Why Do So Many Pregnant Women Hate Their Bodies?

How twisted is it that skinny remains the default ideal even when a woman is pregnant? That bulge wasn't bloat--it was a growing baby girl.
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Can we talk a moment about your abs? If you occasionally (or, OK, daily) wish they were a little sleeker, you are officially normal. But what if you're pregnant -- and still wish your stomach were flatter? Sadly, that appears to be normal too.

A new joint survey from SELF and CafeMom.com reveals the disturbing news: For far too many women, carrying a baby brings on a struggle with body hate and disordered eating. As SELF contributing editor Jennifer Wolff Perrine writes:

•Forty-eight percent said they engaged in disordered-eating behavior such as restricting calories, overexercising, restricting entire food groups and eating lots of low-cal or lowfat foods. A few even confessed to fasting or cleansing, purging and using diet pills or laxatives.

•Fifty-two percent said pregnancy made them more insecure about their body image. Only 14 percent said pregnancy made them more confident.

Seven in ten worried about weight gain. Yet many also did a poor job controlling the scale: Twenty percent of normal weight women didn't gain enough, and about 30 percent of women gained more than they should have, according to Institute of Medicine (IOM) guidelines.

None of this is healthy. Eating disorder experts note that some disordered eaters smoke during pregnancy to keep their weight down. And they've noticed a new phenomenon they call "pump purging": breastfeeding or pumping only to shed calories, sometimes after the baby is weaned. The habit is always disordered -- it flips an essential, life-giving act into a negative, self-hating one. And in some cases it can be physically dangerous, because a mom can start to deplete her nutrients, especially if she's also purging food.

I started to wonder about our warped notions about pregnancy and body image when was I pregnant last year. When you're knocked up, you get used to hearing the same comments over and over. "Is this your first?" (Nope, I have a daughter at home.) "Do you know what you're having?" (Another girl, and I'm excited about that.) "How are you feeling?" (A lot more, er, pregnant than I felt the first time around.)

But there was something else women said to me constantly: "You're so tiny! You don't look pregnant at all!" Huh? Before pregnancy, people rarely commented on my size: At 5'8" and 155 pounds, I was perfectly healthy, but no one's definition of tiny. Now, as my belly began to bulge, friends called me thin. Friends of friends did. Strangers on the freakin' street did.

I struggled with how to answer. I knew it was said in kindness. And if I'm being totally honest (let's just keep it between you and me, though), I felt a little thrill at being called slender for the first time in my life. But I also felt sick about it. How twisted is it that skinny remains the default ideal even when a woman is pregnant? That bulge wasn't bloat -- it was a growing baby girl.

The obsession with staying "tiny" is hugely ironic: Because the dirty secret of disordered eating behavior is that it rarely leads to weight loss. And this is true when a woman is pregnant, too. Here's Jennifer Wolff Perrine, again:

Women who practice disordered habits do so with hopes of preventing weight gain. And a small group -- "pregorexics," as the popular (but not medical) label has it -- doesn't put on enough weight and becomes dangerously skinny, eating disorder experts say. But in truth, disordered eating is more likely to increase weight because trying to restrict what you eat can lead to bingeing. Either way, these habits are a bad idea. "Gaining too much or too little during pregnancy is unhealthy and can cause problems later on for the mother and child," says Anna Maria Siega-Riz, Ph.D., professor of epidemiology and nutrition at the University of North Carolina Gillings School of Global Public Health.

Wolff profiles two women with a history of bulimia who struggled to keep their eating on track during pregnancy. One managed to hold off her urge to purge and ate healthfully, but the other fell into binge eating and gained more than 60 pounds. One big difference between the two experiences: Support from others, including family, doctors and therapists. Yet in the new survey, 21 percent of women with a history of eating disorders (and more than 30 percent overall) heard nothing from their doctor about weight gain, and another 10 percent didn't get advice until they asked. These results suggest doctors need to do better at talking to pregnant women about weight gain, body image and eating habits -- and recognize that a woman's size often tells little about whether she is practicing disordered eating.

Meanwhile, we can all offer better support to our pregnant friends and steer them away from screwy body messages. I plan to start by watching what I say. "You look healthy and beautiful" is something any pregnant woman would want to hear. And any not-pregnant woman, come to think of it.

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