Helping Women Manage Eating Disorders during Pregnancy

Fighting Back

Experts say the key to a successful pregnancy for a woman with a history of an eating disorder is to get help as early as possible and to find an OB/GYN who understands her situation. For example, a doctor sympathetic to her patient's weight concerns will weigh her backwards at the monthly weight checks so the patient can't see the numbers on the scale.

Debra Franko, program director for the Harvard Eating Disorders Center, has written extensively about detecting and managing eating disorders in pregnancy. In the June 2000 issue of Obstetrics and Gynecology, she and co-author Emily Spurrell suggested three warning signs obstetricians should watch for: "Lack of weight gain in two consecutive visits in the second trimester, history of an eating disorder and hyperemesis gravidarum," that severe vomiting associated with pregnancy. They recommended a team approach to treatment where the patient works with her OB, a mental health professional, and a nutritionist. With the exception of a few setbacks, it was that three-pronged approach which helped Watts through her first pregnancy.

Navigating the Postpartum Period

Women with eating disorders are especially vulnerable to postpartum depression since about half have also suffered from depression at some point before pregnancy. And while eating disorder symptoms tend to dissipate during pregnancy, they may resurface after the baby is born. Dr. Kim Pearson, a perinatal and reproductive psychiatrist at Massachusetts General Hospital in Boston, explains, "They may have worked very hard not to have symptoms during pregnancy. Then, afterwards, if they're really struggling with their new role and new body, that can make symptoms worse."

Dr. Diana Dell of Duke University adds that when these women were pregnant, society said it was OK for them to eat more and gain weight. "Once the baby is out, that cultural protection is gone. Plus, there is cultural pressure to regain the previous level of thinness," notes Dell. Just think of all the post-baby photos of any celebrity who has recently given birth. Do they ever look like they're even wearing maternity clothes a few months postpartum? For most women, it takes a while—sometimes up to nine months or longer—to lose all of their pregnancy weight.