Rebel Wilson built her career as an icon for so-called “body positivity” and then wanted to have a baby. Obesity causes higher risks for pregnancies. In fact, pregnant women who are obese face a 131 percent increase in pulmonary embolisms, a 121 percent increase in sepsis rates, and a 120 percent higher risk of cesarean section.

The 44-year-old blonde Australian actress best known for her star role as “Fat Amy” in “Pitch Perfect” wrote candidly about capitalizing on body image to claim Hollywood fame in her new memoir out this month, “Rebel Rising.” The book is as honest as it is hilarious, particularly the audio version narrated by Fat Amy grappling with the “emotional war going on inside.”

“On the one hand, I’m a proud fat female. I’ve used my weight to my advantage. I’ve turned lemons into lemon cheesecake,” she explains in one of the first chapters about a visit with a fertility doctor. “On the other hand, I’m ashamed of my eating behaviors. I feel guilty. I feel unlovable. Luckily nobody lives with me, so they can’t see what I do at night.”

Wilson, who changed her name from Melanie to Rebel when she was 17, landed one of her first television gigs in an Australian comedy called “Fat Pizza.” From there, Wilson continued to win comedic roles as the “funny fat girl.” The actress was candid about leveraging her size at the beginning of her career, taking a course titled, “Comedy and Power” when she was in college.

“It became clear to me that the psychology of comedy is that people like to laugh at people that they DON’T want to sleep with,” Wilson wrote. “I was like, ‘Well f-ck you. F-ck you to all those diet-obsessed people, f-ck you to people who think women must be skinny… I’m just going to be fat. Because guess what? It’s going to be awesome for my career.”

Yet Wilson was still conflicted, because she was diagnosed with polycystic ovarian syndrome (PCOS) at 21. The majority of women with the condition are overweight or obese.

While Wilson’s breakout acting roles built around plus-sized characters in “Bridesmaids” and “Pitch Perfect” propelled her to stardom, her weight remained a heavy burden in her private life by complicating romance and breeding insecurity. “Being a big person, you also must face the fact that when it comes to dating, first impressions matter,” she wrote. “Being overweight was a barrier preventing me from truly being intimate with people.”

As light-hearted as Wilson took her weight on screen, the conflict was a primary theme throughout the book. At one point she reflects on a time she wondered whether to remain apathetic about her size to save her Hollywood reputation or commit to being fit.

In fact, she had to forfeit a publicity contract for losing weight with Jenny Craig to play Fat Amy in “Pitch Perfect.” After she dedicated 2020 to a “Year of Health” so she could have a baby, she writes about grappling with the apparent contradiction between fame over fitness in the bathtub after a performance at the Oscars’ February award ceremony.

“I think to myself, ‘I’ve made it. I really have made it.’ And then the thoughts creep in. ‘Maybe I should just stay the fat Rebel Wilson that everyone knows and loves,’” she said. “What if my weight loss costs me my career?”

Wilson got her answer with the success of “Senior Year” on Netflix, a cheerleading comedy she starred in after she lost a significant amount of weight. “Eight-nine million unique Netflix accounts watch it within the first ten days of release,” she wrote. “It’s a global hit! I think I’m fine.” Yet doubts remain.

“I still wonder,” she added, “am I going to be less interesting?”

Wilson says she's struggled with a sugar addiction. That's all too familiar to the tens of millions of Americans who resonated with the Australian actress for embracing her plus-size profile.

“You call yourself ‘Fat Amy'?” Wilson’s character is asked in her introduction on “Pitch Perfect.”

“Yeah, so twig b-tches like you don’t do it behind my back,” Wilson replies.

The unapologetic role made Wilson a star. But behind the screen, Fat Amy says she “was ignoring the fact that I was mistreating my body.”

“It’s like my not wanting to date someone once I knew they had substance abuse issues – because they weren’t treating their body or themselves with respect,” she wrote. “I was doing the same thing, just in a different way, with bad eating.”

Wilson compares her sugar addiction to substance abuse throughout the memoir, often describing sweets as her “comfort” and coping mechanism. A tub of ice cream at the end of the night became routine in her career.

“I think I have one of those brains where eating sugar is like taking a hit of cocaine,” she writes. “My face just lights up when I eat it.”

Indeed, French researchers have found sugar can stimulate a reward response in the brain stronger than that of cocaine. Children are especially vulnerable to developing such an addiction. A hyper-sweetened food supply desensitizes the next generation to sugar. It's no wonder, then, that Wilson — who wrote, “I couldn’t abstain from sugar if someone held a gun to my head” — developed her addiction in childhood.

“I've always had a sweet tooth,” she said. “The first prayer I ever remember saying was to ask God to let me win the Easter raffle at the dog show, where the prize was a giant basket of chocolate eggs.”

But once she was on the cusp of turning 40, Wilson faced a fertility doctor who offered a blunt analysis of the actress's ability to have a baby. That became her “motivating factor number one” to lose weight.

“You'd have a much better chance if you were healthy,” the doctor said. At first, Wilson was taken aback.

“That hit me like running into the sharp corner of a kitchen counter in the middle of the night (whilst searching for ice cream),” she wrote. “What is this doctor talking about? I'm not healthy? I am a beacon of body positivity to so many people, Doc. Young people. 'Beauty at any size.'” But, she adds, “even though body positivity, self-confidence — all that stuff — is so super important, if I'm going to be really honest with myself, I know this doctor is telling the truth.”

Once Wilson lost the weight following her “Year of Health” in 2020, she wrote that she felt “freer” being “the healthiest I've ever been in my adult life, both physically and mentally.”

Wilson still ultimately commissioned a baby by renting a surrogate's body in November 2022, citing concerns about carrying the pregnancy herself due to her polycystic ovary syndrome. Now 44, Wilson never has outright abandoned body positivity, but the movement abandoned her. In 2022, she appeared on the cover of People Magazine for a cover story speaking about weight loss.

“I thought of a future child’s needs that really inspired me to get healthier,” she told People.

Staffers at the magazine were reportedly outraged by the spring issue. According to The New York Post, “staffers accused new editor Liz Vaccariello of taking a fluffy approach to weight loss and fertility without providing insight from medical experts or any scientific information with the interview.” One source told the Post Wilson's claims about her own health amounted to “fat-shaming” for noting that obesity is a risk factor for infertility.

Wilson addressed the weight-loss backlash at the end of the book.

“For the few haters out there trying to troll me, saying things like 'Ah, now that she's not big, she's not relatable anymore,' or 'Now she's not funny anymore,' or various permutations of 'She's changed and how dare she change and we hate her now,'” she wrote, “I guess I say: I can't hear your voices 'cause they're muffled under the water while my head remains above it all.”

“I haven't abandoned my fan base,” Wilson added. “I haven't been hypocritical. I still think beauty is in every shape and size. I still love the bigger version of me. I've changed and I'm now a healthier person. Who am I hurting? No one. I'm saving my own life.”