Dieting and Pregnancy

by KMom

Copyright 1996-2001 KMom@Vireday.Com. All rights reserved.


DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.

CONTENTS

 

Introduction

Most experts agree that dieting during pregnancy is very inadvisable. However, there is less agreement on dieting before and after pregnancy. This is a difficult dilemma for the fat woman considering pregnancy-----if you choose to lose weight, will it help or harm the pregnancy (or any subsequent ones)?  

Unfortunately, there is very little data on this issue, just assumptions.  Doctors regularly recommend losing weight on the assumption that of course it is going to help, even though there is little study of whether this really does help or hurt in the long run.  Even if losing weight offered some advantages, any possible health benefits of losing weight have to be weighed against the considerable risks of dieting itself, especially of yo-yo dieting.  Thus, the dieting dilemma is a difficult one indeed.

Any possible benefits of short-term losses have to be considered against the very real statistics that show that almost all diets 'fail' when long-term results are monitored. A diet cannot be considered a success until at least 2 years of weight maintenance have occurred, not including the actual period of loss and learning to maintain the loss, according to the Federal Trade Commission. However, almost no diet companies and scientific studies adhere to this standard, so it is very difficult to access reliable data regarding dieting. (5 years of weight maintenance is actually a better measure, but by two years, most programs 'fail' anyhow, so it is rarely measured with the full 5 years.)

In most cases, dieting does not work long-term, involves considerable risk, and offers only minimal short-term benefits.  If the weight is regained (which it usually is), it often can make things worse than when you began.  Repeated sessions of extreme yo-yo dieting are particularly bad for you.  On the other hand, in some people losing the weight and keeping it off permanently can offer some benefits and may improve health. So what do you do? 

It's important to remember that not all fat people are alike.  Some are fat from genetics, some are fat from bad eating habits and/or  sedentary ways, some are fat because they have dieted up the scale from 'chubby' to 'obese', some are fat because of true eating disorders, and some are fat from combinations of these factors.  For some, improving health habits may create some weight loss that may be beneficial for them.  On the other hand, significant dieting may set off a yo-yo weight cycle for others that may actually worsen their health.  

Basically, each case must be decided on its own merits.  Some people may decide that in their case, the possible benefits outweigh the possible risks.  It is important to always take the individual's own weight loss history into account, and any health considerations as well.  

Sometimes, modest weight loss may perhaps be the best choice for an individual, given their history and situation.  But for most fat women who have yo-yo'd up and down all their lives, dieting either before or after pregnancy is just another link on the chains that bind them to an unhealthy lifestyle.  Breaking the chains and learning to emphasize a healthy lifestyle without  dieting can be the first step to freedom!

Each woman must look at her own dieting history, health concerns, genetics, and habits in order to decide what is best for HER.

Note:  Obviously, Kmom's own bias is towards size-acceptance that emphasizes health.  This must be acknowledged before beginning. After years of dieting, ostensibly to improve my health, I had to acknowledge that I was actually considerably heavier and much less healthy than when I began. Except for one very-low calorie diet (VLCD), these were all very moderate, 'sensible' diets like Weight Watchers or the standard doctor's plans, and ALL (even the VLCD) were supervised by medical personnel. So my health was not impacted because I was doing the 'fad' diets; it was impacted by the sensible, moderate, 'healthy habits and lifestyles' diets, and I finally realized that the diets were making the problem worse. 

I stopped dieting, and after a period of re-adjustment, my weight stabilized for the first time in years, I felt healthier, my cholesterol dropped 50 points, and my eating habits and self-esteem returned to normal. Now I concentrate on consistent eating habits and keeping a more stable weight.  With minor variations, it has stayed within the same range for about 15 years. This is far healthier than when I was yo-yoing so strongly. I have also now added regular daily exercise since research clearly indicates that activity level is more important than weight to longevity and health.  It is my belief that size acceptance that emphasizes healthy habits as a way of taking loving care of your body to keep it healthy is the best choice.  Obviously that influences my writings here.    

Your choice does not have to be the same as my choice.  If you want to keep dieting, go ahead.  But I urge women to consider carefully the very substantial risks of dieting, especially prior to pregnancy.  Frances Berg's The Health Risks of Weight Loss would be an excellent resource for general information about the risk/benefit tradeoffs.  But obviously, each person must make this decision for themselves, considering their own history and health needs.   

Just don't make the diet choice from fear that pregnancy could not possibly go well at a higher weight.  Many other women have had healthy pregnancies and healthy babies at many different sizes.  No one can guarantee you that you will have a healthy pregnancy or baby at any size, but perhaps the most important proactive behavior is not losing weight but instead improving health habits.  Kmom's personal opinion is that THAT should be your emphasis, instead of on losing weight.  However, your opinion may vary!

 

Dieting Before Pregnancy

Many doctors do emphasize losing weight before beginning a pregnancy. They emphasize the 'increased risks' of pregnancy at larger sizes, and imply that if you lose weight, these risks will go away.  

However, there is little research to support or disprove this.  At this time, it is simply based on assumptions that losing weight is always helpful or at least benign; doctors have great difficulty imagining that losing weight could actually cause any harm.  Because there is little research on this issue, it is difficult to know what the best course is.  The only evidence we really have at this time is mostly anecdotal, with a few hints from small studies here and there, plus research on weight loss outside of pregnancy.

Possible Benefits of Losing Weight Before Pregnancy

It is clear from research that heavy women have increased rates of some pregnancy complications.  In a nutshell, the main risks of being 'overweight' in pregnancy are a somewhat increased risk of gestational diabetes and/or pre-eclampsia, although it should be emphasized that the majority of fat women do NOT experience these.  It is assumed by the medical establishment that losing weight will reduce your risk of these, or at least  be benign. There is no proof of that.  At least one small study has shown that losing weight between pregnancies does not decrease the rate of gestational diabetes, for example.  

On the other hand, losing weight is known to have beneficial effects on blood sugar in some (but not all) diabetics, and sometimes losing some weight can also help improve blood pressure.  It's therefore possible that for some women, losing weight might decrease their risk for these conditions.  

However, there is no proof of that.  While some people are "responders" and their medical conditions clearly respond well to weight loss, others' do not.  In addition, weight CYCLING is known to increase blood pressure in some people, and may increase diabetes rates in some people as well.   Thus weight loss might be helpful in some and harmful in others.

In women with certain medical conditions (i.e., Poly Cystic Ovarian Syndrome, or PCOS), sometimes weight loss may be helpful.  Women with PCOS tend to have difficulty conceiving, and when they do conceive, have a fairly high rate of miscarriage.  There is some research that shows that weight loss may help improve fertility or decrease the miscarriage rate in these women.  On the other hand, these women are often the ones with the most severe yo-yo dieting histories, and if a weight loss sets off another yo-yo cycle, any benefits may be mitigated.  So automatically pressuring women with PCOS to lose weight before pregnancy may help some but may also create other problems.  

Some research has also found that obese mothers had a higher rate of babies with Neural Tube Defects (NTDs).  Not all research has found this and even if true the risk is actually probably less than 1%, but there is enough data now for concern.  Unfortunately, news articles and website reviews of these studies imply that if you lose weight, you may reduce your risk for a baby with a NTD.   However, this is not established by research and does not automatically follow.  In fact, it could be that dieting or chronic dieting (which tends to deplete B vitamins in the body as well as producing significant ketosis) might actually be what is producing a higher risk for women of size!  Even the authors of one classic NTD study (Waller et al., 1994) caution that, "There is at this time no evidence to support a recommendation that weight loss before pregnancy will reduce the risk of birth defects among offspring of obese women."  

At this time, what factor causes a higher rate of NTDs in larger women is unknown; best guess is that some metabolic factor is at work, and that women who are obese and tend towards diabetes are probably most at risk (see the FAQ on Neural Tube Defects: Don't Panic on this site for more information and references).   Therefore, be sure your blood sugar is normal before pregnancy, and do as much as you can to help prevent or minimize gestational diabetes during pregnancy (see GD: Prevention for more information).   Be sure to get plenty of folate from your diet naturally, and be sure also to take extra folic acid before and during pregnancy.  Consult your provider regarding the most optimal dosage.   

Another concern cited by those who promote weight loss before pregnancy is that big mothers will have big babies.  Although most babies born to big mothers are of average size, there is a higher rate of bigger-than-average babies among big mothers.  Most big babies are born without problems, but a very large baby can sometimes lead to delivery complications, so some sources recommend losing weight before pregnancy. 

This assumes that losing weight will reduce subsequent birth size when there is no proof of this. Birth weights often have a genetic connection. Some large women do indeed have large babies, just as tall women are more likely to have long babies, yet other large women have average-sized babies.  Your baby's birth size has more to do with your family's birth weight history and that of your partner. Although it is possible to make a baby extra-big by eating all junk food, gaining excessive amounts of weight, or having out-of-control gestational diabetes, in most cases a baby's birth weight is largely genetic.  Being sure your blood sugar is normal before and during pregnancy and eating healthily is the best step you can take to assure your baby of a birthweight that is 'proper' for him, given your genetics and birthweight history.  There is NO proof that losing weight will make you have a smaller baby or an easier birth.

Doctors also like to point out that larger women have higher rates of C-sections, but the assumption that losing weight would therefore lower your chance for a c-section is unsubstantiated.  The reason big moms have a higher c/s rate is probably multi-factorial.  Some is probably a result of the higher rates of complications in big moms (and the treatment protocols often associated with them). Big mothers are also documented to be induced at higher rates than average-sized women for various reasons, and inductions are definitely associated with increased c/s rates, especially in first-time mothers.  Fat moms have also been trained throughout life to think of their bodies as 'defective' and 'incapable'; this in combination with being treated as 'high-risk' probably creates a self-fulfilling prophecy for problems in many cases.  

However, prejudice from health practitioners also plays a very significant role in a higher c-section rate.  Many big moms report that they were told from early on that they would 'probably need a c-section' and consistently steered in that direction.  In fact, many big moms have had a c/s and were told that it was because they were 'too fat',  'too out of shape', or 'had too much padding' to give birth normally.  Yet many of these women went on to have a normal vaginal birth later on anyhow, thus proving that provider prejudice does play a significant role in the c/s rate.  A considerable amount of the higher c/s rate in big moms is due to provider bias, both outright prejudices and subtle practices that undermine normal birth in bigger women.

There is no proof that losing weight before pregnancy will decrease your chances for a cesarean based on physical factors, but ironically, it may reduce your chances for a cesarean simply by helping you avoid the size-phobic prejudices of some providers.   However, the best answer to that is not to lose weight to avoid prejudice, but instead to find a provider that is SIZE-FRIENDLY, one that does not see you as 'defective' or a cesarean waiting to happen.  

Many large moms----some very large!----have given birth normally.  The key seems to be seeing a provider that is as birth-friendly and as non-interventionist as possible, that does not see a fat woman as automatically 'high-risk', that has a very low induction rate, that does as few interventions as possible, and who uses lots of different techniques (mobility, alternate positioning, etc.) to help the mother instead of keeping her immobile in bed.  THAT is probably a better and safer choice than trying to lose weight simply in order to avoid provider bias. 

Thus, losing weight before pregnancy does not have many proven benefits.  There is no proof that it would help lower your chances for a cesarean, help your baby be smaller, prevent neural tube defects,  or help you have a better birth.  On the other hand, in some women, losing weight before pregnancy might help if blood sugar or blood pressure is a concern, but definitive proof of this is lacking.  

If you are one of the women whose blood sugar or blood pressure responds well to weight loss (or if you are a woman with PCOS who has a strong history of miscarriage), weight loss might possibly be helpful if you do it healthfully and stabilize well before pregnancy.  However, if you are a chronic dieter and have yo-yo'd up and down the scale a lot, trying to lose weight before pregnancy might actually do more harm than good.

Possible Risks of Losing Weight Before Pregnancy

Because it has not been suitably studied, most of the evidence for possible risks of dieting before pregnancy is anecdotal (stories from women rather than official studies).  Anecdotal stories are not conclusive proof.  However, because we lack official  scientific data, it is all that we have for now.   And it shows that there ARE potential risks to dieting before pregnancy.  In addition, there is research that shows that weight loss in general has significant risks.  

Why isn't there more research on dieting before pregnancy?  First, the biggest factor is probably the medical mindset about dieting----doctors simply find it difficult to imagine that weight loss might actually be harmful.  They assume that of course it will be helpful, and at the very least would be benign, so they see no need to even study the question in any meaningful way. 

Second, it is not in anybody's economic interest to fund such a study. Studies on weight loss are mostly funded by the weight loss industry, and lots of studies showing harm from deliberate dieting would certainly not be in their economic interest. In fact, they often use fear of complications in pregnancy as one of the marketing tools for their particularly radical 'treatments' (like drugs or weight loss surgery).  They play up and overly emphasize studies finding complications in the pregnancies of larger women, implying that almost no fat women have healthy pregnancies or healthy babies.  They blame fat as the only possible cause of these problems, and they paint radical weight loss as the only possible solution.  This is an emotionally manipulative, distorted and insidious marketing tool.   

A good book to read on the general subject of weight loss is The Health Risks of Weight Loss, by Frances Berg (a Registered Dietician). It is a good, neutral look at the research about the health benefits and dangers of dieting. She points out that much of the research about the benefits of dieting is too short-term to be conclusive and is quite often funded by the diet or pharmaceutical companies, who have a significant economic incentive in certain outcomes. {Would you accept smoking research from the tobacco companies as definitive?} It is a well-rounded look at the possible advantages and disadvantages of dieting, and the underlying assumptions of traditional attitudes towards weight loss.  

Basically, even the most well-meaning doctors and their sponsoring companies simply assume that losing weight will help and not hurt, so they don't even study the question of possible disadvantages.  However, the possible risks of dieting cannot be dismissed as insignificant. The medical credo clearly states, "First, do no harm."  There is scientific evidence that losing a lot of weight/weight cycling can be harmful, and also anecdotal evidence that losing a lot of weight before pregnancy can also be harmful at times.   Therefore, caution is warranted and more investigation is needed.

Anecdotally, there are a number of cautionary tales of women who have lost weight for a pregnancy. Many women lose a lot of weight before pregnancy only to gain it most or all of it back during pregnancy.  For example, one woman lost 100 pounds only to gain back 80 during the pregnancy.  Many other women have had similar stories.   25 pounds is the standard recommendation for weight gain in pregnancy for average-sized women; larger women may need to gain even less.  So a gain of 80 lbs. in pregnancy is definitely quite excessive and may present real risks.  Excessive weight gain may increase the risk of an abnormally large baby, and may also increase the risk for getting gestational diabetes or other complications.  Yet these women did not go and try to gain the weight back, or start bingeing because they were pregnant and 'eating for two'.  Most of these women gained like this while trying not to regain.  Excessive weight gain during pregnancy is a very real and substantial risk of dieting before pregnancy.

What probably happens is that the body goes into starvation mode during dieting, so the body tends to slow down to try to replace the fat it has lost.  In regain mode, your body puts on weight extremely easily, and often with a higher degree of fat than before, especially in the middle.   Abdominal fat tends to predispose people to higher blood pressure and more blood sugar problems, so a significant weight regain (and especially bouts of large weight cycling) may particularly tend to increase the risk for health complications.  

Similarly, in pregnancy, the body puts on a fat layer for energy later on in birth and breastfeeding.  If you enter pregnancy after a diet where your body has already been in starvation mode, the body 'panics' and tries to put on even more weight because it thinks it's been starving and baby is going to need so much more energy.  So women often accumulate pregnancy weight at an increased pace after dieting because of the combination of starvation/regain and pregnancy fat storage mode. As noted, this is potentially very risky for both mother and baby, tends to lead to extra-big babies, and may make a woman more susceptible to gestational diabetes or other problems. 

Another risk is starting out the pregnancy malnourished.  Dieting (especially strongly hypocaloric diets) tend to deplete the body of vitamins and minerals, and particularly of B vitamins.  Dieting is already a stress on the body; add in nutritional depletion before taking on the stress of making another little human being inside you (and all the huge hormonal changes associated with that!) and it may be hard for your body to cope.  You want to be at your most OPTIMAL nourishment before conceiving a child, not in a state of malnourishment.  

Another possible scenario Kmom has seen several times is the women whose dieting has actually propelled them into diabetes before beginning a pregnancy, or whose gestational diabetes came on very early in pregnancy. It is certainly possible that this diabetes was pre-existing and is not attributable to the weight loss, but weight loss is supposed to have helped blood sugar and obviously didn't.  Also, it is suspicious that none of these women had diabetes before when at greater weights, but that the diabetes came on directly after a significant weight loss. This is not proof, but it is suspicious.

Kmom suspects that in certain susceptible individuals (probably those with a strong history of very large yo-yos) that a strong weight loss might be enough to set off complications like borderline diabetes. Obviously, this is not conclusive proof, but Kmom has heard of enough cases to wonder about it.  Weight loss is supposed to help prevent diabetes, and for some people it does.  However, weight cycling in others may actually tip the person over into diabetes.  This needs to be scientifically studied, but again, Kmom has seen this enough to make her wonder about a connection.

It has been Kmom's frequent observation that many women who have dieted significantly before pregnancy seem to have more complications during the pregnancy.  Again, this is only personal observation from anecdotal stories, informal surveys over the Internet, and years of participation in pregnancy email lists online. It is certainly not scientific proof, but is strong enough that people ought to think twice about dieting in order to have a 'healthier' pregnancy.

Summary 

There is very little scientific proof regarding dieting before pregnancy, either pro or con. Put your emphasis instead on improving your habits and lifestyle.  If your body drops some weight before pregnancy because of improved habits, that's fine---just give it a chance to stabilize before trying to conceive.  But avoid trying to lose weight as your GOAL.  Make your goal being HEALTHIER.

There may be two exceptions to this:  women who have blood sugar or blood pressure concerns, and women who may have fertility concerns that might respond to weight loss.  Because it is well-established in research that some people's blood sugar and/or blood pressure responds well to small, sustainable weight loss, those who have blood sugar or blood pressure concerns might want to consider a 5-10% loss.  However, this might also set off another weight yo-yo cycle which might be even more harmful to blood pressure or blood sugar, or cause the woman to gain even more in pregnancy than she should.  Therefore, if these women choose to diet, they should probably strive to lose and then stabilize their weight well before trying to conceive, and to concentrate on small losses instead of large ones that are less likely to be sustainable.  It should also be pointed out that increasing exercise and improving nutrition can often offer the same benefits as weight loss, so the choice doesn't always have to be only to lose weight in order to improve health factors.

There also seem to be women whose fertility is affected by their size. Weight loss can sometimes apparently help some women regain their fertility, so that must be considered. However, it must also be noted that every woman's fertility threshold is different. Some women are affected by very little extra weight, while others have no problems whatsoever conceiving at 350 lb. or more. One study in the British Medical Journal in 1993 showed that, contrary to popular opinion, average-sized and obese women actually had similar conception rates up to a Body Mass Index of 38 or greater, but it also showed that body-fat distribution (i.e., a larger waist-hip ratio) negatively impacted fertility. (Kmom note: My BMI is in the low 40s and I had no trouble conceiving, but I am a pear/hourglass shape, which may help.) 

If your doctor feels that your size is impacting your fertility, it is worth considering that this may be true. However, do pursue aggressively other possible causes of infertility as well, and be sure to ask your doctor what things he would be investigating if another, smaller patient presented with the same exact symptoms of infertility as you. In other words, be sure that size prejudice is not blinding your doctor to other infertility possibilities.  Also consult the website at www.fertilityplus.org for more information on infertility concerns in women of size.   

Also keep in mind that while low-carb diets can help some infertile women (i.e., many of those with PCOS) return to ovulation, the really low-carb diets are NOT SAFE FOR PREGNANCY.   A side effect of low carb diets (and indeed, of many weight loss regimens) is the production of ketones.  These are 'spilled' into the urine; you can test for their presence by testing first-morning urine with ketone strips that you can buy in any pharmacy.  An occasional small amount of ketones is probably not a big concern in pregnancy, but consistent or large amounts of ketones ARE a concern.  In some studies, ketones have been associated with problems with the baby, so most providers recommend avoiding ketones in pregnancy.  

If your carbohydrate intake drops below 40% or so, you are almost sure to spill ketones.  Therefore, it is probably wise not to use any low-carb diet whose intake is less than 40% carb anytime close to trying to conceive, and an intake of at least 42-45% would probably be safer.  If you are not sure, buy the ketone test strips and test regularly before trying to conceive and during early pregnancy.  Also be sure to consult a registered dietician to fine-tune details of any such program.  

If your fertility has been affected by weight (i.e. your menstrual cycles have been affected negatively as you gained weight over time), it is possible that weight loss may be of assistance to you. Be sure that you do it healthfully and not too quickly, so that the impact on your long-term health is minimized, and watch carefully for complications during the pregnancy. Consider stabilizing your weight before pregnancy if possible, although for many women with fertility concerns the time of greatest increased fertility is right after weight loss, so they may not want to wait too long.  Also be sure that your carb intake is reasonable and that you are not spilling ketones in your urine.

In the end, the decision on whether to diet or not before pregnancy is a personal one. All fat people are NOT alike, so their decisions regarding dieting will not be alike either. If you have a true eating disorder, Kmom strongly urges you to get counseling and stabilize your eating before beginning a pregnancy. If you are fat because you eat poorly, then improve your eating habits and perhaps some weight will come off---which is fine, as long as you give your body time to stabilize at its new weight. If you have been a yo-yo dieter, the healthiest decision for you may be to stabilize your weight and concentrate on good habits instead. Whatever your decision, consider carefully all the possible outcomes and do what makes sense for your situation.

Your chances of having a healthy pregnancy and a healthy baby at a larger size are actually good, but of course the state of your health at the beginning of a pregnancy is very important. (See Am I Healthy Enough for A Pregnancy for further discussion.) Do everything you can before becoming pregnant to maximize your chances of a healthy pregnancy.  If you are already pregnant, don't obsess, but do start acting NOW to be more healthy.  Emphasize PREVENTION now instead of INTERVENTION later!

 

Dieting During Pregnancy

Almost all medical experts advise AGAINST dieting during pregnancy. Your baby needs good nutrition and is depending on you to get it. Do not try to lose in order to keep from gaining too much during pregnancy; as a large woman you will probably not gain as much as a smaller woman would anyhow (see section on Weight Gain in Pregnancy), and dieting during pregnancy may cause significant harm to your baby. 

If your baby cannot get good nutrition, it may be malnourished and underweight at birth or have other significant problems. Pregnancy tends to be more complicated and delivery tends to be premature and more risky in undernourished women.  Keep in mind the most important priority right now-----your baby's health. 

It probably IS a good idea to restrict sugar and other simple carbohydrates like fruit juice or sweets to small amounts only or to omit them entirely. Smaller, more frequent meals do tend to reduce nausea and heartburn and keep a consistent energy level, but restricting caloric intake is NOT a good idea. Most pregnant women need 300-500 calories over the level needed to maintain weight (this will differ depending on your size and activity level). Generally speaking, most registered dieticians give large women caloric intakes of around 2000-2300 calories during pregnancy.  

A few antiquated doctors still do recommend that fat women try to lose weight during pregnancy, and while some don't recommend actually dieting during pregnancy, they will tell women not to gain any weight during pregnancy.  This can be harmful too!  One woman pregnant with twins was actually put on a restricted-calorie diet and told to drink SlimFast during the pregnancy!  Researchers on gestational diabetes often call for restricting the intake of obese women with GD by 30% or more, yet the disturbing fact is that they RARELY follow-up on these children to see if there is any long-term harm from this practice!   There is little research proving that restricting intake is not harmful to babies; providers should err on the side of caution and NOT recommend restriction or dieting during pregnancy. 

Yet a few doctors still are doing this, even today.  One recent research study examined the use of a diabetes medication in pregnancy, which it gave to all the fat women with GD in the study.  When the perinatal mortality rate rose, they blamed the medication or the women's obesity for the problem, conveniently ignoring the fact that all of the fat women had been put on 1200 calorie diets during the pregnancy.  1200 calories is barely above official starvation levels as dictated by the World Health Organization for a single non-pregnant person; it is completely inadequate for a pregnant woman!  Yet the doctors refused to consider the possibility that undernourishment or ketosis in the mother may have produced the higher mortality rate.  Even in pregnancy, some doctors simply cannot conceive of the fact that dieting or restriction might be harmful.  

Although periodic examples of restriction do exist even today, the majority of doctors and midwives feel very strongly that fat women should NOT diet during pregnancy.  Yet surprisingly, many women of varying sizes do choose to diet during pregnancy, especially in the last trimester when weight gain really begins to add up and their new girth suddenly seems threatening. The book, A Good Birth, A Safe Birth (Korte and Scaer, 1992), notes:

Madeleine Shearer reported that a survey showed 25 to 80 percent of women in childbirth education classes were dieting to hold the line at their seven-month weight gain. The end of pregnancy is not only the time when the baby has a huge growth spurt...but it is also a time of rapid growth of her brain cells. "Even mild degrees of maternal undernutrition in the last few weeks can interfere with the normal growth and development of the normal fetal brain," says John Dobbing, British research professor, quoted by Gail Brewer in What Every Pregnant Woman Should Know: The Truth about Diets and Drugs in Pregnancy.

Occasionally, some heavy women who have been on so-called 'sensible diets' and become unexpectedly pregnant have wondered if they could stay on those food plans during their pregnancy to try and help the pregnancy be healthy and to try to avoid excessive weight gain during pregnancy.  This is a difficult question, because so much depends on the program involved. 

Controversially, a few places like Weight Watchers have, in the past, offered special food plans during pregnancy that are sometimes called 'diets'. These may not be true diets, however, just healthy eating plans (so they argue), but extreme care should be taken when considering one of these. Beware of excessive caloric restriction; anything less than 1800 calories a day is probably not sufficient, and many feel that 2000 to 2300 is probably safer. Ketones in the urine must be kept track of to be sure that these acids are not being 'spilled' as a by-product of weight loss----as noted, some studies have linked excessive amounts of them to learning disabilities later in life for baby. If ketones are not being tested in your 'diet' plan, then you should probably not BE on that plan. 

If your so-called 'healthy pregnancy diet' is planned to include all the extra nutrition you need as a pregnant woman AND monitors for ketone spillage AND has sufficient caloric intake, then it may not be harmful---------if it's just a sane healthy eating plan. In this situation, why pay someone else big bucks for that? Do you have so little control over your own eating that you need a weekly weigh-in or meeting to keep you honest? Isn't your baby's health sufficient motivation?  For a few, such a plan may not be harmful, but must be considered extremely carefully. This is a decision you have to make for yourself. Just be SURE that any 'diet' you consider is not restrictive and is actually just healthy eating and good monitoring. 

However, probably the safest and most sensible position is to absolutely avoid dieting during pregnancy.  Doctors are quick to add in that this doesn't mean you can go out and go crazy 'eating for two'.  Sensible, healthy eating is still very important, and  QUALITY of nutrients is more important than QUANTITY of food.  However, be sure to get enough food that baby can get enough protein, folate, and other nutrients to build a strong and healthy body.  Avoid junk, but don't be afraid to eat healthy foods.  Good nutrition in pregnancy is very important.  Your baby needs you to feed him or her right!

 

Dieting After Pregnancy

Many big moms tell themselves that they will lose those extra pounds after the baby is born and things settle down.  However, be careful with this idea.  Dieting after pregnancy has special implications when breastfeeding.  It should not be done in the early weeks to months of breastfeeding, and only very cautiously thereafter.  Even if you are not breastfeeding, it is important to be well-nourished in order to keep up with the physical demands of caring for a small baby.  And of course, dieting at any time always brings the usual health risks with it as well.  

For many large women (especially in the bigger range), extra pounds come off easily within a few weeks after birth without dieting. Some women can lose 20 pounds or more this way, without effort.  However, not all do, so don't depend on this happening.  Some theorize that this loss is because of the increase in a woman's metabolism during pregnancy (which only really shows up in significant loss after pregnancy is done), but there are no definitive studies on this.   Unless you are careful, this weight can come back as your metabolism returns to normal, or if you are not careful about your eating.  For some women, the loss generally stays off, but for others it may not. 

If you are not one of the larger women who easily and naturally lose weight after pregnancy and you are sure that it is important for you to lose weight, go about it carefully and slowly.  Smaller women normally take up to 9-12 months to return to their pre-pregnancy weights. It took your body 9 months to gain the weight gradually; it is probably best to lose it in the same way.  

Breastfeeding often helps many women with easy, natural weight loss, since about 500 extra calories are burned up just in the process of nourishing the baby. Studies do show that breastfeeding women do tend to lose weight more easily than those who do not breastfeed, but there are some women for whom it does not make a difference.  In a few women, sometimes breastfeeding can make it hard to lose the last couple of pounds, because the body needs to hang on to a little extra fat reserve for energy.  So although breastfeeding does help most lose some weight, this is not always true for every woman.  

One significant concern is that if you lose weight too quickly while breastfeeding, your milk supply may decrease significantly.  Therefore it is best not to start right dieting right away after pregnancy.  Wait at least 8 weeks, until breastfeeding is very secure and the supply well-established and regulated.  Often it is best to wait at least the first 3 months or so.  Remember that starting too soon or losing too quickly may affect your milk supply.

Another concern is that if you lose weight too quickly, toxins that have been stored in fat layers may be released into your system and affect baby. Losing weight slowly instead seems not to have this effect. If you are determined to lose weight after pregnancy, don't start right away while baby's liver is relatively immature and unable to process toxins very effectively, and once you do start, go slowly and avoid crash losses.  

Some women decide to wean so that they can start dieting.  This is foolish.  Breastfeeding is so good for baby's health and helps lower your own chances of certain types of cancer that you should do it, regardless of whether or not it helps you lose weight.  Taking great care of your baby does not end with pregnancy, and breastfeeding is very beneficial to mom as well as to baby.  Don't sacrifice your baby's health or yours so that you can start dieting right away.  The American Academy of Pediatrics recommends at LEAST one year of breastfeeding, and the World Health Organization at LEAST two years.  

What if you are really determined that losing weight is a good thing for you to do after the baby is born?  If you are determined to diet after pregnancy, it is best not to begin too soon. Let some months go by post-partum before beginning any efforts at this to let your body fully recover from birth and to establish breastfeeding securely.  Remember also that a breastfeeding woman NEEDS extra calories to build and maintain a healthy milk supply, especially in the first 5-6 months when she is baby's sole source of nutrition (you usually need to add about 200 calories to your pregnancy diet, though this will diminish after baby starts solids). After this, caloric need reduces somewhat but is still significant, so don't cheat yourself and your baby.

Perhaps the best approach is to concentrate on reasonable eating and exercise habits.  Take your baby with you on regular brisk walks----it's great for you and for him! Cut down on your fat intake and sugar intake, but don't try to be 'perfect' every single day----this is just setting yourself up for failure. Be reasonable instead.  La Leche League recommends the book,  Eat Well, Lose Weight While Breastfeeding (Ellen Behan, available from www.lalecheleague.org ). Many have found this book to offer a reasonable approach to weight loss without sacrificing breastfeeding.

Midwife Susan Moray says that "Exercise is the safest way for a lactating mother to control her weight. 30-60 minutes of sustained exercise every day will burn off between 150-300 calories a day. The calories lost from breastfeeding, exercise, and avoidance of unnecessary calories should help you to lose a pound a week---a safe amount for most breast-feeding mothers." (The Oregonian, November 1996).  While Kmom disagrees that losing weight is always a matter of energy in-energy out equations, increasing exercise while avoiding overindulgences is probably the most sane way to go about losing weight while still breastfeeding.  

The best approach is not to look at the scale but at your lifestyle and habits. Get these into good shape and let the rest follow. Again, the possible health benefits of dieting have to be weighed against the considerable risks of dieting itself, and the short-term losses and benefits have to be considered against the very real statistics that show that almost all diets 'fail' when long-term results are monitored. Instead, reform your habits and your attitudes about yourself, stop apologizing for your size, and find a reasonable, sustainable weight and exercise plan that is suitable for YOU. Don't put your emphasis on thinness but on HEALTH.

 

Size Acceptance Information

Given Kmom's own situation and bias, her opinion is always to improve your eating and exercise habits and forget about the scale.  Good health is always important, but ignore the scale as a judge of your health. Work on accepting and loving yourself right now, as is, while working towards healthy habits.  Stop judging the outside; work on your insides instead, both emotional and physical.  

As Mary Ray Worley writes about size acceptance at www.naafa.org/documents/essays/fatandhappy.html, "We're not giving up, and we're not letting ourselves go.  Rather we're forging a new relationship with our bodies, one that doesn't involve self-loathing; one that appreciates the miraculous bodies that we have, one that brings joy." 

Size acceptance is not 'giving up', but it is choosing to live NOW, in this body, not putting off your dreams until you someday reach a magic number on a scale.  It is NOT living unhealthfully or 'letting yourself go'.  Size acceptance means treating your body lovingly, with good nutrition and exercise to help take care of it.  Most women actually find that they live the healthiest lives when they have given up dieting/weight loss and concentrate instead of self-acceptance and taking care of their health.

If you have health concerns, by all means work on them!  Size acceptance is not a license to dismiss health issues.  However, it is often more effective to work on improving them slowly and reasonably.  Emphasize healthy eating habits, increasing exercise, and finding a weight that you can easily maintain.  This weight may not be the same you were able to maintain when younger, but let your 'ideal' weight now instead be the one at which you can remain stable for long periods when eating and exercising reasonably.  Many fat women have never had a stable weight for any length of time in their adult life.  Instead of trying to change your weight, consider trying something radical-----work on maintaining your weight while also increasing your fitness.  You don't have to  have to become a 'jock', just work towards improvement from whatever level you're at now.  Progress is your goal, not perfection.

Take an overall, long-term view of your health, and find some exercise (like walking or swimming) that you can do regularly and enjoy enough to maintain consistently.  Find again the joy of moving your body just for the fun of it, instead of because you have to do it in order to lose weight or to keep from getting fatter.  Rediscover the joy of exercise just for the sheer pleasure of moving your body through space, of the ecstasy of dancing, of swimming, of whatever it is that gives you physical pleasure.   Don't let exercise be a chore; find the activities that will make it a joy in your life.

Change your emotional diet mentality too.  Forget about  holding yourself to perfect standards; concentrate on finding reasonable ones instead. Disregard the old diet mentality of 'success' and 'failure' or having to be 'perfect', and forget about 'good' foods and 'bad' foods.  All foods can be eaten, but with the emphasis on moderation, on enjoyment because you are not going to be deprived of things, on not having to be obsessed with food.  Instead of making food your enemy or your secret lover, let food be your friend and companion again.  Make peace with food and with eating.

Learn to love and appreciate the body you have, and learn to change the negative messages you give yourself.  Channel your energy into positive directions, and break the old negative patterns.  Rediscover your self-esteem, and find that when you stand up for yourself against sizism, people are less likely to be as rude and discriminatory. Think of your size as just another aspect of yourself, like brown eyes or a big smile. It doesn't have to define you, but do let it be a part of you.  

Transform your body image and your sense of worth.  Be as healthy as possible.  Love your body as it is and choose to live NOW, in this body, however it is. Treat it lovingly and with care.  EVERY body is a good body!

 

References

Besides the references listed in the text above, here are more.  In addition, many more can be found in other articles on this website.  

Pole, JD and Dodds, LA. Maternal Outcomes Associated with Weight Change Between Pregnancies. Canadian Journal of Public Health. July-August 1999. 90(4):233-6.

Examined wt. change between pregnancies in women in Nova Scotia between 1988 and 1996 to see if there was an association for wt. loss or gain with c-sections, occurrence of gd, or Pregnancy-Induced Hypertension (PIH). 19, 932 women were studied. Found that weight GAIN between pregnancies increased the risk for developing gd (about 1.5x relative risk), but did not find that wt. gain OR LOSS was associated with any other outcomes.

Watts, NB et al.  Prediction of Glucose Response to Weight Loss in Patients with Non-Insulin-Dependent Diabetes Mellitus.  Arch Intern Med.  April 1990.  150(4):803-806.

135 obese patients with NIDDM who had lost at least 9.1 kg (20 lbs.) were examined for predictors of improvement in plasma glucose levels after weight loss.  41% of patients were "responders", meaning they had significantly improved plasma glucose levels after weight loss, even after only slight weight loss.  However, 59% were "non-responders" whose plasma glucose levels did not improve even with weight loss.  "We conclude that, in contrast to conventional teaching, many patients with non-insulin-dependent diabetes mellitus will not have any improvement in plasma glucose levels after a 9.1 kg weight loss."  However, a substantial minority will, and this will often show up quickly with even small weight changes. 

Holbrook, TL et al.  The Association of Lifetime Weight and Weight Control Patterns with Diabetes Among Men and Women in an Adult Community.  Int J Obes.  1989.  13(5):723-729.  

Examined 886 men and 1114 women, aged 50+ between 1984-87.  Those who were underweight as children or teens had higher rates of diabetes as adults, especially those classified as overweight now.  (In other words, those who were thin as youngsters and gained a lot of weight later on had the highest risk for diabetes.)   Weight gain OR fluctuation of 10 lbs or more between the ages of 40 and 60 significantly increased diabetes rates, as did significant weight gain after age 18.  Exercise as the only means to control weight was associated with a significantly reduced diabetes rate.  

Morris, RD and Rimm, RA.  Long-Term Weight Fluctuation and Non-Insulin-Dependent Diabetes Mellitus in White Women.  Ann Epidemiol.  September 1992.  2(5):657-664.

8232 white females who were members of TOPS (Taking Off Pounds Sensibly) between the ages of 40 and 50 were studied to see if long-term weight fluctuation was associated with NIDDM.  An index of weight fluctuation was developed.  Weight fluctuation, waist-hip ratio, relative weight, and family history all showed increased risk for diabetes.  "The results suggest that the magnitude of long-term weight fluctuation is associated with the development of NIDDM."

 

Size Acceptance Resources

Books - available from www.amazon.com, www.naafa.org, or www.amplestuff.com. 

Bruno, Barbara Altman.  Worth Your Weight: What You Can Do About a Weight Problem.  Bethel, Connecticut: Rutledge Books, Inc., 1996.  

Dedicated to 'ending people's suffering about weight'.  An excellent book on self-acceptance, breaking through dieting myths, being fat in a fat-phobic culture, working towards self-acceptance.  Recognizes that all fat people are not alike!  Unique in that it offers support for fat women who are not overeaters as well as recovery exercises for those fat women who have real eating issues, from emotional eating to diet bingeing to unhealthy food behaviors, etc., yet all within the context of size acceptance and self-love.  A good buy for many different 'types' of fat people. 

Erdman, Cheri K.  Nothing to Lose: A Guide to Sane Living in a Larger Body.  New York:  HarperCollins Publishers, 1995.

For women struggling with weight and body image, this book has information and personal stories from women struggling to take back their bodies from the fat-hating messages around us. Has a great chapter on the 'spiral of fat acceptance'----the stages along the way of coming to accept our body, backsliding into diets, coming back to go on to deeper levels of self-love and acceptance, and becoming a part of the cause in your own way.  

Hutchinson, Marcia Germaine.  Transforming Body Image: Learning to Love the Body You Have.  Freedom, California: The Crossing Press, 1985.  

Imagery and step-by-step exercises to help transform your self-image, help you experience and accept your body as is, help integrate body, mind, and self-image, and learn to love your body now.  Written by a psychologist.

Ernsberger, Paul and Paul Haskew. Rethinking Obesity: An Alternative View of its Health Implications. Journal of Obesity and Weight Regulation. 6(2): 84-85, Summer 1987.

Superb, must-read article challenging the traditional view of obesity as a disease and weight loss as the cure. The authors are professors associated with various medical schools. Some of the article's citations are a bit dated (it's from 1987) but the overall presentation clearly shows that the dangers of obesity and the all-out effort to 'fix' obesity through weight loss at any cost are more questionable than previously thought. Does not overlook the risks of obesity or minimize them, but looks honestly at the data, methodology and prejudices of many obesity researchers (many have conflicts of interest) as well as the dubious research on the 'benefits' of weight loss. An excellent resource.

Gaesser, Glenn A. Big Fat Lies: The Truth About Your Weight and Your Health. New York: Fawcett Columbine, 1996.

Book that centers discussion around the problem of insulin resistance and its relationship to weight and dieting. Although the book is a bit patronizing in tone and certainly has an agenda to promote (the author's approach to improving insulin resistance and general health), it still is a good resource for largely sensible information about fatness and health, size-acceptance, the importance of exercise regardless of weight, the dangers of weight cycling, insulin resistance and its role in disease, and the importance of excellent nutrition in long-term health and in improving insulin resistance. The author is a PhD who is an associate professor of exercise physiology.

Berg, Frances M. Health Risks of Weight Loss. Hettinger, North Dakota: Healthy Weight Journal, 1995.

Another superb, must-read resource that re-examines carefully the usual prescription of weight loss as solution for the risks of obesity. Concludes that often the risks of weight loss are quite substantial and overlooked. Takes a consumer approach to looking at the weight-loss industry, examining the safety and efficacy of various weight loss approaches, as well as government's role in regulating them. Examines the research literature about obesity and weight loss as well; is fair in examining the risks of obesity as well as the risks of weight loss. The author is a licensed nutritionist and Adjunct Professor at the University of North Dakota School of Medicine. She is the editor of Healthy Weight Journal. This book is highly-recommended by the Journal of Nutrition Education, and was selected by CHOICE, American Library Association, as an "outstanding academic book of the year."

 

Size-Acceptance Websites 

 

 


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