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Pregnancy Weight Gain: When the Guidelines Might Not Be Right for You

Monday, May 19th, 2014

When you find out you’re pregnant, one of the first things your doctor will probably want to discuss with you is how much weight you should gain over the course of your pregnancy. The guidelines say that most pregnant women should gain between 25 and 35 pounds – more if they start out underweight, less if they are overweight to begin with. How does that weight gain break down?

  • 1  pound for the placenta
  • 2 pounds for amniotic fluid
  • 2  pounds for the increased weight of the uterus
  • 1 pound for increased breast size
  • 3 ½ pounds for increased blood volume
  • 6 ½ pounds for maternal fat stores
  • 6-7 ½ pounds for the full-term baby

All of this adds up to between 22 to 24 pounds that a healthy woman of normal weight can safely gain during her pregnancy.  The operative term here is “normal weight”.

However, many women don’t start pregnancy at their ideal weights. For a woman who is very underweight, somewhat more weight gain may be optimal, and may be the natural outcome of eating enough nutritious food to nourish herself and her growing fetus.

A much more common problem, though, is that of the woman who starts her pregnancy overweight. One in five pregnant women (20%) are obese at the start their pregnancy.   Gaining too much weight during pregnancy is one of the most preventable causes of complications, ranging from gestational diabetes to preeclampsia to overly large babies that require cesarean deliveries.

A woman who is overweight or obese can safely gain less than 25 pounds during her pregnancy as long as she eats a healthy diet. Keep in mind that “eating for two” should mean that you are eating twice as well, not twice as much.  The fetus usually weighs less than 1/20 of its Mom’s weight. So for an overweight or obese woman, switching to the healthy diet she needs for pregnancy may actually mean a reduction in calories, and gaining less than the recommended amount or even losing weight may be the natural result.  And, an obese pregnant woman shouldn’t get overly concerned about it.  If you are obese, you already have a fluffy substrate or matrix upon which your pregnancy will grow.  A numerical end-point, i.e., weight gain or loss, should not be used in obese pregnant women, but rather a healthy, balanced nutritional intake should take priority. 

This is perfectly fine as long as your doctor agrees (always discuss matters related to your pregnancy with your own doctor, because your situation is unique), and as long as your diet contains all the necessary nutrients and fluids you and your baby need.  I, as the principle investigator, have done the original research and have published the first and, to date, the only randomized clinical trial regarding the outcomes of nutritionally monitored obese pregnant women.  A well-balanced diet is the way to go resulting in less problems during the pregnancy.

A pregnant woman should be drinking lots of water – at least eight cups a day – and another four cups of skim milk, leaving very little room for soda or fruit juice (which are both mostly sugar). And eating all the fresh fruits, vegetables, lean meats, fish, and whole grains you need does not, for the most part, leave room for junk food.

The occasional treat is fine. A cup of coffee, a small serving of chocolate, and the like do not have to be abandoned entirely for nine months, and trying to do so would most likely set you up for failure anyway as the temptation to “cheat” would be too great. Tell yourself you can have treats – just not every day and not in large amounts.

Exercise will also help you feel better and keep your weight in check during pregnancy. Walking, swimming, and using a stationary bicycle are excellent exercises now. Keeping track of everything you eat and which exercise you perform each day and for how long can help you stay accountable and motivated.

Just because countless people – even strangers – will tell you that you “should” be gaining 25-35 pounds does not make this necessarily right for you. They don’t even know you!  Talk to your doctor to determine whether you can safely gain less; delivering a baby in better shape than they were in nine months ago is a very real possibility for many women. See my book, Inside Information for Women, for much more information on this and other women’s health issues.

– Yvonne S. Thornton, M. D., M. P. H

Menopausal Weight Gain NOT Inevitable

Thursday, May 8th, 2014

It may seem like weight gain is an inevitable effect of menopause. It is indeed common, and there are several reasons why, including:

  • Levels of estrogen, which appears to have a weight-regulating effect, drop significantly during menopause.
  • Older women are less likely to get enough exercise than younger women.
  • Muscle mass declines, and this has a slowing effect on your metabolism. This means that you may need fewer calories, but if you adjust your food intake accordingly, creeping weight gain will likely be the result.
  • Older women are more likely to have jobs that demand very little in the way of physical labor; they may also eat out more with the kids out of the house.

And weight gain isn’t just a cosmetic issue – it also increases your risk of many health problems, including diabetes, heart disease, high blood pressure, and several types of cancer.

However, you still have plenty of control over your weight during and after menopause, so don’t fall for the notion that weight gain is natural or that there’s nothing you can do about it. Even though weight control may be more of a challenge because of physiological and lifestyle changes that take place during menopause, it still boils down to taking in no more energy than you expend.

If you find the pounds adding up, your first line of defense is to eat less. In your fifties, you probably need a couple hundred calories a day less than you did when you were younger. Make your food choices more carefully. No one needs empty calories, but menopausal women should be especially careful to choose mostly vegetables, fruits, lean meats, whole grains, and low-fat or non-fat dairy products.

Exercise is another key step to beating menopause weight gain. Exercise gives you more energy and burns fat, while building muscle. And maintain or increasing your muscle mass is important because the more muscle you have, the faster you burn calories all day long. Adults up to 65 years old need at least 30 minutes of moderate-intensity exercise five days a week, such as brisk walking, and at least two muscle-strengthening workouts a week. You may need to add even more if your goal is to lose weight.

A good support system is also important. Enlist the support of your family and friends, or better yet, find a partner to work out with who can help encourage you and keep you motivated – and do the same for him or her.

The answer to menopause weight gain isn’t glamorous or easy, and there is no secret formula. But with concentrated effort to control your diet and exercise habits, you can absolutely maintain or even improve your weight at any stage of life. For more information on menopause, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H

Obesity A Major Cause of Death for Women that Survive Cancer

Monday, July 1st, 2013

A diagnosis of cancer can put a person’s entire life on hold. Fortunately, treatments for cancer, and especially for women’s cancers, are becoming increasingly better at helping women prolong their lives and even enter into remission. This is wonderful news for both doctors and patients that have to deal with this horrible and tragic disease. However, as the rate of women who survive cancer increases, alarming statistics about what can happen after surviving this disease are coming to light.

It has been suggested that one of the main killers for women that survive cancer is obesity. Hormonal changes in women who have received oophorectomies can severely impact their ability to maintain a healthy weight, and in some cases can cause women who have never had weight problems to face weight gain. Additionally, many medicines such as steroids that are used to treat cancer can cause weight gain. This does not even begin to take into account the many emotional and mood changes faced by women who have survived cancer, which can also be a major contributor to weight gain.

So what can a doctor such as myself do about it? How can those who have survived cancer move on with their lives and continue to preserve their health? One study suggests that it is extremely important for those who have been diagnosed with cancer and those who have entered remission to discuss the problem of obesity and how it can factor into a woman’s health after she has begun to recover from such a devastating disease. It is also important for women who have survived cancer to seek the support of other survivors that may be able to help them understand what they face after remission and recovery.

Discussing the other factor surrounding a diagnosis of cancer can be just as important as discussing the disease itself. Whether an individual is a doctor, a patient, or even a close friend or family member of the person who is recovering, the “what comes next” dialogue is an essential part of preparing for a woman’s long-term health prospects. Women should not be surviving cancer only to face further health complications, especially if steps can be taken early on to prevent these issues. Whether it is due to hormonal fluctuations, medication, or an issue such as depression, weight gain can be prevented. The entire community needs to work together to put an end to this growing problem.

– Yvonne S. Thornton, M. D., M. P. H.

Is Your Birth Control Making You Gain Weight?

Thursday, November 1st, 2012

All medications have side effects. From Advil to Zantac, every medication we need for common ailments might have a drawback. For women, birth control can be a bittersweet prescription. On the one hand, women who take it will be protected from pregnancy. However, those same women might experience some unwanted side effects such as moodiness, fatigue and a change in their sex drives. One of the major concerns about birth control—especially for women in the United States—is the potential for weight gain as a side effect. We all try to maintain a healthy weight, so adding birth control into the mix of challenges can be disheartening. Luckily, recent studies show that weight gain might not actually be a side effect of modern birth control.

Every birth control is different, but they are all combinations of the same hormones. They either contain progestin and estrogen, or progestin on its own. However, the levels of each are low, and they have no real effect on weight gain or weight loss. So, why do women think birth control causes weight gain? Many brands list this as a side effect to cover themselves, but the notion started in the 1960’s when birth control became available. The pills back then contained almost 1,000 times the amount needed to prevent pregnancy, so side effects ran rampant.

The hormones themselves might not cause weight gain anymore, but that’s not to say the weight you gain while taking a contraceptive isn’t related to the pill, ring, or patch. Birth control has many other, real side effects that could easily affect your weight. For example, the hormones might cause changes in your mood, which could leave you feeling down in the dumps more than usual. If you’re like most women, you might eat when you’re sad, so weight gain will be inevitable in that scenario. More bad days will lead to more overeating, which will lead to weight gain. You might feel (and act) like a bottomless pit at every meal. Most pills also cause water retention in one form or another, so you might feel especially bloated.

If you notice significant weight gain and feel that it’s related to your birth control, talk to your doctor about switching brands. The hormones alone do not do it, so there’s a good chance your side effects are especially strong. Different brands affect people differently, so try your luck with another.

– Yvonne S. Thornton, M. D., M. P. H.

Dance Your Way to Fitness?

Thursday, July 22nd, 2010

I read a press release the other day from the University of Illinois at Chicago where researcher David Marquez is conducting a study. He plans to get older Latinos out on the dance floor to determine whether doing the mambo, merengue and cha-cha-cha will help them stay fit, and perhaps avoid obesity, diabetes and other ills of a sedentary lifestyle.

While the results won’t yet be in for a while, I whole-heartedly endorse the premise. A number of years ago, I had gained a lot of weight, was overworked and was getting little exercise. Then I signed up for ballroom dancing classes. Not only did I have a blast (winning a dance contest along the way), but I whittled down my waistline while doing it.  Other studies have shown that ballroom dancing can also benefit your mental fitness and decrease your risk of developing Alzheimer’s disease.

So, if you’re bored with exercise machines, and if jogging just isn’t your thing, put on your dancing shoes and go. Unless your doctor advises against physically challenging activity, I can’t think of a better, more fun-filled fitness routine.

See you on the dance floor.

– Yvonne S. Thornton, MD, MPH

Leading Ob-Gyn Group Backs Findings of My Weight Gain in Pregnancy Study

Tuesday, January 12th, 2010

Last June, in the Journal of the National Medical Association, I published the results of clinical trials that showed that it was safe for obese pregnant women who followed a well-balanced diet to gain little or no weight. Prior to my study, the conventional wisdom was that all women, even obese ones, should gain 26 to 35 pounds. That guidance had come from the most august body of ob-gyns in the U.S., The American College of Obstetricians and Gynecologists (ACOG), whose recommendations were based upon what we knew in the 1980s. That was before we fully understood the dangers of obesity in pregnancy. Yet, the guidelines had never been updated.

Being obese during pregnancy greatly increases the risks of preeclampsia, diabetes, stillbirth, and blood clots, among other problems. Gaining more weight if you’re already obese makes complications more likely while limiting weight gain makes them less so.

But until my study was published, obstetricians lacked the evidence that limiting weight gain among pregnant women was safe. The ACOG’s guidance from the 1980s stated that, unless a woman, obese or not, gained at least 26 pounds, the baby in her womb would be at risk of dying.

Right before my study results were published, a government body recommended that obese women gain somewhat less weight: between 11 and 20 pounds. It was a start but still not enough. And most board certified obstetricians would wait for the ACOG to – you’ll excuse the pun – weigh in before they changed their practices.

I’m delighted to say that, in a commentary in the peer-reviewed journal Obstetrics & Gynecology, the ACOG has just come out in favor of limiting weight gain among obese pregnant women. My study, which was quoted in the commentary, appears to have been instrumental in effecting this turnaround.

Now that the ACOG is changing its recommendations, obstetricians are more likely to change how they manage their patients. Fewer women will be told that it’s fine to gain weight during pregnancy if you’re already obese. And that will mean healthier moms and healthier babies.

I’m proud to have played a role in helping to make this happen.

– Yvonne S. Thornton, MD, MPH

More media attention for the study

Friday, June 5th, 2009

Forbes reports on my study, showing that obese pregnant women should limit weight gain as does Medline.

Other media outlets giving the study prominent coverage are United Press International, Yahoo News, The Baltimore Sun, US News and World Report, and even the Times of India.

– Yvonne S. Thornton

My study on obesity and pregnancy in the news

Wednesday, June 3rd, 2009

I’m pleased to see that the media is getting the word out: obese pregnant women should be eating healthier diets and limiting their weight gain.

In the past few days, I’ve been interviewed by a number of news organizations about the study. You can see some of the reports at the following links:


The Atlanta Journal-Constitution

Science Daily

The Los Angeles Times

and Health Day

– Yvonne S. Thornton, MD, MPH

Study’s author concerned that new guidelines for pregnant obese women don’t go far enough

Tuesday, June 2nd, 2009

You may have read the headlines last week that The Institute of Medicine (IOM) is changing its guidelines for obese pregnant women. Instead of recommending that women who are obese gain at least 15 pounds during pregnancy, the IOM now recommends a weight gain of 11 to 20 pounds.

It’s a start. But, as the lead researcher of a new study of obese women, pregnancy and weight gain, I’m concerned that obese women are being told to gain any weight.

My study, which is being published today in the Journal of the National Medical Association, found that obese pregnant women who followed a well-balanced diet and gained little or no weight had maternal-fetal outcomes that were equal to or better than those who gained substantial weight.

As a specialist in high-risk pregnancies who has delivered more than 5,500 babies over a 35-year career and supervised the delivery of 12,000 more, I wasn’t surprised by the findings of our study. I know that those extra pounds mean extra risks for both mother and baby. Obesity greatly increases the chance of developing complications in pregnancy such as preeclampsia, stillbirth, and blood clots, among others.

Twenty-three of the more than 200 obese women in our study lost weight. The average weight gained was just 11 pounds. And yet, these women and their babies were at least as healthy as those who put on substantial pounds. There were fewer babies weighing 10 pounds or more, fewer cesareans, and the mothers were less likely to develop gestational diabetes.

You can read more about the study, here.

So, if you’re carrying significant extra weight, forget the old adage about eating for two. Believe it or not, for a pregnant woman of normal weight, only an additional 300 calories per day is needed during her pregnancy – the equivalent to a quart of skimmed milk per day.

– Yvonne S. Thornton, MD, MPH