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Getting Your Body Back After the Baby

Ellyn Ward remembers the moment she realized how much she'd changed. "We were going to pick out our Christmas tree," says Ward, who'd given birth to her son in October. "We videotaped it because it was Gavin's first tree. When we played the tape, I saw what I really looked like -- I wasn't the same person I knew myself to be."

The weight she'd gained carrying Gavin wasn't coming off. Because she'd been overweight when she got pregnant -- five feet three inches, 170 pounds -- she'd only needed to gain 15 to 25 pounds. But she'd put on 40.

Now, two months after having Gavin, she was 184 pounds, and it really bothered her. "I'd been exercising off and on -- running on a treadmill, lifting weights a bit -- but when I found out I was pregnant, I pretty much stopped altogether," recalls Ward, of Anderson, Indiana. "That first trimester, I was so tired. And I felt like it was okay to eat anything. I wasn't worried about gaining the weight." Now she was.

She's not alone. Millions of moms don't lose all the extra pounds they put on during pregnancy. For many, having a baby is a turning point -- and not a positive one -- in a lifelong struggle with weight. "There's a school of thought that a woman's risk for obesity increases with each pregnancy," says Edith Kieffer, Ph.D., a researcher in public and maternal health at the University of Michigan.

Gaining too much during pregnancy can turn a temporary weight increase into a permanent one. In a study by Cornell University professor of nutrition Christine Olson, Ph.D., half of 540 women weighed more a year after giving birth than before getting pregnant. A quarter were more than ten pounds heavier. Not surprisingly, most of the women weren't happy with their bodies.

The consequences of putting on those pounds are more serious than not fitting into your prebaby jeans. Over time, being overweight increases your risk of breast cancer, heart disease, high blood pressure, diabetes, and other ailments. And it could cause problems for your next pregnancy.

Gaining for two?

What's the healthiest weight gain during pregnancy -- for the baby and the mom? Current guidelines outline different goals depending on a woman's weight before pregnancy:

* Underweight: 28 to 40 pounds * Normal: 25 to 35 pounds * Overweight: 15 to 25 pounds * Obese: 15 pounds

The guidelines' top priority is the health of the baby, and there are potential repercussions to gaining too much or too little. Putting on too much increases the risk of gestational diabetes (which, if not tightly controlled, can adversely affect the baby) and of labor complications. The baby may also be very large (more than ten pounds), putting him at increased risk of Type 2 diabetes. Women who gain too little weight are at risk of having a low-birth-weight or preterm baby, while outright dieting -- especially Atkins-style -- can produce compounds in the blood called ketones, which are toxic to a fetus.

How pregnancy weight gain affects a mom's health, though, isn't as well researched. Some experts think the standard 35-pound upper limit is too high, that gaining this much may contribute to obesity. Never before have women been advised to put on so much weight; prior to 1990, when these medical guidelines were developed, doctors usually advised a gain of between 20 and 28 pounds for women who start their pregnancy at a normal body weight.

A bigger problem: The guidelines are often ignored. "The range for normal-weight women -- twenty-five to thirty-five pounds -- looks pretty reasonable," says Barbara Abrams, a professor of epidemiology, maternal and child health, and public health nutrition at the University of California, Berkeley. "But only about one in three women who begin pregnancy at a normal weight stay within it. It's not that the guidelines are wrong. It's that we can't follow them."

"My obstetrician didn't give me any specific weight-gain advice," says Ellyn Ward. "He said, 'Don't worry about how much weight you gain -- be concerned with eating healthy.'" She also had a routine meeting with a nurse who "went over the food groups," but it didn't make much difference. "It was helpful advice, but I didn't follow it. I had pretty bad eating habits, and I didn't really change my lifestyle," she says.

It's women who are already battling their weight who need the most support when they're expecting. "In the early months of pregnancy, many women are concerned with gaining too much," says Bonnie Berk, a nurse and the creator of Motherwell, a fitness program for pregnant and postpartum women based in Carlisle, Pennsylvania. "But as they become larger, they give up worrying about their weight and start eating indiscriminately. I see this often with women who tend to be on diets a lot. Once they're pregnant, it's like a license to eat."

Yet only a modest increase in calories is needed to sustain a healthy pregnancy -- about 300 a day. That's as little as an extra apple and a yogurt, a turkey sandwich with lettuce and mustard on whole-wheat bread, a baked potato with a slice of cheese, or a milk shake made with low-fat ice cream. By contrast, a pint of superpremium chocolate-chip ice cream might have 700 calories.

"There's this belief that you should eat for two," says Kieffer. But that doesn't mean you need to eat twice as much as you did before. "What experts really mean is to eat better for your baby. It takes very little to add those calories to your diet, and they should come from healthy sources. Instead of having an iceberg-lettuce salad, start with dark greens like Romaine lettuce; try walnuts rather than cheese; substitute a slice of melon for pastry."

A fitter pregnancy

One way to avoid the extra-weight-gain trap when you're expecting is to exercise regularly. Doing so also helps labor go more smoothly, reduces the risk of gestational diabetes, lifts your spirits, and boosts energy. For a decade, the American College of Obstetricians and Gynecologists (ACOG) has been clear that most women can maintain prepregnancy workout routines -- and that healthy moms-to-be who haven't been active can start to exercise. But this advice hasn't filtered down to many women -- or their doctors.

"A lot of expectant moms are still fearful about being active," says Kieffer. "There are misconceptions about what's healthy and what's safe." It's fine to do almost any physical activity or sport -- dancing, low-impact aerobics classes, swimming, brisk walking, jogging -- at moderate intensity, as long as you don't become exhausted, dehydrated, or very overheated. Just steer clear of sports in which you're more likely to take a fall or otherwise get injured: soccer, basketball, hockey, gymnastics, horseback riding, skiing, and scuba diving.

The more a woman knows, the easier it is to get fit and stay that way throughout the pregnancy. When Heidi Sowers of Carlisle, Pennsylvania, wanted to conceive, she started going to the gym nearly every day. She'd been walking a couple of miles a day, but now she added step-climbing, treadmill running, and strength training on machines. When she found out she was pregnant, she tapered her routine to walking a mile or more each evening, plus once-a-week water aerobics and yoga.

"I know it's going to be hard to take off weight after pregnancy," said Sowers at the time. "But I think if I maintain a healthy diet and exercise, I'll be okay." (And she was. Sowers weighed 170 pounds before she got pregnant and 183 when she gave birth to her son, Mason; within a few months, her weight was 168.) Others become more active after the baby arrives. "I started exercising about five weeks after my second daughter was born, and I noticed a difference within a month," says Carolyn Mastrangelo of Roseland, New Jersey, mom of Isabella, 3, and Kate, 9 months. "The weight came off slowly but steadily after that. I ran on a treadmill for forty-five minutes four times a week." Her eating plan was just as simple: "I was careful with what I ate, but I wouldn't call it dieting. I tried to do things like eat a turkey sandwich instead of the grilled cheese I was making for my older daughter. I snacked on low-fat yogurt instead of cookies. I just made it a priority to lose the weight."

The best time to shed postbaby pounds may be that first six months. In a study by epidemiologist Brenda Rooney, Ph.D., of the Gundersen Lutheran Medical Center, in La Crosse, Wisconsin, women who didn't lose the weight after six months were more likely still to be overweight ten years later. "Six months isn't a magic point," says Rooney. "It's not hopeless after that, but it is a good time to take stock. Not being able to lose all the weight at the half-year mark may be an indicator that you can't get a grip on controlling your weight."

The hard part: After the baby

Having a baby transforms your life in many ways -- none of which make it easier to take good care of yourself. Suddenly there's little time or energy to prepare nutritious meals. You may feel isolated and stressed out. And then, perhaps, you go back to work full-time a few months later. Too often, food provides comfort.

The idea of exercise can seem even tougher than eating right. You may be embarrassed about working out in public, or not ready to leave your new baby with a sitter while you hop off to the gym -- not to mention that finding the time may seem impossible. Yet exercise is the single most powerful determinant of long-term weight control. According to ACOG, it's a good idea to start exercising again four to six weeks after giving birth. (If you've had a c-section, though, check with your doctor first.)

Postpartum moms are more successful at keeping up regular physical activity if they have a plan and are confident they can carry it out, studies show. Make it realistic -- one reason many women can't lose weight is that they think they can take off a lot quickly. When this doesn't happen, they get discouraged. But if you're overweight, losing even 5 or 10 percent of your body weight can have substantial health benefits, reducing your risk factors, like high blood pressure, for such chronic diseases as Type 2 diabetes. And you'll feel better about your body as well. More ideas:

Line up support. Have your husband take care of the baby so you can hit the gym, for instance. And make a vow to help each other get fitter: In Olson's study, women were more likely to exercise regularly if their partners also did so, suggesting that it helps if fitness is a family value. And it's a good example for your child!

Enlist fellow moms. There's comfort in numbers. Women who work out with a friend or join an exercise class often have more success, studies show.

Bring your baby. Find a mom-and-baby exercise class, or put on music and dance with your child. Work out to a video during one of her naps.

Be brisk. While any activity is good (even pushing a stroller at a leisurely pace), if you can get some aerobic activity into your life -- anything that gets your heart rate up -- you'll drop the pounds faster.

A healthier mom

One year after having her baby -- and nine months after her video epiphany -- Ellyn Ward is a svelte 129 pounds. She lost 55 by joining Weight Watchers. When Gavin was about 10 months old, she and a girlfriend (who also has a baby) joined the YMCA. Each morning at 8 a.m. sharp -- rain, snow, or shine -- they drive to the Y, drop off the babies in the daycare, and work out in the gym.

"I was determined to do something about my weight," says Ward, who credits her husband, Brandon, for his support. "You can't do this, though, until you have the mindset to do it yourself. Other people saying that you need to lose weight is not helpful at all. The key is to really want to do it."

The payoff is terrific. Ward believes she's a healthier mom for Gavin and that her body is in shape for a possible second pregnancy. Perhaps best of all, she just feels good about herself.

There are no simple solutions to eating right and being active when taking care of an infant. But experts agree on one thing: A new mom can't put her own needs last. Women often make an effort to eat healthfully and take care of themselves while pregnant for the sake of their baby -- but then return to unhealthy behavior when "only" their own health is at stake. Says Rooney, "I think the message we need to give moms is 'If you can do this for your baby, why not do it for yourself?'"

Shari Roan, a health writer in southern California, is the author of three books, including Our Daughters' Health. She is a mom of two daughters.