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Glenn D. Braunstein, M.D. Headshot

The Realistic Skinny on Moms, Pregnancy and Weight Gain

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With all the nutty fads and misguided emphases that pop culture can inflict on American society, there’s a harmful health issue that our celebrity-obsessed nation needs to let go of: Idolizing stars who appear to instantly shed every ounce of pregnancy weight gain immediately after giving birth, while ignoring most real women’s struggles with pre- and post-partum pounds.

Supermodel Heidi Klum, for example, won kudos in the star-struck press for walking the Victoria’s Secret runway just weeks after delivering her second child and again after her fourth. Entertainer Beyoncé -- back at fighting weight -- was dubbed People’s “Most Beautiful Woman” four months after having her first child. And on its website, Us magazine boasts a gallery full of “Jaw-dropping post baby bods,” from Celine Dion to Penelope Cruz.

Sure, these miraculous transformations are great for magazine sales. But they also may distort expectations of regular women, who do not have around-the-clock childcare, housekeepers, personal trainers and people to prepare their meals. Moreover, the mania for “Mom-shells” -- women who look like dynamite swiftly after pregnancy and delivery -- obscures real concerns. Retaining pregnancy weight is a significant problem that -- more crucial than how a mom looks in a bikini -- contributes to the obesity epidemic among both women and children in our country. Instead, we need focus more on supporting real moms with this challenge.

Health care practitioners may not discuss weight management sufficiently with pregnant patients. The media’s constant displays of photos of size 2 celebrity moms doesn’t help, either. And if there's anywhere these glossy images make women feel extra pressure, it's got to be right here in looks-obsessed Los Angeles.

“The expectation of getting back into your skinny jeans within weeks of delivery is ludicrous,” says Adrienne Youdim, MD, medical director of the Center for Weight Loss at my institution. “At the same time,” she notes, “childbearing is a common period when young women are vulnerable to gaining weight that is never lost.”

How Much Is Enough?

Many factors influence post-partum weight loss, including genetics, age, pre-pregnancy weight, lifestyle, stress and post-partum depression. But the most consistent predictor is the amount of weight gained during the nine months of gestation. Clearly, the more you must lose, the harder it is.

And yet, many women -- upwards of 50 percent by some accounts -- do over-gain. For the one in five who already are obese when they become pregnant, that figure is even higher. In a major study of more than 1,600 obese women, three in four gained excess weight, and, on average, still carried 40 percent of that weight a year after giving birth.

Gaining too much weight increases a mother’s chance of developing diabetes, high blood pressure and pre-eclampsia, and of needing a Cesarean section. It also sets her children up for health problems. Research shows that these offspring are more than four times at risk of being overweight at age 3 than those whose mothers gained an appropriate amount of weight.

In another recent study, women who are obese while pregnant were more likely to have a child with autism and twice as likely to have a child with other sorts of developmental delays than non-obese women.

Current guidelines, updated by the Institute of Medicine in 2009, recommend that thin women, those with a body mass index (BMI) of 18.5 or lower, gain between 28 and 40 pounds; normal weight women (BMI between 18.6 and 24.9), 25 to 35 pounds; overweight (BMI between 25 and 29.9), 15-25 pounds; and obese women (BMI of 30 or higher), just 11 to 20 pounds. Some experts, however, question whether this amount is too high.

Discomfort About Weight

Many women -- regardless of their pre-pregnancy weight -- do not receive adequate guidance from their health care professionals. In a recent study among 400 women in the early stages of pregnancy, only 42 percent said they received weight gain information. Of these, the majority received accurate information. However, 22 percent of the overweight and obese women were advised to gain more weight than the advised under the Institute of Medicine’s guidelines.

Health care professionals avoid the subject because they feel either uncomfortable about the sensitive nature of women’s weight or they think they are ill-equipped for conversations. Or they don’t think it will make a difference. This is a major missed opportunity that we need to remedy, because women can be uniquely motivated to make healthy lifestyle changes during pregnancy. Once the baby is born, they may well be just too busy to do so.

According to The American Academy of Nutrition and Dietetics, women do not need to increase caloric intake during the first trimester. Women who gain excess during pregnancy typically begin gaining weight early. During the second trimester, 350 calories a day should be added, and in the third trimester, 450 a day.

Women with a history of dieting are more prone to excessive weight gain, whether they are normal weight, overweight or obese when they become pregnant, according to a 2008 study of more than 1,200 women. Dieters who were underweight before pregnancy, however, were more likely not to gain enough weight compared to underweight women who weren’t habitually dieters.

Some women, often teenagers, do not gain enough weight during pregnancy. In rare cases, this is due to a condition unofficially called “Pregorexia," in which women exercise excessively and skip meals because they fear becoming overweight.

Those who undergain are more apt to suffer from anemia, perinatal mortality and have pre-term and or a low-birth-weight baby (less than 5½ pounds). Low-birth-weight babies are at a greater risk for neurodevelopmental and lower respiratory tract conditions than normal-weight infants.

Bottom line, “you need to gain enough weight to provide nutrition for the fetus, but not an excess,” says my colleague Sarah Kilpatrick, MD, chair of the Department of Obstetrics and Gynecology.

Exercise, Exercise

One of the best methods to maintain a healthy weight is to exercise throughout pregnancy. The American Pregnancy Association advises against skiing and horseback riding, due to the risk of falling. But pregnant women should not be afraid to continue most activities. Kerri Walsh Jennings, USA’s beach volleyball gold medalist, last month revealed that she was about five weeks pregnant while competing at the London Olympics.

After delivery, new moms may welcome weight-loss information, but again, often do not receive it. In a recent study, nearly 85 percent of new moms said they had not received any advice from their health care practitioners by four months after having given birth.

In general, they can expect to lose more than 10 pounds during childbirth. This is a combination of the weight of the baby, placenta and amniotic fluid. In the first week after delivery, additional fluid weight is lost. The rest requires balanced eating and exercise.

Exercise can be resumed two weeks after vaginal delivery, says Kilpatrick. “For Cesareans,” she adds, “the old message was to wait six weeks, but most of us now think that’s excessive. You only need to wait three weeks or four weeks.”

When it comes to diet, a balanced menu is best, Youdim says. Packaged meal replacements from programs such as Jenny Craig, she adds, “may be a helpful short-term bridge to jump-start weight loss because they restrict portion size. But don’t trust supplements, because they are not regulated. You never know what they entail.”

Breast-feeding,whose benefits I’ve written about in this blog before, helps the weight-loss process, too. In addition, women who regularly eat breakfast and lunch, and less snacks, are more successful in losing baby weight.

Sleep, elusive for most new parents, plays a key role, as well. Mothers who slept less than five hours a day when their babies were 6 months old were three times likelier to retain 11 pounds or more at a year post-partum than those who slept seven hours a day. New moms, who slept less at the one-year mark than they did at six months, were twice as likely to retain a significant amount of weight.

Losing weight is challenging, even for those who have not just given birth and care for a newborn. Celebrities may make it look easy. But remember, they have entourages to help. So forget any temptation to make comparisons. Instead, eat healthy, exercise, sleep whenever you can, and as Kilpatrick says, “be realistic. To expect to take all of your weight off in less than six months is just adding more stress that you don’t need.”