The fantasy, a familiar one to many new mothers, goes like this: Those excess pounds that didn't disappear in the delivery room will magically melt away with the high-calorie demands of minding a new baby.
After all, it happens that way on television and in the movies as women deliver babies one day, then zip themselves into skin-tight jeans the next.
20% Gain Too Much
But the real-life script can be radically different. Physicians and exercise instructors polled by The Times say one in five women gains too much weight during pregnancy and then has trouble taking it off. (A 20- to 30-pound range is considered acceptable by the American College of Obstetricians and Gynecologists.)
Some who work with postpartum women believe the figure may be even higher. "At least 25% of women have difficulty losing weight after a baby," said Bonnie Rote, a nurse who directs the prenatal exercise education program for the Sherman Oaks-based Aerobics and Fitness Assn. of America.
Women older than 35 can face a double whammy, given the age-associated tendency to put on weight and pregnancy-related food cravings.
On the average, new mothers have 15 or 20 pounds to lose after childbirth, finds Dr. David Heber, director of the Clinical Obesity Center and the Division of Clinical Nutrition at the UCLA School of Medicine.
The Optimal Gain
The more weight a woman gains over 20 pounds, the more she retained by the start of her next pregnancy, found Dr. Geoffrey Greene, assistant professor of human nutrition at Penn State University. He studied more than 7,000 women who had two pregnancies within six years and published his study in the May issue of the journal Obstetrics & Gynecology. But a 22- to 27-pound gain is best for optimal fetal growth, Greene said, acknowledging, "It's a dilemma."
Researchers aren't certain which women are most likely to gain excess weight during pregnancy, but speculate that previous weight problems may be one indicator. According to Heber, the profile of a new mother most likely to hold onto "baby fat" has lower-body obesity or experienced stress-related overeating before pregnancy (to cope with pressures on the job, for example). She holds a sedentary job or is a homemaker and after pregnancy has more than the average number of child-rearing problems.
"Thin fat people"--those who would have a weight problem if they didn't follow a careful diet--may also have difficulty keeping pregnancy weight gain within acceptable ranges, said Cheryl Rock, senior dietitian for the outpatient department of medicine at UCLA. During pregnancy, she said, there is a tendency for some women to think, "It's OK to eat now. On one hand, they freak out when they start looking like blimps. On the other hand, everyone's telling them to eat."
Experts Offer Tips
On an intellectual level, minimizing weight gain during pregnancy sounds like a reasonable, healthy idea. But when buttery croissants or deluxe double-cheese pizza beckon, it can get tough. Yet keeping weight gain within acceptable limits is possible, contend experts, who offer these tips:
-- Don't buy old wives' tales. Whenever a patient talks about "eating for two" early in pregnancy, Santa Monica obstetrician Dr. Ross Donald shoots back: "But one of you is the size of a golf ball."
-- Distinguish between psychological and real hunger. Many women use pregnancy as an excuse to eat ice cream and other high-calorie foods, Donald found. "For many women, pregnancy is the first time gaining weight is socially and personally acceptable," said Rock.
-- Don't diet during pregnancy. Insufficient weight gain during pregnancy endangers the fetus, experts agreed.
-- Consult with a dietitian. Growing numbers of obstetricians are referring pregnant patients to registered dietitians who often recommend keeping a diet log. Sheryl Rosenberg Thouin, a Woodland Hills registered dietitian, sometimes asks women to bring in grocery tapes to learn about their eating habits.
(In some cases, insurance coverage is provided for dietitians' services. In April, for example, "some Blue Cross plans began to provide the services of a dietitian for diabetic mothers-to-be," said Dr. Brian Gould, senior vice president and medial director of Blue Cross of California. And at CIGNA Healthplans of California, a health maintenance organization, physicians can refer patients to registered dietitians on staff for consultations, said spokesman Del Bowman.)
Even with the best of eating and exercise habits during pregnancy, some women still gain too much weight. Bonnie Rote, for example, taught seven regular aerobic exercise classes and five prenatal exercise classes a week during her second pregnancy in 1985 and watched her diet carefully. "I still gained 35 pounds," said Rote, who had gained 45 pounds during her first pregnancy. "It took me about a year each time (to return to prepregnancy weight)."
Changes in Life Style
Donald advises postpartum women to relax and adjust to life-style changes before embarking on a weight-loss program. "The first month after you get home from the hospital is (devoted to) pure survival," he said. "Don't worry about body image right away."
When he thinks they're ready, Donald gives his patients a three-point plan for weight loss: "Eat normally, exercise normally and breast-feed."
Breast-feeding is often recommended as a way to lose weight more quickly while giving an infant important nutrients. "You burn off 50 calories per pound of a baby's weight" when you breast feed, Donald said. "A 10-pound baby costs you 500 calories a day in breast milk. You'll drop 3,500 calories a week, and so you'll (theoretically) lose a pound a week breast feeding."
But breast-feeding isn't an effortless route to weight loss, as studies suggest and some women can attest. In fact, the weight loss that accompanies breast-feeding may be more gradual than generally assumed, found Nancy F. Butte, a nutritionist and assistant professor of pediatrics at Baylor College of Medicine in Houston.
She studied 45 lactating women for four months to examine milk production, dietary intake and body composition. Weight loss "is quite variable," said Butte, who published her findings in the American Journal of Clinical Nutrition. The mean weight loss during the first postpartum month was about 8 pounds; the mean loss for the next three months was 1.5 pounds per month.
"It may be that women who breast-feed for longer periods, say nine months to a year, are going to tend to lose quite a bit more weight than you would predict," Greene said. "But there may be a rebound phenomenon (of weight gain) when you wean the child."
Resume Exercise Slowly
Exercise programs after delivery should be resumed slowly.
"Laxity of the joints and ligaments can persist as long as three months," said Dr. Raul Artal, an associate professor of obstetrics and gynecology and exercise sciences at the USC School of Medicine. For that reason, new moms should get their doctor's approval before beginning a program and may want to rejoin their prenatal exercise class, where the pace is slower.
"Stay in special programs for at least six weeks," said Rote, who finds that lightheadedness during exercise is not uncommon for a month or longer after delivery.
"I would recommend avoiding the type of exercise that may affect joints and ligaments such as weight lifting, ballistic movements, and action that requires sudden changes in direction," Artal added.
Exercising after breast-feeding is best, he said, because full breasts can make physical activity uncomfortable and "fat-burning during exercise may result in more acidity of the (breast) milk."
The weight-loss program should depend on how much a woman has to lose, Greene suggested. "If it's 5 or 10 pounds, it's relatively easy to accomplish" simply by increasing activity and restricting calories with a physician's approval, he said. If a woman has 40 or more pounds to lose, a formal program is advised, including input from a registered dietitian. The more rigorous the caloric restriction, he said, the closer the child's weight should be monitored if the mother is breast feeding.
Instead of counting calories, dietitian Thouin suggests cutting fat, sugar and low-density nutrients. "I rarely give anyone a calorie level," she said.
Weight loss should be slow, generally 2 to 4 pounds a month, experts agree.
How long should it take to shed pregnancy-related weight?
Experts say most women have unrealistic expectations of how quickly they should regain their figure. "I have seen women look great in three weeks," said Rock, "but I believe they're in the minority." Others said postpartum shape-ups can take from three months to a year.
After childbirth, some women learn to accept heavier versions of themselves, Donald said. That's better and more healthful, he believes, than yo-yo dieting. His advice: "Either accept the fact that you're 10 or 15 pounds heavier or accept that it's going to be painful (to take it off)."
Some women are able to do just that, Rock said. "Before they have a child, some women's entire ego strength is dependent on weighing 110. But once they have a child, they realize the world won't end if they weigh 130."