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.)

What are preg women supposed to do though?

I am 6 weeks pg with no 2...was a curvy size 12/14 with DS but was so hungry and constantly feeling sick, I was eating every two hours. It was mostly healthy stuff but its still calories. I put on 4st in the pg, had such bad water rentention that I couldn't walk very far so exercise was out - even if I wanted too - even doing the dishes had my feet swelling up badly. And this was with me being a healthy weight and BMI when TCC and when concieved. Was also on a low Gi plan so was having an excellent diet full of good fats etc

With DC2 am already starting this pg 2st overweight and am very conscious of what is going in but when you are really hungry, it is so hard.

Today for example:

Breakfast: 1 piece of wholemeal toast with Raspberry jam - have only been having 1 piece of toast rather than two as I know I'm going to be hungry later anyway, so trying to spread the calories out

9am in work - wholemeal toast with marmalade

10.30am - banana

11.30am - two slices of Ryvita with philidelphia

12.30 - normally have a sandwich for lunch but was so hungry and didn't want to spend afternoon snacking as a result of it, decided to have a proper lunch in work canteen - veggie lasagne with salad and piece of garlic bread

Had estate agent coming around this evening so no time do a full on meal like I normally do so had chicken tikka masala (sauce from a jar) with rice and naan bread. I made sure only had a small amount of the rice and the sauce and tore off a tiny piece of the naan bread but no more than that as trying not to eat too many carbs

No snacks this evening as haven't felt hungry, which is good so just been drinking a lot of water

However, this is still a lot of calories even though am not chowing down on endless milk tray bars!

Pussin I do know what you mean because I was starving with dd2 and craved bacon sandwiches but it does usually settle down later.

Carbs do add lots of weight and banana is also full of carbs. If you want to control it (and I am not suggesting you should) you could eat more berries/ citrus fruit that all have less carbs in them to nibble on. Carbs give peaks and troughs in blood glucose which mean you need more of them to feel satisfied.

You would probably be less likely to snack by eating some protein at breakfast because they take longer to digest. So eggs/beans/sausage/bacon with toast.

I ate similar to you in pregnancy and gained 4 stone!

Pussin - are you doing any exercise? It is difficult to avoid snacking I know, but some exercise can counteract those calories!
So many people just give up and slump on the couch when pregnant and then are horrified later when they realise how much they have gained!

DBennett,

RE:

"@ arses

You mean like on page 14:

"Use the 6?8-week postnatal check as an opportunity to discuss the woman?s weight. Ask those who are overweight, obese or who have concerns about their weight if they would like any further advice and support now ? or later. If they say they would like help later, they should be asked whether they would like to make an appointment within the next 6 months for advice and support." "

My point was not that they had omitted this as guidance, but that there is no need for anything further. I have no issue whatsoever with a healthcare provider asking about weight related to health. I do have an issue with the manner in which the document is written: as though women who were overweight had never really considered that excess weight might not be fantastic for their health.

As someone who became overweight a short time before getting pregnant, I think it's a good deal more complex than they are suggesting. I had been within healthy weight guidelines my entire adult life. I was hospitalised shortly after getting married with an acute illness and put on nearly two stone due to medication. My intention was, absolutely, to get rid of this weight before conceiving. However, for about a year, I seemed to lose and regain the same 5lbs. I was exhausted following the illness, in retrospect, and found exercise quite difficult so I would go at it in bits and bats but was still eating as much as I used to when I was exercising regularly and found it extremely difficult to cut this down. Eventually, I was too anxious and eager to start my family and I started trying to conceive while also eating healthily. I got pregnant straight away.

At the booking appointment, my midwife (who was a good deal larger than me!) rabbited on at me about healthy eating and what it meant e.g. no rubbish and I smiled wryly. I know healthy eating inside out and backwards. I've been on some sort of healthy eating regime my entire adult life and for the most part I've maintained my weight. You can't actually tell someone's habits from their weight.

That is my story. Every women with weight has hers. I think the "back up" advice is simplistic. The majority of women are well aware what constitutes a healthy diet. I find the tone of the document patronising and simplistic given the complexity of women's issues with weight.

Not exercising as finding if I do too much, I start having niggling pains in lower left side and get crampy...why risk it is my motto although once the first trimester out of the way, I am hoping to go back to walking to DHs work after my work - about 20mins or so and when DS is in school - Sept, was hoping to use some of my free time to go swimming as this is excellent for pregnancy. Meanwhile, I can feel my arse spreading..

I do feel quite inactive but I really can't ignore my body when it starts niggling

I really want to do something about my bingo wings though...they are awful...how to tone them in a pregnant friendly way?!!

May have to start making a more protein friendly breakfast...I know bananas are carbs but its still fruit and good for the baby!

Pussin - nibbling Twiglets all day, really nibbling them (not scoffing) helped me with MS early on (I too wanted to eat constantly).

I also found cherry tomatoes helped as an alternative to fruit - but get really nice sweet ones that are lovely to eat.

If you can swim, I'd do that for the bingo wings. By far the nicest fat-burning exercise I've found for pg so far. Especially as you get further along and the baby helps you float (or at least mine does!)

Perfect, by the time you're full term, you'll have had people call you huge, too small, irresponsible and maybe question your age.

I had strangers touch my tummy without asking, ask all sorts of personal questions and condemn me out loud in Tesco for buying a prawn sandwich. I was told off in the pub for having one small G&T on the day I quit work.

I had my (idiot) midwife tell me I had diabetes before testing me (wrong) and that I was breech and needed a section (also wrong).

I'm afraid you just have to go with your instincts and ignore everyone else's mithering (including NICE) unless they are medically qualified and have produced individual test results that show something to be incontravertibily a problem.

Go ahead and enjoy your pregnancy. Eat and exercise sensibly and you'll be fine.

I haven't read every single post on this thread, but have read quite a lot...

I think there are a few issues here, some more complex than others:

1. Of course it is fine for NICE to publish these guidelines and announce then via the media. it is their job to look at the evidence and research surrounding all aspects of medical care and report on the evidence based findings. My best friend is a researcher who does a lot of work in this area specifically (i.e. maternal and antenatal health) through CMACE and these findings have been known about for some time.

1. Not everyone is perfectly aware of what "overweight" and "obese" looks like. Many people with a bmi of over 25 do not know their bmi and would not consider themselves overweight. They would say they are curvy etc. I do not want to pass judgement here, but bmi, although fairly crude when it comes to children and professional athletes, is a fairly useful indicator for normal adults. And evidence points to a bmi of over 25 being a potential problem in terms of health.

1. I really don't think these guidelines are out to be anti-female etc. They are, as I said, evidence based findings and are guidelines. Some reporting is, perhaps, anti-female (I personally am not so sure), but I suspect (and I am not an expert here), that maternal healthcare spending across the country would be reduced if less pregnant women were obese/overweight. The facts show that there are increased risks where a mother is obese/overweight, so why not warn about these risks and cut unecessary healthcare spending? By the way, I doubt that the spend on this aspect of pregnancy is sky high, but still, the principal is, I think, valid.

1. And this is the complex point... for women who actually are overweight or obese, that is rarely the end of the story. The reasons for weight gain are myriad and complex (as arses story shows) so it is not as simple as telling someone they should lose weight (and I speak as someone who had the opposite problem with anorexia - if I simply couldn't gain weight for many years, so of course it must be as hard for someone with complex issues to lose weight!). In this sense, simply saying "you and your baby are at risk because of your weight" really doesn't help address the issue. I have no idea what the solution is, but just warning about the risks clearly isn't the answer!

So, what I am saying is, the NICE guidelines should be published and reported - I am sure they are right. BUT, the solution is always going to be complex and, of course, no medical professional should ever use a woman's weight as a "stick to beat her with". TBH, I don't think they do, BUT, the reporting on the genuine risks for obese women etc is, in my opinion, totally fair enough.

Everyone knows that pregnancy is a special time in a women's life and the NICE guidelines are there to help clear up confusion that arrises for many women during this time. They are also setting out to make sure that woman is at her most healthy so that she and her baby are not at risk of complications during or after pregnancy. Some already know the information outlined but for every women who does, there are plenty who don't. They are reporting the risks and the healthy way to prevent these I think as opposed to make anyone with these issues feel picked on.
Working as a Nutritional Therapist I see this in clinic with women wondering how much more they should be eating, which foods to include and exclude, how to prepare for the arrival of the little one and how to quickly lose weight afterwards. Some can feel really pressured by this.
The nutritional guidelines can provide some fun cooking options by opening up other varitey and are certainly not about denial but about making healthy choices for you and your baby. Maybe they could be looked at as a mechanism of support to confound that what you are doing is good for you and the baby bump. Again, I often see this and part of my job becomes providing reassurance that what women are doing is what we know to be the best nutritional advice for a healthy pregnancy.

Personally I find all the advice and guidance for pregnant women patronising and needless, but do understand there are women out there who need these things spelt out for them (regardless of whether they are pregnant or not). The problem is how the info is put out there by the media - the women who need this advice will never have heard of NICE, probably don't listen to the news and would doubtless ignore it anyway. All the media hype does is piss off women like me, who already understand what they should be eating/doing and make us feel crap that we are not a paragon of fucking virtue. So OP, YANBU. And can I just add.... what an absolute waste of money - how much did it cost for NICE to tell us things we know already, in a manner which will not reach those who need it?

I agree with you KathyJelly, you wrote what I wanted to say, but much more eloquently.

I am 19 weeks and already pissed off with family, mw random strangers commenting on my size/shape - first pg I was 'enormous', this time I am 'too small'... cue lots of cats-bum-mouths and insinuations that I am not taking care of myself (which btw, I bloody well am) - you can't win. I am healthy, my baby is moving and kicking and has a lovely strong heartbeat, so everyone else can fuck the fuck off, and when they get there, fuck off some more.

I agree with all your points legallyblond. I suppose I feel that there has been little attempt to deal with (4) in the document.

I would value non-judgemental appropriate support to manage my weight - but simply wagging a finger and telling me to lay off the biscuits and move my arse off the couch isn't going to do it.

My BMI is 28 post-pg. I walk an average of 20 miles a week (non-car driver! 6 miles yesterday and that's not atypical) and mostly eat a range of healthy foods e.g. wholegrains, lean meats, fruit and veg etc. The problem is that when I'm excessively tired I have a tendency to overeat carbs.. wholemeal bread, rice, pasta, lentils.. nothing particularly terrible but I do overdo it and it is related to tiredness. I want a full belly feeling. I beat myself up terribly about it. I know what I should do but I can't do it..

This poem sums up the situation for me:

?There?s a Hole in my Sidewalk?, by Portia Nelson

Chapter 1.

I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost?
I am helpless.
It isn?t my fault.
It takes forever to find a way out.

Chapter 2.

I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don?t see it.
I fall in again.
I cant believe I am in this same place.
But it isn?t my fault.
It still takes a long time to get out.

Chapter 3.

I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in? its a habit.
But, my eyes are open.
I know where I am.
It is my fault.
I get out immediately.

Chapter 4.

I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter 5.

I walk down another street.

Personally, I think I am between chapters 2 and 3 at the moment and I'm not even someone with a lifelong weight problem! I think my issue with the NICE guidelines is that they seem to assume most women don't see the hole. I think many do. They even know how to get out, they just don't have - for whatever reason - the strength in their arms to climb out.

not to be offensive or anything, but a poster on here mentioned being morbidly obese yet eats a healthy diet. How does that work? I would imagine that with a healthy, varied diet and sensible portion control, it would be pretty difficult to be, or remain, morbidly obese (ruling out medical conditions anyway....)

As for the NICE guidelines, can't see a problem with them, though they are just that - guidelines. I spent the first 14 weeks eating junk because that's the only thing that stopped me feeling sick. Now I no longer suffer with MS I have resumed exercising and eat a balanced diet. Sometimes that includes a little more chocolate or crisps than it should, but overall it is healthy and balanced. That's all any of us pg ladies should aim for whatever our weight, balance and moderation.

Arses that is a really good way of putting it.

Legallyblond - that was a really well put post. I do find it hard to understand how anyone can justify getting upset when a medically qualified professional tells them the clear facts and risks about being overweight. BUT i fully accept that some people need help to lose weight and just giving them the facts is not necessarily enough.

balance and moderation is what we should aim for is what I meant

tanmu82, I didn't see a post from a 'morbidly obese' person claiming to eat healthily.. but I feel do eat healthily but am overweight (BMI 28 now, size 14-16).

I was defining healthily as relating to nutritional value of the foods I consume. If you define health related to portion control (which I suppose is sensible in terms of a truly healthy diet) then it's not so possible.

However, you can become really quite fat eating a varied diet of nutritionally sound foods. It's all about input and output in the end of the day. While I have been breastfeeding I feel very, very hungry. I make the right food choices and mostly eat a balance of good, healthy foods in terms of ratio of fats to protein to carbs but I find portion control impossible and have done ever since I ballooned while on steroids.

The reality is that once weight goes on (for whatever reason) it's quite difficult to take off without working hard at it. I expected that weight would fall off me but it doesn't.. and that's largely governed by my appetite. I recently had a pub lunch with a friend with a baby a bit younger than mine who snapped back into her size 10 jeans - she had garlic bread as a starter, lasagne and chips and a rocky road sundae for lunch. I had a fillet of salmon with no sauce, some rice and salad and no dessert. We both polished off the whole plate and this is really quite typical of both our diets.. yet I have excess weight I need to lose and so a full restaurant plate of salmon and rice and salad is just too much. You have to reduce your calories to quite a low level to actually get weight off.. it's not just about food choices. I am losing about a half a pound to a pound a month on what I am having now (had hoped it would fall off while bfing but no go, I am 10lbs heavier than when I got pregnant and it seems to be going nowhere).

Arses - exactly. That is the problem. It is fine and, in fact, necessary to let everyone know about the (well-researched) risks of being pregnant and overweight (and actually not everyone knows when they are overweight/what the risks are etc) BUT the solution when a woman does have a weight problem is much more difficult than, as you say "lay off the biscuits and move your arse off the couch"!!!

Its like trying to help someone with anorexia by saying "just eat more"... errr, yeah right!

Trouble is, I don't know what the answer is! (If there was an easy answer, I guess the diet industry wouldn't be a multi-million pound industry....)

I am glad NICE published the report setting out the risks (that is the job of medical professionals, after all), but, as you say, more focus is needed on finding a workable solution to help women to get out of the complex "hole" of weight issues.

At the risk of leaping back in without having read everything in between, my own reaction to this wasn't to do with getting upset about being told the risks of being overweight. I am not overweight - I was a size 10 with BMI of 21 before pg - but I've put on a fair amount during the pregnancy, and I found the message of all weight gain being 'bad' irritating. It is obvious that some women eat 'too much' in pregnancy not just because they are ignorant, but for what I would see as a mixture of physical and emotional reasons. And, even if the message is only meant for women whose weight puts them at high risk, the 'every pound gained increases the risk' message is just bloody annoying.

Having said that, I totally agree with what many posters have said about the benefits of these guidelines. Clearly it's good to inform people about risk. But next time they should take out the bit about the milky drink, it's fucking patronising .

arses, it's on the first page. Overweight I can see how that could be possible - but morbidly obese on a healthy diet? I'm not convinced. A healthy diet does means portion control too as all food has a calorific value.

Like you said, weight is difficult to lose without working hard at it. I hope I don't sound judgemental or preachy, but I do feel that anyone can lose weight (or maintain a healthy weight) if they want it badly enough to eat less, cut down on the junk and exercise more. I have never been overweight in the BMI sense, but I have (particularly after my second pg) been uncomfortable with my size. I worked bloody hard to get back in shape and stay that way.

As for during pregnancy, little changes for the better will do a woman and her baby the world of good, so being given this advice is necessary IMO. Being harassed with it is another thing though....

Congratulations OP. For the record, I don't think NICE are out to get people at all.

However, I do get your (and general 'you') frustration. Hope nobody will go beserk at this parallel - but it reminds me a bit of being a smoker.
I smoked for well over decade and only managed to stop smoking when I wanted to get pregnant badly enough. I knew that smoking was bad for me etc. etc. etc. but the more the message was publicly played (esp. after they banned smoking in public places) the more it seemed like it was ok for any memeber of the public to remind me of how bad it was for me etc. etc... They weren't wrong, and I did want to quit (and had no wish to die an early painful death as a result of my smoking habit) but it still did my head in and made me want to insult them.

PS- haven't got round to reading whole thread so apologes if I have repeated anything.

Reading this thread today has done two things for me:

Thing One - made me really, really hungry.
Thing Two - made me realise how incredibly lucky I am that my DP took over the cooking entirely when I started getting morning sickness when pg with DS, and has been doing it ever since. Now I'm pg again and although I 'fend for myself' during the day, knowing that someone is going to put a plate of good proper food in front of me in the evening makes such a difference.

He saw it as 'his job' to feed me, especially when I was bf and he felt like he couldn't do much to help...

He's a bloody good cook too.

it just nonsense as always its the mimority that overdo things and the rest of us get slated. I am nearly 13 wks and like others have said i cannot get hungry or i feel terrible and sick i am trying to work and take care of existing kids and canty just walk about puking all day.Inccidentally despite my huge food consumption over the last weeks i have put on no weight thererfore can only assume my body is using the extra calories to make a human being. As for the recommended 30 mins of excercise per day most people dont do that when they are not pregnant,i was at the gym 3-4 times per week before but since i was pg i have been twice and felt terrible stomach cramps and sickness then tried swimming and bled both times so i have assumed that i should stop until about 14 wks but i do ride my bike everywhere but would stop if felt it was having negative impact.Nice need to look at the fat problem we have as a society and target the problem at source rather than picking on us.