June 14, 2007
FAMILY MEALS FOCUS #17
Interpreting the news and research about feeding and eating

Family Meals Focus #15 and #16, addressed how history is repeating itself with respect to concern about weight gain during pregnancy and efforts to restrict it. The studies noted in this newsletter show that weight-loss efforts are no more effective in safely producing sustained weight loss when applied during pregnancy than at any other time. In fact, food restriction and striving for a defined weight-gain outcome is particularly dangerous during pregnancy, as demonstrated by the dietary behavior of pregnant women who have weight concerns.

• Most women diet, most of the time. 78% of women are attempting to lose weight or maintain weight loss at any one time.¹ ''Overweight'' women are particularly likely to be chronic dieters.
• In contrast to women in the 1970s, today's chronically dieting women don't know how to ''eat as much as they are hungry for and gain weight accordingly.'' (See FMF #15) Chronic dieters lose touch with their internal regulators of hunger, appetite and satiety. When the pregnancy directive to stop dieting deprives them of their external guidelines for eating, they have neither internal nor external controls, and their eating is likely to become chaotic.
• Many restrained eaters (chronic dieters) gain too much weight during pregnancy,others gain too little.²
• A high proportion of women classified as overweight or obese, those most likely to be restrained eaters, gain more than IOM-recommended amounts (See FMF #16) during pregnancy.³
• Compared with controls, food restriction interventions produce excess weight gain in many pregnant women.^4,5
• Pregnant women who strive to limit weight gain resort to extreme and potentially destructive weight-restrictive behaviors: not eating before an obstetric visit, trying not to look pregnant early in pregnancy, and trying to adjust monthly weight gain based on previous gain.⁶
• Eating infrequently increases the risk of preterm delivery⁷ as does going without food for prolonged periods.⁸
• Women who report weight-restrictive behaviors have higher anxiety, depression, anger, stress, and demoralization from pregnancy in general. These reactions are unrelated to the individual's absolute body weight or BMI. Weight-restricting women have negative attitudes about weight gain even if they gain within recommended ranges.⁶
• In a group of women having low-risk, normal pregnancies, those who were more fatigued, stressed, and anxious consumed a greater amount of food and lower-nutrient food.⁹
• Only 30 to 40% of women gain weight within IOM guidelines,¹⁰ and women regularly achieve good outcomes with weight gains that are above or below recommendations.³

Restricting food intake during pregnancy distorts not only eating attitudes and behaviors, but also metabolism. The predominant nutritional requirement during pregnancy is calories. If the mother doesn't consume enough calories, she breaks down dietary protein and her own muscle and organ tissue into blood glucose. High levels of the hormone that does the work, glucocorticoid, have been implicated in predisposing low-birth-weight infants to susceptibility to metabolic syndrome in later life.¹¹

What can we conclude about weight management during pregnancy?

From my perspective, while IOM weight-gain guidelines (FMF #16) are moderate and offer a range of target weights, they are still absolute. Achieving such weight standards during pregnancy is no more realistic or possible than achieving stated weight standards at any other time in the life cycle. But far more importantly, such absolute standards put pressure on the pregnant woman, teach her to distrust and control her body, and undermine her eating competence as well as her metabolism. Such distortions carry the potential for doing harm to the mother as well as to the fetus and increase the risk of distorting feeding dynamics throughout the child's growing-up years. Attitudes of negativity and control toward eating and weight management are likely to persist and generalize to feeding the infant, child and family.

Such fearful, negative and controlling attitudes and behaviors represent a tragic loss when viewed from the perspective of what is possible. Pregnancy gives each woman an opportunity to gain appreciation for her body and for the miracle of giving birth. It can teach her be loving and nurturing with herself as she gets support in taking good care of herself with food, detecting and trusting information coming from her body to guide her eating and respecting her own distinctive patterns of weight gain.

Family Meals Focus #18 addresses recommendations for helping without harming with food management during pregnancy to allow each woman to gain weight in a way that is right for her and for her baby.

Reference List

1. Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW. Prevalence of attempting weight loss and strategies for controlling weight. JAMA. 1999;282:1353-1358.

2. Conway R, Reddy S, Davies J. Dietary restraint and weight gain during pregnancy. Eur J Clin Nutr . 1999;53:849-53.

3. Carmichael S, Abrams B, Selvin S. The pattern of maternal weight gain in women with good pregnancy outcomes. Am J Public Health. 1997;87:1984-8.

4. Olson CM, Strawderman MS, Reed RG. Efficacy of an intervention to prevent excessive gestational weight gain. Am J Obstet Gynecol. 2004;191:530-6.

5. Polley BA, Wing RR, Sims CJ. Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes Relat Metab Disord. 2002;26:1494-502.

6. Dipietro JA, Millet S, Costigan KA, Gurewitsch E, Caulfield LE. Psychosocial influences on weight gain attitudes and behaviors during pregnancy. J Am Diet Assoc. 2003;103:1314-9.

7. Siega-Riz AM, Herrmann T, Savitz DA, Thorp J. The frequency of eating during pregnancy and its effect on preterm delivery. Am J Epidemiol. 2001;153:647-652.

8. Herrmann TS, Siega-Riz AM, Hobel CJ, Aurora C, Dunkel-Schetter C. Prolonged periods without food intake during pregnancy increase risk for elevated maternal corticotropin-releasing hormone concentrations. Am J Obstet Gynecol. 2001;185:403-12.

9. Hurley KM, Caulfield LE, Sacco LM, Costigan KA, Dipietro JA. Psychosocial influences in dietary patterns during pregnancy. J Am Diet Assoc. 2005;105:963-6.

10. Abrams B, Altman SL, Pickett KE. Pregnancy weight gain: still controversial. Am J Clin Nutr. 2000;71:1233S-41S.

11. Stocker CJ, Arch JR, Cawthorne MA. Fetal origins of insulin resistance and obesity. Proc Nutr Soc. 2005;64:143-51.

Family Meals Focus by Ellyn Satter, MS, RD, LCSW, BCD. discusses trends, research and clinical issues in eating and feeding and interprets other research from a feeding-dynamics, eating-competence perspective. For past issues of Family Meals Focus, click here.

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Copyright © 2006 Ellyn Satter