OH THE WEIGHT!

Suzy* is a bubbly 26 year old first time mom. She is excited about motherhood and having had an uneventful pregnancy and delivery, she has nothing to complain about. When she comes for her post-natal clinic at two weeks, she is doing well, and has settled into breastfeeding rather easily. Her final post-natal clinic is rather dramatic though. She is accompanied by her older sister, who is not amused that the new mom had gained seven kilograms since the delivery of her baby, not counting the nine kilos gained during pregnancy. From a svelte 56kgs to an uncomfortable 72 kilograms! She has no fitting clothes and has invaded her sister’s wardrobe

Motherhood is one of the most cherished states for the woman. It brings contentment, excitement, a sense of accomplishment and even societal elevation in some communities. In Africa and India, most communities will look down upon a woman who has not achieved this feat.

During pregnancy a woman should on average, gain eight to twelve kilograms by the time the baby is being born at term. This weight is derived from the baby itself, the amniotic fluid, the placenta, the increased breast tissue, the expanded maternal blood volume and a bit of fat stored in preparation for breastfeeding, commonly noticed under the shoulder blades.

The smaller the woman, the more likely she is to gain less weight. The obese woman has challenges balancing the necessary weight gain against an excess that is unhealthy. Women with pregnancy complications such as pre-eclampsia will gain several kilograms due to excessive retained fluid. This weight gain is usually sudden and the patient appears puffy.

The expectant woman’s caloric requirements in pregnancy vary with gestation. In the first trimester, one has no need for extra calories, hence dietary intake should provide about 1,800kCal a day. This requirement goes up to 2,200kCal in the second trimester and 2,400kCal in the third trimester.

The myth perpetuated in our society about a pregnant woman eating for two are not only false but outright harmful. Extra calories taken in during pregnancy lead to piling on unnecessary weight that sets in place a cascade that leads to unwarranted obesity. This myth is continued into the post-natal phase under the pretext of breastfeeding. Studies have shown that patients who put on weight beyond the recommended pregnancy values have a higher chance of retaining the excess weight right up to a year after delivery.

Once the baby comes, the new mom has a new mountain to climb. Well-meaning family members will visit with heaps of food and they expect the new mom to eat non-stop for the duration the breastfeeding duration. Mugs of hot chocolate, porridge, soup and fermented milk are served without ceasing. The food serving on her plate is increased and the number of meals increases from three to five. Woe unto her if she has challenges establishing a good flow of breastmilk, or if the baby is colicky and cries all night. She will be forced to eat more to produce ‘enough’ milk for her baby.

Within weeks, instead of shedding the baby weight, the new mom continues to gain weight at an alarming rate. Since she is still at home on maternity leave and does not need to dress up, she lives in comfortable loose clothing and has no idea that her wardrobe no longer fits.

Suzy is in this trap. She has a doting mother-in-law who is visiting her first grandchild ever. The older lady spends all day in the kitchen cooking one delight after another and Suzy cannot resist pigging out.

In the breastfeeding phase, all Suzy and her contemporaries need is an extra 500kCal in addition to her daily requirement to cater for the baby. This way, they are able to lose the stored pregnancy fat and resume normal weight. What is required in large volumes is water. Quite an amount of water is lost in the breastmilk and it is important to replace this.

It is not in order to keep unnecessary weight in the guise of having more babies. Most lazy mothers will ignore the weight and cite their desire to have another baby and complete the family size as the excuse. They will plan to lose the weight after they are done with having a second baby. The danger is that, with the successive pregnancy, they are already starting from a point of disadvantage of being overweight or outright obese. The weight loss project ultimately becomes even more difficult.

Post-pregnancy weight loss must start from the delivery room. The mother should learn to eat only what her body requires. She must decisively choose what she needs to eat and not let that be dictated to her. Simple exercises to trigger her metabolism are encouraged, such as brisk walking and swimming. Above all, breastfeeding in itself helps with the weight loss as the body is pushed to use the pregnancy fat that was stored specifically for this.

This is also a good period to initiate weight loss in those diagnosed with obesity during pregnancy. The danger of rapid weight loss in pregnancy is gone and the joints are under less pressure hence can tolerate exercise.

Look out for the contraceptive used too. Some women may gain weight especially if they use progesterone-based hormonal contraceptives. For this group of women, safe options are available and should be used as needed.

It is also important to caution that each woman is inherently different in how their bodies manage their weight. Some may have a high metabolism and they lose weight in weeks. Others need a little longer to catch up. Whatever the case, let us shed off the post-natal weight safely!