Let’s Talk About It: Struggling With An Eating Disorder During Pregnancy and Postpartum

It’s the six-week postpartum checkup for my client and I’ve had this date circled on my calendar for weeks. The doctor cleared them to resume normal, everyday life activities. But there was one small comment.

“At my six-week check, the doctor commented on how it didn’t even look like I had a baby,” I heard my client say during our session. 

My heart sank for what this may mean for her. While many women would love to hear that statement six weeks after having a baby, my client felt conflicted because my client had an eating disorder.  

Photo: Pregnancy & Newborn Magazine

As a therapist who works in perinatal mental health, I dread the six-week postpartum appointment for my clients who struggle with eating disorders. This is the appointment where women may be cleared to start exercising again, but for these particular clients, this conversation can bring up a lot of emotions and questions that are often left unaddressed by healthcare providers. It also plants the seed that a woman's body should be healed just six weeks after growing a human for approximately nine months, then delivering said human through the miracle of birth.    

Best case scenario at this six-week check is that my clients have a caring provider who is aware of their challenges with eating and exercise and will spend time discussing finding balance as they resume healthy movement. Worst case scenario is that a provider makes a comment about their patient’s body without having a full picture of how she feels about her body and no medical reason whatsoever for commenting on said body.  Examples of comments I’ve heard include “It doesn’t even look like you had a baby” or “Your BMI is high, so you should consider losing weight,” which can be very harmful. Unfortunately, many of my clients are given the green light for exercise without much discussion at this six-week check, sending clients with eating disorders into a spiral.  

These clients inevitably come in with lots of questions during our next session. Should she keep breastfeeding to keep the weight off, or stop breastfeeding so she could get back to her pre-pregnancy workout regime since she was cleared to exercise now? Should she eat all the meals we planned out for the past week, or could she skip a few here or there? What would everyone think if she couldn’t get back to her pre-pregnancy weight (or even lose weight) after having baby?  

I would love to say that most women I work with who don’t have an eating disorder feel ‘OK to good’ about their bodies and food after they have a baby, but they don’t. Body dissatisfaction after pregnancy is not isolated to clients with eating disorders. One study found that a whopping 68.8 percent of postpartum women feel dissatisfied with their body shape and weight (1).  

What about those women who actually have a diagnosable eating disorder during pregnancy and postpartum?

Let’s look at the stats:  

• Studies have shown that many women may moderate or completely stop eating disorder behaviors during pregnancy to care for their babies, but this population of women has a high relapse rate. By 18 months postpartum, up to 70 percent of these women will relapse back to eating disorder behaviors to cope with their stressors postpartum (2).

• Ninety percent of women with a history of an eating disorder reported problems regarding adjustment three months postpartum compared to 13 percent of the general population, meaning this population of women is extremely susceptible to experiencing a perinatal mood and anxiety disorder (PMAD)( 2).     

So as a therapist who specializes in eating disorders during the perinatal period, how do I help my clients during this time?  

Define their support networks.  

Eating disorders thrive in silence, and individual therapy is only one of the supports needed to begin recovery. During my first session with clients with eating concerns, I try to understand what their current support looks like and make specific recommendations to help patients navigate this journey. This may include finding an OB/GYN who they trust, incorporating a dietician, joining an eating disorder group, or looping friends or family into their recovery process. 

Monitor the changing nature of the eating disorder during the perinatal period. 

Eating disorder behaviors can change or even stop during pregnancy; however, there is a very high relapse rate for this population of women. It’s important for me to assess how my clients are feeling during and after pregnancy to monitor potential or changing eating disorder behaviors. 

Help with accountability when it comes to eating and movement.

My goal is to support my clients in getting to a more intuitive place when it comes to eating and movement.  However, many of these clients need extra accountability and support as they discover what feels good for their body. This may include clients tracking their food and exercise for us to review during sessions together, adding in a meal support group, or having a family member, friend, or mentor to help encourage when a client may be struggling.  

Increase insight to help clients understand origins of their eating disorders and factors that may increase urges to act on behaviors. 

Eating disorders don’t develop overnight. Contributing factors include genetics (family history of eating disorders, temperament, biology related to hunger/fullness cues, etc.), psychological history (depression, anxiety, trauma history, lack of healthy coping strategies, etc.), and social-cultural (societal pressures surrounding body and food, normalcy of diet culture, social media, etc.). Additionally, some of the symptoms during the perinatal period (nausea, constipation, cramping, bloating, weight shifts, etc.) can be very activating for an eating disorder. By helping women understand the driving factors of their eating concerns, they are better able to get out of old patterns and use coping skills outside of their eating disorder.  

Build skills to use instead of relying on eating disorders. 

Ultimately, eating disorders are strategies that have developed to cope with difficult emotions and situations. As I work with clients, they become better able to understand how they have been using their eating disorders to cope. From there, I can teach them new strategies and behaviors to help them live more in line with their values outside of the eating disorder. 

We live in a difficult culture when it comes to food, body image, and weight. Opinions on best ways to lose weight flood social media and it’s been normalized for anyone to give an opinion about a woman's shape, and the postpartum period is no exception. The postpartum period should be a woman's time to heal, celebrate her body for what it’s done, get to know her baby, and adjust to this new role, but instead women are inundated with ways to “bounce back after baby.” 

Ultimately, the culture that has been created is one of not being enough. I think that almost every mother can relate to the feeling of not being enough in one way or another and those with eating disorders are particularly vulnerable to that ‘not enough’ messaging. It’s important to address the mental, emotional, and physical experiences mothers with eating disorders face by finding professionals that can help. 

This week is National Eating Disorder Awareness Week with a theme of “Let’s Talk About It.” I encourage all women to evaluate and discuss their relationship with food and exercise, and if you or someone you know is struggling, please reach out for help. Don’t live in silence, you deserve support!

Visit Women’s Therapy & Wellness, send us an email or call (571) 208-2467.

(1) Grajek M, Krupa-Kotara K, Grot M, Kujawińska M, Helisz P, Gwioździk W, Białek-Dratwa A, Staśkiewicz W, Kobza J. Perception of the Body Image in Women after Childbirth and the Specific Determinants of Their Eating Behavior: Cross-Sectional Study (Silesia, Poland). Int J Environ Res Public Health. 2022 Aug 16;19(16):10137. doi: 10.3390/ijerph191610137. PMID: 36011771; PMCID: PMC9407984.

(2) Fogarty S, Elmir R, Hay P, Schmied V. The experience of women with an eating disorder in the perinatal period: a meta-ethnographic study. BMC Pregnancy Childbirth. 2018 May 2;18(1):121. doi: 10.1186/s12884-018-1762-9. PMID: 29720107; PMCID: PMC5932857.