Monday, July 28, 2008

Just Lose the Weight

(Banner spotted in Miami, FL)

A recent New York Times Article, titled “Too Fat and Pregnant” warns against the dangers of gaining weight during pregnancy, particularly among the already fat population. The article notes that the already-fat demographic is more likely to experience complications with pregnancy, including hypertension and diabetes. Moreover, the fetuses of fat women are often too large to navigate the birth canal, resulting in a higher incidence of cesarean sections. To combat this, new crops of bariatric obstetric centers are advising fat patients not just not to gain weight during pregnancy, but to lose it.

That's a wonderful recommendation that comes with just one minor flaw. I might be being a little presumptuous here, but if weight loss were possible, wouldn’t the mother have done this already? How is it going to be any easier when she’s with child? Don’t we already know how difficult it is to lose weight, not to mention lose it and keep it off?


Charlotte said...

The whole concept of losing weight while pregnant just makes me sick. The doctors told my sister-in-law to lose 15 lbs during her first pregnancy. She gained 10 instead (which isn't much for being PREGNANT) and felt devastated about her "failure." The baby, incidentally, was just fine.

Telle said...

The whole "large baby" thing is such BS. Our bodies are capable of amazing things if we just let them. I'm obese and I birthed a 10lb 1oz baby in the front seat of my car because he came out so fast.

Lady Jaye said...

I have a colleague who's a BBW and she just became a mother. Well, she certainly did not lose any weight during her pregnancy (she did gain a bit but she looked so radiant, she wore it well). And she just gave birth last week, with no complications that we know of. Take that, dumbass obs-gyn who believe that us fat women can't go through a normal pregnancy without thinning down first!

Christine said...

I started out at about 190 and ended up at about 225. My daughter was a perfect 6 lbs, 11 oz, delivered vaginally.

Anonymous said...

This is complete BS.

My uncle Westly was still born because my grandmother was put on a diet during her pregnancy with him.

YOU ARE SUPPOSED TO GAIN WEIGHT WHILE PREGNANT! And no amount of fat phobia will change that. A fetus CAN NOT survive of the mothers stored fat.

Bacon's Mom said...

My mother was a size 6 before every pregnancy. She'd gain 60lbs., have no hypertension or gestational diabetes, and then have to have C-secs.

I was considered "obese", gained 50lbs., had no hypertension or diabetes, and had to have a C-sec.

My mom's kids were all between 7 and 8 lbs. Mine was between 7 and 8lbs.

So which is the more meaningful correlation: maternal weight, or birth history in the maternal line?

Anonymous said...

Complete and utter BS. You need to get plenty of protein in pregnancy and go easy on the sugar, but that's it.

I was way over 200lbs at the beginning of both of my pregnancies. Gained 40lbs, the first time, 35 the second. Not a single complication, lovely home births, 7 lbs and 8.5 lbs respectively.

Maternal nourishment is VITAL to a healthy pregnancy. Weight loss attempts are anathema.

Suzanne Nam said...

maybe it will work because they want to decrease the odds that their babies will have health problems? it's hard to quit smoking, too, but many women finally succeed when they get pregnant.

no one wants a world where we obsess over our bodies and freak out if we don't fit the ideal. however, obesity is a serious health issue. and the article wasn't talking about women 50 pounds overweight, it was talking about hundreds of pounds.

Chuckles McGee said...

Have to agree with Suzanne here. Before we blow an issue out of proportion, we really need to consider the target demographic and the actual recommendations made.

And please, there's no need to insult doctors, lady jaye. Just because a single obese person delivered a healthy child doesn't mean that being morbidly obese can't contribute to pregnancy complications, nor does it make OB/GYNs dumbasses. Showing me a single healthy smoker doesn't mean that smoking isn't a major factor in lung cancer.

Lara said...

Suzanne, it's actually been shown that mothers who don't get enough nourishment during pregnancy (including fat mothers) greatly increase the chances that their child will be famine-resistant - that is, have the ability to put on and store fat extremely easily.

Encouraging fat mothers to lose weight during pregnancy is a bad thing for the health of the baby - a fetus needs lots of nourishment that simply cannot be provided by the extra fat stores. Growing babies in the womb need fat, yes, but also protein and vitamins and minerals and carbs, which as you might note are not actually stored in adipose tissue. Mothers who under-eat risk low birth weight babies which have high risk for respiratory, circulatory and brain problems, among other things.

The weight you put on in pregnancy isn't just the baby and a bit of extra fat. It's amniotic fliud, increased blood volume, increased uterine size, other fluids, placenta, etc. Not things you want to be skimping on!

Well-Rounded Mama has a great series of posts up discussing weight gain recommendations in pregnancy:

Lara said...

I might also note that few women are actually physically too small to give birth to large babies (over 8lbs). The increased cesarean rate for fat mothers is NOT due to larger babies, it's iatrogenic: ob/gyns just assuming that because a woman is fat she MUST be high-risk and scheduling C-sections without good reason. Most women, if allowed to labor normally (e.g. without induction drugs, under pressure to "progress", etc) can give birth vaginally to even very large babies without even episiotomies: the cervix and vagina need their own time to relax, dilate, and expand. Having the woman's partner or midwife do perineal massage can also help. Allowing the woman to labor in gravity-assisting positions helps too.

The higher blood pressure in pregnant women, fat or not, is not usually the dangerous kind either. It's simply the result of increased blood volume, not atherosclerosis or the like. It's also a noted phenomenon that fat women are often misdiagnosed with higher blood pressure simply because the clinician uses a too-small blood pressure cuff!

Well-Rounded Mama said...

I invite you all to read my blog's continuing series in response to the suggestion that fat women gain no weight or even lose wt while pregnant. Read the series on "bariatric obstetrics" and on "obesity and pregnancy weight gain." It's a series and there's more to come, but it's a start.

Yes, being fat in pregnancy does increase the risk for some complications, but the solution is not therefore to limit pregnancy weight gain. That risks a lot of other problems, and the safety of such an approach has not been proven yet.

Women used to be strongly limited in weight gain during pregnancy years ago because OBs thought it was prevent pre-eclampsia, only to find out later it increased the risk for many many problems, including too-small babies. We also don't know the long-term effect of undernutrition on babies in utero; famine studies suggest that it has long-term health consequences and may actually INCREASE obesity.

If docs are simply suggesting that fat women be sure to eat healthy in pregnancy and get regular exercise, I'm all for that. However, the suggestion comes from an erroneous assumption that all fat people eat terribly and never exercise, so eating healthy in pregnancy must obviously be something new for them, right? (sigh) But eating healthy and regular exercise is always good advice, for any size. If that's all docs are suggesting, okay.

But some docs are going beyond that, to suggesting LOSING weight or restricting gain by hypocaloric diets in pregnancy. The safety of this has NOT been proven and is potentially very risky. And what do they do if they have a woman who exceeds her "alloted" gain before the end of pregnancy? Put her on Slimfast? (It's been done, and recently too.)

Fat women have a wide range of weight gains when permitted to eat normally; wt gain depends on a lot of factors, like prior dieting, starting weight, etc. There's no "one" wt gain range that is clearly "right" for all fat women.

Bottom line, don't try to manipulate weight gain in pregnancy via restrictive nutrition. Instead, emphasize good nutrition and regular exercise and the woman's body will gain the amount that's right for her.

What a radical concept----emphasizing NUTRITION instead of weight gain. But alas, it's a concept that is foreign to many in the obstetrics community.

Lady Jaye said...

@Chuckles McGee: Where did I say that ALL ob-gyns are dumbasses? I'm talking about those who actually do believe in the idea of losing weight at all costs before pregnancy, regardless of whether the woman is perfectly healthy or not, those who fall prey to the "obesity crisis" paranoia, whether well-meaning or not.

I look at my colleague, and AFAIK, she's normally healthy. I would have hated to know that she had been pressured to diet during her pregnancy out of a scare of weight gain when it was not justified. You know, the kind of doctor who takes one look at you and decide on the spot that you need to lose weight asap, without even checking if you have any particular health issues.

Anonymous said...

I gained about thirty pounds with each of my pregnancies, and kept around ten off each. I could probably diet it off, but we all know how well those work on a changed metabolism.

But I weighed twenty pounds less than my pre-pregnancy weight in my ninth month with my second one. I walked out of the hospital in my prepregnancy jeans. How did I do it?

Hyperemesis gravidarum, from four months in to five and a half months along. I lost about forty-five pounds. It also seems to have triggered fibromyalgia in me, and the baby has turned out to be mildly autistic, which may or may not be related. (He was seven pounds, but that had to be stressful on him.)

So yeah, not a good thing, overall, even if there was a certain degree of "back to normal this fast" that I took pleasure in at the time.

I'd rather get my health back than my figure.

Artemis said...

That scares me that they would recommend trying to lose weight when pregnant. How? Eat less? Not getting enough food and enough of certain nutrients can be a lot more harmful to a woman. Exercise? Because every exercise video I own totally doesn't have a warning at the fron not to do it if you are pregnant (or at least not without consulting a doctor first).
Or are fat pregnant women just supposed to go for a walk? Going for a walk never helped me? Cause fat women clearly never go for walsk and remain fat.

Brooke said...

While there are undoubtedly risks related to undernutrition during pregnancy, there is also a demonstrable risk of childhood cancer - in particular leukaemia - associated with overgrowth in the womb and high birth weights (adjusted for baby's sex).

Quite simply, in all things moderation. Michael Pollan has the right idea. Eat neither too little nor too much. There are dangers in being both underweight and overweight patricularly during pregnancy. One may argue the semantics of how/when/whether one loses weight, but this much should be glaringly obvious.

drstaceyny said...

charlotte--10 lbs isn't much at all. Glad the baby's fine.


lj--congrats to your colleague.

christine--congrats to you, too!

anon--interesting points. . .

bm--yes, a lot of it does seem to be genetic.

pw--nourishment is vital--thanks for pointing this out.

sn--but, my point was, how do you suggest these women lose significant weight during pregnancy? Crash diet?

cm--I agree with the importance of not generalizing from a single case, but, what's your recommendation for weight loss?

lara--thanks for the tips!

wrm--great series, lots of good info. Thanks for stopping by. . .

lj--those doctors are out there, and I'm sure some of my readers have had similar experiences.

al--I'm sorry to hear abt the condition you developed. I do hope that you're moving toward health.


brooke--I agree w/you abt the goal of eating in moderation (for most people). But, for those who can't, or for those who do eat in moderation and are still fat, what do you recommend? I don't think it's simply semantics how they should lose the weight--much of the reason that many ppl are the weight that they are is b/c of numerous dieting attempts. If that hasn't worked, what will? We still have no surefire method for losing weight (in a healthy and long-term way)--this is the problem, not semantics.

HappySmiles said...

Wow, I hardly know what to say to this! You know the obsession with weight loss has gone to far when women are being told to lose weight during pregnancy. It's normal to gain 25 or 30 pounds, isn't it? How could you possibly not gain a pound, while having a healthy baby? This scares me.

Brooke said...

DrS: I don't have any particular professional recommendation as re: weight loss. I'm a cancer epidemiologist, not a nutritionist, and think it's important for mothers to know about the strongly demonstrated aetiology is all. There is loads of discussion in this thread about the problems posed by undernourishment but no mention of overnourishment and I wanted to throw it out there, as most people are surprised when I mention the connection - well known in my field but underpublicised elsewhere, presumably because it doesn't come with a handy solution (such as "wear sunscreen" or "eat more fruit").

erin said...

Obviously women need to gain some weight and eat healthy during pregnancy but for women who are starting out in the obesity category they should not gain more than 15 lbs. This is recommended by the March of Dimes. No one (unless carrying twins) should ever gain more than 40 lbs during pregnancy and even then a 40 lbs weight gain is only recommended for women who were underweight to start with (that a BMI less than 18.5)I think too many women use pregnancy as an excuse to overeat for 9 months.

I also agree that just because a few women say they were overweight and had a health pregnancy does not mean that is the norm. Being overweight and pregnant increases the risk of gestational diabetes which is not good for the mother or child.

Fat Bastard said...

I think you may rethink the idea that every woman has an eating disorder. Bingeing and pigging out is not disordered eating. It is normal, natural, fun and healthy.

The disorder is society's disorder. Pigging out, wolfing down, feasting, gluttony or what ever you want to call it IS NORMAL and it should not be stigmatized.

KC Elaine said...

I fully agree. if people simply could lose weight, they would. thanks for blocking out the number - way to not advertise for them. :)

Anonymous said...

I think that there are many good way to lose weight without risking an eating disorder. Programs like WW and has helped me a lot.

It is all about doing it the right way.

wriggles said...

Dieting is not 'moderation' dieting is getting your body to use it's fat reserves by 'undereating'.

Pregnancy is 9 months, that's more than long enough for someone to diet, lose weight, and rebound. During pregnancy weight regualtion tends toward gain, think about combining that with rebound weight gain.