Weight and Fertility

Call overview and agenda

An online discussion on weight and fertility was hosted on Tuesday 2nd September 2021 (5pm to 6.30pm) via Zoom Pro and was attended by 20 members of the public from a wide range of backgrounds.

The aim of this particular online session was to:

• Introduce the Imperial Biomedical Research Centre and the weight and fertility research undertaken by the Metabolic Medicine and Endocrinology Theme.
• Give attendees an opportunity to ask questions
• Facilitate small group discussions around the topic

Key Insights Summary

Attendees of the discussion session on 2 September 2021, provided perspectives about the following main areas.

Views on the research area

Overall, all attendees were supportive of the proposed research area and recognised the importance of this research to help increase understanding of the complex topic of weight and fertility which will empower patients to make more informed decisions about fertility treatments.

A few attendees noted that ‘not all overweight people have a problem getting pregnant’ and that it is not the only factor to be considered when looking at infertility and other co-morbidities (e.g., high blood pressure, gestational diabetes), with each individual having their own personalised risk of health outcomes based on both physiological and psychological factors.

Attendees also raised concern around the limited options for fertility treatment in clinical practice, and the parameters around accessing these which are currently focused on age and weight-related metrics (body mass index, BMI) to decide who gets to access treatment, rather than other important health outcomes (such as amount of exercise, nutrition, and other lifestyle factors).

Views on other factors which required consideration

Attendees considered that a number of other factors should be considered when undertaking this research to increase understanding of this complex area. The impact of weight (and infertility) on mental and psychological health was identified as extremely important. The role of cultural factors was also raised, as for some cultures, weight can be seen as a sign of ‘wealth and power’, and also how infertility is perceived across different cultures. Other areas for further exploration included understanding whether better criteria could be used for access to fertility services, understanding physiological and psychological factors which play a role in weight-gain, weight-loss, and fertility. Research into Polycystic Ovary Syndrome (PCOS), Type 2 Diabetes, eating disorders, and the impact of health promotion messages on weight loss were also suggested.

For some, other areas of health were raised as important areas to explore further in relation to weight. These included cardiovascular issues, diabetes, cancer, and gestational diabetes. Others, however, highlighted that they were more concerned with completing daily tasks and activities than the risk of long-term health problems, perceiving that their weight only minimally increased the risk of such outcomes.   

Education and awareness around health and fertility was considered important, to empower people to engage with their health and to access support and treatment. Linked to this, attendees felt there was a need for better access to clear and understandable information and evidence about this topic, particularly for under-represented communities.  It was also considered critical that there was greater awareness around stigmatisation linked to weight.

Views on weight and/or fertility interventions and treatment

When discussing access to support and treatment for weight and fertility, attendees suggested that such clinics and interventions should: be specific and personalised to each individual, include referral to or provision of support services such as mental health or nutritional support/advice,  provide increased mental health support when navigating weight and fertility services and throughout treatment and pregnancy, be person-centred and look at problems holistically, including any underlying factors (both physiological and psychological) which could be contributing to infertility, and give patients a choice and a voice in their treatment.

While some felt that these interventions should be initiated by their GP, others felt that this would only be appropriate if the patient had a personal or established relationship with their doctor.

Views on communicating with patients and the public about weight and fertility

When communicating about health risks, attendees felt that it was critical ‘not to always assume that weight is the issue’ and wanted researchers and clinicians to take a more balanced view on risk, with attendees noting the harm which negative messaging around risk may cause to people. This included recognising people as individuals and not ‘lumping people with high BMI all into one category’.

When communicating about weight, attendees felt that weight-related terms should not be the only terms used, as ‘some individuals may not recognise themselves as obese, overweight, or having a high BMI’. Attendees suggested that focusing more on blood pressure and other aspects of physiology may be a better ‘tactic’.  Asking patients for their preferred terms for describing their weight was suggested, as it is unlikely that there would be ‘one term for everybody’. It was cautioned that stigmatising language which passed blame and made assumptions around food and exercise should never be used and that providing further context to support any language or terminology used would be helpful.

How we used the insights

Insight reports summarising key points from the activities were made available to Theme leads, the BRC Executive and the public who took part in the involvement activities. These reports are summarised in the full report and were used to shape the BRC application and have specifically informed the Patient and Public Involvement, Engagement and Participation section, including proposed public involvement in governance and resourcing. In addition, the discussion from this activity will also inform weight, fertility, and psychological service provision. 

Attendees were also given the opportunity to sign up for future public involvement, engagement, and participation opportunities.

We would like to thank all those members of the public who gave their time and thoughtful insights through these activities, and the researchers who engaged enthusiastically in the process.