Is Obesity Killing New Moms?
The answer is complicated
How much of the rise in maternal deaths in the past several decades can be attributed to the obesity epidemic? A reader asked this question in response to my recent post about the way childbirth has changed in the past 45 years—namely, that we are more likely to die from complications related to birth than our mothers were.
But pointing the finger at obesity is complicated, perhaps even dangerous, says Rachel Hardeman, founding director of the Center for Antiracism Research for Health Equity and one of the country’s leading experts on racial disparities in maternal health. She emailed me to explain.
When conversations center obesity as the primary factor, it can lead to victim-blaming, particularly for Black birthing people, who are often held responsible for poor outcomes without acknowledging the structural forces that shape health.
Obesity is a health condition, and like many others, it can contribute to complications during pregnancy, postpartum, and beyond. However, the way it is framed in maternal health discourse often ignores the broader systemic issues—such as lack of access to quality care, medical racism, and socioeconomic barriers—that place Black and Indigenous birthing people at higher risk for adverse outcomes. Addressing maternal mortality requires confronting these structural inequities, not just individual health conditions.
I agree. According to the Centers for Disease Control and Prevention, most maternal deaths occur postpartum, and suicide, overdose and other mental health conditions are the leading cause of death at that time. These are not conditions that can be blamed on excess weight. However, among Black mothers—whose death rate is more than three times higher than that of white mothers—cardiovascular conditions are the leading cause of death.
Obesity is the “common soil” for such conditions, increasing a patient’s risk for diabetes, hypertension, and cardiovascular disease, says Dr. Michelle Ogunwole, an internist and researcher at Johns Hopkins School of Medicine who specializes in obesity and maternal health. One CDC study showed that obesity was a factor in about a third of pregnancy-related deaths in 2020.
While writing her dissertation, Ogunwole found that maternal mortality has changed in the past four decades. Since the 1980s, death by hemorrhage or infection has decreased as doctors learned how to prevent and treat such emergencies. Meanwhile, death by chronic disease—such as cardiovascular conditions—has increased.
Ogunwole sees pregnancy is an opportunity to identify people at risk for such diseases, and help them before they’re in a life-threatening situation. For example, if a woman can lose weight between pregnancies, she reduces her risk of preeclampsia in the future. Or if she has gestational diabetes during pregnancy, she can follow-up and continue to get tested after the baby is born, so make sure she doesn’t develop more complications in the future.
Black and Latino women have higher rates of obesity than white women, and in our current system, “it’s easy to blame the individual,” Ogunwole says. But she agrees with Hardeman—blame is not the goal. Nor does she want to give every new mother Ozempic (especially if they are breastfeeding). Instead, she wants to address the structural barriers that give Black women fewer options for healthier foods.
Many low-income women of color live in food deserts, with more fast-food chains than grocery stores selling fresh produce. In Ogunwole’s focus groups, one mother told her she keeps unhealthy food in her home as a safety precaution. She doesn’t want her kids to go to the corner store for their junk food fix. “What’s on those corners is not anything good,” Ogunwole says.
Plus, buying fresh produce is expensive. Ogunwole is trying to get groceries covered by Medicaid in Maryland, because food stamps are not enough.
Other moms are simply trying to convince their picky toddlers to eat (see: the hot dogs and fish sticks in my fridge). “People are just tired,” Ogunwole says. They’re raising other children along with a newborn, and “they’re not even thinking about themselves.” If a mother isn’t buying healthy food for her family, she won’t eat it herself. But it’s tough to ask a sleep-deprived, anxious mom to meal plan.
“Women are just doing the best they can,” Ogunwole says. The best approach is to help ease their burdens, not shame them for their weight.