How to Apply Health at Every Size to Pregnancy

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If you’re pregnant, you’ve probably heard instructions about weight gain in pregnancy. Don’t gain too much weight, well-meaning friends may have told you. Even your care provider likely mentioned the weight gain ranges that are recommended for you based on what your body mass index (BMI) was at the beginning of your pregnancy.

But these types of instructions can be stressful. For one thing, it’s difficult to do any kind of mindful eating if you’re experiencing nausea and vomiting during your pregnancy. When I was very sick for the first 16 or so weeks of both my pregnancies, I mostly ate cheese crackers and just the thought of chewing a vegetable made me vomit. Another issue is that people’s bodies make babies all kinds of ways. If you gain more than the recommended amount during pregnancy, that may just be the way that your body makes babies.

In her book Expecting Better, behavioral economist Emily Oster discusses the weight gain recommendations. These were developed, she writes, largely due to associations that researchers found between the pregnant person’s weight gain during pregnancy and the size of baby at birth. Babies who are particularly large or small for their gestational age are more likely to have problems—especially small babies, who may have issues breathing or feeding.

If you gain below the recommended weight during pregnancy, it’s more likely that you’ll have a small for gestational age baby. On the other hand, if you gain more weight than is recommended, you’re more likely to have a larger baby. That said, in her book Oster explains that gaining more weight than is recommended increases your risk of having a large baby just slightly and may decrease your risk of having a very small baby. Her take home message about weight gain? “Mostly, chill out.”

Enter Health At Every Size. This philosophy, abbreviated HAES and described in a book also called Health At Every Size, was created by researcher Lindo Bacon and “acknowledges that well-being and healthy habits are more important than any number on the scale.” While HAES is a framework that can be helpful to apply at any time in your life, it may be especially helpful during pregnancy when so many people have so many opinions about what you weigh.

To apply HAES during pregnancy, first tune in to how you are feeling about food. Pregnancy is a great time to listen to your body because so very much is happening there. And people joke about pregnancy cravings, but paying attention to what you’re hungry for and to how hungry you feel can help you feel better. If all you can stand to eat is cheese crackers, give yourself a break and trust that sometime soon you’ll be ready to eat other things that might provide different types of nutrients. If one day you feel the urge to eat a giant bowl of beans and rice and the next day all you feel hungry for is a popsicle, that’s okay.

Next, ask yourself how you feel about being weighed at your pregnancy checkups. It’s typical to weigh people during pregnancy, as the number may help care providers know how baby is growing and things like sudden weight gain can be indicative of problems, such as preeclampsia. But if you aren’t comfortable being weighed or knowing your weight gain, you can ask to stand on the scale backwards so that you don’t see the number, and you can discuss your concerns with your care provider and check in about whether you need to be weighed at all. People who have experienced disordered eating before may find opting out of knowing how much weight they’ve gained especially helpful.

Finally, work to decenter your weight and size from your experience of pregnancy and invite your family and friends to support you. Rather than focusing on the size of your body or your bump, acknowledge how you are feeling. Are you tired, energized, taking long walks or naps, enjoying certain foods more than others? There are many aspects of pregnancy that have nothing to do with weight gain and body size and focusing on those instead will help take you out of the pervasive, weight-focused mindset. Another benefit of this type of mindful awareness of your body is that it may help you during labor, birth, and recovery.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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