Weight-inclusive maternity care

This blog post helps answer a different question: if weight-centric care is the problem, what does the alternative actually look like?

What is weight-inclusive maternity care?

To understand what weight-inclusive care means, it helps to start with what it’s contrasting itself with.

Most maternity care today operates within what researchers call a weight-centric or weight-normative model.

In this model, a woman’s weight or BMI is treated as a primary indicator of her health, and managing or reducing weight is often framed as a key goal of care.

This affects everything from which services women can access, to what conversations happen in appointments, to what risks are emphasised, and which are overlooked.

A weight-inclusive approach works from a fundamentally different premise.

Rather than treating weight as a proxy for health, it recognises health and wellbeing as multifaceted; shaped by genetics, circumstances, social determinants, and much more besides.

Weight-inclusive maternity care: a brief history

A paper by Tylka et al (2014) compared the weight-inclusive and weight-normative approaches in healthcare.

They concluded that the evidence strongly favours a weight-inclusive approach. Not only does a predominant focus on weight and weight loss fail most people in the long term, but it actively contributes to the stigma that worsens health outcomes (Tylka et al 2014).

In a weight-inclusive model, the starting point is that every woman deserves respectful, individualised, non-stigmatising care, regardless of her shape, size, or weight.

There are now a number of useful papers that explore this issue in a more general way.

The Weight Inclusive Healthcare Initiative through the Institute for Healing and Justice in Medicine have created a really useful (and free) guide available both as a video and book.

They explain how the history of anti-fatness is rooted in anti-Black racism, which in turn explains why Black women are at higher risk when it comes to a weight-normative approach than white women.

And here is a paper on weight-inclusive approaches to nutrition and dietetics,

A systemic problem

A major systematic review published in Obesity Reviews, which drew on 70 studies across 13 countries, mapped how weight stigma shows up not just in individual interactions, but in the structures of healthcare systems themselves.

Some of the key findings include that:

• Many fertility and pregnancy services apply rigid BMI cut-offs that delay or deny care, often without clear individual clinical justification.
• Clinical environments (e.g. rooms, furniture, equipment) frequently aren’t designed with larger bodies in mind, which affects comfort, dignity, and access.
• Funding models often don’t account for the longer consultations that may genuinely be needed, leading to rushed care.
• Training gaps mean clinical guidelines and healthcare professionals often overlook the lived experience of women in larger bodies.

The review’s authors call for systemic reform: removing arbitrary BMI cut-offs, redesigning care environments and pathways, updating guidelines, and involving women with lived experience in shaping policy.

This kind of evidence matters because it shifts the conversation away from “a few individuals need to be kinder” and towards “our systems need to change.”

The RADIANT Study

One recent Australian study (Jenkinson et al 2026) helps us understand what weight-inclusive care can look like.

The paper, “A Total Paradigm Shift”: Interviews With Australian Maternity Care Providers Who Practice Weight-Inclusive Care, comes out of the RADIANT study.

The researchers interviewed 24 maternity care providers , including doctors, midwives, and allied health professionals, who had been identified by colleagues, by women themselves, or who had self-identified as practising in a weight-inclusive way (Jenkinson et al 2026).

“A total paradigm shift”

Three themes emerged from those interviews:

1. Time and space for reflection. Most participants described starting out in a fairly conventional, weight-centric mindset, shaped by their training. A shift towards weight-inclusive practice tended to come gradually, often triggered by a personal experience of weight stigma, or by witnessing its impact on a friend, family member, or patient. One GP described now having “my own beautiful weight-inclusive GP,” reflecting on how that experience shaped her own approach with patients.

2. Questioning weight science. Many participants had come to question how much weight, and BMI specifically, really tells us about an individual’s health. Several were uncomfortable with BMI’s continued use despite recognising its limitations. One specialist doctor pointed out how flawed it is to apply the same BMI categories across women of different ethnic backgrounds, given what we know about how body composition varies. Some had come to view body weight more as a non-modifiable characteristic — similar to height or eye colour — rather than something to be “fixed” before someone could access good care.

3. Taking action to make change. This is where the study gets really practical. Providers described concrete changes they had made. For instance, ensuring that clinic spaces had appropriate seating and equipment (including longer epidural needles where needed), offering “blind weighing” (when weighing was truly needed) so women could decline to know their weight, using non-judgemental language, and making sure conversations focused on the positives of a pregnancy rather than defaulting to risk and pathology.

One midwife summed up a key principle simply: weight-inclusive care means “meeting people where they’re at,” being collaborative about what matters to the individual woman, rather than starting from assumptions based on a number on a chart (Jenkinson et al 2026).

Nutrition care matters too

A useful companion to this is a literature review from the University of Minnesota’s School of Public Health, looking specifically at weight-inclusive approaches to nutrition care in pregnancy.

This review found that approaches like intuitive eating and mindful eating, which focus on tuning into the body’s needs rather than restriction or weight targets, were associated with better outcomes across the board. These included improved body satisfaction, fewer depressive symptoms, and (for some women with gestational diabetes) improved outcomes through to a year postpartum.

Interestingly, the review also found that most pregnancy nutrition guidelines focus heavily on gestational weight gain targets based on BMI, but offer very little guidance on how to actually talk about this with women in a way that doesn’t reinforce shame. But there is, of course, a deeper issue here, because such targets are an issue in some countries and areas, but not others. As Denison et al (2018) point out, such guidelines aren’t evidence based. I also look at this further in Plus Size Pregnancy.

Given that both providers and women report not having enough appointment time to discuss nutrition properly anyway, this is clearly an area where there’s a lot of room — and need — for a more individualised approach.

What weight-inclusive care can look like in practice

Here are a few examples of weight-inclusive care can look like, whether you’re a woman trying to work out what to look for, or a care provider thinking about your own practice:

• Being offered the choice of whether or not to be weighed, and how that information is recorded
• Clinic spaces with seating, gowns, and equipment that work for all body sizes
• Practitioners who do not make a fuss or ‘big deal’ out of getting a larger piece of equipment
• Conversations that focus on individual health and wellbeing, not assumptions based on weight or BMI alone
• Recommendations explained with their reasoning, so they don’t feel arbitrary or judgemental
• Care that emphasises a woman’s strengths and the positives of her pregnancy, alongside any genuinely relevant clinical considerations
• Recognition that weight is one factor among many, and not a stand-in for someone’s overall health, effort, or worth

Weight-inclusive maternity care matters

Weight-inclusive maternity care matters, for many reasons.

The evidence is clear that experiencing weight stigma is not a neutral or motivating event. It increases stress hormones, worsens mental health, and is independently associated with poorer outcomes. Pregnant or not, it is not “for someone’s own good.”

Becoming a parent is one of the most significant transitions in a woman’s life. Parents need to feel capable, confident, and supported at this time, not shamed or diminished. How a woman is treated during pregnancy and birth shapes how she enters motherhood.

Informed decision-making requires feeling safe enough to ask questions. Women who feel judged, shamed, or dismissed by their care providers are far less likely to engage meaningfully with decisions about their care, which undermines the entire principle of consent.

Every woman deserves care that sees her as a whole person. Not as a number on a scale, not a risk category, not a body to be managed. Weight-inclusive care is, at its heart, simply respectful care.

Change is possible

What I find genuinely heartening about the research that I’ve discussed in this blog post is that it shows that change is possible.

Weight-inclusive care isn’t just a theoretical ideal. The RADIANT study shows that providers can and do shift their practice when given the space to reflect. I have plenty of anecdotal evidence of this as well. Weight-inclusive maternity care is already happening, in real clinics, with real providers who’ve actively chosen to do things differently.

But it’s not enough.

And, at the same time, the structural review reminds us that individual good practice can only go so far while systems, guidelines, and training continue to centre weight and BMI as primary measures of health. We need change at every level.

How to find out more

If this is a topic that resonates with you, whether you’re pregnant now, supporting someone who is, or working in maternity care yourself, I go into much more depth on the evidence around BMI, risk, and decision-making in my book, Plus Size Pregnancy: what the evidence really says about higher BMI and birth.

It’s written to help you understand what the research actually shows (and this is often more reassuring than you might expect) and to support you in making the decisions that are right for you.

We also have an information hub which will take you to all of our resources relating to plus-size pregnancy.

Plus Size Pregnancy

Plus Size Pregnancy Resources

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