How to Protect Yourself Against Diet Culture in Prenatal Care

May 12

Written By: Hannah Daigneault MS, RD, LDN

You finally get to the appointment you've been waiting weeks for. You're nervous, excited, maybe a little emotional. And then, before you’ve barely had a chance to get to know your provider, someone's commenting on your weight. Not asking how you're feeling. Not asking what you've been eating or how your stress levels are. Just commenting about the number on the scale and why you should be concerned about it.

If that's happened to you, you're not alone. And if you're newly pregnant and worried it will happen, that worry is valid too.

Honestly, this type of thing isn’t unique to prenatal care. Our entire healthcare system suffers from a weight bias problem and stigmatizing care is real and harmful. Unfortunately, diet culture doesn’t take a break during pregnancy. There are a few exceptions and some wonderful providers out there, but for a lot of people, pregnancy is actually when diet culture and weight stress gets louder.

This post is about helping you walk into your prenatal care with your eyes open and your boundaries intact so you can arm yourself against diet culture – because you deserve to.

How Diet Culture Shows Up in Prenatal Care

During pregnancy, most providers aren’t telling you “you need to lose weight” (at least, they better not be). But there can be intense focus on your weight, your body changes, and whether or not you are meeting your provider’s expectations for what a normal pregnancy should look like. Sometimes it might be subtle enough that you leave the appointment feeling vaguely bad about yourself but can't quite name why.

Here's what it can look like:

Routine weigh-ins with unsolicited commentary. Weight monitoring during pregnancy does have clinical uses, but a provider announcing your weight changes with a raised eyebrow, a warning, or a comparison to "the guidelines" without asking about how you’re eating or feeling isn’t helpful.

Weight gain targets framed as pass/fail. The ACOG gestational weight gain guidelines were always meant to be population-level recommendations, not a grading rubric for individual pregnancies. Rooted in BMI, the gestational weight gain targets are problematic at baseline. And using them to “grade” pregnancies just creates anxiety without actually improving outcomes.

BMI-based restrictions or fear messaging. Being told you're "high risk" primarily because of your BMI, being pushed toward certain interventions, or having your food choices scrutinized more heavily than thinner patients… These are all places where weight bias shows up in clinical care.

Food policing disguised as education. There's a difference between genuinely informed guidance about nutrition in pregnancy and a provider rattling off a list of things you shouldn't eat with a heavy focus on weight management. [insert Bernie Sanders meme here: I’m once again asking for OBGYNs to refer to dietitians for nutrition advice.]

None of this is an essential part of prenatal care, and you don’t have to accept it.

How This Affects Those with Disordered Eating Histories

For people who've struggled with disordered eating, body image, or years of internalizing diet culture messaging, prenatal care can feel like a minefield.

When a provider frames your body as a problem to be managed, it doesn't just sting in the moment. It can trigger old coping patterns – restriction, hypervigilance around food, disconnection from your hunger and fullness cues. It can make you dread appointments you're supposed to feel supported by. It can make you feel like your body is failing at the one thing it's "supposed" to be good at (and let me be someone here to remind you that your body knows exactly what it needs to do).

Your nervous system doesn't know the difference between a stigmatizing comment from a prenatal provider and body commentary from decades ago. It often responds the same way.

The environment you receive prenatal care in matters. You shouldn’t have to white knuckle your way through judgy prenatal care. Here are some things you can do to set yourself up for a more peaceful pregnancy.

Your Rights as a Pregnant Patient

Let's talk practically, because this is where a lot of people get stuck. Knowing something feels wrong is one thing. Knowing what to actually do is another.

You can decline to be weighed, or request a blind weigh-in. A blind weigh-in means you step on the scale backwards so you don't see the number. It gets recorded in your chart, but you're not handed that information at the moment (you may want to remind whoever is weighing you that you do not want to know your weight, because I’ve had many people tell me that sometimes the assistants will voice the number intentionally or not). This is a completely reasonable accommodation to request, and you don't need to justify it.

You can ask providers to keep weight data clinical. Something like: "I'd prefer you only mention my weight if there's a specific clinical concern, otherwise I'd rather not make it a focus of our appointments." That's a direct, reasonable request. A good provider will hear it.

You can ask questions and push back. If a recommendation is being made based primarily on your weight or BMI, you're allowed to ask: "What does the evidence say about this for someone in my situation?" or "Are there other factors we should be considering here?" You don't have to take the first answer you get.

You can seek a second opinion – or a different provider entirely. This one is harder, especially if you're navigating insurance or limited options. But it's worth knowing: you are not locked in. If a provider consistently makes you feel shame or fear around your body, finding someone else is not "difficult" or "dramatic." It's advocating for yourself and your health.

What Supportive Prenatal Care Actually Looks Like

You're not just looking for someone who doesn't say anything harmful, you're looking for someone who actively creates a safe environment.

Some green flags:

They ask about your relationship with food and your history before making assumptions
They discuss weight-related data in context, without alarm or judgment
They explain why they're recommending something, not just what
They take your concerns seriously without making you feel like you're overreacting
They treat you like an expert on your own body

When you're interviewing providers (and yes, you are allowed to interview them), a few questions worth asking:

"How do you approach gestational weight gain conversations with your patients?"
"What does your practice look like for patients who have a history of disordered eating?"
"How do you handle it if a patient wants to opt out of routine weigh-ins or weight-focused check-ins?"

Their answers will tell you a lot about whether this is someone who will support you or someone you'll have to constantly manage.

You Don't Have to Navigate This Alone

Pregnancy is already a lot. The physical changes, the emotional tides, the logistical overwhelm… you don't need to add "defending your body in medical settings" to the list.

But if it does show up, and it might, you now have language for it. You have options. And you have every right to use them.

If you're looking for additional support around food, body image, and nutrition during pregnancy, working with a weight-inclusive registered dietitian who specializes in perinatal care can be a game-changer (hi, that’s me!). The goal isn't just to eat "well" during pregnancy, it's to feel safe in your own body while you do it.

For more information about weight-inclusive prenatal nutrition support, you can visit my website (www.nurturedandwell.co) or reach out to me at hannah@nurturedandwell.co. I’d love to hear from you!

Hannah is the a mom of two littles, who created Nurtured & Well to be the kind of support she wants to see more in the world: compassionate support for eating disorder recovery in preconception, pregnancy and postpartum. She walks alongside individuals as they heal their relationship with food and step into parenthood feeling strong, nourished, and at peace.