Obesity in pregnancy: Considerations and simple tips

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Before I get too deep into this blog, think for just a moment about the last time someone (you or anyone else) mentioned something about your weight. Was it positive? Did it make you feel self-conscious or uncomfortable?

No matter what our size, many of us women (me included) struggle with body image and weight management, all of which can affect our self-esteem.   Messages about how we “should” look are pervasive in fashion magazines, movies, passing comments and jokes. The stigma associated with being (or feeling) overweight or obese makes having any discussion about weight a bit tricky, even when it comes to discussing health and pregnancy.

I think it would be helpful to address a few definitions, assumptions and attitudes before proceeding further:

• Every body is made up of lean tissue (muscle, bones, skin), water and fat (adipose tissue). Each individual has his or her own optimal proportion of lean and fat tissue for health, and this proportion changes as we get older.

• The body mass index (BMI) is a measurement used to determine someone’s risk for carrying too much body fat. Weight is another such measure. BMI is calculated by dividing someone’s weight in kilograms by the square of their height in meters (kg/m2). A calculator that allows you to enter your height (in feet and inches) and weight (in pounds) is available here.

• Currently in medicine, the BMI is widely used as a marker of whether or not someone is of a healthy weight.

• The BMI measures weight and height, and therefore is not a perfect indicator of “fitness” or “fatness.”  In fact, based on BMI alone, most body builders, who may have very little body fat, would be considered obese.  Most individuals who have a high BMI, however, are not as lean as the average body builder.

• There is very clear evidence that, on average, people around the world, especially in developed countries, have been getting heavier. You can check out the CDC’s current and historical data about prevalence of obesity by clicking here.

• Certain diseases, particularly cardiovascular disease (heart disease, stroke), hypertension (high blood pressure), venous thromboembolism (such as deep venous thrombosis or pulmonary embolism) and type 2 diabetes are linked to overweight and obesity. As the number of people around the world who are overweight or obese has risen, so has the prevalence of these diseases.   

• In pregnancy, obesity is associated with a higher risk of preeclampsia (high blood pressure in pregnancy), gestational diabetes, babies who are born too small or too heavy, and in some cases, an increased risk for preterm birth.

• Weight and size do not always equal health or disease. There are “thin” people who are in terrible health, and “heavy” people who do not have diabetes or high blood pressure. It is even more surprising to see how many “normal” weight women feel badly about their weight or size, and how many “overweight” or “obese” women are very happy – or have lost a remarkable amount of weight by the time I have first met them.

• Obesity presents challenges to health care providers. This does not mean women who are obese deserve less care or respect, but it is important to be honest about our own limitations. Ultrasound is not as effective at detecting all birth defects, but birth defects may be missed more often in women who are obese, because of technical limitations of ultrasound. A baby’s heart rate may be more difficult to monitor in some women, especially if they carry most of their weight around the abdomen. Epidural placement is also more difficult, and may take longer to perform.  Additional nursing and support staff may be needed to assist with delivery or to move a patient if a cesarean delivery is required, and the risk of wound infection increases the higher a patient’s BMI. We work hard to ensure we have systems in place to deliver the safest care possible, no matter what your weight.

• Overweight and obese women can have healthy pregnancies. There is evidence that weight loss – even as little as 10% of weight – prior to becoming pregnant can reduce the risk of gestational diabetes and preeclampsia. Most importantly, ask questions and talk openly with your health care provider about concerns you may have about your weight.

So, should we as doctors simply tell our patients to “lose weight” or “stay a healthy weight?” Well, it’s not that simple.  

First, when I mention overweight or obesity, it is strictly in the medical definition of someone’s BMI. It is not a judgment about character, worth or self-control.  Sadly, this is often not the hidden (or sometimes blatant) message people perceive. Someone’s weight, size or appearance is only one aspect of that person – not something that defines them as a whole. 

I can think of a slew of inspirational, smart, funny, successful women of all shapes and sizes, from Ruth Bader Ginsburg, Venus and Serena Williams, to Oprah and Melissa McCarthy, just to name a few. It’s all too easy for someone to “hear” judgment, however, when I ask about weight, no matter her size.

So, rather than focus sole on a number on the scale, a measurement taken in the doctor’s office or the size on the tag, I find it more helpful to focus on healthy behaviors, that I would advise for women of any size:

Be kind to yourself. Giving in to negativity, making disparaging remarks about your body (or anyone else’s, for that matter) only makes getting or staying healthy harder. It is a lot easier to engage in healthy behaviors when you care enough about yourself to treat your body with the respect it deserves. Be Happy. Be Healthy.

Changing your shape or weight depends upon changing your behaviors. Diets fail because they promise quick success. Weight gain doesn’t happen overnight, neither does weight loss. Sustaining those changes means keeping up with new, healthier habits.  

Exercise most days of the week. While there is a lot of advice about what exercise is “best,” the reality is the “best” exercise is one you will do regularly and that you enjoy. The good news is, even if you haven’t found the exercise you like best, our bodies are built for movement. Walking, dancing and running/jogging are all inexpensive and accessible to most. Now, even things like low-impact calisthenics and yoga can be found on the internet at low- or no-cost. On “rest” days, even a short walk or stretching is a healthy way to allow your body some active rest. Of course, always check with your doctor before starting a new exercise regimen.

Eat real food, and when hungry. This is perhaps the most important part of the equation when it comes to weight management. Think about your last snack or meal. Were you stressed, eating just because “it was time” or because everyone else was? Can you name what tree or plant or animal your food came from just by looking at it? Did it contain ingredients you can barely pronounce? Did you stop and leave the rest when you were physically full? 

If you have grown accustomed to eating until your plate is clean, emotional eating, or eating highly processed foods that are high in sugar, salt and fats, you many want to consider rediscovering whole, healthy foods and healthy proportions. If you are unsure about how to start, I recommend making an appointment with a registered dietitian. These professionals can even help people with dietary restrictions find options for a healthy, balanced diet.

Enjoy your food. If you are eating foods just because they are “healthy” but you can barely choke them down, you will quickly fail. Why waste time, money and calories on food that doesn’t taste good? Again, for those who have gotten used to a lot of sugar, salt and added fat, you may have to give your taste buds time to acclimate to “real” food, before you find foods you enjoy.   

Cook more of your own food. For some, this seems like a monumental task. “It takes too long,” “I don’t have time,” “Healthy food is too expensive.” It does take adjustment, but for one week, really pay attention to how much time you wait in line or at the drive-thru, how much you spend on your meals, and how many calories you get (most restaurants have this information). The next week, try packing your lunch every day. You may want to prepare several meals in advance, on your days off. See how much you really spend on basic food items, how much time you save pulling out your lunch bag. You may be surprised that it’s actually cheaper and faster to cook for yourself.

Get tested for obstructive sleep apnea if you snore, or if your partner says you occasionally “stop breathing” or “gasp” at night. People with sleep apnea have a condition where the back of the throat collapses against the airway while sleeping. When properly treated, people with obstructive sleep apnea have a reduction in high blood pressure, weight gain, and some report increased energy because they are able to get more restful and restorative sleep.

Surgical weight loss (such as a gastric bypass or gastric sleeve) may be an option. If you have a BMI of 40 or more, or 35 or more and other health problems, like diabetes, heart disease or high blood pressure, you may be a candidate. Surgery is effective, and people who undergo surgical weight loss tend to have longer-lasting results than those who diet and exercise alone. Surgery also entails significant lifestyle changes (for example after surgery, people may not be able to eat certain foods, or as much as before).  

Get help if you suspect an eating disorder. If you overly restrict food, hide food or eat in secret, binge uncontrollably with or without purging (vomiting, using pills or over-exercise), you may have an eating disorder. No matter what your size, disordered eating is not healthy. Getting help is essential. You can start by talking with your doctor, seeking a self-help group (such as Overeaters Anonymous), finding resources through the National Eating Disorders Association, or speaking with a mental-health professional. 

Resources:

• University of Connecticut Rudd Center for Food Policy and Obesity: http://www.uconnruddcenter.org/
• USDA MyPlate.gov: https://www.choosemyplate.gov/
• Forks Over Knives: forksoverknives.com
• SparkPeople: sparkpeople.com
• Weight Watchers: weightwatchers.com
• Overeaters Anonymous: oa.org/
• National Eating Disorders Association: nationaleatingdisorders.org/