Body Image During Pregnancy

A while back, I posted an awesome video of Jennifer Garner commenting about her latest "baby bump." I felt thankful to see a woman being proud of her body for the amazing feat of bearing children. In a culture that judges women based on appearances so much, it was a breath of fresh air!

I have heard so many pregnant women comment about feeling overweight and unattractive, and I've always thought, "Stop being dramatic. You're pregnant! You're supposed to look like that!"

Little did I expect that when I experienced pregnancy myself, my feelings about my body would be so mixed. Realizing that I am about to surpass my husband in body weight is hard, even though I know that weight is what's healthy for my baby. Seeing so many other parts of my body change beyond just the weight is hard, too. Things leak and sag and ache in ways they did not before. I need my husband to tie my shoes when we go on a walk (and I still have 12 weeks of getting rounder left to go!) Amidst these changes, I sometimes struggle to keep a positive attitude.

Some days, when I look in the mirror, I think my bump is pretty cute, I feel excited about what is to come, and I have joy about the ways my body was made for this purpose. Other days, I walk around calling myself "pudge muffin" or using any number of names that I know in my heart are not helpful or uplifting; I would never say those things about another woman, and yet I feel ok thinking them about myself.

Me at 26 weeks (left) and my friend
Lillian who is due a few weeks later.

Further complicating the pregnant body experience is the way it affects my interactions with others. During the first trimester, I wrote about how lonely it felt to be pregnant and feel sick, with almost no one else knowing. Now, I find the opposite is challenging. Something that began with the most intimate expression of love is now on public display to every stranger on the street; whether I want to share or not, my pregnancy is being carried with me on my physical body everywhere I go.

One particularly trying aspect of this is attempting to graciously listen and respond to others' comments and opinions about this body. (These comments are on top of all the opinions about breastfeeding, co-sleeping, modes of dress, discipline, and all of the other advice well-meaning folks share when they see my baby bump - but those are for another post altogether.)

Even though my weight is on track for my stage of pregnancy, and I have been told as much by my doctor, in just one single week, I had three different people - yes, three - look at my baby bump and ask me whether I was sure I was not having twins. (Aka, "You look enormous!") Each time, I laughed it off and reassured the person that I am not having twins, to the best of my and my doctor's knowledge. Other times, I have had people tell me I am not eating enough at an event and that I shouldn't be depriving myself. I usually just chuckle and let them know that I have eaten a meal beforehand.

But inside, I keep wondering why so many people (mostly women) think these comments are ok, especially when they are in direct response to the size of my abdomen.

Here is what I really wish others around me knew. Being pregnant is physically and psychologically hard! And if you've been through it before, you should know that better than anyone! I hope that personal experience can lead to extra sensitivity instead of extra license to critique.

Comments about a pregnant woman's size in almost any form can cut especially deep; not only do they single out a woman's appearance, but they also carry the added weight of critiquing a mom's ability to adequately care for her unborn child. If I can't even manage to feed myself correctly for the sake of my baby's health now, imagine the parenting disaster when the child comes out!

Anything along the lines of, "Wow, you're huge!" no matter how cleverly disguised or cutely worded, does not feel good. I am capable of tracking my own weight and making decisions about when I am hungry and what is best to eat. Even if I were visibly struggling with putting on more weight than is ideal, that would be a matter between my doctor and me. And then there are some women who struggle with not being able to put on enough weight during pregnancy and can feel belittled or saddened by kind-sounding comments about how they "don't even look pregnant."

A pregnant body is no less personal than any other body. Every woman carries pregnancy differently, and each person who experiences pregnancy has to come to grips with a new physical reality that is different than any she has experienced before.

I am sure I have made insensitive comments to pregnant women in the past and not even realized the implications. I may even still be doing it from time to time! Going through it myself, however, I can really see the importance of being positive - and when in doubt, silent.

Despite the experiences described above, it's not all bad.

For me, the second trimester involved increased energy and much more positivity about the life stage my husband and I are entering. And I can confidently say that my close friends and family have been amazingly supportive. My mom and sister helped me shop for maternity clothes and kept telling me how great I looked. My husband reminds me every day that he loves me, appreciates what I am doing for our child already, and thinks I am beautiful and sexy. And many friends, both young and old, have said things like, "You look great!" or, "You have that pregnancy glow!" that make me feel uplifted and encouraged. They have listened well and even laughed with me in response to my so not carrying twins! To these amazing folks, I say, keep doing what you're doing. I am so thankful for you!

19 week ultrasound - It's a boy!

Baby feet.

Sleep is Important to Maintaining a Healthy Body Weight....Again

You may recall that I recently wrote about a study showing that sleep may affect the expression of "obesity genes." Today, I read about two other recent studies once again highlighting the link between sleep and overall health/weight.

According to the first study, conducted at Columbia University, when your brain is sleep-deprived, you are more likely to crave junk food. This study used an MRI to compare brain activity in 25 volunteers after getting a good night's rest and again after a night with four hours of sleep. The researchers ran scans while showing the subjects various images of unhealthy and healthy foods. When participants were sleep-deprived, the parts of their brains associated with craving and reward were more active than when they had more sleep, particularly when looking at the images of unhealthy foods. One hypothesis is that a tired brain is looking for an energy pickup as though it were food deprived. Other recent studies may lend credence to these findings, showing that those who are sleep-deprived tend to snack more and gain more weight. Scientists are still trying to determine the possible hormonal and appetite factors that trigger these effects.

The second study, conducted at UC Berkeley, showed that higher order brain functions associated with decision-making are inhibited in those who are sleep deprived, which in turn affects the food choices a person makes. This study was similar to the above in using MRI imaging to determine 23 participants' desires for various foods after being well rested versus being awake for twenty four hours. After being awake for the extended period, participants expressed a stronger preference for unhealthy foods. However, not only were subjects' brains tested for heightened pleasure-seeking activity (as in the above study), but also for decision-making activity. The researchers found that pleasure-seeking activity was not increased, but decision-making activity was diminished, and this may have played a greater role in the ability to weigh healthy versus unhealthy choices.

It sounds like both studies say that sleep deprivation affects food choice, but one attributes this to craving/reward and the other to decision-making (but not craving/reward). So why the difference? Well, one thing to remember is that these were both fairly small studies, so more extensive work needs to be undertaken to draw definitive conclusions. Another consideration, pointed out directly in the article, is that there could be a difference depending on the amount of sleep deprivation; in the Columbia study, participants had four hours of sleep, whereas in the Berkeley study, subjects had no sleep. Perhaps both craving/reward and decision-making play a role in food choice, but decision-making impairment becomes more pronounced relative to the reward centers of the brain as sleep deprivation increases. Right now, there is no concrete information on whether this theory is correct, but it is certainly worth exploring. As mentioned above, both studies still need additional confirmation with future research.

Although we should read these results as very preliminary and wait to see what future research either confirms or disputes, we can still observe that both studies in some way support past research showing a link between sleep and weight. So once again, the lesson is, take care of your body with some rest!


Image credit: http://www.healthytimesblog.com/2011/03/5-amazing-facts-about-sleep/

Exercise and Eating Right May Matter Less if You Sleep Less

The time we spend sleeping has been linked to heart disease, longevity, interpersonal relationships, decision-making, stress and mental disorders, and a host of other health concerns.

Now, a recent study by the University of Washington Sleep Center, which appears in the journal Sleep, shows that sleeping more may counteract some genetic predisposition for weight gain. In the study of twin pairs, lifestyle choices such as diet and exercise were significantly more effective at combating weight gain among those who also got more hours of sleep per night.

Previous research has been able to show that lack of sleep contributes to excess weight. However, this study is unique, because it uses twins to specifically identify the lifestyle contribution to weight gain versus the genetic factor. According to USA Today, "For twins averaging nine hours of sleep, genetic factors accounted for about 32% of weight variations; for those sleeping less than seven hours, genetic factors accounted for 70% of weight variation. For those sleeping seven to nine hours, 60% of the variation was due to genetic factors."

Although they have not yet definitively identified why this link exists, it could involve hunger, fat storage, inflammation, or other metabolic functions. According to the same USA Today article, "Scientists have known for years that sleep deprivation increases levels of hunger hormone and decreases levels of a hormone that makes you feel full." This study, however, takes it to another level. Even if a sleep deprived individual did not eat more than a well rested person, and even if the sleep derived individual exercised the same amount, the study indicates that the sleep deprived would be less successful at maintaining a healthy weight.

Health Magazine quotes lead investigator Nathaniel F. Watson, M.D., who explains, "The less you sleep, the more important genetic factors are to how much you weigh. The longer you sleep, the greater the influence of environmental factors, like meal composition and timing." In other words, the amount of sleep you get can influence your gene expression.

One possible explanation posited by Carl Boethel, M.D., from the Sleep Institute at Scott & White Healthcare is that when an individual is consistently deprived of sleep, the body enters a state of stress. In that situation, the portion of the individual's genes that are designed to handle a stressful environment start to take over by holding calories or altering other metabolic processes.

Regardless of the mechanism for the genetic expression in this research, the message is clear from both this study and a host of others that we can help ourselves stay healthy by getting enough sleep.

Image credit: http://fivehourfitness.com/5-tips-for-better-sleep/

Food Insecurity and Obesity in Children

After my posts on Jamie Oliver and McDonald's, a doctor I know asked me why so many of her young patients from lower income families are obese. "Many of these families struggle to provide three square meals a day," she said, "so where are the calories coming from?"

According to a 2010 Los Angeles Times article, which summarized a study from the journal Health Affairs, nearly one in three children currently has a body mass index above what is considered healthy. The study also found significant discrepancies between children of different racial groups, socioeconomic groups, and regions of the country. According to the article, these factors are not necessarily independent. For example, the article says, "In Alaska, poor children were only 1.2 times more likely to be overweight or obese than better-off children. But in Arizona, the difference in rates was 3.8. Why would it be different to be poor in Alaska than Arizona? That's basically what it amounts to - it's not the same being poor in one state as it is in another."

According to the Food and Research Action Center's (FRAC) page on poverty and obesity, "obesity rates increased ten percent for all U.S. Children ten to seventeen years old between 2003 and 2007, but by twenty-three percent during the same time period for low-income children."

One thing that is important to note is that the stereotype that virtually all low-income people are obese is not true. The Food and Research Action Center (FRAC) also shows that the link between income and obesity has actually been weakening over the past few decades. But the question still remains, why do the statistics show a link at all?

For answers, I turned to the FRAC page on food insecurity and obesity. Most of the information I am going to mention below is from this website, and the authors of the studies are specifically mentioned there. For me to put a citation after every sentence would make this post very long, so please refer to the FRAC food insecurity and obesity link for the authors of the studies and facts mentioned.

One of my friends, Sara, commented on my McDonald's post that many families live in "food deserts," which is actually one of the main points FRAC makes, as well. According to multiple studies, low-income neighborhoods often lack a full service grocery store where families can purchase fresh produce, whole grains, and low-fat dairy. Instead, many residents rely on small convenience stores, which do not carry the variety of healthy and low-fat options available in larger establishments. Low income communities, especially areas near schools, are also more likely to have fast food restaurants. Frequently eating fast food has been linked to high-calorie, low-nutrition diets, which may lead to weight gain.

According to other studies cited by FRAC, fruits and vegetables in low income neighborhoods are often of poorer quality, thus making it less likely that residents will be prone to purchase them. Furthermore, healthy food, such as fresh produce, whole grains, and low-fat options are often more expensive compared to more processed fats and sugars. Many families trying to stave off hunger look to purchase the maximum calories per dollar by buying energy-dense foods, which provide the calories a family needs, but not necessarily the other nutritional components of a healthy diet. "Feeling full" may be the priority for a family who is unsure when the next meal will be available, especially when it comes to preventing feelings of hunger in children. Carbonated beverages, such as soda, for example, will make a child "feel full," even if they do not provide any other nutritional value.

In addition, chronic ups and downs in the availability of food may encourage people to eat more when it is available. This can lead to general over-consumption or even metabolic changes that affect fat retention.

According to FRAC, the problem is not just about food consumption. Low income communities also have fewer resources for physical activity, such as parks and recreation centers. Even in communities that do have open space areas, they may be less attractive due to trash, noise, traffic, and criminal activity. It makes sense that parents would not want their children to play at the park in a particularly dirty or high-crime neighborhood. This puts children at a higher risk for staying indoors and living a sedentary lifestyle. According to other studies, lower income children are less likely to participate in organized sports or to have access to/participate in physical education classes and recess.

Additionally, the financial and emotional pressures of poverty may have a serious impact on both adults and children. Stress can contribute to unhealthful eating behaviors, hormonal/metabolic changes, and even chronic anxiety or depression, which have all been associated with adult and childhood obesity.

Many low income families also lack access to quality, affordable health care. Chronic illnesses that are related to obesity may not be diagnosed. Furthermore, families may not realize their child is overweight. For example, according to Strong4Life, an organization fighting childhood obesity in Georgia, 75% of parents of overweight or obese children in the state did not believe their child had a problem. I recently read an article saying that even among families who do have access to health care, less than 25% of parents of overweight or obese children recall a doctor telling them their child is overweight. If even medical professionals are unwilling to confront or acknowledge the issue, how can we expect households who have less access to health education and basic health care to recognize obesity and take action steps to prevent or correct it?

To me, the fact that obesity is inversely related to income is further support that the socioeconomic disparity in our society is not just a matter of money, but is linked to a complex set of dynamics that affect all aspects of life.

So what can be done to stave off the obesity epidemic in lower income communities in particular? I would suggest communities can start with the specific issues mentioned above, by bringing farmers markets to lower income neighborhoods, investing in community recreational centers and low/no-cost sports leagues, requiring schools to provide more hours of physical education, providing free health education for parents and kids, offering free classes on how to manage a tight food budget, focusing efforts on preventive health services (including attention given to decreasing stress), among other actions.

I have tried to lay out some of the reasons for the weight disparity, but I think it will take a lot of people with a lot of brain power to improve the health future of all our nation's children. If you have other ideas, please share!

Photo credits:

• http://www.knowabouthealth.com/common-cold-virus-ad-36-may-make-kids-fat/6527/
• http://lawblog.legalmatch.com/2011/08/04/3540/