Dietary Restraint and Gestational Weight Gain

I’ve previously blogged on the importance of both pre-gestational weight and on excessive gestational weight gain for negative outcomes in mother and child. I’ve also argued that targeting weight in pregnancy may be a “root-cause” solution to the childhood obesity epidemic (i.e. if the findings on intrauterine and perinatal epigenetic programing in animal studies hold true for humans).

But this may be easier said than done. Reason for concern on this approach comes from a recent study by Sunni Mumford and colleagues, from the University of North Carolina at Chapel Hill, published in the Journal of the American Dietetic Association.

Mumford and colleagues assessed dieting practices among a prospective cohort of 1,223 pregnant women. Women were classified on three separate subscales as restrained eaters, dieters, and weight cyclers.

Restrained eating behaviors were associated with weight gains above the Institute of Medicine’s recommendations for normal, overweight, and obese women, and weight gains below the recommendations for underweight women (The Institute of Medicine suggests that women should gain 28 to 40 lbs, 25 to 35 lbs, 15 to 25 lbs and at least 15 lbs for underweight, normal weight, overweight and obese women, respectively). 

Furthermore, women classified as cyclers gained an average of 2 kg more than noncyclers and showed higher observed/expected ratios by 0.2 units.

This obviously has important consequences for counseling women planning to have children. If pre-gestational maternal weight is important and women with overweight and obesity should be counseled to manage their weights prior to pregnancy, dietary restraint may not be the best strategy. In fact, as outlined by Blake Woodside, Director of the Toronto General Eating Disorder Program, at a symposium I spoke at last Friday in Toronto, dieting and restraint are a sure-fire recipe for promoting binging behaviour and setting yourself up for weight gain. 

So “yes”, pre-gestational weight is important, but “no”, dietary restraint is not the answer.

AMS 
Edmonton, Alberta