“That was such a revolution to me, of like, it can be both.  I can have both of these things. I can be fat and happy. That just blew my mind.”

Leah Kern [00:00:08]:
Welcome to shoulders down, a podcast for truth seekers who want to heal their relationships with food and body. I'm your host, Leah Kern, and I'm an anti-diet dietitian, certified intuitive eating counselor, and fellow truth seeker with personal experience navigating disordered eating. In this podcast, you'll learn to harness your body's innate wisdom to govern not just how you eat, but also how you live. It's my mission to help you heal your with food and body, so you can live your most aligned and fulfilling life. Welcome, and I'm so glad that you're here. Hello, and welcome back to another episode of shoulders down. Today, we have such a great guest on the podcast and such a great topic. It's a topic I've been wanting to cover for a while, and I'm so glad that I found the right guest to speak on this topic.

Leah Kern [00:01:00]:
So today's topic is fat positive fertility and our guest is Nicola Salmon and we cover so many interesting things. We talk about the myth that being higher weight leads to worse fertility outcomes. We talk about weight stigma in the fertility worlds. We talk about what you can actually do to improve fertility outcomes and spoiler alert, it's not restricting your calories or losing 5 to 10% of your body weight. We talk about what to do if you're in a situation where your fertility clinic is telling you that you need to lose a certain amount of weight in order to have access to fertility treatment and so much more. Nicola is such a gem. I love her compassion and empathy. It really shines through in this conversation and I can't wait for you to hear it.

Leah Kern [00:01:53]:
I'm going to introduce Nicola and then we will dive right into today's episode. Nicola is the leading voice for fat folks seeking fertility support, bringing a unique fat positive perspective to her work as a fertility coach and author of the groundbreaking book fat and fertile. She's a prominent figure in the world of fat activism using her platform and expertise to challenge the weight bias and stigmas that exist within the fertility industry and empower those who are often marginalized to take control of their reproductive health with confidence and self assurance. Through her innovative and evidence based approach, she helps clients find their own path to wellness, free from diets and body shaming, and encourages them to trust and believe in their ability to conceive. With her expert guidance and compassionate support, Nicola is changing the way people approach fertility. Welcome to the podcast, Nicola. I'm really looking forward to this conversation.

Nicola Salmon [00:02:47]:
Thank you so much for having me, Leah. I am so thrilled to be here.

Leah Kern [00:02:51]:
I'm trying to think of how I found you. I think it was through Bree Campos, Body Image with Bree, who was on the podcast at the time this airs probably a few months ago. But I I'm pretty sure she connected me to your work if I'm if I'm remembering correctly. Yeah. She's awesome. I've learned so much from her. I don't know much about you personally, which is always one of my favorite parts of doing the podcast is learning about people's stories. So, Nicola, I'd love if we could start with you sharing a bit about your story with your relationship with with Food and Body as much as you're comfortable getting into.

Nicola Salmon [00:03:23]:
Oh, yeah. I would love to. So I guess I first experienced, like, I would say, like, a difference in how my body was perceived by other people. From the age of, like, 9 or 10, that was kind of when I really first acknowledged that, hey, people thought my body was different or like a bit of a problem, and it started really subtle. Even like things like my sister who is in a smaller body was given different snacks to me. Like, she had different crisps, and my crisps were lower calories or, like, chips in the US. And it was really subtle things like that, but it really started to escalate in my, like, early teens. So I was diagnosed with polycystic ovarian syndrome or PCOS when I was 16.

Nicola Salmon [00:04:08]:
But I had, like, super irregular cycles before them. And the doctor basically said, you won't be able to have kids. You need to diet if you want to kind of like control this and lose weight. And then gave me the oral contraceptive pill to regulate my cycles, and that was it. So I went into, like, my teens, my early twenties with this idea that my body was somehow broken, that I was wrong, that I wasn't going to be able to have children, and that the way to fix that was to make my body smaller. So that led to so much, like, issues with self esteem and dieting behaviors and, you know, this constant never ending cycle of trying to make my body smaller, which surprise, surprise, never worked. And I was in this total roller coaster yo yo dieting mentality for a long time. And then I did the uni thing, went to university, got a degree, did a master's, and I found my partner who is now my husband.

Nicola Salmon [00:05:13]:
And through this process, I had decided that I wanted to completely change tack with what I was doing. I decided to train to be an acupuncturist, which was very random and kind of led me into the fertility space because so many folks who I was working with at the time were like really wanted to use acupuncture for fertility, which was amazing. Works really well. But that's kind of what led me to be into fertility coaching, which is where I am now. And it was around this time that me and my husband had got married and we wanted to start trying to get pregnant for ourselves. And it was this real really difficult point in my life where I was convinced that I needed to break my body smaller in order to get pregnant. I was expecting it to be really difficult. I thought things were gonna be really, really hard.

Nicola Salmon [00:06:01]:
I was almost, like, gearing myself for this really big challenge that was coming in my life. And we got pregnant really easily. Like, it was wild how easy it was for us. I was still, you know, had PCOS. I was still navigating a 100 plus day cycles. I was in a bigger body. We'd kind of planned we were going to Glastonbury, like, this big music festival for the summer. So we were like, okay, we're gonna properly, in quote unquote, start trying after that.

Nicola Salmon [00:06:27]:
And I was 6 weeks pregnant at Glastonbury, which was not the best idea. But it was it was wild and it was that was really the very first time that it planted a seed of like, well, why was it so easy for me? Like, how did this even happen? Like, how is this a thing? And it was through my first pregnancy that was filled with so much anxiety because I thought everything was gonna go wrong. I was convinced that every single possible thing that could go wrong was gonna happen, but nothing did. It was totally boring, totally ordinary. And as I was kind of gearing up for like the big day, I had, you know, specific things that I wanted to happen. Like, I wanted to have a home birth. I wanted to have a water birth. And I kind of was met with these, like, refusals of like, no, you can't do that.

Nicola Salmon [00:07:12]:
Like, your body's not capable of that. It's, you know, we can't let you do that. So that was really the first time that I ever even considered saying no to a doctor or, like, going against medical advice. And I did a really, like, deep dive into some research found, loads of really useful sites about people talking about this. And it was the very first time that I, like, set up an appointment to go and see my midwife and go, here's the evidence. Like, this is the decision I'm making about my body. And I was 29. And before that point, I had never even heard of the words like body autonomy or like, you know, consenting to medical procedures.

Nicola Salmon [00:07:48]:
And they said yes. And it was just like, okay. I believe that my body could do this, and I had the evidence to back me up. And it made me really realize that doctors don't know everything. Like, the the decisions that we have with our health care providers, they're not, like, fully informed and, like, the gods of all and knowing. And it was just it was wild. And then after my first child was born, I was still in the throes of diet culture. I still thought I'd have to, like, bounce back and lose the weight.

Nicola Salmon [00:08:18]:
And it was when he was about 6 months old and I kind of started to begin to realize that he was absorbing, like, what I was saying in my words and my actions. And I was like, I can't do this anymore. Like, I can't have him hear me talking about my body in a negative way or talking about food in a negative way. Like, it just I didn't wanna pass that on to him. So that's kind of when I went cold turkey, and I was like, no more dieting, no more weighing myself, smashed the scales in the garden. It was this big, like, dramatic moment. That was it. That was it for me.

Nicola Salmon [00:08:49]:
I was like, I'm not doing this anymore and I do not want him to see me and hear me talk about myself in this way. So around that time, you know, I was really lucky to find so many incredible folks on Instagram talking about being in a bigger body and being happy. And that was such a revolution to me of, like, it can be both. Like, I can have both these things. I can be fat. I'm happy. That just blew my mind. And then, like, you know, after kind of a few months of of reading and researching, the my 2 kind of worlds collided almost of, like, my work of the fertility stuff that I was doing and my own personal values and beliefs now about my body.

Nicola Salmon [00:09:29]:
And I realized, like, how problematic, not only the work that I've been doing was in terms of, like, the normal fertility device you give, but also like how harmful the whole fertility industry is. And it's just I got to a point where I was like, I can't can't think they need to work in the way that I've been doing. I need to find something another way to do this. And so I looked around. I tried to find somebody that I could, like, follow or learn from, and I didn't find anybody. So I just started talking about it, and that's kind of how I've ended up where I am now where I just this is the work that I do. I specifically work with fat folks who want to get pregnant because, you know, I know that could have so easily been me where I couldn't have got pregnant, and I would have struggled to access the support and the care and the advice and the guidance that I needed. So I'm now in a position now where my family is complete.

Nicola Salmon [00:10:20]:
I have the capacity to be able to do all the nitty gritty research into all the fat phobic stuff that's out there and really kind of can distill it and help people in a way that's supportive and helpful from my own kind of lived experience of navigating pregnancy and the healthcare system. So, yeah, it's been a wild ride.

Leah Kern [00:10:39]:
Yeah. Nicola, thank you for sharing all those pieces of your story. So were you a fertility coach before you got into the weight neutral health in every size anti diet space?

Nicola Salmon [00:10:51]:
Yes. So it was the the learning, the teaching, the training that I had was very weight centric and very, you know, you've got to follow these good foods and these bad foods. And, you know, like, everybody's got to lose weight. Like, it was so very, you know, like, typical health advice. And it's I really had to kind of acknowledge how much harm that I have done in the past to really be able to move forward with it.

Leah Kern [00:11:13]:
And and it's part of so many provider stories. So the other dietitians and other health providers I have on the show, it's such a common thread of like started by being in the weight normative framework and only through lived experience of witnessing clients and the shame and the pain and, you know, your own story. Can you get to the place of switching over and reconciling with all of that? There's so many things I wanna respond to in your story, but I just think it's really interesting that, like, everyone told you from a young age of, like, you have PCOS. You're in a bigger body. All of these things are gonna make it really hard to get pregnant. And you were almost, like, underwhelmed by how easy it was. And I think that it makes a lot of sense that that would, like, create this foundation for sort of being skeptical about the, you know, just taking doctor's advice as the words of God, which I think so many of us do because doctors hold a lot of power, and and there's, like, that white coat thing or they said this thing. And and, of course, like, they do know a lot, and they are so knowledgeable, and they're human, and they're also subject to diet culture and fat phobia.

Nicola Salmon [00:12:18]:
100%. And I mean, when I was diagnosed so I was 16. I'm 40 now, so that's how long? 24 years ago? We didn't have the Internet. We didn't I didn't have resources or people I could talk to about this. Like, I was so limited. So I didn't have any other options, really. I just I had to take the doctor at face value because I had no other way of really researching or exploring what that meant. I didn't know anybody else who had it.

Nicola Salmon [00:12:42]:
It was just this thing. So, yeah, like, it had such an impact on how I defined myself and my body and the relationship I had with food and movement, you know, all of those things.

Leah Kern [00:12:56]:
So now the work you do is is fat positive fertility. Can we define for someone who's listening and they're not clear exactly on, what does that mean? What is fat positive fertility?

Nicola Salmon [00:13:07]:
So for me, what it means is really centering fat people and their needs and experiences as they're navigating getting pregnant. It's about really normalising what that looks like and really centring, like, what they need, really helping them to feel that their bodies are good enough as they are, and they don't need to change them or lose weight or diet, anything. Like, their bodies are not broken. They're not something to be fixed. It is just a very unique experience, unfortunately, of, like, having to advocate for care and having to go against the kind of norm of what advice is given out there around fertility in terms of like, should I eat these foods, shouldn't eat these foods, must lose weight and all that stuff. So it's a really kind of very counter to the normative advice around already.

Leah Kern [00:13:55]:
The sort of elephant in the room is for someone listening and they're like, well, but what about the research that says, you know, being in a larger body or being higher weight leads to worse outcomes when trying to conceive? What what do you have to share on that? I I think I've heard you speak on this, but I'd love for you to get to share with the listeners your sort of thoughts and response to that super common question.

Nicola Salmon [00:14:20]:
And it's really it's a great question, and it's one that I encourage all everybody to ask about anything that you know, any advice that they give them, especially by strange people on the Internet. But it's it's so layered, and it's so interesting. So the way that I try and, like, explain it is almost like in several layers. So the first is like this idea, like you mentioned already, that so many doctors and researchers are in this, like, diet culture phase with us. Like, they they're not away from it or they're not they don't have a completely neutral lens when it comes to the research. So any research that they're doing, you can see in the first line or 2 where their biases lie. Normally, like within the first paragraph, you will read about like the O word epidemic or like, you know, these foundational beliefs that they hold around fat people. And if you read that in the first few sentences, you know where it's going, you know that they're taking this research and starting it from a place of, well, we believe that a fact is bad, therefore, how can the evidence and the research that we've done, you know, how does that align to that foundational belief that we already hold? But a lot of the research is so much more when you start to really dive into it, it's actually a lot more nuanced than we're led to believe.

Nicola Salmon [00:15:36]:
So for example, there's this myth, this thing that everybody says that fat people take longer to get pregnant. And when I looked at the research around that, the research that I found said that, yes, this was true, that it took fat people longer to get pregnant. It was 1 month longer. That is what they found. And it is wild to me that we are really sensationalizing this idea that it's so much harder for fat people to get pregnant. And know, it's way more complicated, way more difficult when actually the research shows that it's a month. Like it's it's nothing in the big scheme of things.

Leah Kern [00:16:10]:
Yeah. Like, probably not even statistically significant.

Nicola Salmon [00:16:14]:
Absolutely. Absolutely. And the thing about, like, people who do a lot of research around BMI is that they often will take their conclusions, and they will create these, like, stories. And they will look at correlations and make them into causation where they're saying that, well, fat is obviously causing this. And really ignoring a lot of the subtleties around being in a bigger body. Like, it's not just the fat cells on my body that is different. It is how I'm treated in society. It's the medical support that I get or do not get from my healthcare provider.

Nicola Salmon [00:16:50]:
It's how I think about myself, and how I've been conditioned to think about myself and my body, and the stress that that causes on me. It's the history that I have of dieting and weight cycling, my weight going up and down. There are so many more variables that exist because I live in a fat body that have absolutely nothing to do with the fat cells and what they're doing, but everything to do with how I exist in society. So it's really crucial that when people are doing this research that they look at that, but it's so often missed and it's never taken into consideration. And I think from some of the research that I'm looking at now, when we're looking at IVF and fertility treatments, for example, people are making wild assumptions, like saying, oh, it doesn't work as well for fat people, or it's it's not as effective. And actually, what they're doing is they are looking at a treatment which has been designed and tested only on thin people. It has been like they've picked the medication doses and the times that things take based on thin people's response, and have totally excluded how fat people's bodies might respond differently, which we know that they do. You know, we just need to look at medication examples.

Nicola Salmon [00:18:04]:
Like a really common one that's talked about is plan B. Like, we know that over a certain weight limit, it's not as effective, But yet we don't take that into consideration when we're giving fat people medication or we're looking at how treatments are provided and given. So, of course, fat people sometimes in research tend to show higher cancellations of IVF cycles because they're not given the appropriate dose of medication that their body needs. So there's so many different plays and layers to it. But realistically, it regardless of what the research says, fat people deserve to be supported through this. Regardless of why they're fat, of how it happened, of the biomechanisms of going on or anything like that, we are all human and we all deserve to be supported in growing our families if that was what we desire. I

Leah Kern [00:18:53]:
just wanna say like amen to that. It's so beautiful. And, and I wasn't aware of the piece about medication dosages for fertility treatment. It makes me so angry because the amount of people whose biggest dream is to have a family and fertility treatment is the avenue that they're pursuing for whatever the reason is. And if they're told like it's not working or they've had a lot of failed cycles and they stop and it's expensive, especially here in the US. And then to find out that the research hasn't been done or the dosages haven't been tested and curated for people in larger body sizes is so infuriating, and, and how much that is like life changing for someone to not be able to have a family because of weight stigma.

Nicola Salmon [00:19:39]:
It is wild. And the thing is, like, regardless of what the research says, like fertility doctors should be treating people as people. Right? They should be personalising. Someone's not responding well. They should be increasing doses. And, like, that's the medicine we deserve. We deserve to have it personalized to how our body responds and how, you know, we react to certain medications. And there are some incredible clinics that are doing that, and they get incredible results, but not every clinic.

Nicola Salmon [00:20:06]:
And the fertility clinics, it's an industry. It's a massive money making industry. And for some clinics, all they wanna do is get more people through the door, get them out, and just get the good results. So they'll cherry pick clients that which is why we get BMI restrictions. And it is just yeah. It's infuriating to me, like, how some people can be in the business of fertility and just not care about the people that are walking through the door.

Leah Kern [00:20:30]:
Absolutely. So to go back to to the big question, right, like, what about the research that shows that being higher weight leads to worse fertility outcomes? What I'm hearing so much from you is that it it's like a situation of correlation doesn't equal causation. Like, there are so many other things that come with the experience of being fat that are not the fat cells itself. It's the treatment. It's it's the the weight stigma, the medical weight stigma, the the stress levels from existing in a world that is oppressing your body size. All of these things can be factors that lead to worse fertility outcomes, but but not necessarily the weight.

Nicola Salmon [00:21:06]:
And some some of the research is actually not even that conclusive. So, like, the bar is so low when it comes to deciding what doesn't work for fat people and, you know, deciding that something is because somebody is fat. So I did a bit of a deep dive into research around pregnancy loss and BMI. And what I found is that the majority of the research was either didn't show any correlation or was not statistically significant. But yet the author concludes that because there was like a third of research that showed there was this correlation and there was no biological mechanism found, that therefore we can conclude that as BMI creases, pregnancy loss increases because somebody is fat. And it it blows my mind that the bar is so low when it comes to basic research and how we are looking at this. And we are just letting this slide because of our bias against fat people. And they're like, well, of course, even if it doesn't meet the rigorous criteria that we set for research and what that should mean, like, we're gonna let this slide because, well, obviously, that's the conclusion that we should draw from this research.

Leah Kern [00:22:09]:
I have an episode where I go deep into the problems with weight research. And I think the episode's titled, the real reasons why being higher weight leads to negative health outcomes. And then, parenthesis, hint, it's not the weight. So I think so much of that applies to this conversation, and I'll link it in the show notes because that's a whole other deep dive in and of itself. But, yeah, I also think something we haven't talked about yet is, like, the element of different motives. And sometimes, like, the person writing the paper has a real reason that they wanna show that higher weight leads to worse fertility outcomes for whatever whatever reason it is, whatever financial reason they might have stake in that sort of hypothesis.

Nicola Salmon [00:22:49]:
Oh, 100%. Like, there are, of course, pharmaceutical companies who profit off, you know, medicalizing fatness and, you know, bariatric surgeons. And, you know, there's so many people who who benefit from having a culture where being fat is bad and we must do everything that we can in order to make ourselves smaller.

Leah Kern [00:23:10]:
So aside from the myth that being fat leads to worse fertility outcomes, what are some of the other common myths about getting pregnant in a fat body?

Nicola Salmon [00:23:20]:
One of the biggest ones is that weight loss will help and dieting will help. There's some really good research that's come out recently that shows that actually it makes no difference. Like if you lose weight, it's absolutely not gonna improve any fertility outcomes. The other big one that's talked about a lot is obviously because you wanna get pregnant. It's around, like, pregnancy risk and the fact that going through pregnancy in a bigger body is seen as inherently more dangerous. And actually, again, so much of the stuff that we talked about about the fertility research, about the weight stigma and the weight cycling, and all of those things, like, so heavily impact pregnancy risk and pregnancy outcomes. I think if we'd had a much more supportive maternal healthcare system, that would have such a huge impact on potential chances of things going wrong in pregnancy. You know, both for fat people, but also black people, queer people and trans people and other people who live in marginalised bodies, like their health outcomes would be so vastly improved if we had made positive changes to the maternal healthcare system.

Leah Kern [00:24:21]:
And to to go back to the piece about the recommendation for weight loss to improve fertility being completely incorrect. From from the research that I'm familiar with as a dietitian, it it's like actually the the opposite of that calorie restriction can be harmful in the preconception phase. Not only does it not lead to to improve fertility, but it can lead to worse fertility outcomes because the body's in, like, a stressed mode and that's in, you know, no conditions for fertility to thrive. Is this something you've encountered in your research?

Nicola Salmon [00:24:56]:
Oh, absolutely. Like, there's so many studies that show especially like very low calorie diets, which for fat people, of course, like, you if if the doctor tells you that you need to lose weight in order to get pregnant, that is going to be your first, you know, how am I going to do this the fastest? And of course, like, things like very low calorie diets are going to be the way that people go. Like, it makes total sense. Like, if you need to lose weight, you're going to do it the quickest way possible. And yeah, they've shown to be so harmful to folks going through that. Like, like you say, like it increases the stress response in your body. Like it sends you into a mode of like, oh my gosh, like there's no food. Like it's, it's famine, you know, famine mode really for our bodies.

Nicola Salmon [00:25:33]:
And that is not a time you will need to be getting pregnant. So, you know, I'm not a nutritionist, I'm not a dietitian. The only food advice I give to people who come and work with me is that I want you to eat enough. I want you to make sure that your body knows that it's safe for you to get pregnant, that you have enough nutritional, you know, nutritional needs met, that there's enough food coming in to support you through this process. Because otherwise, like, your body is just gonna be in that fight or flight mode, and that is not gonna help things when it comes to getting pregnant.

Leah Kern [00:26:01]:
Yeah. If your body doesn't have enough fuel to nourish you, how can it have enough fuel to build a new human inside of you?

Nicola Salmon [00:26:09]:
Absolutely.

Leah Kern [00:26:10]:
I had a a dear client who I still work with who was going through fertility treatment, and she encountered a doctor who who prescribed a very to me, it was just so frustrating because it was such an arbitrary number. They were like, you need to lose £7 to get I think it was 7, whatever the number was, to get your BMI from here to here. And, it was just so upsetting because a person cannot just snap their fingers and choose a specific amount of weight that they'll lose. And this is someone who really, really, really wanted to have a baby. And and just knowing that the pursuit of of what a person might have to do to lose £7 and how that could harm their fertility for the long haul and how much, like, doctors have tunnel vision for weight and are ignoring other factors factors that contribute to fertility when weight doesn't even contribute to fertility? It's wild. And it's

Nicola Salmon [00:26:58]:
like, they all hold on to this magic. Well, if you just lost 5 to 10% of your body weight, you know, that magic number comes in every kind of health condition. But it's, yeah, it's very rife in fertility. And what the doctors don't seem to understand is that, you know, there's a difference between, like, the the impact of the weight that they potentially may have lost and the impact of the health promoting behaviors that they may have changed in order to reduce their weight. Right? Like, I don't understand. Like, it seems so logical to me that we we can separate those out and they can still do the behaviors and it's doesn't matter what your weight does. Like, it's wild.

Leah Kern [00:27:33]:
Yeah. Can you speak on that a little bit more for someone listening who's like, what do you mean, like, if if someone does have better fertility outcomes and the doctors are like, oh, it's because you lost weight. How do we know that that that might not necessarily be the case?

Nicola Salmon [00:27:46]:
Yeah. Of course. So for me, when I see it, like so many people, the doctors have this experience of they're like, I've seen it in my clinic a 100 times. Like, if you lose a really small amount of weight, then that absolutely magically you could just get pregnant and your ovulation comes back and everything's magic. So what people but what people tend to do is they go away and they change things. So when I say health promoting behaviors, what I mean is like drinking more water, increasing the variety in your diet, maybe moving your body a little bit, maybe getting better sleep, maybe, like, having conversations with partners. Like, the health is so multifaceted and there are so many more things going on than just even your body eating differently. And what then what the doctors see is like, oh, maybe they've dropped like £3 or £4 because of these different things that they've done in their body to change.

Nicola Salmon [00:28:29]:
And they're like, well, it must be the weight. Right? Like, oh, all these people come back, they've lost a few pounds. So it must be like this magic 5 to 10% that they need to lose in order to have the outcomes. And they're not separating that logically from the actual actions that they've taken and the things that they can control because, like you say, you can't snap your fingers and decide that, oh, I'm just gonna lose £7 today because it just doesn't work like that. So it's really helping people understand that there are things that they absolutely can control that will influence their health and helping them find the ways that work for them to help meet their own health goals because we're all different. We all have different health. We all have, you know, people have chronic health conditions. We all have different needs, desires for our health.

Nicola Salmon [00:29:11]:
And I think a lot of the work that I do is around meeting people exactly where they're at, finding out what health means to them and what's important for them, and then working out how to move them towards that without, you know, extreme measures, without dieting, without weight loss, without, you know, destroying their relationship with food forever. And, yeah, just finding ways that work for them in their lives because we are all different, and we all have different needs and wants. And we all deserve for those to be honored and acknowledged and supported.

Leah Kern [00:29:41]:
Absolutely. I just think again about correlation doesn't equal causation just because the weight went down. And, you know, the doctor's like, I've seen it a 1000000000 times. The weight goes down and they get pregnant. But we're not then looking at, okay, but what behaviors were they engaging in that could have led to unintentional weight loss? But it's it's really the behaviors that could increase the fertility, whether that's, you know, lowering stress, increasing improving sleep quality, increasing variety. It's such a good point, and it's wild that we're not looking at that. And sometimes you can engage in those behaviors and your weight doesn't change.

Nicola Salmon [00:30:14]:
Yeah. Doesn't matter because that's the behavior which you can control rather than the weight that you can't. And I think one of the things that that frustrates me, I think so much about that magic 5 to 10%, is that the doctors can say it to somebody who's like in a super fat body and they lose that magic 5 to 10%. Well, they're still in a fat body. So how can that be the thing that's gonna make the difference for them when somebody who started at that weight that they've got down to has to lose their magic 5 to 10%. Like, it just doesn't logically make absolutely any sense.

Leah Kern [00:30:45]:
Yeah. I just shared the story with some clients last night on an alumni call. It's not about fertility, but it it is about that 5 to 10% number. My mom had was diagnosed with fatty nonalcoholic fatty liver disease. And she went to a doctor. They said, you need to lose 5 to 10% of your body weight because I'm her daughter and she knows about this work. She was like, Leah, this is what they told me. And then she ultimately went to another doctor, got another opinion.

Leah Kern [00:31:08]:
And thank God because she can't just do that. Like, that that would put her into a very dangerous and disordered place. And the doctor was like, oh, you need I can't remember if it was vitamin e or some supplement. And she started taking the supplement. Her fatty liver went away, and her weight did not change. So I think it's such a good example of, one, get a second opinion if you're being told to engage in intentional weight loss. And 2, like, the body size didn't change, but the problem did. The health problem did.

Leah Kern [00:31:39]:
And it's not always that simple, but I think that that's such a clear example of the case we're talking about.

Nicola Salmon [00:31:44]:
That is a beautiful example. And I think, you know, so powerful when it comes to, like, it can be something really simple. Right? That just completely transform your health, and it's got absolutely nothing to do with your weight. And it didn't cause it. Like, it was not her fault that it happened. Right? Like, she did not cause that condition because of her weight. And I think, you know, being able to see that link disconnect is really powerful for your own responsibility around your own health as well.

Leah Kern [00:32:08]:
Yeah. And the only thing I think about is, like, people in smaller bodies also have trouble getting pregnant. So if if if it was if that wasn't true, then this conversation might look different. But that it's like, okay. Well, if people in smaller bodies have trouble pregnant, then what are the interventions they're given to help with their fertility? And they're not told to lose weight because they're already in a smaller body. And I I just think about that as well.

Nicola Salmon [00:32:32]:
And it's not all fat people. Right? Like, not all fat people struggle to get pregnant.

Leah Kern [00:32:36]:
Right. So it can't be like x equals y. Yeah. What are some of your tips for helping fat folks who are navigating weight stigma in fertility settings when the desperation to have a baby is so intense. And maybe their fears of the doctor getting angry, or like the doctor turning them away as a client and and sort of like losing their chance is is is loud, that fear is loud?

Nicola Salmon [00:33:01]:
I think the first thing that I always tell people is that, like, your fears are so valid. There are so many other people navigating this. You are not alone. It can feel like that often because we're so often afraid to talk about it, especially as fat folks, because of the fear of, like, the shame and the judgment. But you are not alone. There are so many other people navigating this. And it's so understanding that you're afraid of that. It's such a good coping mechanism of your body to kind of give you that fear because, of course, that can be really traumatizing, especially if you've had experience of navigating that in the past.

Nicola Salmon [00:33:36]:
So I think it's really important to recognize that this fear is doing a really important job of trying to keep you safe. And sometimes that fear is doing a great job, and sometimes that fear is holding you back from doing something that you really wanna do. So I think acknowledging that fear and going, like, this is totally understandable. It's here. It's doing a really important job to keep me safe. And also, I might need to go and access care and support to go through this. I am totally worthy of accessing that care and support no matter what that doctor says. Like, that doctor's opinion of me says nothing about my worth, am I deserving to grow my family, to get support in doing this? But sometimes, folks need to build up kind of a resilience to that.

Nicola Salmon [00:34:13]:
So learning the skills to advocate for yourselves in doctor's appointments, understanding that sometimes our bodies are going to respond wildly in those kind of situations. And that is, again, totally normal. Like crying, like pretend like just nodding along and and, like, going along with whatever the doctor was saying, like, getting really angry and getting really frustrated. Like, all of those responses are totally normal, but still you absolutely deserve to keep pushing and fighting and finding someone who will support you through this. Sometimes it can feel like there's nobody out there and, like, all the doctors are just gonna turn you away, but that's not true. There are doctors out there. There are clinics out there who will help. And there are people like me, like or people like you, like nutritionists and dietitians and coaches and therapists and other health care professionals that can help you navigate through this if the doctors, if the clinics aren't being super helpful.

Nicola Salmon [00:35:03]:
So there are people out there who want this for you as much as you want it for yourself, and you absolutely deserve all the care and the support that you need to get there.

Leah Kern [00:35:13]:
Mhmm. I love your response in terms of recognizing your body's on your team. Like the fear is there for a reason because weight stigma is real, anti fat bias is real, and your brain being nervous about going into a healthcare setting where there's something super vulnerable, like wanting to have a baby and feeling fear about what the provider's response is gonna be or how you're gonna be treated. Is your body trying to protect you and it's doing doing a good job, and you might have to override it and say, I see you. I know you're afraid, and this is something we want. We're we're prepared to kind of go out there and and, of course, having support from coaches, dietitians, therapists, friends, all of those things can help along the way. With fertility treatment specifically, so there's, like, different parts of this conversation. There's trying to conceive, you know, without fertility treatment and that whole everything that comes with that.

Leah Kern [00:36:07]:
But with fertility treatment specifically, when a provider says that you can't access fertility treatment due to your BMI, This can obviously be so heartbreaking for for people who wanna grow their family and this is like their only option. How do you recommend navigating this?

Nicola Salmon [00:36:25]:
It's a tricky one because, obviously, there are so many factors when it comes to to accessing fertility treatment. Like, some people will be able to go to another clinic. Like, that could be really simple for some folks. Like, there are clinics out there who are gonna be a lot more supportive. So if your local clinic has said no, then my first recommendation would always be bind a better clinic. Because if they said no now, even if you can convince them, it's likely that they're still gonna treat you as if you're a no. Right? Like, as if they don't believe in you, they don't believe in your body's capacity to do this. So if it's available to you financially, geographically, like, with the time that you have, you know, to be able to travel somewhere a bit further away for treatment, then I would absolutely recommend finding a clinic who totally believes in your capacity to do this.

Nicola Salmon [00:37:08]:
And I totally believe that your body is capable of this with the right support 100%. If that's not available, like whether it's out of your insurance or whether it's just, you know, like you can't take the time away from work or it's just too far, you can't financially afford it, then there are a few options. So there are, you know, like, I have worked with people who've been able to influence their clinics to be able to change their policies, you know, with evidence, with support, with like opening their minds a little bit. Like that is an option that is available. Obviously, that takes a lot of labour on your part, a lot of time, a lot of difficult conversations, a lot of research. Like, it is labor intensive and that is not work that you should have to do. But if, you know, if that's something that you want to take on, if something that you choose, if that's your only option, then absolutely, you know, like I send people lots of research all the time they can go and have these conversations because that is something that is so important for me to be able to share that with people. And obviously, some people choose to reduce their weight by, you know, and I want people to be fully informed when they're making that decision.

Nicola Salmon [00:38:11]:
Like it's not something I can help with. But I totally understand people often feel like they're stuck between a rock and a hard place, right? Like, if they have no other way to access fertility support and it's something that they need, then they'll choose to understand the lots and lots and lots of risks that come with, you know, reducing your body weight intentionally You can go down that route to get below that BMI barrier so that they can access the healthcare, knowing full well that their body weight will likely increase again, and they can lead to all kinds of things. So it's just I don't wanna take people's body autonomy away from them. That is something they must decide on their own. There's no shame and no judgment in making that decision. Like, I, a 100% do not agree with the weight loss industry and losing weight and all of that stuff. And there's nuance levels. Right? Here, like, people sometimes have to make that decision, that really hard decision, in order to be able to access the care they need.

Nicola Salmon [00:39:00]:
And that is a systemic problem that should not exist in our health care. But some people individually need to make that decision in order to access the care that they need.

Leah Kern [00:39:10]:
Absolutely. And and ultimately, everyone has body autonomy. And the other options, like, aren't great. Like, for a lot of people, they're they're not great. Like, having to travel far, having to spend time and energy going from clinic to clinic, opening yourself up vulnerably, seeing if they're gonna be the ones to give you access to the treatment. And the other option of, like you said, the labor and, like, emotional vulnerability involved with presenting data to a doctor who, like, you already have, like, a power differential of, like, you're a layman and they're a doctor. Awesome to hear that that's worked for certain clients. And I, I can just imagine how, like, those 2 options could seem inaccessible for a lot of people.

Leah Kern [00:39:50]:
And it's like, okay, like, here we go. This is my last option is to I know everything of with the informed consent of of what weight loss can can lead to, and having a child is so important that this this might be the last option viable option for someone. I also think about I've worked with a client who was in the army and she, like, ran into a really similar situation where there is a certain BMI that she had to be, which was so messed up. But first of all, like, as a woman, that she had to complete certain physical activities, and then they were like, your BMI is too high. And it's like, okay. Well, she could run the mile. She she could do all the things that they asked. But just because her BMI was too high, her job was at risk.

Leah Kern [00:40:32]:
And that was a real moment too of me learning, like, the body autonomy piece is so real because I can never understand what the value of having this job is to her. The sort of pros might outweigh the cons of being able to keep your job or in the conversation we're having, being able to get access to that fertility treatment. This is just where so much nuance come in. Like, this kind of stuff you're, like, don't see on Instagram unless you're on your page.

Nicola Salmon [00:40:59]:
A 100%. And it is just yeah. It is just a total mind, you know, meld when it comes to that. I mean, when it comes to looking for other fertility clinics, like, I have a list on my page, which is kind of collated over time. So it's a good place for folks to start if they're looking for ideas without, like, emailing every clinic in the US. So that is a good place to start. If I also recommend, like, getting people involved in the labor of this. So if you are looking for another clinic, like, getting your partner to email them, setting up, like, another email address that you just email clinics from so that you decide when you can go in and look at the the responses rather than it just, you know, hitting you in the face every time you open up your emails.

Nicola Salmon [00:41:38]:
You can even, like, hire people. I've heard of someone, like, going on TaskRabbit and just asking somebody to, like, email all these fertility clinics for them and ask them about their BMI barriers, which I thought was brilliant. But, yeah, there are ways that you can do it. It doesn't involve so much intense emotional labor from you because it it can be another heartbreak every time a clinic emails you and says, sorry. We have this BMI limit. Like, that can be another stab in the heart. So there are ways you can protect yourself from that if you're navigating looking for clinics. But, yeah, ultimately, if you're getting pregnant with a partner, you should, you know, look to share that labor as much as possible with them.

Leah Kern [00:42:13]:
I think that's great advice. And to to sort of round out this conversation, if pursuing intentional weight loss doesn't help with improving fertility outcomes, we touched on this a little bit before, but what are some actionable things that folks can do to improve their fertility?

Nicola Salmon [00:42:30]:
So giving up dieting and weight loss would be my always my first number one and making sure that you eat enough food. Like, just making sure that your nutritional needs are met in terms of the energy that your body needs and in terms of, like, keeping it safe and making it feel safe. I also talk a lot about safety in the work that I do. So being in a fat body can be inherently feeling safe in our society. So looking at ways we can support our nervous system around that. And that doesn't have to be complicated. It can be, you know, proactively, you can be doing super simple things like making sure that you turn off your work emails and don't switch on your work computer when you're off off hours, making sure that you get some time getting a big hug from your partner or a family member. You know, finding places that that help you laugh.

Nicola Salmon [00:43:18]:
So like watching a silly rom com or going to a comedy show, like there's so many ways that you can signal to your body that like it's not stress time, it's like time to down and really support your nervous system with that. So it's finding what works for you. It can be like therapeutic measures like acupuncture or reflexology or having a massage or, you know, there's so many ways we can access that kind of body response. They don't have to be expensive. It doesn't have to be your kind of typical self care of like going in a bath. It's just anything that helps your body signal that, okay, like, stress time is over. It's time for us to have a bit of downtime and relax. And then there are things that you can do in the moment of, like, if you're in a stressful situation of calming your nervous system down, whether that's, like, just a few deep breaths, whether that's, like, gentle touch, like, lots of ways and tools that you can learn to support your nervous system through that.

Nicola Salmon [00:44:04]:
Sleep, rest, super important. Always talk about that. We know we live in such a production heavy society of like do this, do that. You always have to be switched on. So how like, you know, encouraging people to learn about different types of rest and what that could look like for them and making sure they're getting good quality sleep and all of those things. And then movement, if it feels appropriate to talk about, like, for some people, their relationship with movement can be really tricky to navigate and feel really heavy. So this is something that we always talk about, but very, you know, kind of with the caveat of this is not necessary. This is not a required thing to do in order to support your fertility.

Nicola Salmon [00:44:41]:
But if it feels useful to do so, finding movement that feels joyful or supportive or anything that, you know, helps them reach the goals that they deem important for them in their health, whether that's feeling like you've got more energy or feeling fitter, or if they have those kind of goals around their health, then looking at ways to support them through that. I mean, exercise in general in the research showed it's got a really good relationship with fertility, but it's, again, so much more nuanced than just, like, you've gotta do cardio 3 times a week or, you know, like, all of this stuff. Like, it's so much more nuanced than that. But if we can find a way of moving our bodies that feels good, that feels helpful, that we look forward to, and that feels exciting, then absolutely that can be a really powerful puzzle piece of this experience.

Leah Kern [00:45:25]:
I love the tip about safety because I again, I just think about how smart the body is. And if the body is in, like, sympathetic nervous systems activated constantly and chronically, and it's in a stressed out state, then that's no time to have a baby because the brain is like, oh, there's not safety. Like, you want your child to survive. And there's always I think it's interesting to go back to earlier times in our evolutionary wiring of, like, oh, stress and not safety equals no time for baby right now. Like, focus on fight flight, getting away from this predator. I I think that's really beautiful advice. And and everything else you've said, I love it. It's so holistic.

Leah Kern [00:46:02]:
And sometimes I hate that word because it can be kind of co opted by diet culture. But, really that's what it is. And it's also so centered on the person and their goals. Like, like the caveats you gave with movement of like, yeah, if if that's something that you want to have in your life and if it feels okay for you in the context of your story and your relationship with movement in the past, I think that's beautiful.

Nicola Salmon [00:46:22]:
Yeah. And I feel so many people have like shoulds around what they should be doing. And I think recognizing those and acknowledging that this doesn't have to be a piece of it if you don't want it to be. It can be really give people permission to be like, oh, okay. I don't have to do this. Like, there's always gonna be other things that are gonna move the needle if that's not what you choose.

Leah Kern [00:46:40]:
This is sort of a loaded question, but it just came through for me, and I'm curious to hear your thoughts. How can someone work through the feeling that their fertility is their fault?

Nicola Salmon [00:46:51]:
That is a heavy question. And it is I think it's a really important one, and especially for fat people. I know so many people would resonate with that, of like, yeah, this is totally my fault that this has happened. This is totally my fault that I can't get pregnant. And I think there's extra layers to it as well about, it's not only my fault, but this is impacting other people. So it's my fault that my husband can't have a a child. It's my fault that my parents can't have grandchildren. Like, this, like, ripples out.

Nicola Salmon [00:47:20]:
And that shame and that guilt is so heavy, so, so heavy. And I think it's almost like a little domino effect for folks. So the piece that we've started to work on is helping them understand that their the size of their body, they haven't caused that. So when people can recognize that, oh, like, my weight is impacted by a 100 different things, like, I haven't caused my body size, you know, like, this is not my fault that my body is this size. And also it's nothing to be ashamed of. Like, being fat is not a bad thing. Once that domino starts to fall and once that belief that their body size is their fault starts to fall, we kind of work on like the health piece as well of like, okay, so once we understand the weight stuff, that can lead to, okay, well, health. Health is multifaceted.

Nicola Salmon [00:48:10]:
We talk about the social determinants of health of, like, there's so many things beyond what we can directly control that impacts our health. And once people can zoom out on that picture and understand, okay, so it's not my fault that I'm my body is the size it is. It's not my fault that my health is as it is. Like, I haven't caused these body issues. I haven't caused these health issues. And as soon as they can start to unpick that, then those dominoes can start to fall. And they'll be like, oh, well, if I haven't caused this, and this is not my fault, then it can kind of start to unpick that belief of of yeah. Well, of well, of course, that logically then means that I didn't cause this.

Nicola Salmon [00:48:45]:
Like, this is not my fault. And also another kind of domino in that, like, sequence is looking at the systems and looking at how the systems are set up to mean that fat people don't get the support they need in order to get pregnant. And we have all these stories and these ideas and these beliefs that we inherit from our medical system that say, like, oh, well, fat people you know, like the belief I had that fat people can't get pregnant. Like, that I didn't make that up. I didn't just dream that up one day and decide that that was a belief I was gonna hold. Like, that was something I was told from a really, really young age. But as soon as that belief was kind of broken for me, when I got pregnant, you know, like really quickly and really easily, that set off the dominoes. And I was like, wow, well, if if that's not true, then what else is not true? And it can kind of help people slowly unpick those beliefs and, you know, like help people figure out where they've got them from? And do they really believe them? And what evidence do they have to support them? And once we can build up an evidence bank of, oh, well, I've got all this other evidence that shows that actually this is not my fault, and my health and my weight are not determined by my, you know, they are not solely my responsibility.

Nicola Salmon [00:49:47]:
And there are so many other things going on. People can start to let that go. But it is so heavy, and it can take a long time because we can hold that so deeply because it often feeds into our idea that we're not worthy and we're not deserving of this. And that is a really heavy wound to carry. And I know so many people who, whether it's fertility or completely something unrelated, hold that idea that they are not worthy in some way. So anything that kind of supports that is really easy to believe and to carry and to hold on to.

Leah Kern [00:50:19]:
Yeah. And, and after thinking that for so many years, whether it's I'm not worthy or I, I won't be able to get pregnant because of my body size or my health is my fault. It's like that neural pathway is just burrowed so deeply and it takes time and repetition to form new thoughts and beliefs. And I love all of the advice you've given of forming a information bank of of sort of evidence to the contrary and seeking out support. I that's a hard it's a really hard one to tackle, and probably if if you're feeling that really deeply of, like, my health is my fault, probably working with a coach like you could could be really supportive.

Nicola Salmon [00:51:00]:
Yeah. It's definitely something we work on a lot because it can be like you say, it's, like, so deeply ingrained because of all the years of conditioning. Right? Like, we are in doing, in my case, like 40 years of conditioning. And that takes time. It just does.

Leah Kern [00:51:16]:
Okay. So I like to ask these 2 questions to everyone who comes on the show. The first is, what is your biggest diet culture pet peeve?

Nicola Salmon [00:51:23]:
Oh, that's a good question. What is my biggest diet culture pet peeve? I just need to think of a really good one. Okay, so biggest diet culture pet peeve. Oh, I've got so for me, like, something that still sticks with me that I find really really hard to get rid of is it's gonna sound so silly. Running up the stairs. So from a really young age, like, one of these diet culture rules that was embedded in me was, if you just run up the stairs, it's gonna burn more calories, and it's going to, you know, like, help you lose weight if you run up on the stairs. So even now, I find it really hard to walk up a flight of stairs because I have this just, light yeah. This very, very well trodden path of like, oh, stairs must run up then because I've gotta lose weight even though I'm so far beyond that now, it's just something that is just almost like I don't even think about it anymore.

Nicola Salmon [00:52:20]:
It's this immediate response. So, yeah, that's one of the things that's really stuck with me all these years.

Leah Kern [00:52:26]:
Oh, man. That's such a niche one. And and I could totally imagine one of these diet books or, like, people saying, just just simply run up the stairs. Yeah. And I I think about, like, I think I got ingrained with that too, and I have stairs in my home. And when I go up them, I I try to switch it to thinking about, like, oh, like, blood is moving around my body. And, like, that feels nice. And, like, noticing my heart rate increasing and trying to, like, make it more neutral.

Leah Kern [00:52:54]:
Because it's like, I still think about it, but, like, to to move it away from this equals calories burning and weight loss and more to, like, objective awareness of, like, how does it feel to be going upstairs right now? That's something that just popped into my head. Yeah. Okay. I also love to ask everyone. We're talking a lot about, you know, rejecting diet culture and instead listening to your own body, your intuition. And I think the word intuition gets thrown around a lot. It's like intuitive eating and everything, and it's such a loaded word. So I love to understand from other people what does intuition mean to you and how do you experience it.

Nicola Salmon [00:53:28]:
So for me, intuition is a real tugging in my gut. Like, that is how I experience it. Like a real inner knowing of, like, this is the right thing for me. And sometimes it's loud and sometimes it's really quiet. I think it can sometimes be really hard to quantify exactly when you know this is my definitely my intuition talking versus when this is just like something you've read or something you've seen somebody else do or something you, like, wanna follow and somebody else that you admire or appreciate. I think for me, like, when I get really, really quiet, like, if I in the house on my own or if I'm, you know, driving in the car and I just it's almost like things just, like, pop up out of nowhere. Like, I haven't been thinking about something. I haven't been, like and it just, like, something just pops up fully formed.

Nicola Salmon [00:54:17]:
Like, I've not been, like, going over it or like ruminating on a thought or something. And loads tend to be the things where I know like that is my intuition, like that is something that is just, like, arisen from somewhere. I don't quite know where. But those tend to be the voices that that feel truest me, if that makes sense.

Leah Kern [00:54:38]:
So beautiful. I love it. Is there anything else on your heart that you're feeling called to share or anything that we missed?

Nicola Salmon [00:54:45]:
I don't think so. I think we covered a huge gamut of things there. I just yeah. I'm so grateful to be able to chat with you today. I think this has been such a wonderful conversation. And I think if there's one thing that I love people to take away, it's just that, you know, there's no shame in wanting to get pregnant in a bigger body. And you are absolutely worthy and deserving of getting all the support that you need to do it.

Leah Kern [00:55:06]:
Thank you, Nicola. It's so beautiful. And I know this will touch so many people. Where can people find you to stay connected or learn more about your work?

Nicola Salmon [00:55:15]:
So I'm on Instagram over at fatpositivefertility, and then I have all the things that I'm doing on my website, which is nicholasammon.co.uk.

Leah Kern [00:55:24]:
And we didn't talk about your book at all. You wrote a book. Right? Fat and Fat? Oh, yeah.

Nicola Salmon [00:55:28]:
Yeah. So that is really just like a mixture of some coaching tools, my experience getting pregnant in a bigger body, and some research around being, you know, fat and wanting to get pregnant. So that's available on Amazon. It's it's a great place to start if people want some ideas to, like, read about other people's lived experience and to just kind of get a really good I'd like to describe it as a bit of a, like, a hug in a book. So it's really just a very, like, in the same way that I talk, it's just a really, you know, very down to earth. It's just written how I speak. Like, I self published it. So it's not the most polished, but it is just really from my heart in terms of, you know, offer advice and tools that I can share with folks.

Leah Kern [00:56:10]:
So beautiful. I love a hug a hug in a book. Thank you so much, Nicola. I'm so grateful for your time and everything you shared. Bye. Thanks so much for tuning into this week's episode of shoulders down. If you enjoyed the episode, if it inspired you or if you learned something, consider sharing it with someone to help spread the anti diet message. A special thanks to Softer Sounds for producing the podcast and making these conversations sound as beautiful as they feel.

Leah Kern [00:56:41]:
For more intuitive eating and body image support, visit leo kernrd.com, and check out the blog and our free resources. To stay in tune with me and what's happening in my business and personal life, subscribe to my newsletter at leokernrd.com/newsletter. Thanks for listening. Talk to you soon.