Dr. Erin Basinger & Dr. Margaret Quinlan on Anti-fat bias in reproductive health

10 Minutes to Better Patient Communication

Today’s episode is about anti-fat bias in the reproductive health context. I talk with two researchers, Dr. Erin Basinger and Dr. Margaret Quinlan, about anti-fat bias as a life-or-death problem in patient communication. They also generously share a fantastic list of resources that I link to in the transcript below.

Dr. Erin Basinger is Associate Professor of Communication Studies at UNC Charlotte. She studies how people manage stress in their interpersonal relationships. Dr. Margaret Quinlan is Professor of Communication Studies at UNC Charlotte. She's interested in the role communication plays in public understandings of health.

Today’s episode is about a specific issue in women’s reproductive health. This issue is anti-fat bias that people encounter in the reproductive health context. I talk with two researchers, Dr. Erin Basinger and Dr. Margaret Quinlan, about anti-fat bias as a life-or-death problem in patient communication.

Hi everybody. This is 10 Minutes to Better Patient Communication from Health Communication Partners. I’m Dr. Anne Marie Liebel. If you like this show you’ll love our courses. Equitable Patient Education promotes high -quality clinical practice in patient education by helping prevent avoidable errors. Learners say there's a lot of eye -opening information I hadn't considered before, and, this course helped me look at myself as an educator and helped me to step back and analyze how I can be a better nurse. For more information, visit healthcommunicationpartners .com.

March is Women’s History Month and it’s also a 3 episode month for us here at HCP. To celebrate, this month we’re bringing you 3 interviews with women from different places and spaces who all care about health equity and patient communication.

First, it’s Dr. Basinger and Dr. Quinlan talking about anti-fat bias in reproductive health. What they have to share is difficult to hear. For some people, it may be triggering. If this might be you, I appreciate your listening and we can catch up in the next episode. Transcript continues below.

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Many thanks to Dr. Basinger and Dr. Quinlan for these resources:

Peer-Reviewed Journal Articles

• Basinger, E., Quinlan, M. M., & Curry, A. (2024). Trust yourself and your body : Advice from fat individuals on how to navigate fat fertility, pregnancy, and birth. Fat Studies, 13(1), 6-21. https://doi.org/10.1080/21604851.2023.2248364
• Basinger, E., & Quinlan, M. M. (2023). She didn't think fat women deserved to have children : Memorable messages from healthcare providers in the context of fat pregnancy. Women's Reproductive Health. Advance online publication. https://doi.org/10.1080/23293691.2023.2174823
• Basinger, E., Quinlan, M. M., & Rawlings, M. (2023). Memorable messages about fat bodies before, during, and after pregnancy. Health Communication, 38(13), 3069-3079. https://doi.org/10.1080/10410236.2022.2131982

Recommended Podcasts

• Maintenance Phase
• Burnt Toast Viriginia Sole-Smith
• PlusMommy
• Fat and Fertile

Social Media Accounts

• Nicola Salmon
• Plus Mommy/Plus Size Birth

Recommended Readings

• What We Don't Talk About When We Talk About Fat by Aubrey Gordon
• You Just Need to Lose Weight and 19 Other Myths About Fat People by Aubrey Gordon
• Fearing the Black Body by Sabrina Strings
• Fat Talk: Parenting in the Age of Diet Culture by Virginia Sole-Smith
• Fat and Fertile: How to Get Pregnant in a Bigger Body by Nicola Salmon

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Anne Marie: I’m live via Zoom with Dr. Erin Basinger and Dr. Margaret Quinlan. Erin and Maggie, welcome to the show.

Erin: Thanks for having us.

Maggie: Thank you. It’s such an honor to be here. We’ve been looking forward to it.

Anne Marie: And I’ve been looking forward to interviewing the both of you. So we’re going to go ahead and jump right in. What is an issue in patient communication that you have been facing?

Erin: So our work focuses on anti -fat bias and negative attitudes that people encounter, especially in the context of reproductive health. We started this work because I had personal experiences, I, Erin, had personal experiences navigating this context as a fat person, the reproductive health care context. And Maggie had research background in fertility, and patient communication in that context, in parenting. And so our experiences together led us to look at what’s happening in interpersonal interactions when people are trying to conceive when they’re pregnant and then postpartum. What is it that they’re hearing from their providers?

AM: So you are facing this problem through research.

Erin: We are, and our research has taught us a lot about what’s happening in these conversations. We were not exactly sure what we were going to find when we started asking people about these experiences, but we found that they were really hungry to share what was happening when they were talking to people across the pregnancy trajectory. And it was really striking that a lot of what they heard was super negative. We didn’t ask people to report on negative messages, but 77% of what people told us was negative messages. “Your body is to blame. Your body is bad. Your body is wrong.” And so our research showed us this is something that really needs attention.

AM: So you just asked for, like, tell us about the messages you received. You didn’t ask for negative messages.

Erin: Right, exactly. And it is often really shocking to people, especially thin people, that what we heard was overwhelmingly negative. But for people who are fat, like me, it’s not surprising at all because this is our lived experience all the time. So it is rage-inducing. It’s terrible. And if you read our article, you can see some really vivid examples of what these messages sounded like. But unprompted, all we said was “tell us what you’ve heard.” And what they heard was really, really horrifying.

Maggie: Yeah. I mean, for me, that somebody could get denied fertility treatment because of their body size, even though I’ve been researching fertility for about five years before, it was still really hard to hear. Somebody saying that, “you don’t deserve to be a mother because of your body size,” like just still like blew my mind. And, you know, to say that fat mothers are the cause of the “obesity epidemic” in quotes like is, I mean, you know, just saying like very eugenic thinking that they don’t deserve to be mothers is horrific to me.

AM: So what are you learning from your research into this particular problem in patient communication?

Erin: So if we kind of distill down our findings, there were three overarching ideas that we saw coming up over and over and over. So the first one was the idea that fat mothers cannot be good mothers and there’s a lot there. But the overarching idea is that if you are not healthy–because we assume that fat people can’t be healthy–you cannot be responsible for the health and well-being of a child. So that was the first thing we found. The second was a lot of blame and shame around pregnancy experiences. So people not being able to to get pregnant, that was blamed on their weight. Or if they experienced any challenges during pregnancy, or even just kind of holding the idea, “you’re gonna miscarry” over people’s heads. So just generally a lot of blame and shame. And then the third big idea we saw was just a denial of treatment, that if you have a BMI of X or above, you will not receive fertility treatment. So we saw those three big negative messages and we saw those come up in different ways over and over and over in our data.

AM: Wow, thank you.

Maggie: And there were positive messages that we found. And it’s going to sound a little ironic, but providers not talking about weight or body size at all was seen as very positive. So the silence around weight was seen as something that patients really appreciated. And instead, you know, focusing on, you know, bio-indicators of health, that was more comforting to patients than, you know, anyone mentioning weight or body size for every appointment, or every concern that an individual has.

AM: Wow, it’s remarkable to think about that. Not commenting on somebody’s weight as taken as a positive. Thank you for that. So you’ve shared with us the problem, how you are approaching it, what you are learning from this approach. And the fourth question I ask people is, what are next steps for you? But I also want to give you the option of, are there things you want to share with folks who are listening who want to get better at their communication with patients?

Maggie: One huge takeaway that that we’ve taken out of this research and hope, you know, to advocate and to remind people, that the poor treatment that individuals are facing, the discrimination that they’re facing, that it’s not an individual’s fault. That there are resources and support systems available to you, and there are people such as Erin and I and other activists and other researchers, who are really working to address some of these issues and to promote more inclusive and compassionate patient care. And just a reminder that for individuals in fat bodies that you are not broken, it’s the system that is broken. And just again, to say that this is not your fault. And a lot of work needs to be done in this area.

Erin: Yeah, one thing we always emphasize when we talk about our work is that this is not an interpersonal problem. It is a structural problem. And the stakes are very high. This is life and death for people. And so we don’t ever want people to come away from these conversations thinking that it’s about hurt feelings. “People are having their feelings hurt. So we need to make changes.” It’s lives that are on the line. And so it’s really important that we as communication researchers, and people in other fields, continue to understand more about why this is going on. And with that said, we know that this experience is not the same for every person in a fat body. That maternal mortality in general is exponentially higher for people in Black and Brown bodies. And experiences for people who are gender non-binary, genderqueer, their experiences are different. People who are not in heterosexual relationships or marriages. And so we always want to make note that an intersectional approach, when we talk about health care in general and especially reproductive health care, is really really vital. Because people live and die by what happens in these encounters. And so it’s really important we continue to look at it.

AM: Thank you so much for this. Maggie and Erin, thank you for taking the time to be on the show today and to educate us. I’m going to go ahead and drop links to your articles in the show notes so that people can read them. And thank you for the learning that you’ve helped me to through your research and through our conversation today. I’m so glad you came on the show.

Erin: Thank you.

Maggie: Thank you. This was awesome.

Thanks again to Dr. Erin Basinger and Dr. Margaret Quinlan from UNC Charlotte. They have shared with us some wonderful resources whichIi’m linking to in the transcript. So be sure to visit healthcommunicationpartners.com and click on podcast for those links. You’ll get the links to these resources and resources from every episode in our series. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio Engineering and Music by Joe Liebel. Additional music by Alexis Rounds.

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