Tuesday, February 12, 2008

Baby Weight

A while back, a pregnant friend informed me that her ob-gyn had issued some pretty strict guidelines about her pregnancy weight. I was surprised to hear some of her doctor's recommendations and asked this friend if I might interview her for my book/blog; we agreed to talk once she had delivered. Said friend is now the proud mother of a healthy, adorable baby girl, has returned to work (as a psychologist), but still found time to answer the questions below:

1) What foods were you advised to eat, to avoid? Did she propose a daily caloric intake?

She said to avoid fruit (eat it only once or twice a week), avoid the "bread basket" and refined flour. . . . It sounded to me like she was recommending a low carb diet. I was told not to eat any more than I was eating before I got pregnant since I looked "normal" and "thin" (pre-pregnancy). She said that the fetus does not need much in terms of calories.

I told her that I was eating fruit, bread, etc. She said "okay" but encouraged me not to eat more than I was already eating or change my eating habits (except to avoid high mercury fish, more than one serving of caffeine per day, avoid alcohol, etc.).

Another patient that I met in the waiting room (our doctor told her that she was gaining too much weight) said that our doctor told her to eat the following: eggs for breakfast and maybe some yogurt and then salad with protein for lunch and dinner (fruit as a dessert/treat 1-2 times per week). She was told to avoid bagels since they are high in carbohydrates/calories.

2) What did your doctor suggest would be a healthy weight-gain during your pregnancy? What were her concerns about you gaining more?

She said that she recommended to her patients not to gain more than 20-25pounds despite the standard medical recommendation being 25-35 pounds because you don't need more than 20-25 pounds. . . . She explained that any more is "just weight you have to lose."

3) Do you think the above information was correct? How do you think the advice would have differed in a non-NYC population?

Most doctors (even in NYC) suggest gaining 25 to 35, but there is definitely more emphasis on weight gain here. I don't think her advice was very helpful. The way she encouraged her patients to eat (avoid fruit when it is so rich in vitamins, etc.) did not seem helpful. A plan-based diet rich in whole grains (e.g., whole wheat bread) and fruits, etc. is a part of a healthy diet during pregnancy (and always). She is encouraging eating behaviors that are not consistent with nutrition research or standard advice given to pregnant women (especially for someone that may have struggled with an eating disorder). Then again, doctors don't get much nutrition training in medical school.

The average weight gain during pregnancy is supposedly 25-35 pounds (that is what most doctors recommend to their patients). Most people I know gained at least that, often 40 or 50 pounds. To be honest, I don't think you have total control over it. My girlfriends have varied so much! And it did not totally have to do with how much or what they were eating. With respect to weight gain during pregnancy...I think some of it genetic, depends on body type, weight before pregnancy, etc. You can stay active (exercising in moderation) and avoid binge eating, eat healthy, etc. to prevent excessive weight gain but at a certain point you only have so much control.

I felt that her advice was extremely troubling! There seemed to be more emphasis on weight gain than eating healthily. I understand gestational diabetes is a problem and some people see pregnancy as a break from watching their weight (e.g., eating a lot of sweets or high fat foods, etc.) and end up gaining a large amounts of weight...HOWEVER, women already have enough to worry about during pregnancy (the baby, health, body changes, etc.).

I think the advice should should be on health NOT weight gain. It should be to eat as healthily as possible and to eat sweets, etc. in moderation...and to stay active (doing exercises adapted for pregnancy) to promote a healthy baby (first priority) and healthy pregnancy and postpartum recovery. Weight monitoring should be emphasized to make sure the baby and mother are healthy...not as pressure to keep your weight gain low so that you look good afterwards. Patients should be informed that there is a great deal of individual variation, so they should just try their best to eat a healthy diet and exercise in moderation (to feel well and prepare for late pregnancy when it harder to get around & labor & recovery).

4) Did you follow your doctor's guidelines? Did you, at any point, think about switching doctors?

I was quite ambivalent about staying with her. I felt self-conscious and the major goal of each check-up was to check my weight gain (even during visits when she did not bring it up, I found myself bring it up and seeking her approval). I think that if I had gained more than her recommended amount, I would have changed. I seriously thought about it during my second trimester (when I gained the most weight, at the point I had gained 15 pounds) and she suggested that if I wanted to "follow" her recommendation of 20-25 pounds instead of the average 25-35 (30ish), I should slow the weight gain down. She asked me if I was exercising as "vigorously" as before, what types of foods I was eating, etc. She said not to "stress" too much since I was "thin" to begin with if I ended up gaining around 30. She said that if I had been overwieght to begin with, she would have been "upset" that I had already gained 15 pounds.

I did not gain much during the third trimester and she complimented me on it several times, telling me that she was "really happy" with my weight gain. The reality is that everyone's weight gain occurs at a different rate (some people gain more in the middle, others at the end). I don't think it was due to me doing anything to slow my weight gain down.

I ended up gaining 22 pounds. However, I did not really follow her diet advice. I think it was just genetic (similar to my mother during her pregnancies). I ate a decent amount of fruit and bread products, chocolate, etc! I was just mindful of eating everything in moderation (not restricting), trying to eat as healthily as I could) and staying active.

5) What did your doctor have to say about you losing the baby weight post-delivery?

Not much, thank god. But if I had gained more weight, I am sure she would have! If there's anything else, please let me know! Thanks so much, Stacey

Thanks, G, for sharing your story. . .


Anonymous said...

i am completely disgusted with her doctor's approach! As said in the post your major concern during pregnancy should be your HEALTH and the baby's HEALTH. This kind of counseling would be awful for someone with an eating disorder and even for women without previous problems this could definitely lead to disordered eating and low self-esteem.


Anonymous said...

Wow. Fruit and whole grains are one of the few things that can help prevent you from getting constipated and hemorrhoids! With my first pregnancy I ate 5qt packages of strawberries every 2 days..plus apples and grapes. I did gain a lot of weight but I don't think it was the fruit. I think it was the boxes (yes that is plural) of gimungous oatmeal cream pies I ate (read binged) before I found out I was pregnant.

Now, THIS time around (I am 19+ weeks) I haven't gained an ounce. Nothing. Nada. I asked my doctor since everyone keeps asking me how much I have gained (I was deathly sick for the first 16 weeks...a whole other story)...and he said no, I haven't gained weight...but don't worry about it. He said as long as I am eating healthy (didn't tell me specifically what healthy was...but I AM an adult) and the baby is fine that the old ideas of weight gain aren't strictly followed anymore. He did mention that I was already a little overweight...but it wasn't as in a concern...it was more of a "you have some stores to make up the difference of not gaining any" than "you dont need to gain any".

This doctor was actually giving her BAD advice! No, you don't need a whole lot more calories....however...what you are NOT taking in through your diet the baby WILL take from YOU ie your bones, muscle, fat, etc. Babies are parasites at this point and will take what they need from the mother even at the cost of the mother's health. That is why a healthy diet is so important!

My MIL (I have mentioned in other posts/blogs that she is anorexic) refused to eat when she was pregnant with her kids...and she ended up with a ton of health issues because she didn't take in enough nutrients not to mention her babies were all low birth weight.

Besides, all that extra fat you gain usually goes towards energy stores and milk production after the baby is born. Mother Nature made it like that knowing that we were going to be sleep deprived and near insane for that reason.

Anonymous said...

All three of my children have been born in the UK, and my midwives have never weighed me. Not once. During my first two pregnancies, I asked about weight gain, and I was told that anything up to 40 or 50 lbs was well within the range of normal. During my last pregnancy, the issue of weight gain was never even discussed.

I'm certain that if my health care providers were concerned about my weight gain (and the baby's growth), they would have brought it up.... but they didn't, because it wasn't an issue. My body took care of things.

After a year of nursing my youngest, I have come back down to my pre-3rd-pregnancy size. Weight? Not a clue. I don't weigh myself.

I guess the point of my ramblings is that I was left to allow my body to gain the right amount of weight for each pregnancy, and use those fat stores for milk production.

I'm never, ever gonna look the same after having three kids in less than four years. I'm a little fatter, a lot softer, and a whole lot saggier. But my body is the roadmap of my life, and those scars and sags are evidence of my children living inside me. If you ask me, this is a good thing.

Eema-le said...

I can't believe that an obstetrician could give such irresponsible advice. Ditto to the constipation remark. If I didn't eat A LOT of fruits and whole grain foods I would have been in agony.

My mother was actively bulemic during her pregnancies (me and my younger brother). Her OB told her not to gain any weight (she was 5'5" and weighed 119). With me, she ended up gaining 50 lbs., and lost it all immediately. With my brother, he pressured her even more. She ended up getting hospitalized for esophageal bleeding, because she was vomiting so often. I guess it's better to bleed than gain weight in pregnancy.

Anonymous said...

I have always been overweight and my ob/gyn frequently commented on it. (However, I was at my thinnest when I was seeing her because I was recovering from cancer. But, I digress.) When I got pregnant, she told me that I should gain no more than 10 pounds. Since I knew that most women lost around 25 pounds when giving birth, I was shocked. She explained to me that since I was already overweight, that extra would compensate for the weight I would normally gain during pregnancy. I found a new doctor and delivered a health baby girl. I could not believe I was expected to lose weight while pregnant! (I'm signing in as anonymous because I don't have a username yet. Oops)

Zmama75 said...

What terrible advice. I can't believe her focus was on the mother's weight/body size and not what was needed to nourish her body and the growing fetus.

My (ex) OB was different - she never talked to me about eating healthy. She was too busy zooming in and out of the room to give it much concern.

mrs.millur said...


Cuz it isn't like building an entire person out of two half-cells is any kind of WORK or anything, there's no need to provide adequate fuel for your body to do that.

At 24 weeks, I'm anticipating some weight-gain grief from my Doc on my next visit- but it will be nothing compared to this madness.

And now I'm hungry- for a bagel. And fruit.

Anonymous said...

I was born in 1963. My mother was overweight when she became pregnant with me, and her doctor put her on DIET PILLS. No kidding. She only gained 13 pounds (and I weighed 8!!). He told her if she gained more than 15 pounds she was going to be a "really big woman" after the baby came.

I have 3 kids, gained 40 the first time (but I admittedly ate a LOT), around 20-25 with the next 2 BUT I was a good 30 lbs overweight at pregnancy. Never did my OB say anything about my weight gain, only to monitor me toward the end ot make sure I wasn't retaining too much fluid (preeclampsia). I had gestational diabetes with #3 so had to watch it.

Even with the GD, I was ENCOURAGED to eat fruit and whole grains!! I think this doc was way off and I would have been on my way to another OB.

Meowser said...

It might interest you to know that Luther Vandross, the late great soul singer, had the middle name "Ronzoni." The reason? That was the only thing his mother could keep down during her many episodes of hyperemesis gravidarum. If she had listened to that doctor's advice, we'd never have gotten to hear Luther's voice at all.

Karen said...

Funny, the book I'm reading that my OB gave me (yes, my OB actually hands out FREE a book similar to What to Expect When You're Expecting) that says you need at least 300 extra calories just for baby and, by the end of pregnancy, you may need as many as 600. It also says that starvation diets are bad for baby. It also, shockingly, says that a fat-free diet is just as unhealthy as an excessively fatty diet. It *gasp* makes a difference between fat present in foods that are not significant sources of vitamins and minerals, and food like cheese and eggs which are high in vitamins and minerals thus making a significant contribution to your overall nutrition.*

It also emphasizes that most food cravings (not just in pregnant women) reflect the body's need for a missing nutrient.

Its not a perfect book, from an FA standpoint, but its advice is pretty sane, and certainly doesn't mesh up with the whole "baby doesn't need anything special, so ignore your child and focus on yourself" mentality of this loon.

*Heavy paraphrasing

azusmom said...

Wow! Wowowowowow! Some people should NOT practice medicine, and certainly shouldn't be working with of pregnant women!
I gained 50 pounds with both of pregnancies, and lost the weight afterwards. Both of my children are healthy, and my milk production was good. The only time my OB-GYN commented on my weight was to ask if I was eating whole grains in place of too many refined carbs, because they're healthier.
I will never look the same as I did before I had kids, nor do I want to. I am healthy and strong, as are my children. I'm even training to be a fitness instructor, which is something i never thought I'd be able to do.

I'm amazed that doctor hasn't been sued for malpractice!

Hekateris said...

My OB's have been great about my weight, even though I get weighed every time I go there. They've never told me how much I should gain or not, just that as a fat woman they expected to see around 25lbs or so, and if I went over they weren't overly concerned unless I became diabetic and stuff.

However, when I had to see the dietician two weeks ago for 'advice' as I was a borderline gestational diabetic, she told me to increase my carbs to at least 250gr a day.

Later that week, I said to Dr B, Um, C told me to increase the carbs? And then Dr B freaked out and told me that under no circumstances was I to do such a thing, it was counter-intuitive, etc, and what was the dietician's name? Now I test my blood twice a day and am perfectly fine with the blood sugars.

I know a lot of fat women on the mailing list I'm on (OPSS) who are on diets because their OB's have told them to do so, or to not gain any weight at all, which pretty much amounts to the same thing. The really sad thing? They all weigh far less than I do and I'm currently 287 lbs, having gained 17lbs thus far with a month to go.

It's sad, and what's more, it's only going to get worse with the current hysteria.

Phledge said...

The one thing I would say about watching weight trends during pregnancy is that it can help identify if and when a patient is rapidly gaining/losing water weight, which can signal preeclampsia. But geez. I have a really hard time trusting anyone that says "don't' eat fruit." That's bullshit.

Beth said...

Right, like 1-2 servings of fruit a week is healthy. Sure, cutting back on fish and refined carbs is probably best for the baby. Who NEEDS white pasta every day? I imagine, though, that constipation from inadequate fiber during pregnancy would be painful.

Sandy, everything you said makes sense. Congrats on your pregnancy and I hope to have your attitude when I'm in that situation.

Anonymous said...

I am amazed by all this emphasis on weight during pregnancy, vs the baby's health. It's like, ok doesn't the baby need room to grow inside the body?! Oh we can't be having that, cause you know that's unsightly and ect. Whatever happened to the whole it's fashionable to show your baby-bump thing?

PalmTreeChick said...

That doc was nuts!

bigcitymama said...

That's crazy - I am pregnant with my second in NYC and my OB is the opposite - I gained 40 lbs my first pregnancy (I am 5'1" and very small boned - 100 lbs before pregnancy) and she told me not to worry about it, she'd let me know if my blood pressure was high, etc - said my body was gaining what it needed.
Second time, though, my glucose levels were high and she did recommend restricting carbs and sugar (including fruit) to avoid gestational diabetes - therefore, I've gained less this time

Becky-BBW said...

Being fat is ok as long as you're fit--I like this saying when I first time found it on the http://plusmingle.com, which is a lovely community for plus sized people only

Anonymous said...

"...said that our doctor told her to eat the following: eggs for breakfast and maybe some yogurt and then salad with protein for lunch and dinner (fruit as a dessert/treat 1-2 times per week)."
I'm disgusted with this advice from that doctor. I mean, that hardly sounds like enough to keep a non-pregnant woman going, truth be told.
This all brought up for me one of the various reasons fat women often avoid gynecologists. First, it's innately a humiliating exam wherein one feels very vulnerable! (Past history of abuse can certainly complicate this, but it's still an exam that makes most women feel...um...Very Exposed, because, well, she Is). Second, who the hell wants to be this exposed and vulnerable and Then be lectured on losing weight???? It enrages me, quite frankly, how doctors and nurses can be so insensitive and controlling. I really detest how much a low weight is emphasized by doctors.

Anonymous said...

I'm a registered dietitian. Your friend's doctor is a crackpot and should be banned from dispensing nutrition information.

Prenatal weight gain is different for every woman, particularly depending on pre-pregnancy weight, health, etc. Although there are -very- serious concerns with too little or too much weight gain during pregnancy, limiting fruit and complex carbohydrates is not the means by which to protect the mother and baby!

Prenatal -balanced- nutrition is extremely important for the health of mom and baby, and maternal weight gain is the most readily available measure of fetal growth/health. Here is a rundown of what the weight gain actually entails (and why it's so important) (in no order):
2-4# uterus/womb tissue development
1.5-2# placenta
8.5-9# increased blood/fluids (to feed baby/tissue, remove waste, deliver oxygen, cushion baby, etc.)
+/-7.5# baby
1.5-3#, mom's breast development
4-8# mom's extra fat stores (cushions, energy to baby, energy for labor and delivery and to produce milk after birth)

This is approximately 25-35#, and is the average prenatal weight gain we use as a *model*. As a sidenote, women who are very thin or carrying more than one fetus need to gain more weight, and those who already have excess weight don't need to gain as much weight to produce a healthy child. Studies support this information, and I think it's fairly clear why this is when you examine the numbers above. Also, what may be most important is a steady rate of weight gain - steady growth rather than peaks and valleys is vital to healthy fetal development. So the 20-25# as recommended by this doctor is just too low for the average woman - and as you can see it isn't "just weight you have to lose."

Also, that her MD wasn't concerned that she didn't gain much weight during her final trimester is troubling to say the least. The third trimester is -usually- when the most weight gain occurs, because the fetus goes through a rapid growth period.

Your friend suggests that emphasis be on the "health" and not the weight gain. There is some truth here, but the baby and mom still need to grow to be healthy. What she eats should be balanced, with the allowance to splurge now and then, but she still needs to gain weight (and have this monitored by a medical practitioner).

I feel very strongly about prenatal and postpartum health, and I strongly encourage any woman who is considering becoming pregnant or who is already pregnant to regularly visit a registered dietitian (NOT a nutritionist; an RD is accredited by the American Dietetic Association). Unfortunately, doctors receive very little nutrition education (if any? I wonder), and can no longer be trusted as the only source for prenatal care. It seems to me that if a pregnant woman has concerns that her doctor is not knowledgeable or supportive, she won't be able to trust him/her fully. She may not return, and therefore not receive adequate prenatal care. This is of the utmost importance - adequate prenatal care has been shown to result in better outcomes of pregnancy (fewer complications, very low/low weight births, and neonatal deaths). Isn't a healthy baby (and mom!) the ultimate goal? I would recommend to any woman feeling this way to seek new prenatal care.

Anonymous said...

I don't think the doctor's advice was completely deplorable. She meant well. And concerns about the mother's weight are legitimate, because her weight will impact the baby's health as well.

At this very moment the AMA is reviewing the weight recommendations for pregnant women in light of the problems with excessive weight gain during pregnancy and the high possibility of huge babies and the risk of obesity to these babies later in life. Not to mention the risk of obesity in the mothers. In Europe and Japan, the weight gain recommendations are 10 lbs less than here in the US.

I think you have a great amount of control over whether you will turn into a land whale during pregnancy. What the psychologist said is very telling: I understand gestational diabetes is a problem and some people see pregnancy as a break from watching their weight (e.g., eating a lot of sweets or high fat foods, etc.) and end up gaining a large amounts of weight... Exactly. Excuses, excuses.

Personally, I wonder why doctors are giving nutritional advice to pregnant women in the first place. Isn’t that what a dietician is for? But my feeling is this. The emphasis should be on nutritional health, and not weight. I don’t think you do need to eat a lot of extra calories. Calories are not nutrition. Fruit, vegetables, whole grains, legumes, dairy, and lean protein is nutrition. Throw in a multivitamin, eat when you’re hungry, take a 30 minute walk everyday, and you and the baby should be fine.

I don’t understand the emphasis on “fat stores” Unless you have 10% body fat or something, do you honestly need to have more fat stores? I don’t think so. Nature endows most women with enough fat stores to give birth already. That’s why you are able to menstruate in the first place. I’m pretty sure our ancestors weren’t somewhere getting their fat stores up in preparation for child birth. I’m an average weight, and I can tell you I currently have enough fat stores in my thighs to support five pregnancies.

If weight recommendations should be made it should be on how much actual fat a woman has on her body, which is independent of weight. Telling someone who actually has more than enough body fat to gain 30 extra lbs is a recipe for gestational diabetes, a large baby at risk of obesity later, and a fat mom afterward. Doctors should stop giving out nutritional advice and send a pregnant woman to a dietician to recommend how she can get the most nutrition out of her food with a reasonable amount of calories if she is of normal weight and fat percentage. From there, the body will do what it’s going to do.