Starving for two

Just last week, new guidelines were issued by the Institute of Medicine for how much weight women should gain during pregnancy. For the first time, the guidelines focused on the growing American population of overweight and obese moms-to-be.

The new directive calls for limiting the pregnancy-related weight gain of obese women to 11-20 pounds. Overweight women shouldn’t gain more than 15-25 pounds during pregnancy. For normal women, the range is 25-35 pounds.

These guidelines are conservative, but MedPage Today talked to at least one expert who says they aren’t conservative enough:

"It’s been well shown that such a patient can lose weight in pregnancy and still be fine," said Jacques Moritz, M.D., of St. Luke’s-Roosevelt Hospital in New York.

"[The guidelines] are still concerned with small babies. That was a problem when women smoked and drank in pregnancy. Now it’s just the opposite."

"Women don’t need to eat for two, but for  1.1," he said.

 For some women, however, the last thing they need is to obsess about their weight during pregnancy, as this first-person account shows all too clearly. Maggie Baumann writes at about the "pregorexia" she experienced while pregnant with her second child.

She called it "a nine-month battle in which I lived in a dissociated state from my body – horrified by my expanding ‘self’ that protested every ounce of weight I gained. I did not experience the freedom of eating for two, rather, I experienced the restriction of starving for two."

The phenomenon of pregorexia first started to be noticed by the media last year. It’s unclear how widespread it might be; most likely these women represent a minority. But it’s hard to ignore the pressure that some women feel to remain slender, even during pregnancy. A history of eating disorders and latent emotional issues with anxiety or depression also appear to play some role.

A British expert estimated that 1 in 20 pregnant women may have an eating disorder. In fact this estimate might be conservative because many women don’t tell their doctor if they’re binging and purging or over-exercising, The Times explained in an article that appeared last August.

Baumann, who later received therapy for an eating disorder, said emotional issues were what drove her to count calories and exercise obsessively during pregnancy.

She writes that pregorexia "is a form of eating disorder that can be reinforced by comments about weight from friends and family, but the root of the disorder is more often based in control, perfectionism, or using the disorder as a coping mechanism to deal with difficult emotions or experiences."

It’s to be hoped that the new weight-gain guidelines for women during pregnancy won’t become yet another way to pressure women into measuring up to some ideal. The real focus needs to remain on healthy moms and healthy babies – and for that, a one-size-fits-all approach is not necessarily the most helpful.

Update, June 8: Maggie Baumann writes a follow-up essay responding to the comments and reaction to her story.

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