to think that the NICE guidelines on obesity and pregnancy are just yet another way of pissing off pregnant women?

[PerfectDromedary]

I'm 9 weeks today, and trying to enjoy a first, very much longed-for pregnancy. But as far as I can work out, NICE is out to get me - and the 40% of pregnant women who are overweight/obese when they conceive.

Am I being unreasonable to think that the medical profession has just put on their judgy pants about yet another aspect of women's behaviour while pregnant? It seems highly unlikely that going on a diet while pregnant is a good idea - plus, if I don't have something in my stomach at all times, I'm quite likely to throw up...

(NB I may also be a little bit hormonal. But seriously, ffs.)

Isn't it just common sense? I found it slightly irritating we have to fund organisations to point this kind of stuff out to us.
I am probably very irritating but I have been size 8-10 for many years and during pregnancy put on 2 stone and lost it all within 2 months post birth without doing anything. The difference is that I can't drink much more than 2 units of alcohol in any one time due to medication I am on for life. Since taking this medication I have not had to watch what I eat AT ALL to remain this size. Apart from walks I do no exercise either. My point is that I find people struggling with their weight often bang on about they don't eat anything or very much and don't deserve to be fat but often ignore alcohol consumption and its effects.

I'm amazed by this.....I thought that fat women couldn't get pregnant?
Surely the first thing that you are told if you have problems trying to conceive is lose weight

seems contradictory that 40% of preggo ladies are fat or obese

i feel unsure that they have any understanding really about this issue
it makes sense that you try to be as healthy as you can prior to and during a pregnancy
did we need a think tank for that?

I've been thinking about this thread a bit - I didn't response immediately as I am classified as obese, with a BMI of about 31 I think (lost track).

When I got pregnant 2 years ago my BMI was about 35/6. I was so scared of being shamed by doctors / midwives that I didn't listen to my body in those first few weeks. When I felt hungry, I didn't eat, because I knew they'd want me to lose weight. When I started being sick, I still didn't eat, because I thought that would, longer term, be bad for me. So I just put up with it, getting sicker and sicker until DH took me to the GP - he'd realised that I hadn't kept any food down in 5 or 6 days and no water in 2 days either. I was admitted to hospital and put on IV antiemetics within an hour, was signed off work for a month, and really struggled throughout the rest of my pregnancy to physically get over it. And it's fucking terrified me for the next time, too.

I don't know whether I'd have ended up with the hyperemesis regardless of how much I'd eaten. But I do know that so many women say eating often is the only thing that helps keep their nausea manageable, and because I was overweight, I was too cowed by the medics to do that.

Just another view.

First congratulations!
Re health - we all get bombarded with messages but I have found that really we only need one.
That is - look after your body - be kind, sensible, careful and considerate. The amazingly powerful experience of giving birth (twice) taught me that the brain is running a show in parallel with our conscious mind. In pregnancy and childbirth it gets bold - even tough - in its demands. But really we should learn to listen to it all our lives and then we will be best served. If you think about it everything else flows from this perspective. for some reason in our society we are hard, even cruel to our bodies!

Congratulations OP...
I understand your frustration totally.

There is a whole angle that is simply ignored re the eating/ not eating in pregnancy. I am now 6 months preg and have put on about 7 kilos. I cannot stop myself eating. Every few hours I feel like I must have something NOW or will faint/throw up. (and salads and citrus doesn't work. bananas and bread are the way for me...)

What am I supposed to do? Faint??

My friend has hyperemesis and is surviving on sweets for the past 5 months and has lost quite a few kilos. Everyone looks at her dh for not taking care of her. What are they supposed to do? Nothing stays down. The smell of everything makes her puke. Walking makes her throw up.

She would love to eat more and I would love to eat less... Nobody says 'how'. Because they don't know themselves...

I can honestly say I ate and ate during my 3 pregnancies as I had an excuse. I didn't feel any hungrier but just felt that I could get away with it more! I was basically a greedy pig and, quite rightly, I paid for it after each pregnancy and had to work really hard to lose the baby weight. Which of course was more difficult each time.
Tanmu 82, I completely agree with your point that "anyone can lose weight" its just bloody hard work. As I have found, pregnant or not, I stuff my face, I put on weight. I eat less, I lose weight.
Having been a size 18 myself I do get bloody pissed off with larger people complaining they can't lose weight but continuing to eat loads. Not sure how thats relevant but there you are.

What care you get with a high BMI does vary a lot according to area I think, I'm amazed at people not being able to go to the MLU because of a BMI of 31 - Here you can go up to a BMI of 35, and I have a BMI of 38 and am on midwife led care as there is nothing wrong apart from my weight. because of this though they can't refer me to a dietician, they can only do that once I'm having problems caused by my weight, which seems a bit late to get a dietician's help...
Last time I had a BMI of around 33/4 and no one said a thing about my weight throughout the pg, I wish they had because I put on loads and have struggled to loose it, this time I haven't gained anything at 14 weeks...

Drom YANBU. Having a BMI of 30 I am classed as obese but I am very much an average UK 14. I eat healthily but I admit I just eat too much (my portion control is rubbish!).

However, I would rather be like that that waif thin, not having enough on me to sustain myself and provide for my growing child. I get pissed off with the media hype surrounding these issues and been considered too stupid to know what I should and shouldn't be doing and that I am clearly going to have a shit pregnancy, heaps of complications and damage my unborn child because I eat a Dominos pizza one night. Being happy and positive I believe is worth more than having a stressful pregnancy and fretting about what is supposed to be the right thing all the time.

brightlight - I don't think that poster was trying to claim they were in that category. She was just mystified as to how she got that large - if you were in the 'sports' BMI catyegory, you would have a high BMI but appear slim.

A TINY % of the population are professional sportsmen/women, with the kind of muscle development that means they are lean, with low body fat - but heavy. Jonny Wilkinson is often cited.

Other people like to kid themsleves that this explains why their BMI is 29 - when they do 20 minutes on the Wii fit every week.
They then claim that this means that BMI is utterly invalid because it isn't applicable to Dwain Chambers.

I had had a miscarriage before my ds was born. The doctor told me no physical activity at all in the first twelve weeks, petrified I of course followed her advice. When I went back to see her at twelve weeks I had put on half a stone, she told me to diet. She also referred to me having put on over two stone since I was last weighed at the clinic which was the year before. I explained that that was because the last time I was weighed was when I was back from an operation in hospital - she just raised her eyebrows. Guilt stricken I went home I tried to stick to three meals a day (I must stress I was still a size 10 at this point) and felt faint and dizzy because of it. At my booking in appointment a week later the midwife took my urine and tutted saying that I had ketones in my sample, these can be incredibly dangerous for baby and proof that I was dieting and I shouldn't be so worried about my figure.....

No pregnant woman is the same but we all get the same message thrown at us. We do not all have straight forward pregnancies that we can run skip and hop through just to maintain a 'healthy' BMI. What worries me about the NICE message is that it is simply not workable for so many different cases of already pregnant women. If they have to why not teach young girls in school sex ed. classes about the health benefits of a moderate weight in pregnancy instead of plastering 'you're a bad mother and they're not even here yet' headline all over the news.

Some recent news/research in the USA recently said that more women are going into labour pre term due to being underweight and not eating enough to support the baby. Also their maybe a link between early miscarriage and being underweight in western society (this doesn't seem to be backed up by proven evidence just something else to throw out into the ether and scare pregnant women with).

I'm taking part in a study about obesity in pregnancy. I'm in the normal bmi group but was told today that I need to be monitored three times a week at the hospital and quite probably induced early. (Cholestasis )There aren't any guarantees in pregnancy.

In Japan women aret old not to put on more than 20 Kg. And they are expected to give birth without an epidural, and to breastfeed also.

I think this NICE guidelines is very commonsense. Basically it says that eating for two isn't an excuse to stuff your body with too much food. The baby is the size of a kidney bean, and later on a kitten, so eating for two adults doesn't make sense. How big is a kidney bean's tummy? A kitten's?

I felt was starving in my final month of PG, but in reality when I look back, I was just anaemic and exhausted. I should have rested and taken more iron (in a way that I could tolerate), but I reached for cake .

I never realised how hard it is to lose weight when you actually have no time to exercise and are so exhausted from night feeds / anaemia....

So being told to take it easy on the refined white carbs, and not to eat for two (adults) is very good sense, as it's so hard to lose the baby weight.

I think it's a helpful, and timely report.

I ate anything that wasn't still moving in the early days of pregnancy as it was the only way to stop being completely wiped out by nausea to the point where I couldn't open my mouth to speak without gagging.

I ate all kinds of junk, plus blue cheese and pepperoni sandwiches, which were my favourites. Plus meals.

I had my babies in the US and not once was I given any advice or even suggestions about weight gain, until I was diagnosed with gestational diabetes during my last pregnancy.

The trick is to focus on health and not appearance, do what you can and don't put pressure on yourself and make yourself miserable. Trying to lose weight when you're not getting a full night's sleep is impossible. Lack of sleep makes you crave carbs. Be kind to yourself when you look in the mirror.

Ginhag I would have killed to have had your DH or anyone -- cooking for me. You really are incredibly lucky. I couldn't even do grocery shopping without wanting to puke. Everything smelled so foul, and I had to think about food.. [green with envy, not nausea]

notyummy - totally agree. It may be a little crude, in that it is not applicable to children and professional sportspeople, but BMI IS a good indicator of health. Yes, people are different sizes, hence there is a healthy "range" of bmis. Even very sporty people will still usually conform to normal bmi ranges - it really is very extreme athletes only, who live on specially monitored nutritionist led diets etc, who will be outside the usual ranges.

I wrote a really long post yesterday, but again, many people really don't know what is healthy and not. (1) Many people don't know their bmi and would be surprised to find that they are medically overweight (they would say "I am a healthy curvy size 16 etc"); and (2) although many people on MN are able to just "know" what eating healthily is, it is surprising how many people really do have no idea.

NICE isn't being patronising or out to get women. this is just a report of evidence based research. It is fact.

The problem is the report is woefully lacking in solutions...! Arses has explained the complex issues well...

notyummy and legallyblond I agree. I come from a family where all the women, other than myself, are overweight. Why am I not, nor ever have been? Because I exercise and don't consume as much in a 24hr period. They all eat pretty healthily for main meals, but they eat too much and too often and snack too much, then make excuses like 'I don't have time to exercise' or 'I'm just big boned'.... I'm not saying that I never snack on junk or eat the odd unhealthy meal, but I practice moderation and I make time to exercise - even if it means getting up before the kids and going for a 20 min run.

I think also a lot of people get 'calorie amnesia' where they simply forget what they have eaten and drunk in a day. Not to mention the fact that 20 mins of gentle exercise will not combat constant over consumption. The 'I run around after kids all day and that keeps me fit' myth is ridiculous. It takes hard slog at the gym (for example) to burn off even a few hundred calories

Zazen - 20kg is a lot to put on in pregnancy imo. That's over three stone. The recommended amount is 1.5 - 2 stone.

I'm fully in support of NICE issuing population based guidelines on this. Having recently spent am evening with my obstetrician friend and listened to him rage about how dangerous maternal obesity is for mother and child and that despite all the advances in medicine obesity is the major cause of maternal mortality. He then recounted in graphic detail the horrors of having to tell a man he's gained a son but lost a wife. The babies of obese women are also often prem, low birth weight etc and don't do as well

so just because the OP has made a personal lifestyle choice doesn't mean she has the right to rage against NIce and the professionals who try to advise encourage and warn

"A personal lifestyle choice"

Have you even read any of the thread?

Handmedownqueen have you asked how many "obese" woman on here have had prem, low birth weight babies that haven't done so well? And how many cases of maternal mortality are we tlaking about that your friend has seen? You make it sound like it is the norm.

As a pregnant woman who had a BMI of 32 at my booking in appointment I've been a bit gobsmacked by the attitudes on this thread. But then again my experiences in the past few months have shown that the medical professionals can't seem to agree on this either!

My midwife at the booking in appointment wasn't fazed at all by my BMI, just said "try to eat healthily". Then at my scan and bloods at the hospital it was totally different it was all "we have to monitor your weight carefully and if you go over 40 then you have to be under consultant care".

They referred me to a dietician, who I saw and dutifully took along my food diary. I was hopeing for some definitive advice from the dietician, but she said my diet looked absolutely fine and healthy, just that I should swap white bread for brown and instead of eating low-fat "Go Ahead" type occasional snacks I should just have a couple of biscuits instead.

Then at my 18 week midwife appointment the midwife was astonished that I'd been referred to a dietician at all, that a BMI of 32 really wasn't anything to worry about and that health wise I'm totally fine, low BP, urine's OK and am generally doing well.

Then this week I'm being told by the media that I'm a feckless individual who's putting my life and the life of my child at risk. So I totally emphasise with the OP, I'm doing everything I currently can to ensure things are OK and these sort of reports really don't help. Yes I'm fat. But I haven't always been fat, but back when I was running six miles a day and eating very little I was still "overweight" according to my BMI so who the hell knows how accurate that is anyway!? Sorry for the long rant but I've spent the last five months getting incredibly stressed and upset by this subject!

OP are you part of the medical profession?

Do you even know who NICE are?

NICE is made up of professionals who advise pharmacuetical companies and the NHS. Their main goals as I understand it (I do work in the medical profession) are to set standards, improve health and prevent illness/disease. How is this a bad thing?

Obviously your pregnancy hormones are going a little crazy and affecting you ? normally sound judgement.

If the government, the media, or my midwife says something that I disagree with, I either feel a bit annoyed, or shrug, or (in the case of my midwife) politely disagree, and then move on with life. I know that compared to some people I'm a paragon of self-confidence, but sheesh. Until I'm going to be dragged away and flogged, or at least denied medical care or something equally actually relevant in a practical sense, I don't personally feel like it's worth worrying about to extreme degrees. Maybe minor grumbling.

(Obviously when irrational reasoning is used to affect the care you're actually offered, there's a problem. I'm referring to those taking things personally that they've read or heard.)

maybe 'lifestyle choice' sounds a bit strong, but ultimately, unless you have a medical condition, how much you weigh is down to input verses output. Eat too much (of even healthy foods) and don't exercise enough and you'll gain weight. It's not exactly rocket science. I think that rather than get offended, if you have a high BMI, then you should take extra care during pregnancy to not gain too much weight. Yes, it may be difficult, but that's the price you have to pay for a healthy pregnancy, birth and baby. And that's all any mother (-to be) wants.

I found these reports: www.kingshealthpartners.org/khp/2009/02/09/pregnancy-risks-for-obese-women/

www.tom mys.org/Page.aspx?pid=363

and I think it's actually quite worrying. Maybe a lot of obese women have normal pregnancies and healthy babies, but enough of them aren't for it to be an increasing medical concern. Therefore, the more that can be done to inform and advise, the better IMO.