Pregnancy is associated with dramatic changes in women’s body shape and size, and for many women, these changes trigger mixed emotions.
For some, pregnancy weight gain can lead to “body dissatisfaction,” or a negative body image. A recent study evaluated changes in women’s weight and body satisfaction from before pregnancy to one month after delivery. It found that mothers were on average 11 pounds heavier after delivery than before becoming pregnant, and were less satisfied with their weight and shape after delivery.
Researchers from the University of Minnesota followed 506 women over a longer timeframe, up to nine months following birth. The women’s body dissatisfaction increased significantly over this time. Despite losing an average of 10 pounds, their mean weight remained an average of 5.4 pounds above the pre-pregnancy weight.
Body dissatisfaction after nine months was associated with overeating or poor appetite, higher current weight, worse mental health (particularly depression), bottle-feeding, being single vs. married, having fewer children, and smoking during pregnancy. But the importance of social factors such as close relationships and employment status remains unclear.
The researchers say, “It’s important to educate women about expected postpartum weight and body changes, and to find ways to enhance mothers’ postpartum self-esteem and body satisfaction.”
A decline in body satisfaction is important in its own right, but is also important because it may contribute to other problems. Many research studies suggest that women who are preoccupied or less satisfied with their body shape are less likely to breastfeed, and more likely to suffer depressive symptoms or psychological distress.
This may contribute to a vicious cycle in which depression provokes body dissatisfaction through diminished self-esteem or overeating, and body dissatisfaction itself lowers self-esteem and contributes to depression. The cycle may heighten the risk for postpartum eating disorders.
Body image prior to pregnancy and the tendency to compare oneself to others physically are also linked to post-pregnancy body dissatisfaction. Women with pre-pregnancy eating disorders are at particular risk. Experts from the University of Illinois say, “The combination of psychological stressors of new motherhood and body image concerns, intensified by the residual bodily changes of pregnancy, may predispose women to have an exacerbation in eating disorder symptoms as well as the development of postpartum mood disorders.”
They add, “Depression can lead mothers to be nonresponsive, inconsistent, or rejecting of the infant, placing the mother-baby attachment at risk. The added existence of an eating disorder compounds these risks, with medical and psychological risks becoming increasingly apparent.”
Health care providers are likely to have greater contact with women during the postpartum period, making such providers “instrumental in the screening and referral process (for eating disorders)”, say the experts. They recommend a multidisciplinary approach, but point out that the effectiveness of standard eating disorder treatments for women in the postpartum period is unclear.
Overall, there is evidence of a decline in body dissatisfaction after delivery even among women with no prior problems. At least two studies indicate that body dissatisfaction reaches its height at six months postpartum. Women become more likely to report that they feel ashamed of their body and avoid wearing tight-fitting clothes.
Several studies show that women want to return to a normal weight after childbirth. “The cultural ‘thinness’ mindset could unfortunately have negative repercussions on a mother’s mental health,” say the team from Minnesota.
However, they found that African-American women had greater body satisfaction, a result that is supported in previous research and has also been seen among non-pregnant women. Caucasian mothers had the least positive body image, followed by Hispanic mothers.
“Given the many ways in which body image, weight gain, and mental health are intertwined, along with current trends toward increasing obesity and postpartum weight retention, it is important to educate women about the expected course of postpartum weight loss and body changes, and to find ways to enhance mother’s body image and self esteem after delivery,” the team conclude.
Professor Jane Wardle of the University of London, U.K., found some more upbeat results. Her team evaluated body image, body satisfaction and dieting during pregnancy, “a stage of life when social pressures for slimness might be expected to be relaxed.”
They showed that pregnant women had lower scores on the Drive for Thinness subscale of an eating disorder questionnaire, alongside lower body dissatisfaction than nonpregnant women. Dietary restraint was less likely, and current attempts to lose weight were less frequent.
Nevertheless, there was “no evidence that pregnancy was associated with any relaxation of body image ideals: pregnant women chose a similar size of figure to non-pregnant women as their ideal.” The team suggest that pregnancy can lead to reduced concern with weight despite an increased body size, but this effect only appears to last during pregnancy itself.
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Davies, K. and Wardle, J. Body image and dieting in pregnancy. Journal of Psychosomatic Research, Vol. 38, November 1994, pp. 787-99.
Duncombe, D. et al. How well do women adapt to changes in their body size and shape across the course of pregnancy? Journal of Health Psychology, Vol. 13, May 2008, pp. 503-15.