Medical Author: Carolyn Janet Crandall, MD, FACP
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Medical Reviewing Editor: Melissa Conrad Stoppler, MD
Weight control is a widespread concern for many women after pregnancy. Although common during pregnancy , weight gain of 30 pounds is difficult for many women to handle emotionally. Many women are unclear about how to separate fact from fiction regarding this "post-pregnancy" weight control.
First of all, women need to understand how much weight gain is actually "normal" during pregnancy. About 15-30 pounds is the wide range of what is considered reasonable. This may vary according to how heavy a woman is before she becomes pregnant. A heavier woman may be advised to try to stay within the lower end of the weight gain range during pregnancy.
Second, there seems to be a myth that weight loss after pregnancy can only be successful if it occurs rapidly. Somehow, many women feel that if they have not lost all the pregnancy weight by 1 year after delivery, something is wrong with them, they are not normal, or they have failed in some way. Actually, the truth is that weight loss after pregnancy can take a very long time, sometimes a few years, without signifying that something is wrong. Gradual weight loss is the norm, not the exception, and the rate of weight loss depends on several factors, such as whether there were complications with the pregnancy or delivery. Pregnancy complications can make a woman feel weak or interfere with her mobility. Certain diseases like postpartum inflammation of the thyroid gland (thyroiditis), which is a common complication that shows itself soon after delivery, can cause massive weight struggles if they are severe. Other factors include whether the woman has other medical illnesses or takes medications that make weight loss difficult in the first place (whether after pregnancy or at another time in her life).
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Third, there is myth about what is the best method for weight loss after pregnancy. A myriad of factors contribute to this confusion, beginning with the fact that there is not enough research about what type of weight program is safe for the mother (especially the nursing mother) after delivery. This lack of research, in turn, means that doctors are reluctant to allow any "radical diets." As a result, less stringent diets are recommended that may take longer to work and are thus less appealing and too frustrating to many women.
What should a woman consider the best plan for weight loss after pregnancy?
First, the woman should first have realistic expectations about how long it takes to lose weight. About 1-2 pounds per week is actually successful! She should also remember that no specific diet has been proven to be more safe or effective than any other, and that she likely cannot risk feeling ill from depriving herself of certain nutrients on radical fad diets. In addition, if she were nursing, she wouldn't want to harm the baby's nutrition by potentially dangerous or severely restrictive diets. Initially, a woman should try to lose the weight on her own by eating a sensible, balanced diet. Exercising every single day, even if that exercise is just walking, is an absolute must. The lack of exercise is what often holds up the process. Weight loss will simply not be satisfactory if exercise is lacking. This is true for many reasons; including that exercise helps keep the body's metabolism from decreasing excessively while dieting. Weight loss while dieting is easier with exercise and very difficult without it.
If a woman's efforts fail, meaning she has been trying the methods reliably for a year, including the daily exercise, she may need additional help. For instance, she may require and evaluation for medical conditions predisposing to weight control problems (such as thyroid abnormalities, which are common after pregnancy). Although there are vastly different approaches to weight control, all weight experts believe strongly that diet plans have to be individualized if a woman plans to maintain the weight loss. Individualized plans are the only way to get around the specific food preferences, eating triggers, and time constraints that each woman will have. (This explains why group weight reduction plans will frequently produce initial weight loss, but are usually followed by rapid weight gain. They do not address individualized eating programs that are tailored specifically for each woman to maximize her chances of keeping the weight off.) Consulting a dietician is an optimal way to obtain an individualized plan. The dietician will review key issues, such as the woman's food preferences, what triggers her to eat, who prepares the meals, and the details of her schedule in order to create an individual plan. Additionally, while a woman follows the dietician's plan, she needs to keep up daily exercise to optimize her weight loss.
Finally, expectations need to be realistic. We are only human. Rapid weight loss will not stay off, but rational weight loss (1-2 pounds a week) can stay off. And, remember that the biggest predictor of maintaining weight after the weight loss phase is keeping up exercise. You can do it!