"Belly Only Pregnancy" & eating disorders during pregnancy

This week, a new phenomenon has emerged that was entirely unknown to me before: "Belly Only Pregnancy."

Searching for definitions online implies that a woman should maintain a defined physique through exercise and dietary regimens during pregnancy. Furthermore, she should strive to ensure a complication-free delivery and regain a slim and toned appearance as soon as possible after giving birth.

In translation, this trend advocates that one should only gain weight in the belly and stay fit through dietary restrictions and intense exercise to avoid unnecessary weight gain.

I must say that I was surprised and almost appalled when I heard about this for the first time. However, I understand that this is an ongoing trend among influencers and others on the internet. Therefore, it feels important for us to discuss why we gain weight during pregnancy and what is considered normal in this week's post.

How much weight is it normal to gain?

Here are the recommendations from the Institute of Medicine:

Normal-weight women (BMI < 25): 11–16 kg (24-35 lbs)

Overweight women (BMI 25–30): 7–11 kg (15-25 lbs)

Women with obesity (BMI > 30): 5–9 kg (11-20 lbs)

Why are we discussing this in the first place? Well, we know that gaining an appropriate amount of weight during pregnancy is beneficial for both maternal and fetal health. That's why it's crucial to monitor weight gain during visits to the Maternal and Child Health Care (MVC) center.

If you also know that a woman has issues with her diet (over/underweight), it's even more important to monitor this.

Sometimes, I meet women who don't want to know their weight. They might have had previous struggles with eating disorders or feel they weigh too much and simply "don't want to know." All too often, with good intentions, this leads the midwife at the MVC to skip noting and following this essential information during pregnancy.

This is quite absurd!

It's important to explain to the woman early in her pregnancy that this is done for medical purposes, just like measuring blood pressure, blood sugar, and all other checks that are performed, even if the woman finds it stressful.

Monitoring weight gain is a crucial part of basic and essential pregnancy monitoring. It's true! The goal is for the pregnancy to go as well and normally as possible, and for the woman and the fetus to be healthy.

The next question is whether, as the trend suggests, you can control where pregnancy weight is gained. Can you make the pounds accumulate only in the belly and then lose it all there when the baby and placenta are out? Does it work? The answer is no. It's not that simple.

To me, this is madness. It's concerning for both the woman's and the child's health, and it poses a clear and risky trigger mechanism for those who are already on the verge of eating disorders to tip over.

Do you have an increased energy requirement during pregnancy?

Should you "eat for two," as it was said before? Or should you, as the trend suggests, follow a strict diet even during pregnancy?

The truth is that pregnancy itself requires only a relatively modest increase in energy intake compared to pre-pregnancy requirements. This means that you don't need as much extra energy during pregnancy as you might think.

"Eating for two" is not recommended.

The actual increased energy requirement depends on factors such as the growth of various tissues in the body, including the breasts, uterus, and placenta, as well as the increase in blood volume. Energy is also needed to build the fetus's tissues and meet the fetus's energy needs.

During the first three months (the first trimester), it's estimated that you need about 100 extra calories per day. In the second and third trimesters, it's about 300 and 500 extra calories per day, respectively. The requirement for more energy increases slightly during the breastfeeding period.

In the long run, this means that a woman towards the end of pregnancy needs more food. It can be very tempting to indulge in a bit more "unhealthy" food like candy, ice cream, or snacks when you have a higher energy requirement.

The problem is that this type of food contains very few of the essential nutrients that a woman needs. As healthcare providers, we must emphasize the importance of proper nutrition and less "junk food."

If a woman's weight gain stays within the recommended guidelines, it reduces the risk of complications such as gestational diabetes (GDM), high blood pressure, preeclampsia, and delivery complications, which is highly motivating.

What's important is that excessive weight gain during pregnancy is also one of the major risk factors for future overweight and obesity in a woman's life.

Many overweight women report that they began their "weight journey" during their pregnancies: they ate improperly, gained too much weight, and couldn't shed it after pregnancy.

If this pattern repeats with each new pregnancy, being overweight often becomes a reality.

"Belly Only Pregnancy" - Eating Disorders during Pregnancy

A distorted body image is called dysmorphia. Dysmorphia results from a cognitive inability to perceive one's own body size (one may perceive themselves as both larger and smaller than reality).

Distorted body image often means that a person's ideal body doesn't match their actual reflection. These conditions can lead to both severe underweight and overweight.

Eating disorders encompass various issues that manifest differently. Anorexia nervosa usually starts during adolescence. It can take on a restrictive form with self-starvation only in 1-2 percent and a bulimic form in 5 percent, where self-starvation alternates with binge eating.

Research suggests that eating disorders can also debut during pregnancy.

Many women with previously diagnosed eating disorders experience symptom improvement during pregnancy, but there is still a risk of relapse. Studies show that around 5 percent of pregnant women suffer from eating disorders. This number increases to 10 percent after giving birth.

A Swedish study published in the American journal JAMA in 2019

The study reported an increased risk of anemia (2 times higher), pregnancy vomiting (2 times higher), preterm birth (1.5 times higher), pregnancy bleeding (1.5 times higher), and fetal brain damage (microencephaly) (1.5 times higher) in pregnant women with or with a history of eating disorders ("Association of Maternal Eating Disorders With Pregnancy and Neonatal Outcomes," JAMA Psychiatry, November 20, 2019). This needs to be compared with the "trends."

So, according to what I've explained above, how should we approach the "Belly Only Pregnancy" trend? Should we accept that influencers and trendsetters, often with a lack of awareness of the risks, should continue? What happens to all the pregnant women in society?

What happens to women who have or have had an eating disorder?

2022 in the journal "Eating and Weight Disorders"

A publication conducted a qualitative analysis of publications related to "Belly Only Pregnancy" and the potential risks and benefits of its content on social media and the internet.

Study Method: They collected image and text data by reviewing Instagram and blog posts that included or linked to #bellyonlypregnancy. The identified data was then categorized using qualitative content analysis (using the software MAXQDA version 2018).

Results: The study included 351 Instagram posts and 8 blog posts related to "Belly Only Pregnancies."

The results: The term "Belly Only Pregnancy" was used to describe:

• The image of an athletic woman whose belly grows during pregnancy without gaining excess body fat.

• An active lifestyle during pregnancy that consists of a healthy diet and regular exercise to achieve goals like rapid weight loss after childbirth. It also discussed bodily and mental changes during pregnancy and the feasibility of this lifestyle change.

The authors summarized their findings as follows: There is a significant need to make obstetricians and midwives working with pregnant women aware of the potential risks of social media consumption in this matter.

Doctors must learn and discuss the potential harmful effects of "Belly Only Pregnancies" on maternal and fetal health. This has received too little attention in daily clinical practice.

In the long term, (digital) educational materials should be developed to provide information on the risks of consuming "Belly Only Pregnacies" and similar content on social media during pregnancy.

Certainly, one should eat wisely and stay active during pregnancy; there's no doubt about that. But the trend we've discussed in this post is crazy. My opinion is that information about the seriousness of this trend must reach pregnant women, and it must do so quickly!

/Dr. Eva