AIN'T NOTHIN' BUT A NUMBER: WEIGHT CHECKS IN PREGNANCY, EVIDENCE-BASED PRACTICE OR CULTURAL OBSESSION?

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In our current healthcare model, it’s easy to think weight and BMI (Body Mass Index- a measure of body fat based on height and weight) are the most important measures of health. Pregnancy is no different and the focus on weight gain and the weight of the baby often takes center stage. While weight checks might serve a purpose in your prenatal care, it’s good to contextualize this practice within the research and know when the focus on weight might be more harmful than helpful.

So How Much “Should” I Gain?

There really is a range of normal and healthy weight gain during pregnancy!  

The Institute of Medicine (IOM) issued weight guidelines outlining “appropriate” weight gain during pregnancy based on pre-pregnancy weight and BMI. This weight gain can range anywhere from 11-40 pounds, depending on the pre-pregnancy weight category you fall into (underweight, normal weight, overweight or obese).  

How Do I Contextualize These Guidelines?

According to experts in the fields of health and nutrition, Dr. Linda Bacon and Dr. Lucy Aphramor state, “BMI profiling overlooks 16.3 million ‘normal weight’ individuals who are not healthy and identifies 55.4 million overweight and obese people who are not ill as being in need of treatment...this means that 31 percent of the population is mis-identified when BMI is used as a proxy for health” (Bacon and Aphramor, 2011). Therefore, these guidelines are based on overly simplified, and dangerous, scripts of the relationship between weight and health. They prescribe a one-size fits all approach that does not account for the myriad of other factors that contribute to a healthy pregnancy.

While weight gain can be one tool for tracking how your pregnancy is progressing (a really rapid increase or decrease in weight gain can be an indication of something else going on), it can also be totally normal and unconcerning. More useful markers of a healthy pregnancy that healthcare providers should use are: blood pressure, blood sugar levels, and an actual conversation about how you are eating, moving and feeling.
 

What should I do if my provider is putting a lot of emphasis on my weight?

If your care provider has running commentary on your weight fluctuations, know that there is a spectrum of care and you have the right to choose. Some providers focus heavily on weight checks, while others hardly rely on them at all and instead focus on those more useful markers listed above.  If you feel uncomfortable with your care provider, it is never too late to switch. Many experts are moving away from formulaic weight-centric approaches to health. If you’re concerned and need additional support, try connecting with a Health At Every Size nutritionist.

What if I’m struggling emotionally with my changing body?

We all come to birth and parenthood with a body history. If you have a history of body hatred, dieting, or disordered eating, this time of transition might trigger some old thoughts and feelings. Here are some tips to stay grounded:

  • Let your birth team know how you’re feeling. This could be your partner, care provider, labor doula, family member, or friend.  Consider connecting with a therapist to process these changes.
  • Find body positive community. Surround yourself with people that make you feel good in the body you are in right now. Get hooked up with body positive projects like 4th Trimester Body Project, Endangered Bodies, Plus Size Birth, This Is Beauty Project and Body Positive Pregnancy & Parenting Facebook Group.
  • Practice intuitive self-care.  Frequently weighing yourself, comparing your body to others and scrutinizing your body in the mirror can encourage living outside the body, rather than inside. Focus instead on internal cues of hunger and fullness, and feed yourself with nutritionally dense, diverse, and pleasurable foods. Similarly, practice movement that is enjoyable and honor when you might need rest.

And remember...

Weight fluctuations are not just based on the size of the baby but multiple other adjustments that your body must make to support a growing fetus. You are literally carrying extra organs inside of you- and those things weigh something (a lot actually).

In fact, here’s a breakdown from March of Dimes:

  • Amniotic fluid - 2lbs.
  • Growing uterus - 2lbs.
  • Extra blood - 4lbs.
  • Baby - 7.5lbs.
  • Placenta - 1.5 lbs
  • Breast Tissue Growth - 2-3 lbs.
  • Stored fat for delivery - 7 lbs

That’s roughly 25-35 pounds right there!

Pregnancy is a profound time to evaluate your relationship with your body. Your care provider and birth team should be an affirming community that inspires you to take care of yourself during this big transition. Honor what is working for you (and what isn’t) and don’t be afraid to advocate for what you need! 

References:

ACOG: Weight Gain During Pregnancy

L. Bacon and L. Aphramor. “Weight Silence: Evaluating the Evidence for a Paradigm Shift.”

Nutrition Journal 10.9 (2011) https://doi.org/10.1186/1475-2891-10-9                          

IQWIG. Pregnancy and Birth: Weight Gain in Pregnancy

March of Dimes: Weight Gain During Pregnancy

Plus Size Birth: Pregnant Women of Size: What to Expect and Not to Expect!

 

Written by: Sarah Lewin, LMSW.  Sarah is a Doula & Body Positive Activist in NYC. She facilitates workshops on body positivity for pregnant people as well as birth workers.