Pregnancy and Eating Disorders: Balancing Prenatal Health and Body Image

Moms-to-be on the Main Line and beyond are up against unrealistic body image goals during various stages of pregnancy, and fixating on the scale can lead to dangerous results.

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Illustration by Stefano Morri
See also "A Momorexia Action Plan."

Monitoring pregnancy weight gain and loss in celebrities has become a popular form of entertainment in this country—so much so that it’s given rise to a new pop-culture term: momorexia. Worse yet, many women see it as a goal.

“Many Main Line mommies have body-image issues and try to stay as thin as possible,” says Dr. David Ufberg of MLHC Obstetrics & Gynecology Associates in Wynnewood. “One of the most common questions I’m asked by pregnant patients is, ‘How much weight do I really have to gain?’”

It’s a valid question for any pregnant woman to pose. It’s also normal to have trouble accepting the physical changes pregnancy brings, to monitor food intake, to exercise, and to step on a scale regularly. And it’s really not unusual for pregnant women to be vomiting, binge eating and using laxatives.

Knowing when these behaviors do become symptoms of a dangerous problem is the challenge in diagnosing all eating disorders. Further complicating things: Such symptoms are often long-held, deep-seated secrets.

“Women with EDs may not even admit it to themselves,” says Beth Rosenbaum, a primary therapist in the outpatient program at the Renfrew Center’s eating disorder treatment facility in Radnor. “Many women have been restricting food, overexercising and purging since they were teenagers. By the time they’re in their 20s and 30s, they’re very, very good at hiding those behaviors.”

And what about the baby? Neurological development, bone growth, blood-cell maturation and a host of other critical functions of gestation are compromised when mothers rob their bodies of vitamins, nutrients, calories and healthy fats, Ufberg says.

Is being thin really more important than the health of a child? “That’s a logical question. But this is a disease, and you can’t impose logic on a disease,” says Rosenbaum. “These women often can’t control their symptoms, but they absolutely don’t want to hurt their babies.”

To that end, Rosenbaum says, most pregnant women stop purging because they’re afraid of harming their babies. They often curtail calorie restriction for the same reason. At that point, some EDs go into remission. But others simply turn to overexercise and laxative abuse.

Jennifer was one of those women. Thirty years old and a newlywed, she very much wanted to have a baby. But doing so would involve the one thing she could not abide: weight gain.

“The pregnant belly I was OK with, because I knew my child was in there,” she says. “But I didn’t want to gain weight anywhere else—not in my arms, legs, rear end or face. Not one extra pound, not one extra ounce.”

Since age 16, Jennifer had battled an eating disorder. “So I lined up a support system to help me deal with it,” she says. “I had a therapist, my husband, my family and friends.”

But they wouldn’t be able to help Jennifer deal with her pregnancy weight gain. That’s because she lied to all of them. “I had to gain weight to even get pregnant, and I had to go through fertility treatments, so I stopped restricting and stopped exercising,” she says. “But as soon as I was pregnant, I started again. Eventually, I had to have meals and snacks in front of my husband so he could make sure I ate. But exercise was something I could do without him knowing. When he was at work, I ran, walked and snuck in exercise videos.”

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