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Family Forum / Pregnancy / Pregnancy / November 2007Gain weight
Hi every one. I'm in the first trimester of my pregnancy and I started to gain a lot of weight (something like 8 pound). I found this article http://www.babyhold.com/pregnancy/Diet/Weight_Gain_During_Pregnancy_-_A_Dietary_ Guide/ That say I suppose to gain only 4 pound till now. Is it normal to gain 8 pound till now? Thanks > Hi every one. > I'm in the first trimester of my pregnancy and I started to gain a lot > of weight (something like 8 pound). > I found this article http://www.babyhold.com/pregnancy/Diet/Weight_Gain_During_Pregnancy_-_A_Dietary_ Guide/ > That say I suppose to gain only 4 pound till now. Is it normal to gain > 8 pound till now? Weight gain is one of those things that can be very individual, and it's usually a bad idea to try to manage weight gain. If you are underweight, you may well need to gain more than "normal." If you are overweight, you probably don't need to gain as much as the books say is "normal." Instead of focusing on weight, the best thing to do is focus on what you're eating and how you're moving. If you are eating a reasonable diet full of the right kinds of nutrients, and if you are getting a reasonable amount of exercise, then whatever you gain should be the right amount for you. If, on the other hand, you focus on trying to gain the "right" amount of weight according to some book, you could be doing the wrong thing for yourself and your baby. Best wishes, Ericka > talisa...@yahoo.com wrote: > > Hi every one. [quoted text clipped - 16 lines] > amount of exercise, then whatever you gain should be the > right amount for you. This approach would work well in a context where most people are eating reasonably healthy and getting an appropriate amount of exercise, so that people would have an appropriate frame of reference re: what constitutes a reasonable diet and reasonable exercise. However if the OP is from the US, she's from a society in which a majority of adults are overweight, and about a third are obese. Statistically speaking, any given American probably does not have healthy eating habits and adequate exercise at baseline. Also, a majority of American women gain more than the current recommendations based on their pre-pregnancy body weight. When most people start out at a healthy weight and most people gain appropriate weight, those who don't are more likely to just be biologically different and doing the right thing for themselves. When most people are overweight and most gain excessively, there's something else at work. There is emerging evidence that even the current recommendations advise too much weight gain. It's long been dogma that everyone should gain some weight, whereas some recent studies have shown that severely obese women (BMI >35) can actually improve outcomes for themselves and their babies by *losing* weight during pregnancy. Weight gain below current guidelines appears not to increase the risk of small or big babies, or the risk of C-section, while it appears that children of those pregnancies have lower blood pressures and less obesity at age three years. > If, on the other hand, you focus > on trying to gain the "right" amount of weight according > to some book, you could be doing the wrong thing for yourself > and your baby. Again, I must disagree with Ericka fairly strongly here. Slavishly weighing yourself every moment and starving or gorging yourself in response to the scale would be unhealthy. Using your weight as feedback about whether or not your current diet is healthy and appropriate is a good idea. Quite likely if you've gained 8lbs in the first trimester you're overdoing it, and shouldn't diet or starve yourself but should try to cut back on portion sizes, avoid junk food, and make sure you're getting moderate exercise several days a week. If you cut back on portion sizes, be sure to keep some healthy snacks around so that if you do get hungry you have something to keep you going until the next meal. As a pediatrician in an inner-city practice, it's utterly depressing to think what sort of life so many of my severely obese patients will have in 20 or 30 years. It's depressing to diagnose type 2 (aka "adult" onset) diabetes in a 16 year old. It's depressing to see a child who weighs over 40 pounds, has high cholesterol, and hasn't turned two years old yet. Yes, these are the extreme cases, but in an environment where most people are overweight or obese, and most people gain more than guidelines which are probably too generous to begin with, to say that you don't really need to worry about the numbers on the scale is just not realistic. On the whole our eating and exercise habits are grossly out of whack and so some sort of external verification (ie, weighing oneself) is absolutely necessary. There will occasionally be someone who does everything exactly right and still gains substantially less or more than you'd expect, but nowadays that's the rare exception. Kate, ignorant foot soldier of the medical cartel who is incredibly frustrated trying to deal with pediatric obesity practically every stinkin' day (as if you couldn't tell) and the Bug, 4 years old and something brewing, 4/08 >> talisa...@yahoo.com wrote: >>> Hi every one. [quoted text clipped - 77 lines] > frustrated trying to deal with pediatric obesity practically every > stinkin' day (as if you couldn't tell) I can understand your frustration, but I think the fact still remains that weight is a very crude measure of what the OP (or any pregnant woman) is trying to get at. Yes, it is an indicator that something may be off, but it is not the real factor that needs to be controlled. The real factors that need to be controlled are diet and exercise. If your weight gain is "correct," but you are not eating a healthy diet or exercising, you aren't doing right by yourself or your baby. If you are eating and exercising right, but somehow your weight gain isn't textbook, you probably shouldn't be trying to change good eating and exercising practices in order to bring weight in line. Your views may also be very skewed by your experiences. For instance, although pediatric obesity is obviously a huge problem if you look at national statistics (and an even bigger problem in your practice, it seems), it's actually not as big a problem in my particular neighborhood. That's not to pooh- pooh the concerns about pediatric obesity--they're very real. It's just that I'm actually as likely to see a thin pregnant woman not eating what she should in order to minimize her weight gain so she still looks good as an overweight woman gaining too much weight because she sees pregnancy as a free pass *in my neighborhood*. So, perhaps I'm a little less likely to assume that the weight gain the OP describes is necessarily a problem. When the size 0 next door puts on 8 pounds fairly early, it's likely not such a bad thing. And really, how do you tell whether 8 pounds is a problem? You figure out whether the person is eating properly and exercising properly. You can't figure out whether it's a problem or not in a vacuum. Hence, my argument that the question is whether one is eating and exercising well. Best wishes, Ericka > >> talisa...@yahoo.com wrote: > >>> Hi every one. [quoted text clipped - 95 lines] > problem in your practice, it seems), it's actually not as big > a problem in my particular neighborhood. You're making the point that each of us has our own views skewed by our experiences -- mine working in an inner-city clinic and yours living in a neighborhood with less obesity. But even so you admit that in the US as a whole, obesity is a major problem. > That's not to pooh- > pooh the concerns about pediatric obesity--they're very real. [quoted text clipped - 12 lines] > argument that the question is whether one is eating and > exercising well. Granted, that's the fundamental question. However I think for many people that would require a meeting with a nutritionist to go over a 24-hour diet history and a weekly physical activity log -- because obviously most people in the US don't do a good job of implementing healthy diet and exercise habits. I suspect that having every pregnant woman spend one or more meetings with a nutritionist to discuss diet and exercise would not be a cost-effective intervention for the results you'd get in terms of improved lifestyle habits (which would more often than not lead to decreased weight gain). It'd be great to be proven wrong and have all pregnant women see a nutritionist with demonstrable results. But in the meantime we're left with either using weight gain and diet/exercise guidelines together or trusting that most people have a pretty good sense of what "eating and exercising well" looks like and will implement that successfully without paying attention to weight. As I've pointed out, we're not doing such a good job with the former, but I think the latter is even less realistic. Kate, ignorant foot soldier of the medical cartel and the Bug, 4 years old and something brewing, 4/08 > I suspect that having every > pregnant woman spend one or more meetings with a nutritionist to [quoted text clipped - 3 lines] > great to be proven wrong and have all pregnant women see a > nutritionist with demonstrable results. I wouldn't be surprised if there was something that could be offered that would improve outcomes and might help out well beyond pregnancy, particularly if it was targetted at specific groups. I'm thinking something like a series of group meetings and 1 or 2 individual session. I have a suspicion that some kind of voluntary attendance groups covering a broader subject matter than this are on offer in some parts of the UK, though I'm not sure if there are any proven results from them. I think the range of things they were hoped to assist with was very broad and some that they wouldn't have any help at all in dealing with, without adequate welfare provision. I think you have to cover broad enough topics, for example covering breastfeeding as well as nutrition as that is supposed to aide weightloss post pregnancy, but also be specific enough with individuals to make sure they are aware of their particular problems and how to deal with them. So I wouldn't be at all surprised if a well designed course did improve outcomes, the problem would be the range of interested parties who would benefit financially and how to get data from all of them and who would pay for it at the time of delivery, as it just being a benefit in terms of health insurance costs for mother and baby for the time they are with that provider is likely to be much more borderline. DH's employers do very heavily subsidise something along these lines, you have to have a BMI over 27, so I haven't paid that much attention, but it seems pretty comprehensive. The health insurance the company has is administered by an outside company, but apparently operates as a pit the company puts money into. So the company most be pretty confident it's worth it, overall, when considering stuff like sick days as well as health costs, particularly as they advertise it pretty heavily. Anne >> And really, how do you tell whether 8 pounds is a >> problem? You figure out whether the person is eating [quoted text clipped - 8 lines] > obviously most people in the US don't do a good job of implementing > healthy diet and exercise habits. Actually, I don't think it's all that complicated. It's more time consuming for the caregiver to figure out if the person is really doing a good job, but the truth is that the vast majority of us know darned well whether or not we're eating and exercising well. Maybe we don't know the difference between optimal nutrition and exercise and decent nutrition and exercise, but if we're packing on the pounds in pregnancy because we've declared a license to eat whatever strikes our fancy and we've turned into a couch potato, we know we're not doing what we should and we know those excess pounds are probably from poor diet and lack of exercise. This is not exactly rocket science. Even if the caregiver needs to assess the situation, it needn't be a nutritionist. Every midwife I've used has requested a week's nutrition and exercise log to go over at some point early in the pregnancy. They might not be able to handle specialized nutritional or exercise issues, but they can certainly ballpark the difference between a bon bon eating couch potato and someone who's diet and exercise are somewhere near where they ought to be. > I suspect that having every > pregnant woman spend one or more meetings with a nutritionist to > discuss diet and exercise would not be a cost-effective intervention > for the results you'd get in terms of improved lifestyle habits (which > would more often than not lead to decreased weight gain). Actually, given the increase in complications with diet and obesity issues, I suspect it *would* be cost effective, especially since it wouldn't really take a nutritionist's expertise for normal cases. > It'd be > great to be proven wrong and have all pregnant women see a [quoted text clipped - 5 lines] > we're not doing such a good job with the former, but I think the > latter is even less realistic. I disagree that people are *that* clueless about appropriate diet and exercise. I rather doubt that most people are obese because they are unaware that they're eating the wrong foods and failing to exercise. They know darned well that they're eating too much junk and not moving enough. And if they're not motivated to do anything about it, then it doesn't really matter anyway. It's not like you can solve the issue without their consent and willingness to do something about it. I think you probably get 90 percent of the way there by providing information, asserting the importance of good diet and exercise, and periodically asking if they're eating and exercising well. If that doesn't do the job, what else will? Best wishes, Ericka > >> And really, how do you tell whether 8 pounds is a > >> problem? You figure out whether the person is eating [quoted text clipped - 28 lines] > couch potato and someone who's diet and exercise are somewhere > near where they ought to be. We're coming from very different experience bases on this. I'm now at an inner-city clinic, but was previously at an HMO that served 35% of the local population, with a full range of socioeconomic status but somewhat skewed to middle class. I suspect the number of people even there who would complete a weeklong diet and exercise log would be a small minority. Your homebirth midwives were working with a very different crowd. For example, with kids who had chronic headaches many pediatricians suggest a headache diary to help detect triggers. I literally never saw one come back. And though I agree you seldom need a nutritionist's expertise to go over diet and exercise habits, you need a provider with long enough appointments to do it. It's not going to be the OB, who is the primary care provider for most American women (whether this should be true is debatable, but it's true nonetheless). Perhaps a health educator could be the provider, but that would only be available in clinic systems large enough to have health educators. > > It'd be > > great to be proven wrong and have all pregnant women see a [quoted text clipped - 14 lines] > solve the issue without their consent and willingness to do something > about it. I agree that most people are aware that their habits could be better, but there is still a lot of ignorance. I think most people have very poor awareness of portion distortion. People are often quite unaware of how many calories they drink. I think the benefit of having individual sessions with people would come less from the provision of information and more from forming a bond to be something of a "cheerleader" for small positive changes. > I think you probably get 90 percent of the way there by > providing information, asserting the importance of good diet and > exercise, and periodically asking if they're eating and exercising > well. If that doesn't do the job, what else will? Well, then we get really far from the topic of this discussion. What really needs to happen lies in the debate over the farm bill, WIC package makeup (take out the damn juice already!), housing and transport development policy to create walking friendly environments, and changing whatever it is about our environment that's fueling the obesity epidemic. Kate, ignorant foot soldier of the medical cartel and the Bug, 4 years old and something brewing, 4/08 >>>> And really, how do you tell whether 8 pounds is a >>>> problem? You figure out whether the person is eating [quoted text clipped - 36 lines] > many pediatricians suggest a headache diary to help detect triggers. > I literally never saw one come back. But if someone is unwilling to do that part of the job, then the information is essentially unavailable to the care provider, as are any treatment recommendations, you know? Diet and exercise are not under the control of the caregiver. The only impact you can have on them is through the willingness of the patient to be involved. A patient who is not willing to expend any effort in this direction is not going to make any changes, so it's all a moot point. It would be a different situation if it took a lot of work on the patient's part to detect the issue, but the caregiver could resolve it with a magic pill, but that's not the case here. I suspect it's a fairly safe bet that a patient who won't even expend the effort to keep a short diary can't really be expected to make the lifestyle changes necessary to improve diet and exercise. On the other hand, for those who are interested and willing, you need to provide information and answer questions, but you don't necessarily need to belabor the issue. > And though I agree you seldom need a nutritionist's expertise to go > over diet and exercise habits, you need a provider with long enough [quoted text clipped - 3 lines] > educator could be the provider, but that would only be available in > clinic systems large enough to have health educators. It doesn't really take all that long--certainly no longer than a lot of the less useful stuff that is done! Heck, you can even point a lot of people at resources like online diet evaluators such that the caregiver doesn't have to do a whole lot more than hand out resources and answer some remaining questions. >>> It'd be >>> great to be proven wrong and have all pregnant women see a [quoted text clipped - 21 lines] > information and more from forming a bond to be something of a > "cheerleader" for small positive changes. Sure, but cheerleading can be done by the regular caregiver without even spending a lot of time. I'll bet you get most of the cheerleading benefit just from asking a few questions like, "Have you been eating enough fresh fruits and vegetables?" or "What kinds of physical activity are you engaged in?" I think people often make a mountain out of a molehill here. Yes, it's true that if you *really* want to provide great support in this area, it would be very time consuming. However, if you take that off the table, then what you can gain with anything short of that can mostly be gained without spending a great deal of time. >> I think you probably get 90 percent of the way there by >> providing information, asserting the importance of good diet and [quoted text clipped - 7 lines] > and changing whatever it is about our environment that's fueling the > obesity epidemic. ;-) Well, I was speaking of what could be done from the perspective of the care provider. Of course there are much bigger forces at work. But if you're looking at what can be done at the moment by individual caregivers, I think a lot can be done with fairly little given a willing patient (and little can be done even with a lot of attention to an unwilling patient). Best wishes, Ericka > But if you're looking at what can be done at the > moment by individual caregivers, I think a lot can be done with > fairly little given a willing patient (and little can be done even > with a lot of attention to an unwilling patient). I agree wholeheartedly with you there. Unfortunately the majority of people are not ready to invest in significant change at any given time, but I don't think that means we as care providers should give up on them completely. We might be able to help them identify a few, smaller habits they could change. For the most part I think we're decades away from having a good evidence base about how the medical system can cost-effectively have a positive impact on diet and exercise habits. There's research that shows even a 5-10 minute discussion with a doctor about quitting smoking has a very tiny but statistically significant effect on quit rates. So even though I don't really see the results, I still talk with my smoking parents about quitting. Likewise, I often bring my obese kids in for weight checks and lifestyle discussions every few months, even though most of the time it just means watching their inexorable weight gain in more detail. Until the data is back in, I can always hope that the 3-4 pounds they gain every 3 months is 1-2 pounds less than they would be were I not seeing them. Kate, ignorant foot soldier of the medical cartel and hte Bug, 4 years old and something brewing 4/08 >> But if you're looking at what can be done at the >> moment by individual caregivers, I think a lot can be done with [quoted text clipped - 18 lines] > pounds they gain every 3 months is 1-2 pounds less than they would be > were I not seeing them. I agree. If a pregnant woman is already going in monthly (or more often later on), just taking a few minutes to ask the question may do as much as can be expected without spending dramatically more time. It's an old saw in management that what you measure is what people perceive as important. I would suggest that all other things being equal, it would be better to measure diet and exercise, *even if you can't pursue in detail* than to measure weight. It puts the focus where it belongs, and encourages people to ask questions and seek information and maybe change behavior. Just measuring weight is a more distant measure. That said, I'm not all that opposed to measuring weight. I just think that focusing on it too much simply isn't a good thing in pregnancy. Too many women get hung up on the weight gain already (and they tend to be the ones who can't afford to severely limit weight loss to begin with), and the woman who is obese to start with probably isn't doing her best with "normal" weight gain. If she were focusing on (and being held to account on) diet and exercise, I suspect she'd do better. If she were actually eating well and exercising, she might well be *losing* weight, but no one's likely to raise any eyebrows at "normal" weight gain (and she's likely to rationalize away any concerns because her weight gain isn't that bad). Best wishes, Ericka > Too many women get hung up on the weight > gain already (and they tend to be the ones who can't afford to > severely limit weight loss to begin with), and the woman who > is obese to start with probably isn't doing her best with > "normal" weight gain. Been there, but thankfully engaged my brain and never did purposely restrict calories, but I was tempted to, I figured out what the minimum weight gain I needed to be safe was and I wasn't going to let myself go above that, but then found out I couldn't get near that if I tried, so I guess my information wasn't as good as I thought it was. But I surprised myself in how much I was bothered about it, but then I'm not convinced I have the most normal of body images, I think I'm one of those people who spent a lot of time not quite having an eating disorder and had enough support around me that even though nothing was ever verbalised that I got through the patches where I was really close. Unfortunately I have a horrible suspicion that focus on weight and healthy eating in an effort to reduce the number of people that are obese is going to have an effect at the other end of the scale, but as obesity is far greater problem, it's just to be hoped any changes are small, though that doesn't help when it's someone in your family, my son who is very skinny has latched onto the healthy eating message and has some interesting ideas about what he should and shouldn't eat, but it has no relation at all to size, it's all about healthy or not healthy, which is black and white to him. Cheers Anne  SignatureCheers Anne http://baltimorealbum.blogspot.com/ > Unfortunately I > have a horrible suspicion that focus on weight and healthy eating in an [quoted text clipped - 6 lines] > all to size, it's all about healthy or not healthy, which is black and > white to him. My kids are all skinny-verging-on-underweight, and they're all very physically active, and we're seeing the same problem. DD is too small to have been exposed to most of it, so I don't know what the situation will be with her. DS1 is a very picky eater, so the last thing he needs is any encouragement not to eat things, but he's got a pretty level head on his shoulders. DS2, on the other hand, is worried about being too fat, when he clearly isn't even close. Every time they go through another round of health information at school, it flares up again. I understand the need to do something about obesity in children, which is clearly a huge problem, but I wish there was less focus on weight and more on healthy habits. Best wishes, Ericka >> Unfortunately I have a horrible suspicion that focus on weight and >> healthy eating in an effort to reduce the number of people that are [quoted text clipped - 18 lines] > in children, which is clearly a huge problem, but I wish there > was less focus on weight and more on healthy habits. I believe my DS is the same age as your DD (born 28 May 2003) and there is no focus on weight at all, they did all weight themselves at preschool as part of a topic on being individuals and drawing around their bodies and what not, not sure what kind of scales they used, but DSs weight was no where near what he'd weighed the previous week on reliable scales, but those numbers don't mean anything to a 4 year old, yet he still comes up with all sorts of comments about things we should and shouldn't be eating, which I've no idea where they come from. My understanding is 4 years olds still need a reasonable amount of good fat for their brains, and thankfully so far he hasn't decided milk is off the list. Anne > On the whole our eating and exercise > habits are grossly out of whack and so some sort of external > verification (ie, weighing oneself) is absolutely necessary. There > will occasionally be someone who does everything exactly right and > still gains substantially less or more than you'd expect, but nowadays > that's the rare exception. The trend seems to be in England to not weight routinely, personally, I weighed myself weekly, I'm struggling to put my finger on the motivation for that, I didn't see pregnancy as a free pass to gain weight, nor did I see weight gain as something I had to minimise. For me I was actually starting out from average weight (or rather correct, it's probably below average!) and I was following a reasonable diet and exercising regularly. At 32 weeks I stopped gaining weight, and by 37 weeks it was clear my baby had IUGR - thankfully there wasn't any need to have intervened before this point, but the data the doctor had wasn't sufficient to diagnose it and so I wasn't being watched closely. The lack of weight gain was another flag that might have triggered diagnosis , IUGR gets a lot of incorrect diagnoses and a lot of extra monitoring and intervention results unnecessarily, but if your baby does have it, you do need to watch carefully. Cheers Anne > > On the whole our eating and exercise >> habits are grossly out of whack and so some sort of external [quoted text clipped - 17 lines] > unnecessarily, but if your baby does have it, you do need to watch > carefully. Agreed. I've only been weighed once in three pregnancies-when 20 weeks with #2, when the midwife was concerned at the amount I was throwing up and wanted to check I hadn't lost too much. Debbie > Agreed. I've only been weighed once in three pregnancies-when 20 weeks with > #2, when the midwife was concerned at the amount I was throwing up and > wanted to check I hadn't lost too much. though how she would use the result is not clear, even if she determined you had lost "too much", I don't think I've ever seen anything suggesting that should be an indicator for treating the sickness with drugs. Preventing recurrent dehydration and therefore multiple hospital admissions would be an indicator, as would be the emotional state of the mother. This is clearly a very difficult area to do research on though, unless a women was in desperate need of treatment, they aren't going to consent to being randomised into receiving it or not and if they are in desperate need, randomising some to not receiving it is hardly fair, so there are limited ways of figuring out if treating on the basis of a measurement would improve outcomes for some women and babies. Whenever you measure something, it has to be combined with skill in interpreting those measurements, I'm skeptical about that being the case. I think this is particularly a problem with weighing babies, even with the correct charts, there is still a lot more variation that is fine than just staying on the same line. They did weight me at antenatal appoinments in Korea, I think they may be using a different guideline to the US, they never batted an eyelid at my weight gain being about half the "normal" rate. I conclude that it is normal for me, my start weight being the same in two pregnancies and the difference in weight gained being barely more than the difference in weights of the babies, so probably was the difference once you account for a bigger placenta. I weighed the same shortly afterwards, 4lb above pre pregnancy weight, which I think is enlarged uterus, increased blood volume and breasts, not fat gained. The argument that I already had enough fat doesn't fit with conventional thinking, with a BMI of 23 and fairly fit, my body fat percentage was almost certainly normal. I'm really not convinced that the portion of gained weight attributed to laying down body fat is actually necessary. My mum says her weight gain pattern was like mine and that it was considered normal and that a good number of other women seemed to be the same. Cheers Anne On Nov 15, 6:00�am, talisa...@yahoo.com wrote: > Hi every one. > I'm in the first trimester of my pregnancy and I started to gain a lot [quoted text clipped - 4 lines] > > Thanks Anyone else a little bothered that this poster mentions the same website in every post so far? including the post to alt.support.childfree? --Helen On Nov 15, 8:00 am, talisa...@yahoo.com wrote: > Hi every one. > I'm in the first trimester of my pregnancy and I started to gain a lot [quoted text clipped - 4 lines] > > Thanks Hi! I don't think that watching your weight during pregnancy is a good idea. As long as you're eating healthy, I would just go with the flow. Every one is different. It could be such a thing as too much amniotic fluid. With my first child I gained a lot of weight at first and my doctor told me it was the fact that my body overproduces amniotic fluid. There are all sorts of bad things going around about too much amniotic fluid, but let me tell you with both of my babies I had too much and they are both very healthy kids. I wouldn't be too concerned. One thing to maybe watch out for is your salt intake. That can cause you to gain excess water weight which can be unhealthy. I'm sure all will go okay and best of luck to you!! Miranda |
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