Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
27 Aug

Pregorexia: Fetus, We’re Hungry

250736277 08f23689ceSpinning nausea, wrenching vomiting and relentless exhaustion. No, we’re not talking morning sickness here (although we hope we didn’t give anyone traumatic flashbacks). This is just the everyday reaction to our media’s barrage of celebrity pregnancies. Sure, we wish all the best to anyone celebrating a new child, but the “baby bump” blitz (Did we really just say those words??), let’s face it, has nothing to do with babies themselves and everything to do with the starlets: how they look, how big they’ve gotten, who they’re wearing. (Please, please, make it stop….)

And, if you can bear with us for a few more moments, these depictions (as those of us who’ve been there especially know) are far from nitty-gritty portrayals of pregnancy reality. We’ll mercifully (and gratefully) leave the low down particulars to the entertainment blogs, but suffice it to say that expectant celebrities artfully stage how they’re depicted and most conveniently disappear from the spotlight in the final two to three (i.e. largest) months of their pregnancies. (And then there are the miraculously – or suspiciously, depending on how you see it – slender appearances merely a few weeks post-baby.) These perfect, publicity-cultivated and seemingly omnipresent portraits, many suggest, are encroaching on women’s (and men’s) perceptions of healthy pregnancy. (So much for Grok’s Rubenesque fertility goddess statues…) In fact, these selective and stylized representations of pregnancy are being criticized as contributing factors in a disturbing new phenomenon that reaches beyond Hollywood.

According to medical experts, we’re seeing a marked rise in the number of women who intentionally and dangerously restrict their weight gain while pregnant. Existing on little to no food, throwing up, exercising obsessively – these are the hallmarks of these women’s behavior. Sound like an eating disorder? Well, that’s what they’ve begun to call it. Pregorexia, in fact. Unsettling and sad as a phenomenon, to be sure. Controversial as a diagnosis to some.

One expert, Professor John Morgan, who directs the Yorkshire Centre for Eating Disorders at St George’s University in London, believes that “1 in 20 pregnant women” may suffer from pregorexia. The numbers are hard to nail down, Morgan suggests, because women rarely share their condition or disordered “behaviors” with their doctors. Any indication of low weight gain or vomiting can be rather simply excused as a result of severe or extended morning sickness.

Current medical recommendations for pregnancy weight gain vary based on pre-pregnancy BMI. According to the American Pregnancy Association, women of healthy, “normal” weight are advised to gain between 25-37 pounds. Those who are overweight prior to pregnancy should gain 15-25 pounds. Finally, women who were previously underweight before becoming pregnant are advised to gain between 28-40 pounds. (And, we know what you’re thinking. Most of the aforementioned celebrity community would likely be in the underweight category.)

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Let’s be clear. The stakes here are huge. Insufficient weight gain, as defined by the APA guidelines, has been associated with poor fetal growth, low birth weight, premature birth, mental retardation, birth defects, and reduced breastfeeding. This is absolutely no way to begin a child’s life. Although we don’t often see these kinds of situations in the Hollywood set, it’s important to remember that these women choose how and when they’re seen. And although some of these celebrities might not gain as much as they should during their pregnancies, their nutrition and exercise are meticulously monitored and regulated by professionals they have the means to hire.

And the truth is, we can’t lump it all on celebrities and their image strategy. In the 19th Century, when rickets and other nutritional deficiencies contributed to smaller pelvic openings in women, doctors routinely advised little weight gain. As unhealthy as these recommendations were at the time, you could at least see the logic. This wasn’t exactly an age when C-sections were much of an option. (And when they were, it was typically to save the baby after the mother had died.) But rigid weight gain recommendations remained in place until close to 1970.

Even today, some women may feel pressured by their physicians or relatives to unnaturally limit their weight gain. Though current recommendations offer a healthier target range for women, doctors usually track expectant mothers’ weight gain with a pre-set trajectory chart based on their pre-pregnancy weight. Although these charts offer fairly reliable estimates for weight gain throughout pregnancies, pregnancies do vary. Some women, without any action or intention on their parts, might gain more in the second trimester but then level off more in the third than most women. They might be told in that second trimester that they’re gaining too much and should cut back their food intake, exactly at a time when their baby might be in a growth spurt.

The history of medical recommendations aside, some women today are so distraught over the idea of gaining the significant weight needed for pregnancy that they’ll put their children at risk for lifelong health and cognitive problems. (And themselves at risk for nutritional deficiencies.) Ultimately, pregorexia (like other eating disorders) perhaps has little to do with the number of pounds and more to do with a desperate grasp for control over the extraordinary anxiety some women feel when pregnant. Many if not most women who are diagnosed with the disorder have suffered from an eating disorder in the past. As Liz Fraser, who was diagnosed with the disorder, explains, “Pregnancy is a frightening and disorientating time and new motherhood is for many women an assault on identity and on everything you’ve ever known. Some women get depressed, others get eating disorders. Many get both. My eating disorder became my coping strategy – a habitual response to stress since I was a teenager that kicked in again when I felt vulnerable during pregnancy.”

Health, of course, is ultimately about working with your body’s natural inclinations and navigation toward balance and homeostasis. It goes without saying that a careful, healthy diet and safe exercise practices are crucial. But pregnancy, perhaps, also depends on a kind of individual perceptiveness. Trusting yourself and getting comfortable with the difficult and indeed “disorienting” physical and emotional process can be just as key to a healthy pregnancy – for every expectant mother but certainly for those at risk for pregorexia.

We’ll turn it over to you now. We’re interested in hearing what you have to say. Have you heard of pregorexia before? What are your thoughts, perspectives, critiques, questions, reactions?

mahalie, kellyandapril Flickr Photos (CC)

Further Reading:

Orthorexia Nervosa and Dietary Obsession

Pregnancy Diet Tips

Questions About Soy Baby Formula

Dear Mark: Primal Blueprint for bot Men and Women?

The Great Fitness Experiment – Pregorexia: New Eating Disorder or Overblown Media Hype?

Diet Blog – Pregorexia: Pregnant AND Skinny

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Wow awesome title! It’s good that even informative reading can have a little humor to start out with.
    Cheers to your site-

    Jen C. wrote on August 27th, 2008
  2. I recently saw some pictures of Nicole Kidman two weeks post pregnancy and she’s stick thin! The thing is, she’s always been stick thin, it doesn’t surprise me, and I’d guess she actually had a healthy pregnancy/delivery. But the body image younger women take away from that…I guess I’m trying to say, not everyone has Nicole Kidman hips.

    And I agree, Jen. Funny title.

    Mia wrote on August 27th, 2008
  3. The title cracked me up as well. As I wrote in my post (thanks for the linkage!!), there was a point during my third pregnancy where I would have fit the definition of pregorexia. Eating disorders are hard enough as it is but during pregnancy? They can be hell. When did it become a requirement for women to be sexy at all times? I hate the whole MILF phenomenon. I think being a mother should be reason enough to earn a woman some respect.

    Like Mia, my first thought upon reading this was Hellloooo, Nicole Kidman!

    charlotte wrote on August 27th, 2008
  4. In both of my pregnancies (17 and 20 years ago) I was surrounded by other pregnant women taking pre-natal swim classes at the YMCA. I don’t remember anyone being suspected of not eating enough. On the contrary, being expectant seemed to give us all carte blanche to eat however much we wanted.

    (Personally, I started out slightly over-weight, so the 17 pounds I gained was perfect.)

    Those were the good-old-days before the media infatuation with baby-bumps.

    dragonmamma wrote on August 27th, 2008
  5. My wife is pregnant now (13 weeks along) with our first and she is doing everything she can to keep her and the baby healthy. We both know she will gain weight and that is a good thing! It’s amazing to me that some people would put their appearance/looks before the health of their baby. Great post…very informative.

    Blake wrote on August 27th, 2008
  6. Mark,

    Is there any research that you are aware of that “pregorexia” causes pre-term labor or impedes the development of the fetus?

    SD_Mikey wrote on August 27th, 2008
  7. Once again, the delicious daily apple really hits the spot today. I am shocked by the tabloid covers that hover at the checkout stand; the depiction of celebrity pregnancies as superior, celebrity cellulite as scandalous, and celebrity political views as newsworthy. I just don’t understand the logic and I for one am not impressed. The entertainment industry has come to decide who we should admire and who we should detest much like the pharmaceutical industry determines what we should ingest and the Food & Drug Administration dictates our suggested carb intake. Stand up!

    Nature gave us pregnancy as a time for preparation and consideration of the momentous experience of birth and parenthood. A time for the mind and body and spirit to gather their resources in expectation and joy. Have we become so self-centered that our dimensions take priority over the little person being formed?

    Shocking.
    Thank you.

    DanaLovesLife wrote on August 28th, 2008
  8. To the person that said:
    “It’s amazing to me that some people would put their appearance/looks before the health of their baby.”
    In a sense this is what they are doing but, anorexia is a disease. It is actually more of a control thing. The person usually becomes anorexic when everything in else in their life feels out of control. I had a friend who became anorexic in high school when her mom and dad when through a bad divorce and her dad moved away. She told me it was not really about how she looked, it was more about the control. No one could make her eat anything, it was the one thing she could control in her life at the time. Pregnancy can feel really out of control for many women.

    My guess it that a lot of these pregorexia women were already anorexic. I have a friend now who I think is anorexic and was pregorexic during both of her pregnancies. We became friends during her first pregnancy. She does not eat very much and she even told me once (a year later) that during her first pregnancy she would wake up hungry in the middle of night during her third trimester hungry but she would not eat because she was so worried that she would get too big and not be able to get back to her weight right away. She then told me that she thought she would be better the next time she got pregnant though since she did get back to her weight right away. Unfortunately, this was not true. She seemed to be worse this 2nd pregnancy. She even was put on bed rest in the 3rd trimester because the baby was measuring smaller that it should have been but this really only made it worse, she ate even less while she was on bed rest and actually lost weight. I also noticed that the more people talked to her about eating more, the less she ate. This is a scary disease!

    The baby came out preemie sized even though it was full term and then she breastfed while not eating much and only let the baby eat every 3 hours on the dot and only nursed her on one side each feeding. When she got on solids she only fed the baby fruits and veggies and only beans and eggs for protein and refuses to give the baby whole milk. She lets the baby eat only 3 times a day with the rest of the family most of the time. The baby stayed small and still is small (about the size of a small 1 year old and will be 2 soon!) but is otherwise normal, amazingly! The hilarious part is that my friend thinks her baby is just a “small person” she is in TOTAL denial about the connection to her not eating enough while pregnant and nursing and not feeding her tiny kid more often now.

    She is trying to get pregnant again and I would LOVE to find some facts on what can happen when you do not eat enough while pregnant and nursing.. I tried to find some before and I did find some but not too much. I tried to show some of what I found to her husband but unfortunately he was in denial too and told me that he did not think she was eating any less than her first pregnancy and their first baby was fine (that child is normal sized but does have serve eye health issues but I am not sure if this is related). I tried to explain to him that this was her 2nd pregnancy and the babies are like parasites and they suck out what they need from the mom but that this was the 2nd time so there was less to take. As I said he was in denial though and then just avoided me for a while after this.

    I am hoping with some more facts I can try to talk to him again this time and maybe he will believe me now or at least take more of it to heart since their 2nd baby is not obviously a normal size. I am scared to think what will happen this time if she does manage to get pregnant again.

    Does anyone know where I can find some facts or evidence? Anyone have advice on how to handle this? How to help? Last time it seemed the more anyone tried to talk about it the less she ate because it is a control thing. As stated above in this article these women do not tell everything to their doctors so it is not always easy to figure out that someone has this disease. Maybe this time her husband will get some guts and tell her doctor the truth so she and the fetus can get help!

    Concerned wrote on August 28th, 2008
    • Honestly if they are in denial there is nothing you can do. As much as you love your friend, you are better off confronting them and cutting them out of your life. Not feeding your baby enough food is CHILD ABUSE and if it is serious you should think about calling social services.

      lena wrote on January 14th, 2012
  9. I think the other side of this coin is the terrible idea that a pregnant woman can and should eat whatever she wants. That was the strategy recommended to me, and I didn’t know anything about the primal diet at the time.

    I ate mostly grains. I’m still struggling with the weight I gained (successfully, now that I have learned about Primal Blueprint).

    What I would have killed to have was a simple, but solid guide on how and what to eat while pregnant that included a chapter that talked about keeping active no matter what. Alas, hindsight . . .

    rki wrote on March 28th, 2010
    • I agree, the right information always seems to come too late.

      Suvetar wrote on August 29th, 2010
  10. I think that the weight gain recommendations you have in bold may be out of date. See this article at the NYT:
    “In the first revision of weight-gain guidelines since 1990, the Institute of Medicine and the National Research Council said that women who start their pregnancies very overweight should limit their gain to 11 to 20 pounds. About 27 percent of women of childbearing age fall into this category, defined as obese because they have a body mass index of 30 or more”

    Mich wrote on August 29th, 2010
  11. I am appalled by this article! So every woman that doesn’t get fat while she’s pregnant has an eating disorder? Are you kidding me?

    When I was pregnant I was on the paleo diet. I ate as much as I could. I was home a lot, so really I ate quite a bit. I ate fruits, vegetables, meat, and plenty of fat. I mean plenty! I loaded up with butter and olive oil, nuts, coconut oil, fatty cuts of meat. I never thought about restricting calories and, in fact, never even thought about staying thin. But it just happened. I never gained any weight besides the belly.

    I had a Japanese doctor. I often expressed to him that I thought it was odd I wasn’t gaining weight and he always told me it was fine.

    My daughter was born full term. A few days late actually. She was 8 lbs. She was strong, well tempered. She slept through the night at 3 weeks. I had ample breast milk which I fed her for a year and a half.

    Sure some women may be predisposed to gain a little more weight than I did (maybe), but with a supremely healthy diet and a good exercise routine, I really don’t think it’s going to happen.

    Peggy wrote on May 9th, 2011
    • Peggy I agree with you! I was the same as you, I have had 2 births, 3yrs/3mths apart and they were identical pregnancies and births, with the exception of my galbladder being removed with my 1st (I didn’t know I could heal it myself argh!) Anyway even despite my issues with my son, my daughter’s birth was exactly the same. I pretty much lose weight when I get pregnant and then just put on “baby” weight. I eat, Lots, if I’m hungry I eat. I put on weight for the first couple weeks/month PP, but once I hit around 6mths PP the breastfeeding keeps the weight off of me. I’m still nursing my 22mth old, and I’m way under weight at 100lbs!! I EAT, lots, I know I’m not eating as well as I could/should but better than most people I would dare say. But again, everyone’s metabolism is different and responds to pregnancy differently. I was still very large in the tummy, but I didn’t gain weight everywhere else like many mamas do. It literally was all baby. I never had braxton hicks or swelling issues etc… I had uneventful pregnancies and births (planned natural births, no drugs, no surgery.) my babies were 7lbs and around 18-19″ and perfectly healthy. They are still the epitome of health, luckily because they are vaccine free (my son mostly as we got suckered in with a few shots at first but not after that).

      Anyway, I agree with Peggy completely, Weight gain is not a baring on whether or not you have a healthy pregnancy or not. Proper food intake/nutrients and eating if you are hungry and not starving yourself is really it. No need to worry about gaining or losing weight, unless you are rapidly losing weight and you were NOT obese/overweight BEFORE getting pregnant and your baby is measuring and growing well.

      Mema wrote on May 9th, 2011
  12. This article is not saying if you are skinny during pregnancy you have an eating disorder. It’s talking about a behavior that can lead to malnutrition in a fetus. OBVIOUSLY if you eat enough your baby is getting enough, no matter what you weigh. And its different for everybody, so bragging about how you ate a ton and never gained weight is awesome for you, but not the case for everyone.

    Jessica wrote on May 14th, 2011

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