Body weight and contraceptive considerations: A provider survey

Background: This study explored knowledge and practices of obstetrician-gynecologists (OB/GYNs) in providing contraceptive services to obese women. Prior research has documented inadequate guidance about contraceptive provision in an increasingly obese population, the existence of weight bias among healthcare providers, and negative outcomes associated with unintended pregnancy in obese women.

Methods: Practicing OB/GYNs completed an internet survey about obesity, contraceptive method recommendations based on obesity class, and procedural challenges with intrauterine device (IUD) insertion. Subjects also completed the implicit association test (IAT) for body weight as a measure of implicit bias. Descriptive and bivariate χ2 analyses were conducted.

Results: Of 3,000 OB/GYNs asked to participate, 331 completed the survey (12.5%). Respondents expressed negative views of obesity with 41.8% believing it is the fault of the patient. There was greatest variation in contraceptive recommendations by obesity class for combined hormonal methods, progestin-only methods, and tubal ligation and least variation for IUDs and non-surgical sterilization. More than 80% of respondents reported having one or more challenges inserting IUDs in obese women. Of the 175 respondents who completed the IAT, 76.6% displayed an implicit preference for thinness over fatness.

Conclusion: Most physicians in our study modify their recommendations of certain contraceptive methods based on obesity class. While these recommendations are in line with clinical guidelines, physicians may be unnecessarily recommending against some methods, which are still less risky than unintended pregnancy in heavier women. The large number of insertion challenges reported supports the need for education and trainings around IUD insertions for obese women.