The Postpartum "Bounce Back" DietDiana Davis, RD, RN, CMT
Time to Bounce Back?
You just had your baby and you feel like you are out of the maternity woods, but you can see that the extra body fat gained during pregnancy is still very much “deep in the forest.” Chances are you are in a hurry to bounce back to pre-baby weight and tired of feeling “big.” Plus you’ve heard that breastfeeding can help burn the extra body-fat you gained during pregnancy. But before you start cutting calories while doing lactation aerobics, take heed and consider that your body is still going through many hormonal and metabolic changes that need to be honored for your health and the baby’s food supply. Be prudent! Read on and don’t rush Mother Nature but rather help her along.
Resiliency in Postpartum Weight Loss
The birth process is amazing, and Mother Nature has had a long time to work out the kinks in the process. Some researchers (Butte and Hopkinson, 1998) believe that it really doesn’t matter what the women do in terms of activity and eating post-partum, but rather that the “drive” of the body to return to its pre-pregnancy weight is the primary determinant. In addition, these researchers believe that the weight gained during pregnancy has the biggest influence on postpartum weight and fat mass gain. In their study and in many other studies, there was great variability in the weight gains. These differences in weight changes were likely due to gestational weight gains, cultural practices, physical activity level, and seasonal food availability.
Where does all the fat go?
|Fat, protein and other nutrients||7 lbs.|
|Increased blood||4 lbs.|
|Increased fluid||4 lbs.|
|Amniotic fluid||2 lbs.|
|Breast growth||2 lbs.|
Weight Loss and Breastfeeding
Does weight loss effect the quality of your milk? According to studies (Butte and Hopkinson, 1998) only in the extremes were negative changes seen in lactation. Women who consumed less than 1500 calories per day had 15 percent reduced milk volume during the following week. It seems that women who gain weight above the recommended guidelines during and after pregnancy can also have decreased milk production. However, women who had only a 500-calorie deficit for a 10-week period (which would equal a 10 1/2 pound weight loss) had no measurable changes in milk production. In addition, women who were in an exercise and diet group were able to lose 2 pounds per week and had no changes in the production or quality of milk compared to controls. Many other studies support the claim that weight loss is a normal process during the postpartum period.
Hormonal Revelations Prolactin, the master hormone responsible for lactation can affect a large number of systems throughout the body. A withdrawal of estrogen and progesterone is essential for prolactin production and release. It stimulates the production and secretion of milk, depresses fat production in the liver and stimulates the delivery of glucose and lactate to the mammary gland for enhanced fat production. There seems to also be a suppression of the hypothalamic-pituitary-adrenal axis, which is responsible for the release of the stress hormones. This may dampen the responses to exercise in terms of having increased energy and fat burning.
So as an overall scheme, prolactin facilitates delivery of nutrients to the mammary gland and breakdown of fat throughout the body. Many women will experience a slight lowering of their basal metabolic rate (the calories you burn at rest), and a water and weight retention maintenance.
Weight Loss during breastfeeding requires you to eat 500 more nutrient dense calories a day. Another way of looking at it is to add an additional 200 calories to the perfect pregnancy diet guidelines. Suggested increases in protein, magnesium, zinc, calcium, and several vitamins are also greater during lactation than during pregnancy. This increase translates into adding one serving of dairy products, 1 serving of grain, 1 serving of fruit, and 1 serving of green leafy vegetables per day to meet this increased caloric and nutrient need.
According to the National Academy of Science, one should never go below 1800 calories during lactation because it will decrease the nutrient base of the milk.
How long before you attain your pre-pregnancy weight? If you didn’t gain more than the recommended pregnancy weight of 22 to 30 pounds, then with lifestyle modifications, count on your fat loss to take about eight months to a year to return to your pre-pregnancy weight. The Academy’s “Nutrition During Lactation” report cautions against “rapid weight loss,” as defined as more than 4 pounds per month, after delivery.
Another study (Sampselle, Seng, Yeo, Killion, and Oakley, 1999) found that women who were active retained significantly less weight (8.6 pounds) than their less active counterparts (11.3 pounds). Psychologically, the active women had better postpartum adaptation and participated more in fun activities like socializing, hobbies, and entertainment. Finally, their breast milk was unaffected by the vigorous activity. Thus, the researchers believed everyone should be advised to exercise.
Other studies have not found such optimistic results for exercise. A study from Cambridge did not find any changes in women exercising 4.5 times a week for 12 weeks. They looked at body weight, body fat, energy expenditure, and resting metabolic rate as well as milk output and infant weight gain. However, they did find a significant improvement in aerobic capacity. Another study compared women when they were pregnant to their postpartum state. No changes were found in response to exercise (Lotgering, Spinnewijn, Struijk, Boomsma, and Wallenburg, 1998). Perhaps if they tracked the participants longer the researchers may have found weight loss in the long run.
How to Develop Your POA (Plan of Action) for Postpartum Weight Loss
First, use your intelligence in accepting a realistic postpartum body weight. Research has shown that once you decide on a realistic weight goal and develop the motivation to reduce your body fat, you can successfully lose weight in the long term through lifestyle changes, not drastic diets.
A recent study published in the Journal of Clinical Nutrition found that most people who had successfully maintained their weight loss for two or more years had devised their own personal weight-loss plan. This finding suggests a person needs a “take-charge” approach to lose the weight and keep it off.
The American Medical Association’s Council on Scientific Affairs recently stressed the importance of maintaining a diet that is nutritionally sound—that is, a diet low in fat (not fat-free), nutrient-dense (i.e., full of vitamins and minerals), and high in fiber. The AMA also emphasized the need for incorporating exercise and other lifestyle changes into one’s routine to reduce and/or maintain body weight.
Whatever plan of action you devise, let it be something you can live with for life. Be realistic in your approach. Consider the following points when developing your plan of action:
- Before embarking on your plan, have a thorough medical exam that includes an evaluation of fitness for exercise; setting a goal weight based on your family’s history of obesity; analysis of your body composition, including waist-hip ration; and a review of your dieting history.
- Select areas in your life that you wish to improve. Keeping records of what you are eating, your activities, and other habits frequently will give you a starting point.
- Make a plan to incorporate small, positive changes and follow it!
- Seek advice only from practitioners who have degrees or certification in their areas of expertise. For example, get nutritional help from a registered dietitian. For fitness instruction, consult a physical therapist or a
physiologist who has academic training and is certified by one of the appropriate national organizations, such as the American College of Sports Medicine.
- Follow a low-fat, nutritionally balanced diet that fulfills all the recommended daily allowances for vitamins and minerals. Remember, never go below 1800 calories a day if you are breastfeeding.
- Increase physical activity to at least three and one-half hours per week.
- Educate yourself about nutrition, not diets.
- Adopt behavior modification techniques for changing your eating and exercise habits.
- Consider counseling to improve self-esteem. Note: It is imperative that you seek professional counseling for restrictive eating, bingeing, purging or other eating disorders.
- Develop a maintenance plan you can live with. Maintaining weight requires different skills than losing weight.
- Allow yourself an occasional indulgence. Remember that one indulgence will not push you over the edge! Just do “more of the best and less of the rest.”
- Take your time. Lasting weight loss is best achieved slowly and results from a permanent eating and exercise plan, not a diet that you go on, then go off. If you are sensitive to carbohydrates due to insulin resistance, diabetes or a family history of diabetes, decrease your carbohydrate intake to about 40 or 50 percent of your total calories and select low-sugar foods. Keep records of everything you eat for the first six months for the educational experience of a lifetime.
- Eat consciously. (See the hints below for eating consciously.)
- Feel energized and satisfied with the food you eat.
- Drink eight to 10 glasses of pure water each day!
- Relax before eating. Breathe deeply for one minute, or bless your food before picking up your fork. This time will allow you to become aware of how hungry you actually are.
- Try to place your eating utensil down with each bite. Take at least 20 minutes to eat your meal.
- Put food on a plate and sit down at the table.
- Avoid distractions when eating, such as phone calls, radio, TV, and reading. These diminish the experience of eating. Pay attention to the texture, color, flavor, and temperature of your food. You will be more aware of your hunger level if you pay attention as you eat.
- Get the most out of what you eat. For example, although most people consume the majority of their daily protein at lunch and supper, the best time to get some protein is first thing in the morning.
- Except for breakfast, eat only when you are hungry. Respect your body’s internal cues. Trust yourself to recognize and honor these cues with healthy, energizing “fuel.”
- Be discriminating when eating restaurant-prepared foods. Never allow yourself to feel intimidated when ordering your food prepared in a certain manner.
Watching what you eat is about as simple as pulling a rabbit out of a hat. It is uncomfortable mental work because eating is a complex activity that involves many conscious and subconscious phenomena. Many factors determine whether you will eat food that tempts you. Your physiology may play a role because the temptation may stimulate hunger. Your family upbringing may influence you to eat particular foods or desserts because you associate them with love. Society or cultural pressures can make you feel obligated to eat everything. The stress of a new baby can prompt you to eat for energy due to lack of sleep. And last but not least, psychology may play a part if you are feeling emotional and want food for gratification.
It is very important for you to appreciate the complexities of watching your food intake so you do not get demoralized when you encounter tough times. Good luck and stick with your POA even when times get challenging. You’ll be proud of yourself for doing so!