative maternal exposures can have a detrimental impact on fetal development and postpartum health for both the mother and child; therefore, weight stigma in the gestational period can have a multigenerational effect and mitigation strategies are essential [ 13 ].…”

Adipositasprävention in den ersten 1000 Tagen

“…Auch der kindliche Gewichtsverlauf wird durch die Säuglingsernährung bestimmt. Kinder, die gestillt werden, haben ein geringeres Risiko für kindliches Übergewicht und Adipositas im Vergleich zu Kindern, die Formula-Nahrung erhalten 32 33 . Umgekehrt konnte gezeigt werden, dass nicht gestillte Kinder und Kinder mit kurzer Stilldauer, im Vergleich zu gestillten Kindern (≥6 Monate), ein höheres Risiko für spätere Adipositas aufweisen 28 .…”

Addressing the gaps in nutritional care before and during pregnancy

“…In fact, focusing on weight in the absence of the other health measures may perpetuate weight-related stigma (137,138) . This is especially important in the context of pregnancy which has been identified as a particularly vulnerable time for weight stigma (139) .…”