What To Do After Pregnancy To Lose WeightAdding a new baby to the family can be an exciting time, but for some women, that joy can be overshadowed by the changes in their own bodies, and many of these women have questions about how they will lose the weight they gained over the past nine-plus months. Studies show that many women appear to hold on to at least a couple of pounds postpartum, and a quarter of women retain 11 or more pounds (5 or more kilograms) a year after giving birth. After having a baby, a woman retains, on average, 2.5 to 5 lbs. (1 to 2 kg), said Kathleen Rasmussen, a professor of maternal and child nutrition at Cornell University. That may not seem like much, but if a woman goes on to have more children or gains more weight for other reasons, the pounds can add up, she said.
Holding on to pregnancy weight can lead to serious health consequences down the road, putting moms at risk for chronic conditions like heart disease and diabetes. And losing the pregnancy weight is important not just for new moms, but for babies, too. Going into a future pregnancy at a higher weight can put both the mom and the developing baby at risk for medical complications, such as gestational diabetes and hypertension.
To determine the best practices for women who want to shed the baby weight, Live Science dove deeply into the data, reviewing the best studies on postpartum weight loss and talking to key experts in the field. Ultimately, we found that losing weight after pregnancy boils down to three main points, starting before you even give birth:And although a weight gain of 25 to 35 lbs. for someone with a normal BMI may sound like a lot — certainly, a newborn baby doesn’t weigh that much — those extra pounds do serve a purpose. As illustrated in the infographic below, pregnancy pounds also come from the placenta, the growing uterus and growing breasts, and increased blood and fluid volume in the woman’s body. And yes, added fat also weighs in.In addition, some studies suggest that gaining too much weight during pregnancy increases the likelihood of a cesarean-section delivery, according to the review. (While C-sections are generally considered safe, they do carry additional risks compared with vaginal births. For example, a C-section is a major surgical procedure, and having a C-section for a first birth can often lead to repeat C-sections in future deliveries.) According to the IOM, one of the major reasons women should limit their weight gain during pregnancy is to reduce risks to the baby’s health. Gaining too much weight during pregnancy increases the likelihood that the baby will have a high birth weight, which can put the baby at risk for obesity and metabolic syndrome during childhood, according to a 2015 review published in the journal Expert Review of Endocrinology & Metabolism. (Metabolic syndrome is a combination of medical issues that include high blood pressure, a large waist circumference and low levels of “good” cholesterol.) Finally, gaining too much weight during pregnancy also may be associated with preeclampsia, the authors wrote. Preeclampsia is a serious complication that can develop during pregnancy when a woman has both high blood pressure and excess levels of protein in her urine. It can put both the mother and the baby at risk. But the amount of weight a woman gains should not be spread equally over the three trimesters of pregnancy. The IOM advises women to gain between 1.1 and 4.4 lbs. (0.5 to 2 kg) during the first trimester. Then, during both the second and third trimesters, women are advised to gain 0.5 to 1 lb. (0.23 to 0.45 kg) per week, depending on their pre-pregnancy BMI. The IOM advises that, during these trimesters, underweight and normal-weight women gain 1 lb. per week, that overweight women gain 0.6 lbs. (0.27 kg) per week and that obese women gain 0.5 lbs. per week.But a key point for expecting women to keep in mind is that the amount of weight gained during pregnancy is associated with the amount of weight lost afterward — quite strongly, in fact.The excess weight gained above the recommended amount during the first trimester is primarily fat, as opposed to weight from the fetus, the placenta or extra fluid in the woman’s body (because these weigh very little at this point in the pregnancy), according to the researchers. Unlike fluid and nonfat tissue, this fat gain is likely more difficult to lose after pregnancy, according to the researchers. [Body Changes During Pregnancy] “It can be a challenge to not gain too rapidly” in the first trimester, Oken said. For example, women who experience the fatigue that is very common in the first trimester may overeat; other women may experience nausea that’s helped by snacking, she said. And “in some cases, women might think that, ‘Well, now that I’m pregnant, weight gain is expected, so I don’t need to think so much about what I’m eating,'” Oken said. It’s these women whom doctors especially want to educate about healthy weight gain during pregnancy, she added. However, “many women don’t see their OBs [obstetricians] until the end of the first trimester, so we need to get the word out” in other ways, Oken said. In order to keep weight gain within the guidelines, Oken recommends that women focus on eating nutrient-dense foods, including fruit, dairy products and nuts, and especially avoid “empty” calories or extra desserts. Also, pregnant women should try to avoid drinking their calories in sugar-sweetened beverages, and instead make sure to drink plenty of water, as the symptoms of thirst (such as fatigue and irritability) can sometimes be mistaken for hunger, she said. [How to Gain Weight During Pregnancy, the Healthy Way] But women shouldn’t beat themselves up if they deviate from a day of healthy eating. Pregnancy can be stressful, and focusing so much on being perfect causes needless worrying during pregnancy, said Katherine Tallmadge, a registered dietitian and an op-ed contributor to Live Science. It’s OK to indulge occasionally, but it’s still important to be smart about such indulgences in order to avoid overgaining, Tallmadge told Live Science. So, when moms-to-be treat themselves, they should try for smaller amounts or stay on the healthier side of the “treat,” she said. For example, if you’re craving pizza, go for vegetable, she said. People gain weight at different rates, so women who have gotten too fat should not feel discouraged, Nicklas said. The rate of weight gain should be slowed as a woman’s pregnancy progresses if she gains too much weight early on, she advised. Pregnant women with BMIs greater than 35 may not gain any weight during pregnancy, she said. However, doctors don’t recommend that women intentionally try to lose weight during pregnancy, Nicklas added.Women should be able to lose their extra weight by six months after they give birth, Lovelady said. “We recommend a weight loss of approximately 1 pound per week,” Lovelady told Live Science. However, in reality, women will likely lose more weight at the beginning, and the weight loss will slow as they get closer to their goals, she said. By the end, it may be only 1 pound per month, but that weight loss will be a pound of fat, as opposed to fluid, she added. Not all of the experts agreed that all of the weight had to come off within six months. However, 12 months seems to be the upper limit for how long it should take for women to lose all of their pregnancy weight. That means women who started out at a normal BMI before pregnancy should aim to return to a normal BMI, and women who were overweight or obese before pregnancy should aim to return to their pre-pregnancy weight, and then continue losing weight, if possible, Nicklas said. Nicklas added that the current research suggests that women who don’t lose their weight within this time period are at greater risk of retaining the weight for the long term. “I recommend that women talk to their doctor if they are having trouble losing weight” at this point, she said. “Many women may need the structure of an evidence-based diet or weight-loss program to lose their pregnancy weight.” It’s also important for a woman to lose the weight before getting pregnant again, experts say.A 2013 meta-analysis published in the journal Cochrane Database of Systematic Reviews reached similar conclusions. Looking at data from 14 studies, the authors found that “diet combined with exercise or diet alone compared with usual care seemed to help with weight loss after giving birth” but that further research is needed. Van der Pligt stressed that “diet and exercise” don’t mean women need to go on an extreme diet or start training for a marathon. Several studies suggest that making small changes can be helpful for losing pregnancy pounds. For example, in the Active Mothers Postpartum trial, which enrolled 450 overweight and obese postpartum women, cutting out junk food and being less sedentary were associated with postpartum weight loss. (Lovelady, who was an author on that study, noted that these results were specific to overweight and obese women. Women who start out at a normal weight and gain within the guidelines usually don’t have an issue with postpartum weight retention, she said.) Overall, a woman should be able to follow any healthy diet after pregnancy to lose weight, Lovelady said. Diets such as Weight Watchers, a Mediterranean diet or a vegetarian diet can all be good options, she said. [Mediterranean Diet: Foods, Benefits & Risks] In addition, another, smaller study from Sweden — which included 68 overweight or obese women, all of whom were breast-feeding — found that dietary changes had the greatest impact on postpartum weight loss. Beginning at 10 to 14 weeks postpartum, the women were randomly divided into four groups for a 12-week intervention. One group was counseled about their diet, another on diet and exercise, and another on exercise alone. The fourth group received no advice and served as a control group, for comparison. The women in the diet-only group not only lost the most weight but were also the only group that continued to lose weight nine months later, according to the study.Rasmussen, who was an author on the study, noted that the dietary changes the women made were not major. The intervention focused on cutting out junk food, eating more vegetables and eventually reducing the overall number of calories the women were consuming, she told Live Science. (One limitation of the study, however, was that the exercise component was not a huge change from the amount of physical activity the women were getting prior to starting the study, Rasmussen said. So, while they did adhere to the exercise requirements, it didn’t represent a substantial increase in their energy expenditure, she said.) “I can tell you, diet does work,” Rasmussen said. She said, for weight loss, she recommends a diet that highlights nutrient-dense calories and avoids empty calories. [Diet and Weight Loss: The Best Ways to Eat]Yes, gone are the days when women were confined to bed rest after giving birth — certainly, a woman should take care of herself and recover from giving birth, but it’s important to get moving, Rasmussen said. “Most women can start walking soon after giving birth, regardless of whether they give birth vaginally or have a C-section,” Nicklas said. But women interested in doing more vigorous activity, such as lifting weights, should ask their OB when they can start, she added. All of the experts we spoke with agreed: Walking is a great way for new moms to get exercise. [2016 Best Pedometers] Walking during the postpartum period has been shown to have excellent health benefits, van der Pligt said. Plus, it’s convenient and cheap, and can be an important social activity for new moms, she added. [How to Start Exercising Again After Pregnancy] In one of Lovelady’s studies, for example, the women started their walking program at four weeks postpartum and gradually built up to walking for 45 minutes a day, five days a week, Lovelady said. The women in the study had been largely sedentary for the previous three months, however, she added. For most women, moderate exercise during pregnancy is considered safe and healthy. It’s also important to reduce inactivity. In a 2007 study published in the American Journal of Preventive Medicine, researchers looked at the effects of television viewing, walking and trans-fat consumption on postpartum weight retention. They found that women who watched less than 2 hours of television a day, walked for at least 30 minutes a day and limited their consumption of trans fat had a decreased likelihood of retaining at least 11 lbs. (5 kg) a year after giving birth. Although researchers know that physical activity alone does not appear to cause weight loss, in combination with a healthy diet, regular exercise helps to maintain the weight loss that occurred, said Oken, who was the lead author of the study.
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