Thursday, October 27, 2016

NYTimes — New Goal for the Obese: Zero Gain in Pregnancy

December 15, 2009 by  
Filed under Obesity, Pregnancy

Let me state for the record that I’m not pregnant —  but that eventually I’d like to become a mom.

About a year and a half ago on my blog, at the height of my disordered eating issues, I admitted that pregnancy weight scares me quite a bit — but not enough that I would not be willing to embrace it when the time comes.

Since then, fellow WATRD blogger Claire Mysko’s book, Does This Pregnancy Make Me Look Fat, came out and has been a helpful tool for people like me who are working through body image issues; I hope to read it again when I’m pregnant someday.

That said, for most women, the notion of pregnancy weight is daunting — even if you know it’s for a an amazingly good reason.

But what if you were clinically obese and told not to gain any weight during pregnancy? We know obesity carries with it many risk factors, but what would that do to your mind, and to your body? To your baby’s development? 

And so reading this article in the New York Times today, New Goal for the Obese:  Zero Gain in Pregnancy, really gave me pause.

Per the article:

“One-fifth of pregnant women in the United States are obese, and more and more doctors are advising them to watch their weight if they want an easy pregnancy and a smooth delivery. In May, the Institute of Medicine issued guidelines lowering the minimum recommended weight gain for obese women to 11 pounds, from 15.

Now, a large four-year trial called the Healthy Moms study is going further, trying to keep obese pregnant women from gaining any weight at all. If they do gain weight, researchers want it limited to 3 percent of their baseline weight, about 5 pounds for a woman who weighs 170 pounds…”

“… Restrictions on weight in pregnancy are nothing new: throughout the 19th century and much of the 20th century, women were told to gain less than 20 pounds to reduce the risk of complications and Caesarean deliveries. The guidelines were relaxed in the 1970s and ’80s as Caesareans became safer and the risks to underweight babies were discovered.”

“Rising rates of obesity are now leading experts to question that wisdom. Researchers are beginning to ask whether obesity in the mother may be unhealthy for the developing fetus — and, in turn, whether it could lead to obesity in children. Putting the brakes on weight gain during pregnancy may be an opportunity, in other words, to break the cycle of obesity.”

“But the implications of severely restricting weight are not entirely known. “It’s an experiment,” Dr. Rasmussen said of the $2.2 million trial, which is receiving federal financing. “We need experimental studies that can really show us that if you have women gain within a certain limited range, that will improve their outcomes.”

I’ll be curious to see more results of this Healthy Moms study.

For example, “Ms. Paten, of the Bronx, did well with her pregnancy, but she had high blood pressure and gestational diabetes throughout it and delivered by Caesarean section, despite her weight maintenance. Her baby, Brandon, who was born on Sept. 4, weighed 8 pounds 3.5 ounces. After Brandon was born, she tested free of diabetes, though more checks are needed. And she has lost 22 pounds.”

While I don’t necessarily believe a woman who is 100 lbs overweight is doing her body any good by gaining an extra 35-40 lbs. during pregnancy, my fear is that severe restrictions like this could lead to more cases of  pregorexia.

And there are other concerns, too.  “What we don’t know is: Are there effects on the babies’ neurological development, or other adverse effects, from women not gaining weight?” Dr. Stotland said. “Some of these women may be losing fat mass, and the question is: Is losing fat mass during pregnancy, when you’re in a higher B.M.I. category, is that safe for the baby?”

I’d love to know your thoughts after you’ve read the article in full.

How about you? Do you think these are good recommendations? Were you (or was anyone you know) ever under doctor’s restrictions not to gain “too much” weight during your pregnancy? How did that affect you mentally?


30 Responses to “NYTimes — New Goal for the Obese: Zero Gain in Pregnancy”
  1. Bri says:

    I’m especially concerned about this kind of advice with some of the (admittedly controversial) studies that conclude that inadequate fetal nutrition (say, during the Great Depression) may “code” the metabolism towards retention of calories – essentially, mom starving during pregnancy makes baby fatter than s/he would normally be.

    So, essentially, this kind of advice may CONTRIBUTE to the “childhood obesity” problem, rather than help it.

    • lissa10279 says:

      Bri, exactly–that’s what I fear: pregorexia taking over and having harmful effects on the fetus.

    • Bri, I suspect you are right. I would put money on people in 20 years looking back on this and shaking their heads. Food restriction in general most often has the opposite effect in the long run. I have little doubt that I would have settled at a much lower weight had I not dieted intermittently starting from the age of 10. Now, at 32, I’m looking to start having kids and beginning at my highest adult weight. Although I can’t help but be concerned about things like gestational diabetes, I know that going back to food restriction is not the answer (unless I actually DO develop GD and would have to watch my sugar). In reality, although my BMI is in the obese range, I have no signs of high blood sugar, no signs of high blood pressure, so I think it is irresponsible for the medical establishment to automatically consider me “high risk”. If my doctor suggested that I take steps to gain as little as 3% or even no weight during pregnancy, you bet I’ll be finding another one who will support my efforts to have a healthy baby who is nutritionally supported. Since I am good on reserves, I may indeed gain little weight, and I would definitely be happy about that as long as the baby was getting what she needs. But having a goal of weight maintenance and food restriction? No way.

  2. Candice says:

    I’m obese and when I first went to the OB after finding out I was pregnant, I said something about planning to be careful about how much weight I gain. The nurse off-handedly said to me that she’s known women my size who didn’t gain anything their whole pregnancy. She didn’t seem to be saying this in an instructional kind of way and they have yet to say anything to me about my weight. However, at 18wks I haven’t gained anything yet so I guess we’ll see how it goes when the scale does start moving up. I don’t see how you can be expected to gain nothing. If it happens, it happens – but to work towards that seems counterintuitive.

    • lissa10279 says:

      Thank you for sharing your first-hand experience, Candice (and congrats again!! :)) I agree that working towards that “goal” seems counter-intuitive. Wishing you a great rest-of-pregnancy!

    • sarcasticmuppet says:

      Exactly! Nobody knows how pregnancy is going to effect your body. I can look at my mom and sisters, and how they carried, and how they gained weight, etc, and it might give me an idea, but it still doesn’t measure how I’ll do when I get pregnant. I had a good friend who lost twenty pounds when pregnant because she couldn’t keep anything down for the first four months, and didn’t gain much at all the other five, and as worried as she was, she still had a healthy baby boy. I kinda think that our bodies know how to handle pregnancy far better than doctors do…if you need to lose weight, your body will lose it, one way or another. If it needs the extra stored calories, your body will gain. HAES works wonderfully, yet again.

      I’m heavy, but I try to eat well as often as I can and I don’t foresee that changing when my dh and I start our family. If a doctor tells me to lose or maintain my weight while pregnant, I’d heavily consider giving him the finger and finding a new OB.

  3. I don’t have any first-hand experience with this but it stuck out to me that they picked 170lbs as their example number. Any woman over 5’3″ is not technically obese according to BMI at 170lbs. (In fact women over 5’9″ are “normal weight” at 170.) It’s very imprecise to be interchanging “obese” and “overweight” and using BMI in some measures and absolute weight in others. Why pick 170? Is it because people have a distorted view about what 200lbs looks like, like when articles about people who are obese at 200lbs are accompanied by a “headless fatty” photo of someone pushing 400? Is it bc the weight bar for women is being set ever lower and lower? Is it no big deal? I don’t know, it just jarred me.

    • lissa10279 says:

      Addison, I was perplexed by that number, too. Body weight varies from people’s shapes/heights/body types, so it did seem an odd arbitrary number to pick. It bothered me, as well.

      • Emily S. says:

        With 5’4” being the average height of american women though, it’s not particularly out of the common range. Plus. while about 30% of Americans are obese, only 6% fall in to the “Morbidly Obese” category that you may have felt were more appropriately targeted by the recommendations.

        • Forestroad says:

          But a woman who is 5’4″ and 170lbs has a bmi of 29.2, which is not in the obese range, which is the range I was under the impression the guidelines were talking about…

          • Emily S. says:

            right, i was intenting to say that one inch under average isn’t outside of a the most common range.

            There was a commenter over at Jezebel that had a similar reaction – I am curious as to why it makes people uncomfortable to talk about 170 lbs as obese.

            Is it because it is easier to talk about obesity when it is in the extreme range? Does it make you uncomfortable to address the barely obese in the same terms?

            Because 170, while it may be an example on the low end, it is still factually accurate. I live as a 5’2”, 172 lb obese woman. I live in this world where I’m constantly reading about how the world should solve my “weight problem”, and yet I don’t think that many people who see me on the streets would look at me and say “That is what is wrong with America!” I think it makes me extra reactive to articles like this – because I know when people talk about making laws or recommendations that affect the “Obese” they are talking about me, even though I am less than 1 point over the line. Even though I could get a really bad stomach flu and suddenly be under that line. That less than 1 point does not suddenly make me doomed to heart disease, diabetes, and dangerous pregnancies. And I know that most logical people understand this.

            But when we make laws or official recommendations about people with an Obese BMI, they don’t only affect poeple who YOU think are fat enough to deserve. They affect people like me too. People like me who already eat healthy and work out.

            Addisonhabit – I don’t want to put words in to your mouth, but I really am curious. Could you explain more about your reaction? Why does using 170 lbs as an example of obesity seem disgenuine or offensive to you?

          • lissa10279 says:

            I’m not Addisonhabit but I can tell you that the 170 = “obese” connection bothers me, personally because before Weight Watchers (5 yrs ago) I used to be 5’5 and a half and 175 … yes, I was overweight but I was very fit. I wasn’t “obese” at least no one ever told me that I was. Though I’ve since lost weight and maintained about half my original loss and am much healthier now, back then people never could guess my weight and were always surprised when I’d tell them. So in that sense, the number being correlated with “obese” does sound harsh–ESP if you’re not taking into account body size/structure/height. Then again, I’m sensitive to discussions about weight.

          • Emily S. says:

            Lissa – I totally understand seeing 170 on paper and thinking “but that’s not really THAT fat” – and I agree, it really isn’t.

            But right now, BMI is how insurance companies, doctors, government officials, employers, and other officials determine whether you are overweight or obese.

            I think it’s BS, a total crock, but still – when laws, regulations, or recommendations are being made about obesity, they will still apply to the really fit people who are 170 lbs.

            I am not trying to say “maybe 170 lbs is fatter than you think it is”, my motivation here is that BMI is a crap measure for regulating programs, and the fact that we do not have a better/cheaper/easier alternative does NOT make it right!

            So that’s why I am staunchly against all official measures that single “obese” people out for special taxes, requirements, recommendations – it simply doesn’t make sense!

            I wish that instead they were studying how nutritional value of the mother’s diet affected fetal development. If mothers that eat a diet low in saturated fat and high in fiber have easier/healthier pregnancies. Or if women who get 30 minutes of exercise 5 days a week have easier/healthier pregnancies.

            My biggest problem with this study is not that it is trying to make unhealthy people eat healthy – it is that it is assuming that all women with a BMI .01 over the acceptable limit are inheritenly unhealthy, and that simply by trying to NOT gain weight, they wil have to eat better, and thus have an easier/healthier pregnancy. It does not allow for the possibility that an obese woman is already healthy, and that to lose weight she would have to adopt LESS healthy habits.

          • lissa10279 says:

            I see your points …but BMI takes into account height too so if it’s going to be used as a determining factor, we can’t blanketly say “170 is obese.” — compared to what?! And I agree the study would be better served examining nutritional value.

          • Forestroad says:

            I think I see where you’re coming from Emily and I agree–I think a lot of people don’t realize when they talk about the “obesity epidemic”, they are in fact talking about that 5’3″ 170-lb person who is clinically obese
            but doesn’t match the image most people have in their mind of what obesity looks like.

            I still agree with Lissa that they are making a blanket statement about 170lb people that can’t actually be generalized to most 170-lb people, and that just frustrates me. But feeling like picking that number is reinforcing the idea that women need to meet this unrealistic standard is perhaps my own baggage I’m bringing to the table.

  4. Ellie says:

    I think that unless there is some serious health issue (e.g. gestational diabetes), the focus should be on eating enough healthy foods, and not on weight gain. I enjoyed my pregnancy, gained 60 pounds, and lost it all without a problem. I think it’s a shame to waste such a precious time fretting about weight.

  5. vitty10 says:

    Seriously, this can’t be healthy. You’re supposed to gain an entire baby, amniotic fluid and extra blood without gaining any weight? Dieting while pregnant just doesn’t seem right. I don’t see how the baby is supposed to get all of the nutrients it needs if the woman is restricting her eating.

    I saw the same thing that Bri above saw, that children may be more likely to be fat if the mother restricted her eating while she was pregnant. I don’t remember where I saw it though.

  6. McLauren84 says:

    Wow, really interesting stuff. I know a woman who was within normal BMI limits when she got pregnant, and within three months she’d actually lost 11 pounds just by cleaning up her diet–cutting out sodas, sugar, etc. In general, calorie restriction during pregnancy has to be dangerous. Like the doctor in the article pointed out, we have no idea what the effects of this could be in the future. To me, it just seems naturally counter intuitive. Nature clearly intends women to gain weight during pregnancy, and going against the needs of one’s unborn child seems like a heavy burden to mandate.

  7. Joanna says:

    check out this video it was a school project about the media’s influence on body image.

  8. bri says:

    As with any other time of a woman’s life (or a man’s or boy’s or girl’s or anyone else’s) I think the emphasis should be on a balanced nutritional intake and physical movement that is enjoyable rather than punitive. I find it ridiculous that women should be put under any pressure whatsoever to not put on any weight during pregnancy. I was overweight for my first pregnancy and moribdly obese for my second. I had no problems whatsoever due to my weight either time and delivered vaginally with no drugs. You can be fat and do that! ; )

    (Just to clarfiy, I am not the Bri who commented above, I am that FA blogger, lol)

  9. mamaV says:

    This sends a terrible message. Women are already concerned about their body image when they are considering pregnancy and/or already pregnancy — adding this to the mix is just sad. Are we really to the point that we believe an obese woman can not have a healthy baby?

    Plus — by my count, an average baby is 8 pounds, so that 170 pound woman is not being allowed to gain the 5 pounds they say — she is actually being asked to lose 3 pounds to accommodate for that baby’s actual weight!


    • Meems says:

      I hadn’t even thought about that, but you’re absolutely right!

      It also doesn’t account for body composition – so if a woman is very muscular, is she supposed to lose muscle mass during pregnancy?

  10. Rachel says:

    I am horrified that there are some scientists and doctors who think that it is reasonable to ask pregnant women to follow recommendations based purely on the fact that the women meet some BMI threshold, without having any idea what impact it will have on the fetus. There is absolutely no way that any other “study” would be permitted on pregnant women, this just shows that the medical community is so blinded by the cultural obsession with weight that they have forgotten their ethical obligations to their patients and their patients’ future children.

  11. G says:

    mamaV, that’s that I understood this to say: that the pregnant woman is really being asked to lose weight.

    Now say for instance a woman took that zero gain advice, (which in the example given means she loses weight from her own body while nurturing her baby). Add to that mixture the social pressure to eat and gain weight while pregnant and you have a recipe full of mixed and dangerous signals.

    • mamaV says:

      So true. And you know what is really sad?

      A woman should be focused on this amazing miracle growing inside of her, and enjoying every single minute of it. Instead she is SHAMED for weight gain — which is a natural part of the process.

      I can not imagine going to the OB and having him/her tell me not to gain weight. It would take me about one second to hit the road and find a new doctor.


  12. Emma says:

    During my pregnancy, I ate everything I wanted and put on way more weight than what doctors recommend. I had an uneventful pregnancy and gave birth to a healthy 8 pound, 13 ounce baby boy. I loved being pregnant and gave in to every single one of my cravings because after years of disordered eating, it felt almost liberating to eat whatever I wanted without having to give a damn. The extra weight certainly didn’t hurt my baby. Lol sure, I’ve got a mummy tummy (thanks C-section!) but I have a gorgeous son and I wouldn’t change anything that I did or ate. Love this website!

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