Identify Eating Disorders in Pregnant Women

Body Hate

Would having a baby make you appreciate your body—or hate it? It's a question many women ponder long before they ever take a pregnancy test. When women do conceive, many—both disordered and non-disordered eaters alike—are motivated to eat more healthfully. But others struggle. "Some women with a history of severe eating disorders, although they are a small minority, become so unhappy with what their pregnancy is doing to their body that they intentionally try to sabotage it, beating on their stomach with their fists," says Ovidio Bermudez, M.D., chief medical officer and medical director of child and adolescent services at the Eating Recovery Center in Denver. "That's how overwhelming their feelings can be."

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SELF wondered how widespread these emotions are. So we teamed with CafeMom.com, the website for mothers and mothers-to-be, for a no-secrets survey of about 300 pregnant or recently pregnant women.

About 10 percent of the women surveyed had been diagnosed with an eating disorder at some point, like Kathy. But the body-image fears were widespread even in women without that history.

Among their confessions:

  • 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 low-fat 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.

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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.

Research shows that despite the risks, about half of doctors fail to assess disordered eating. And the SELF survey suggests some women aren't getting basic weight-management advice. "A couple of scientific studies indicate a major gap between doctors and patients on weight," says Kathleen M. Rasmussen, Sc.D., nutrition professor at Cornell University and lead author of the IOM Weight Guidelines. "Doctors report giving more advice than women say they are receiving."

In our survey, 21 percent of women with a history of eating disorders heard nothing from their doctor about weight gain, and another 10 percent didn't get advice until they asked. That's an ominous statistic, given that pregnancy can exacerbate a disorder or reignite one that had seemed left in the past. "It's the same as women who smoke or drink," says Cynthia M. Bulik, Ph.D., director of the University of North Carolina Eating Disorders Program in Chapel Hill. "They know the dangers, but for some women, the drive of the disorder can be so overwhelming that they can't combat it even when pregnant."

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