“You know what’s weird, though? It’s like everyone wants to touch me.”

I was sitting across from one of my closest friends at a downtown Italian bistro, swiping up creamy ricotta and olive oil with grilled bread, nodding along to her story.

She was pregnant. And newly showing.

“It makes me really self-conscious about my body,” she said. “Everyone is obsessing over it, whether it’s my doctor telling me how much weight I can gain or strangers on the subway reaching out to rub my belly, and it just feels inescapable. I’m hyperaware of my body all the time.”

And then: “Those old eating disorder thoughts are popping back up.”

With a tilt of her head, she added, “Does that make sense?”

I nodded, thinking, Oh, does it ever.

I should start by saying I’ve never been pregnant, nor do I have any interest in ever being pregnant (a social faux pas for a woman in her 30s if there ever was one). But as someone who researches and writes about the relationship between eating disorders and sexuality, I’m aware of just how common these concerns are.

Pregnancy is tricky terrain for someone with an eating disorder. And navigating the relationship between the two is hard, whether they’re actively engaging in an eating disorder, in the midst of recovery, or newly developing symptoms after pregnancy as the trigger.

But body image isn’t the only pregnancy-related concern for people with eating disorders. There’s also the chance they’ll be unable to achieve pregnancy at all due to how common infertility is in folks who are malnourished.

Yet despite the many ways in which eating disorders can affect a person’s pregnancy, we rarely talk openly about these issues. And in doing so, we leave people feeling alienated.

I’d like to try and change this by validating three ways that eating disorders can affect pregnancy as well as offering tips for what you can do if you happen to find yourself in these situations.

Questions like “When are you planning on having a baby?” can bring on a flood of pain for someone experiencing infertility who wishes they weren’t, regardless of whether they have an eating disorder.

For people with severe eating disorders, however, the likelihood of infertility increases. Irregularity of menstruation, generally speaking, is significantly associated with reproductive status. People who experience eating disorders where symptoms include extreme weight loss may also experience amenorrhea, or the stopping of a menstrual cycle. That can contribute to infertility.

If this is you, know that you’re not alone and hope isn’t lost: Research suggests that fertility and other reproductive health issues can be resolved by sustaining recovery for a significant amount of time. Your body is resilient, and it can heal.

How you can respond If you’re someone with a current eating disorder who’s trying to get pregnant but having difficulty, discuss your eating disorder with your doctor. Putting pregnancy on hold to focus on your eating disorder may be your best course of action for redeveloping fertility.

Other people’s bodies aren’t public property. Yet, we’re socialized to talk about the bodies of others freely and openly — especially bodies of those who are more marginalized than we are. And this bizarre social norm particularly stands out when someone becomes pregnant.

“You look good for being so far along,” friends and acquaintances will compliment, implying a smaller body is a preferable one.

“Are you sure you’re not having twins?” family members jokingly tut, mistakenly believing that comments on weight gain are par for the course.

“I can tell you’re having a boy,” strangers will brazenly offer, “because you’re carrying the baby low.”

It’s constant. And it’s harmful, particularly for someone with a history of an eating disorder, as body obsession can make symptoms resurface.

As we’ll discuss more in-depth later in the series, surveillance of people’s bodies (in this case, noticing and placing value judgment on someone’s physical attributes and then commenting positively or negatively as a means of reaffirming social norms) can lead to self-objectification, or the internalizing of the social value of one’s body.

And this can result in disordered eating patterns, an especially dangerous behavior for pregnant people in regards to the nutrition of the fetus.

The truth is, no one should comment on anyone’s body, ever, unless you’ve been given explicit permission to do so. And pregnancy doesn’t create an exception to this rule.

How you can respond If you’re pregnant and dealing with unwanted comments about your body, you’re allowed to request that those harmful comments stop. You can tell people directly that you don’t appreciate unsolicited commentary on your body. Or you can imply your discomfort by changing the subject, like to the development of your baby-to-be.

While the general advice to increase your caloric intake when pregnant is sound, the hyperfocus on what pregnant people are eating and how much weight they’re gaining can do more harm than good.

“You’re eating for two now!” someone might chime in, unaware how potentially damaging this seemingly benign statement can be.

This is especially true in eating disorder recovery, a time when neutralizing your weight and diet is of utmost importance.

And this pressure includes innocent-seeming advice from medical professionals.

It can be hard to remember that, in a society that upholds doctors and scientists as bastions of knowledge, these individuals also hold biases. Diet culture and fat stigma run rampant throughout our society, including in doctors’ offices.

In fact, one older review on anti-fat bias found that healthcare professionals, from physicians and psychologists to medical students, believe their patients who are overweight to be lazy, noncompliant, and undisciplined. Moreover, one-quarter of nurses surveyed said they’re “repulsed” by overweight patients.

Weight gain associated with pregnancy isn’t protected from this bias. If you have a history of an eating disorder, advice to limit your caloric intake or gain weight can be triggering. So, while doctors are, ideally, doing their best to support you in your pregnancy, unsolicited or deeply stigmatizing advice about food and weight is unhelpful.

How you can respond If you’re experiencing food and weight stigma from your doctor, you can find a new one. I recommend looking into Health at Every Size (HAES) practitioners. HAES is a framework that decouples weight from health and, very intentionally, includes health enhancement through weight inclusivity and respectful care. You can search a registry of HAES-aligned healthcare professionals here.

Pregnancy, as much as it can be a beautiful and miraculous time in a person’s life, can also be rife with difficulty: Your body changes rapidly. Everyone around you has a tip to share. Your growing belly is seen as an invitation for touch.

Struggling with your relationship to food or your body — even if you don’t experience an eating disorder, per se — only makes it harder.

And for folks who struggle at the intersection of infertility and an eating disorder, the two stigmas compound one another, creating an isolating experience.

Even if you’re not pregnant or trying to be, we as a community owe it to those who are pregnant or trying to hold more space for their struggles and support their well-being. Considering how our words and actions contribute to complications in self-image is the first step.

Melissa A. Fabello, PhD, is a feminist educator whose work focuses on body politics, beauty culture, and eating disorders. Follow her on Twitter and Instagram.