This article was written by Holly Tritschler (Student Dietitian) and was reviewed by Ro Huntriss (Fertility Specialist Dietitian & Founder of Fertility Dietitian UK) and Maeve Hanan (Disordered Eating Specialist Dietitian & Founder of Dietetically Speaking).

For many people in larger bodies, the journey to parenthood begins under the shadow of weight stigma. Across preconception, pregnancy, and postpartum care, bias and judgement can shape not only how individuals are treated, but also their fertility outcomes and emotional well-being (1).

Weight stigma refers to the social devaluation and discrimination directed toward individuals based on their body weight or size. It often shows up as negative attitudes, stereotypes, and biases such as the assumption that people in larger bodies are unhealthy, unmotivated, or noncompliant (2). During a time that is often already emotionally and physically demanding, weight stigma can compound distress and diminish the sense of support and care individuals receive.

This article aims to raise awareness of how weight stigma intersects with fertility care and support readers with how to advocate for respectful, evidence-based care.

Weight Stigma in Healthcare

Weight bias shows up in fertility and reproductive care in a variety of ways. Studies have shown that clinicians are more likely to make assumptions about lifestyle and diet and provide unsolicited advice relating to this for women in larger bodies (1). This can make individuals feel unseen or blamed, rather than supported, during a time when compassion and evidence-based care are crucial.

This dismissal and shaming by healthcare providers can lead to embarrassment, low self-worth and avoidance of healthcare, which in turn increases risks for mother and child (3). Stigmatising attitudes can also fuel disordered eating behaviours, driving restrictive eating, binge restrict cycles, or other harmful eating behaviours.   

Weight stigma extends beyond individual attitudes or behaviours. Pregnant women report that during appointments there has been a lack of appropriately-sized equipment, such as blood pressure cuffs, speculums, hospital gowns and scales. This can lead women to feeling embarrassed and uncomfortable and the perception that they are not as worthy of care as those in smaller bodies (1). 

It can also be challenging for women in larger bodies to access fertility treatment pathways with most fertility clinics in the UK rejecting individuals based on higher BMIs. These restrictions often exclude potential parents before they’ve even completed other basic health testing (4). This means that someone’s hormone levels, ovulation patterns, and overall reproductive health could all be within normal ranges, yet they may still be denied fertility treatment based solely on a number on a scale. Weight is often assumed to be the primary cause of infertility, despite the many other possible contributing factors. Patients are frequently advised to lose weight when the underlying reason for infertility may be entirely unrelated.

Studies show that women in larger bodies are often pressured to plan medical interventions based primarily on their BMI, rather than their individual preferences or clinical indications (5). Many hospitals will not allow women above a certain BMI to access a water birth despite the proven benefits, reinforcing exclusionary practices that limit autonomy and choice in childbirth (3, 6). Of course medical intervention can be vital and lifesaving, but risks should be assessed holistically rather than based on BMI alone.

Understanding Fertility Beyond BMI

Fertility challenges occur across all body sizes, with approximately 1 in 6 worldwide experiencing infertility (7).

Research shows that weight loss for those with a higher weight may improve fertility outcomes (8). NICE fertility guidelines note that conception may take longer for women with a BMI over 30 and that male fertility may also be reduced above this threshold. Conversely, women with a low BMI (below 19) who are not menstruating or who have irregular cycles may also experience difficulties conceiving (9).

However, this does not mean that weight loss is an appropriate goal for everyone, as it’s not that simple and there are lots of individual factors to consider. Those who are vulnerable to disordered eating behaviours are more likely to experience increased distress or a recurrence of harmful eating patterns when weight loss becomes the primary focus. For individuals that have a poor relationship with food this stigma can indirectly affect fertility outcomes via stress and poor mental health, which can be a factor in infertility (10). The person in question might also have a very healthy lifestyle, and we know that BMI isn’t a good individual marker of health.  

Female infertility may result from a range of abnormalities affecting the ovaries, uterus, fallopian tubes, or endocrine system; none of which discriminate based on weight. It’s also important to remember that male infertility is a common but under-researched contributor to fertility challenges which contributes to roughly 50% of all cases of infertility (11, 12). 

A recent systematic review showed that although weight loss prior to IVF increased pregnancy rates, it didn’t increase live birth rate (13). Another large study found that weight loss did not improve assisted reproductive technology outcomes (14). These studies suggest that more rigorous research is needed before recommending weight loss as a universal fertility treatment strategy.

When infertility is assumed to be the result of someone’s size, important underlying causes may go unexamined. This not only delays access to effective treatment but can leave individuals feeling dismissed and unsupported during an already difficult time.

Inclusive Nutrition and Fertility

Nutrition can support fertility in many ways beyond weight. The following inclusive nutrition strategies can help optimise reproductive health, helping you feel empowered on your fertility journey without tying success to weight loss (15):

• Correct nutrient deficiencies – iron deficiency affects many women of reproductive age and is associated with fertility challenges. Aim to include a variety of iron-rich foods such as beans, tofu, grains, and red meat (in moderation). Other frequently observed deficiencies include vitamin D and B12.
• Take a folate supplement – given the well-established link between folate deficiency and neural tube defects, women who are trying to conceive are advised to take a daily supplement of 400 µg of folic acid, with a higher dose of 5 mg recommended for those at increased risk.
• Include foods high in antioxidants – these help prevent cell damage by reducing oxidative stress. Eating a range of colourful fruits and vegetables may support egg quality and overall fertility.
• Aim for an anti-inflammatory diet – this supports egg quality, endometrial health and fertility outcomes. Following the principles of a mediterranean diet and eating a diverse range of fruits, vegetables, wholegrains, fish and unsaturated oils can help with this. 
• Reduce dietary AGEs (Advanced glycation end-products) – AGEs are present in the charring created by grilling, frying and toasting foods and can accumulate in reproductive tissues affecting fertility. Choosing gentler cooking methods like steaming, poaching, or slow cooking can help lower AGE levels.

What works for one person may not work for another. By focusing on variety and flexibility rather than restrictive diets, you can support your overall health and fertility while reducing stress around food. Overall dietary patterns are much more effective than individual foods, and demonising certain food groups will only reinforce shame and an unhealthy relationship with eating.

Supporting Fertility Through Gentle Lifestyle Habits

Supporting fertility isn’t just about nutrition; gentle lifestyle habits can make a meaningful difference too. Finding enjoyable, body-inclusive ways to move, managing stress, and prioritising adequate sleep can all support reproductive health (16). The focus should be on what feels sustainable and nourishing for your body, rather than on restriction or intensity.

Compassionate Care and Self-Advocacy in Fertility

Fair, respectful, and inclusive fertility care should be available to everyone, yet sadly it often isn’t. You should not have to fight for non-discriminatory treatment, and if you have had to, know that it is not your fault. The system, not you, is responsible.

Whilst you shouldn’t have to, there are practical steps you can take to advocate for yourself and ensure your care is respectful and supportive. The following strategies may help you navigate appointments, challenge bias, and access the support you need:

• Don’t be afraid to bring guidelines and research to appointments – having evidence in hand can help you feel more confident and informed, and can support discussions with your healthcare team. It can also help challenge misinformation or bias, ensuring your care is guided by the best available evidence rather than assumptions
• Take a partner, friend or patient advocate to appointments – they can help you feel grounded, provide emotional support, and speak up if needed
• Consider working with a dietitian who specialises in weight-inclusive fertility care – they can help you with advocating for yourself, as well as nutrition and overall reproductive health without stigma or restrictive diets.
• Explain your individual circumstances – explain why dieting and trying to lose weight haven’t served you in the past, and why you feel this isn’t in your current best interests. You could also highlight all the healthy things you already do, and how focusing on weight loss might hinder these (if applicable). 
• Request a second opinion if you feel uncertain or unheard – a fresh perspective can help clarify your options, provide reassurance, and ensure your treatment plan aligns with your individual needs and preferences.

If you’re looking for advice and support on navigating fertility care, check out Nicola Salmon’s work (17). Nicola provides practical guidance on self-advocacy, including tools for communicating effectively with healthcare providers.

Conclusion

Fertility is multifaceted, influenced by physical, emotional, and social factors, and weight stigma can profoundly shape each of these. Experiencing bias or exclusion in fertility care not only impacts access to treatment but can also take a toll on emotional well-being, self-worth, and trust in healthcare providers.

By focusing on inclusive, nourishing nutrition and gentle lifestyle habits you can support your reproductive health without restrictive diets or weight-based goals. Fertility care should be compassionate, evidence-based, and respectful of everybody, empowering you to make informed decisions and feel supported throughout your journey.

References

1. Tran et al (2025) ‘Structural weight stigma in healthcare toward preconception, pregnant, and postpartum women: A systematic review’, Obesity Reviews, 26(9). Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12318919/
2. The World Obesity Federation (2025) Weight Stigma. Available at: https://www.worldobesity.org/what-we-do/our-policy-priorities/weight-stigma 
3. Dever et al (2025) ‘Weight stigma in the preconception, pregnancy, and postpartum periods: A systematic review of women’s perspectives’, Obesity Reviews, 26(5). Available at: https://doi.org/10.1111/obr.13891 
4. Muir and Hawking (2024) ‘How do BMI-restrictive policies impact women seeking NHS-funded IVF in the United Kingdom? A qualitative analysis of online forum discussions’, Reproductive Health, 21(152). Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11514436/ 
5. Kerrigan et al (2015) ‘Obesity and normal birth: A qualitative study of clinician’s management of obese pregnant women during labour’, BMC Pregnancy and Childbirth, 15(256). Available at: 10.1186/s12884-015-0673-2 
6. Royal Devon University Healthcare (2023) Clinical guideline for Water birth Eastern Services. Available at: https://www.royaldevon.nhs.uk/media/e4rpgatp/water-birth-v1-6.pdf 
7. World Health Organization (2023) 1 in 6 people globally affected by infertility: WHO. Available at: https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility/ 
8. Hunter et al (2021) ‘The effectiveness of weight-loss lifestyle interventions for improving fertility in women and men with overweight or obesity and infertility: A systematic review update of evidence from randomized controlled trials’, Obesity Reviews, 22(12).  Available at: https://doi.org/10.1111/obr.13325 
9. NICE (2017) ‘Fertility problems: assessment and treatment’. Available at: https://www.nice.org.uk/guidance/cg156/chapter/Recommendations 
10. Rooney and Domar (2018) ‘The relationship between stress and infertility’, Dialogues in Clinical Neuroscience 20(1). Available at: https://doi.org/10.31887/DCNS.2018.20.1/klrooney 
11. Leslie et al (2024) ‘Male Infertility’,StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK562258 
12. World Health Organization (2024) Infertility. Available at: https://www.who.int/news-room/fact-sheets/detail/infertility 
13. Michalopoulou et al (2025) ‘The Effect of Weight Loss Before In Vitro Fertilization on Reproductive Outcomes in Women With Obesity: A Systematic Review and Meta-analysis’, Annals of Internal Medicine, 178(9). Available at: https://doi.org/10.7326/ANNALS-24-01025
14. Hunter (2021) ‘The effectiveness of weight-loss lifestyle interventions for improving fertility in women and men with overweight or obesity and infertility: A systematic review update of evidence from randomized controlled trials’, Obesity Reviews. Available at: https://pubmed.ncbi.nlm.nih.gov/34390109/ 
15. BDA (2021) A clinical update on diet and fertility. Available at: https://www.bda.uk.com/resource/a-clinical-update-on-diet-and-fertility.html 
16. Centre for Reproductive Health and Gynecology (2025) 7 Evidence-Based Lifestyle Changes to Boost Fertility Naturally. Available at: https://www.reproductive.org/blog/7-evidence-based-lifestyle-changes-to-boost-fertility-naturally 
17. Nicola Salmon (2025) Fat Positive Fertility. Available at: https://nicolasalmon.co.uk/