How to eat at nearly 26 weeks? History of anorexia

[firsttimepregnanthelp]

Hi ladies,

I have a long history of anorexia but pre pregnancy was doing really well - bmi of 20, minimal thoughts, flexibility around food but making sure I ate 2400 calories a day to ensure I ovulated as I had hypothalamic amenorrhea for a long time.

The first trimester was really rough for me - sickness, nausea and food aversions. Despite my best efforts I was only able to manage 16-1800 calories per day and I lost weight which has triggered my old anorexic ways of thinking.

from about week 14 I was able to increase my calories to 2100 and this is what I am currently eating. Baby is growing well and there are no concerns there but I am 3kg below my pre pregnancy weight, which is probably more like 6kg if you take into account the weight of baby and amniotic fluid etc.

my parents and bf have commented on my weight loss and I noticed it yesterday when I put on some leggings that are now loose around the tops of my legs. I

feel I have done well to get my intake to 2100 calories after such a dreadful first trimester and I have worked hard to maintain this but it doesn’t seem to be enough.

i asked for a referral to the perinatal mental health service 20 weeks ago to avoid a situation like this but nothing has materialised despite me chasing and I have also asked for a referral to the eating disorder service. Medical professionals seem unconcerned so I am being left to deal with this alone.

from my experience, my thoughts subside when my weight is higher and my intake is good but I seem to have a mental block around increasing my calories because all the nhs guidance is around not eating for 2 and only increasing by 300 during the third trimester.

i will be 26 weeks on Thursday and I’m thinking of increasing to 2400 calories then - this is the 300 the nhs ‘allows’ from 28 weeks, I will just be doing it 2 weeks before, and it is also my pre pregnancy intake.

im sorry if this all sounds ridiculous, I hadn’t realised quite how disordered my thoughts had become. I did ask my midwife for advice but she just told me that there’s not much research into eating disorders and pregnancy. I’m going on holiday on friday and it is taking all the mental strength I have not to restrict beforehand.

does my plan sound ok?

I’m by no means an expert in this area, but didn’t want to read and run.

I’m so sorry you’ve been let down by professional services in this department, it really seems like you would benefit from additional support, and it’s sad to hear you’re not getting it.

NHS guidelines are there for the average individual not specific cases, so please don’t feel any guilt for adding more calories to your diet based on guidelines that don’t apply for your specific case, your plan sounds ideal and if counting calories of what you’ve found works best for you then I would absolutely do it.

I don’t know if data is helpful or triggering for you but the average woman of normal bmi will gain 15kg during pregnancy. As you’ve lost 3kg at 26weeks you’re well below even the 2nd centile line. Bear in mind many woman have HG and can loose weight during pregnancy and still go on to have very healthy babies, but in the interests of your own health, if you’re able to keep food down now, I would increase calories as soon as possible.

I’ve found during my own pregnancy and breastfeeding babies are leeches and will take every bit of nutrition for themselves before there is any left over for you, which can make the physical nature of carrying a baby and feeding it exhausting.

Is 2400 your maintenance intake or were you still trying to gain weight pre pregnancy?

I wouldn't necessarily worry too much about the weight loss that has already occurred, you just want to minimise any more weight loss.

Try to get steady with your calories, and if increasing them more right now is hard then leave them as is and increase them when it's easier. Baby will take what it needs from you either way.

If you do plan to breastfeed you'll need at least an extra 500 calories a day, so it might be worth gradually increasing your calories through your third trimester, 50 calories a week for example, so you get used to eating more.

And chase the mental health referral, with reference to how you feel about wanting to restrict right now.

@CityKitythank you so much for your kindness ❤️ I have increased my calories to 2400 today. I am so uncomfortable because my digestion is slow but I am really trying not to make this mean that I don’t need this food.

@stackhead2400 was my maintenance and I was doing so well. I can’t believe it has all come crashing down so quickly - the weight loss causes the thoughts which makes it harder to increase my intake. I do want to breastfeed and it is a worry so I think I need to address this sooner rather than later. I’ve chased the mental health referral a number of times, as has my midwife, but nothing happens. I do feel very let down.

You’ve done really well and it hasn’t come crashing down. You’ve had a set back and you’ve noticed and you’re back on the right track. It’s so hard and it’s not really good you’re so aware!

I agree that it sounds like you are coping really well. Good that you have gone back to your maintenance level and got yourself back on track!

@OneOfEachPlease@FairyBatmanthank you so much for the encouragement. I bit the bullet and went back to 2400 today and I could cry with discomfort I’m so full (pregnancy slows digestion). I really appreciate you cheering me on - I had forgotten how intense the mental torture could be. I never want to go below bmi 20 and allow myself to be in this position again - it’s very scary how the brain can switch as a result of a little unintentional weight loss

I agree with others, whilst I can imagine it’s intense for you your coping mechanisms are fully intact- you’re taking action and owing your urges. I think that’s brilliant.

im sure you’ve been through this but maybe double check your typical diet and look for small areas to increase calories - full fat milk, butter, yogurts and cheese for example. Higher calorie fish like salmon. Banana on toast with honey. It can be easy to slip to old habits of reducing intake but a sense check might help you find areas to improve on or reassure you that you’ve got it covered.

give yourself a pat on the back - you really are doing well.

You've done great to recognise what was happening. It's terrible the NHS has not been helpful.

I am not medically trained - but what's flagged up to me specifically is cheese - both to protect yourself from calcium depletion and maybe make it easier to eat more without felling uncomfortable.

If you aren't eating enough, your body takes from your body to build babies. Hence your weight loss. You can always build up your muscles etc again, but your bones and teeth? There's a reason there's an old saying that you lose a tooth for every baby...

A matchbox size piece of cheddar adds little bulk if grated on your food, but provides the calcium your baby needs for their bones, and just over 100 calories including useful protein.

You sound like you’re doing so well @firsttimepregnanthelp . Amazing work upping the calories despite it not feeling hugely comfortable.

At the start of my current pregnancy (I’m 22 weeks atm) I was underweight by bmi, not by choice but due to a short period of sickness. As soon as I found out I was pregnant I tried to up my food intake to make up for the period of time I was unable to eat. It’s not easy at the beginning because your body/stomach isn’t used to a high load of food, on top of the fact that digestion isn’t great during pregnancy anyway.

Echo-ing others advice, try and focus on high calorie dense foods. For me what worked well was cheese, nuts, peanut butter, full fat yogurt, granola, dried fruit etc. Picky bits really! I also took the pressure off 3 big meals, and had 5/6 smaller meals / big snacks instead.

Good luck, you’ve got this 💪🏻

Thank you so much for the advice everyone - I bought peanut butter, cheese and full fat yogurt today and I’m having salmon for dinner. I still feel extremely mentally and physically uncomfortable but your messages and encouragement have really helped me to do what I need to do and remind me that I am doing the right thing, even if my brain absolutely hates it and my stomach feels horribly full