The pressure to stay thin even when pregnant

A worrying new trend is gaining speed among pregnant women, with increasing numbers reported to be suffering, often in silence, from eating disorders. Recent research has shown that as many as 1 in 20 mums-to-be have some form of eating disorder, which could put their own and their baby’s health at risk. 
 
Being pregnant can be a key time for developing an eating disorder as women struggle to come to terms with their pregnancy weight gain and changing appetites. A long-term study of 100,000 pregnant women in Norway showed an unexpected increase in the number of women who developed a binge-eating disorder during pregnancy. Another study, by Tommy’s, found that almost a third of pregnant women worry about what they’re eating.

And women who are already struggling with anoxeria can find it even harder to cope during pregnancy. ‘Women who suffer from eating disorders find pregnancy very difficult as the body naturally gains weight. It can be a very distressing time for them,’ says Patrick O’Brien, from the Royal College of Obstetricians and Gynaecologists. ‘Even if the eating disorder is under control it often resurfaces during pregnancy.’

All those pregnant celebs with sleek bumps who fit back into their skinny jeans within weeks of giving birth aren’t helping, either. Without the stars’ specialist trainers, personal chefs and super nannies to help them, some women resort to desperate measures to get rid of the baby bulge – in some cases, by never really getting it in the first place. Experts from a wide cross-section of fields are becoming increasingly worried that women are putting their bodies under unnecessary pressure as they restrict calories and exercise intensively during pregnancy.

And it’s made worse by the fact that they often feel unable to seek professional help or even talk to friends about their situation. ‘Pregnant women with eating disorders do not readily disclose their disorder,’ says Professor John Morgan , head of the Yorkshire Centre for Eating Disorders.  ‘They may not even confide in family or friends for fear of being judged as ‘bad’ mothers, who are wantonly harming their unborn baby.’

‘I thought anorexics always went into remission during pregnancy and I naively thought that would happen to me,’ says Kate Dean, 28, from north Wales who has suffered from anorexia and bulimia since the age of 14.

But she lost over two stone when pregnant with her son, now eight months old. Doctors became so concerned that, 28 weeks into her pregnancy, they wanted her to go into hospital to be tube fed. But Kate refused and pushed for proper treatment for her underlying eating disorder.

‘I desperately wanted to eat well for my baby but after being in the grip of an eating disorder for years I just didn’t know how to eat normally. It was like I’d developed a phobia of it,’ admits Kate. ‘I’d start each day saying: ‘Today, I’ll eat for my baby’ but when faced with food I just couldn’t do it.’

Whenever she did eat, Kate would make herself throw up straight away. ‘By the end I was eating one small meal a day then getting rid of it and I was exercising to excess right to the end of my pregnancy. It wasn’t that I didn’t care about the effect of the eating disorder on my baby, it's just that the eating disorder was winning.’

Eventually, Kate was referred to the eating disorder unit at Cheadle Royal Hospital in Manchester where she spoke to a counsellor, took part in group therapy and had meetings with a nutritionist. Although, Cheadle Royal is a private hospital, the NHS also pays for patients to be treated there.

But for Kate the treatment was too little too late. Although her son was born without complications, Kate herself continues to struggle with anorexia and now faces the prospect of inpatient care, which would mean prolonged separation from her eight-month-old son.

Pregnancy complications

Being underweight can wreck havoc on the regularity of your menstrual cycle, and in turn, your chance of conceiving. But these traditional infertility problems can now be overcome with assisted reproduction. And it seems that women with eating disorders may be choosing this option rather than struggle to gain a healthy weight in order to conceive. A study of women attending one fertility clinic showed that 16 per cent of patients receiving treatment had an eating disorder.

‘Eating behaviour should be routinely assessed in infertility clinics and women should be counselled to delay pregnancy until the eating disorder is in complete remission,’ says Professor John Morgan.

‘Pregnant women with eating disorders are at increased risk of obstetric complications. Low birth weight, prematurity and higher miscarriage rates have all been reported in women with eating disorders,’ adds Professor Morgan. The women themselves are at risk of developing brittle bones and anaemia if they don’t take in enough calcium and iron during the pregnancy, as the baby will take what it needs first. There can also be health issues for the baby after the birth, namely with breastfeeding.

And it seems that health professionals aren’t alert enough to the risks – either of women becoming anorexic once pregnant or of pregnant women coming to them who may already be suffering. Most obstetricians ask women about their cigarette smoking and alcohol intake during pregnancy, but less than 50% of doctors ask about body weight control and disordered eating.

Out of control

Some women – particularly those with bulimia – may be able to put their eating disorders temporarily ‘on hold’ during pregnancy. Experts aren’t sure quite why this is, but some think that during pregnancy, women with bulimia feel they have ‘permission’ to eat and gain weight for their baby’s sake. However, all this effort to suppress the eating disorder, can mean the bulimia reasserts itself even more after pregnancy. This is a time when women often suffer from low self-esteem and feel under pressure to lose post-baby weight.

Mum of three Barbara Benner, 40, from Nottingham has suffered from bulimia since her teenage years, but by her early thirties she thought she had recovered and come out the other side. Mum to Josh, 6, Mollie, 20 months, and Sophie, 11 weeks, Barbara sailed through her first pregnancy with no sign of bulimia, but second time round she wasn’t so lucky. By her third pregnancy, she was back to square one.

‘Towards the end of both pregnancies, I started bingeing and purging. I only did it three or four times when I was pregnant with Mollie, but I carried on in the months after Mollie was born,’ she says. ‘It stopped at first when I fell pregnant with Sophie, but as I reached my third trimester I started making myself throw up again and this time it was a lot more frequent.

‘I was a lot bigger than when I was pregnant with my son and I felt out of control - if the scales didn’t say what I wanted them to say I plunged into a cycle of fear, guilt and anxiety.’

Barbara never told anyone what she was doing: ‘I felt so ashamed of it – the vanity, the loss of control’. She now has her eating back under control, but thinks she’ll always be in recovery.

As Barbara explains, ‘Any major life change can send you spiraling back into bad habits. Pregnancy changes your body in ways beyond your control – it is bound to be a challenging time for someone with a background of eating disorders.’

If you need help

Support is available if you are pregnant and suffering from an eating disorder. If treatment is started early the chances of a successful outcome are high.

‘Formal treatment is available from specialist eating disorder services but this should be commenced as soon as possible before delivery to improve the chances of success,’ explains Professor Morgan. ‘Women should talk to their midwife or GP if they have  a  history of eating disorders or are experiencing concerns about body image, weight or  disordered eating behaviours during pregnancy.’ 

If you don’t feel able to talk to family or health professionals contact the Eating Disorders Assocation Helpline e Eating Disorders Assocation, UK  Helpline 0845 634 14 14  www.b-eat.co.uk