Let’s Talk About How We Talk About Pregnancy and Weight Gain
Weight gain isn’t among the most important factors for a healthy pregnancy. So why do we talk about it so much?
As I write this, I am 21 weeks pregnant. Everything I assumed would be true about pregnancy has been wrong — and if you want to read more about how epically wrong I was, I put up this much longer blog post detailing the minutiae of my breathtaking hubris.
But more than anything, I want to talk about gaining weight while pregnant. I’ve gained 35 pounds while pregnant so far. For a “normal” weight person, it is recommended that a person gain 25 to 35 pounds total during pregnancy, and most of that during the latter half. I’m already over the limit. Get your judgements about that out of the way, and then we’ll begin.
One of the things that made me decide I was ready to get pregnant was that I’d worked to have a new relationship with my body. Formerly a person who weighed in every day and counted every calorie, I had gotten really into intuitive eating (this book fundamentally changed my life) and paying attention to what my body said it needed and why. I also read “The Body Is Not An Apology” with my friend Jessica in our two-person book club and loved and appreciated it. Also “Pleasure Activism.” Basically, I was done hating my body and anyone else’s body, and I decided I no longer wanted to know what I weighed. This felt like a big adult evolution, and it made me feel ready to share my body — my amazing, incredible, powerful body — with another person.
Also, after reading “Fearing the Black Body: The Racial Origins of Fat Phobia,” it became clear to me that fatphobia was as much a manifestation of racism as it was anything else. The final chapter in that book illuminated studies that showed that BMI is not actually based on anything other than the generalized guesswork of a known white supremacist. Furthermore, people who are “overweight” according to the BMI actually tend to live longer and have better health than people who are of “average” weight. Furthermore, essay after essay showed anecdotally as well as statistically that physicians are so bought into mythology around the correlation between weight and health that they do not provide adequate medical care to people who are obese. So it would be wrong to conclude, based on the data we have, that obesity is the cause of all the health problems some physicians claim that it is. When you are not receiving health care that is equivalent to someone with a different type of body, there is no statistical constant, and you can’t draw conclusions.
When I first got pregnant, I talked on the phone with my general care provider. I shared with her that a fear that I had about pregnancy was that people — and I meant healthcare professionals — would pay too much attention to my weight, and I had just reached a really great place, emotionally, with my own body image. I didn’t want to talk about my weight during pregnancy. I had trouble believing my weight would have all that much to do with my health, or the health of my baby. My doctor literally could not understand what I was trying to say. She thought I was trying to say I was worried I would gain too much weight. She kept reassuring me that there were diet and exercise plans I could stick to to keep my weight down during pregnancy. I don’t fault her for this; I think “too much weight gain” is a pretty common concern for pregnant people.
I started reading pregnancy books and articles, and downloading pregnancy apps. More than once, I read, “You may think that it’s time to start eating for two, but you’re wrong,” or something like that. A family member told me to be careful about what I ate, because it was so easy to get fat during pregnancy, and so hard to take the weight off after you gave birth. (That’s what happened to her, she said, and she’d wished someone had told her.)
In the book “Expecting Better” by Emily Oster (which was recommended to me by every friend who also has a favorite podcast and has ridden an electric bike), weight gain and pregnancy is discussed at some length. Oster is an economist, and uses hard facts and meticulously cultivated data to draw conclusions about how to navigate pregnancy. (This is the book that concludes that a glass of wine a day is fine during pregnancy, and six cups of coffee is OK too.) Generally, I appreciated this approach, because it allowed me to make statements to my friends that were grounded in hard science. Oster is transparent about how the data she uses was gathered, too — so she is able to give more merit to studies that had more participants from diverse backgrounds, rather than small-scale niche ones.
However, Oster writes some about BMI and the risks of obesity, without considering or mentioning the proven non-science of the BMI. That causes her to draw conclusions that neglect important context around weight. This huge oversight made me frustrated. (There were other things that frustrated me about this book — particularly that there were several points throughout it that it seemed to be written for a certain kind of white woman, without acknowledging the assumed audience. Not all pregnant people are white, financially secure, or women. This book sometimes neglects that.)
The book concludes that weight gain during pregnancy doesn’t actually matter that much in regards to the overall health of your baby. If you gain more weight, you are slightly more likely to have a bigger baby; if you gain less, you are slightly more likely to have a smaller baby. Both bigger and smaller than average babies have additional health risks, but there are far more health risks for smaller babies. Overall, though, weight gain has very little impact on the health of your baby, and it isn’t something one should be spending time obsessing over. The main concern about weight gain during pregnancy is that it’s hard to lose it after you give birth. I know that matters a lot to some pregnant people, and there might be great reasons for that, but I was working really hard to let it not matter too much to me.
At the beginning of my second trimester, I had a flare-up of a backache that I’d had before I got pregnant. A trip to the chiropractor had fixed it in the past, so I decided to go again. When I told my chiropractor I was pregnant, he launched into a spiel about pregnancy: what it was like to be pregnant, what I was probably feeling, what I was going to feel, and what I should be concerned about. At no point did he ask if this was something I was interested in hearing from him. (It wasn’t. I’d already read several books, most written by mothers or birth workers or both. I didn’t need my cis male chiropractor to explain pregnancy to me.) At some point in this irritating spiel, he said, “Now, I’ll bet you think you’re supposed to be eating for two. A lot of women think that. It’s a total myth. You really need to be watching your calories.”
In an act of pure courage that amazed even me, I interrupted him. “Actually, I don’t want to talk about that. I have a boundary around talking about weight.”
He looked stunned and said, “This is really important. We do need to talk about it.”
“I have a history of disordered eating,” I said, and then repeated, “so I have a boundary around talking about this subject.”
“Well, I work with dancers for a living, so I know about disordered eating,” he said. “But this is a very important issue. Are you discussing it with your OB? Because if so, then we don’t have to talk about it right now. But you do need to be talking about this with someone. Gestational diabetes is a serious issue, and it can really harm your baby.”
Reader, I wish I could tell you I told him off. Because, as my (also pregnant) friend reminded me later, if he’s saying this to me, he’s probably saying it to other pregnant people. Telling people that they need to be watching their calories during pregnancy can be quite harmful. When even the basic data lady concludes that it is more dangerous to gain too little weight than it is to gain “too much” during pregnancy, we should take heed! What my chiropractor did and said was not OK. He had also clearly never heard the word “boundary” before. (He did fix my back, though. Ugh.)
I didn’t tell him off, but I left his office fuming. How was it this hard to explain to people that my weight was not up for discussion?
At my first few doctor’s appointments, I asked them not to share my weight with me. I told the doctor that if my weight gain became a major health concern, that was when she could bring it up. Until then, I didn’t want to be concerned with it. This request was met with confusion. My doctor acquiesced in the moment but didn’t make a note in my chart or anything like that. So when my lab results came back, there was my weight at the top of the chart, printed next to the important information I wanted to read to know about the health of my fetus. I couldn’t miss it.
I cried because despite all my best efforts to maintain body positivity and mental health throughout my pregnancy, I’d failed. My mental health was deemed not as important as the number associated with my weight, by basically everyone I tried to talk to about it. And once I knew the number, my brain knew how to care about the number. When you spend 34 years caring about that number, it’s very easy to fall back into the same old pattern. The day after I found out my weight, I noticed myself inadvertently counting calories. I signed up for a workout class I had no interest in. I lost what remaining trust I had in my own intuition, and gave in to the idea that this was something I should be caring about — a lot.
When I talked to my mentor Jill about the encounter with the chiropractor, she said, “It’s so funny, because you literally are eating for two. That is what you are doing! The phrase isn’t, ‘You’re eating for two people who are adults and each need the same amount of calories.’ The phrase is, ‘You’re eating for two.’ And that is true. Your baby is getting all her nutrients from you.” That should have been obvious, but I had read and heard that “eating for two is a myth” so many times that I’d forgotten what was actually true: that what you eat matters for the life you’re growing.
For the record, I gained all that weight during the first trimester. I am guessing I gained it because if I didn’t eat something every two hours, I felt like I was going to die. The foods I felt able to eat were: smoothies (fruit, spinach, protein isolate, coconut water), soy yogurt, dry cereal, ginger lollipops, cold pineapple, and one protein bar a day (because you are supposed to get a lot of protein). Normally a big eater of salads and other non-processed things, I guess my body was like, “I don’t know how to break this kind of food down quickly, but I know you need it, so I’m just not going to metabolize it for a while, lol.” I’d imagined that pregnancy would mean nonstop pizza and ice cream cravings, because that’s what I’d seen in movies. Instead, I hated every single food that came into my orbit, and ate food anyway. And then got lectured to by a chiropractor that I didn’t care about my unborn baby because I didn’t want to talk about calories.
People tell you, and it is true, that when you are pregnant, your body becomes a subject eligible for public discourse. But I didn’t expect so many people to feel so entitled to suddenly start talking about my weight, and I didn’t know how that would undermine all the self-work I’d already done to love my body as is. A pregnant person’s mental health matters for their unborn baby arguably more than their weight gain does.
Could someone please tell my chiropractor?