Download Pregnant Women With A History Of Dieting

Nutrition Counseling For Pregnant Women With A History Of Dieting
Do nutrition and weight evaluation to try to determine the cause of any excess weight gain or
inadequate weight gain or fluctuating weight.
The patient may offer information regarding recent dieting. In any case, if a history of dieting is
suspected, you may ask the following questions:
- What was your highest non-pregnant weight ever?
- Ask about recent dieting history and past dieting history. Ask how they attempted to
lose weight in the past and if they were successful or not. Ask if they attended specific
programs. You may also ask why they felt that they were successful or unsuccessful,
and what made them discontinue a successful program.
Ask about use of supplements, herbal products, diet pills or other diet
drinks/foods/products
-
- Ask if they think they eat sometimes for emotional reasons or stress related reasons.
- Ask if they think that they eat ‘compulsively’ sometimes.
- Do you eat large amounts of food on some days and very little food on other days?
- Ask about eating disorders (current or history of anorexia nervosa, bulimia, and
compulsive eating) or any history of binge eating or purging (inducing self to vomit) or
use of laxatives. Ask if there have been any recent episodes of these and when was the
last episode. Also ask if there was treatment for this in the past, and was the treatment
completed.
Eating disorders, such as anorexia nervosa or bulimia, may result in inappropriate caloric or
nutrient intake. Notify the patient’s physician and consider a referral to a Registered Dietitian
and/or psychosocial professional with expertise in eating disorders.
Important to teach on first visit:

Regular meals and snacks are important (during pregnancy it is recommended to eat 5 to 6
smaller meals per day or 3 meals with 2 or 3 snacks)

The recommended rate of weight gain for the 2nd and 3rd trimesters for the patient’s weight
category ( 4-5 pounds per month for normal weight category, 2-3 pounds per month for the
overweight category, and 0-2 pounds per month for the very overweight category).

Weight reduction during pregnancy is not appropriate

Try to eat about the same amount of food every day, rather than large amounts one day and
very little on other days.

Avoid sugary foods and sugary drinks. Give them a list of sugary foods and sugary drinks
that should be avoided – it is best to keep these out of the house so they are not a
temptation:
cakes, cookies, candies , ice cream, chocolate, sweet breads, lollipops,
popsicles, Jello, flan, sugary cereals, flavored yogurts, (Hispanic favorites:
’pan dulce’, ‘arroz con leche’),
and sugary drinks:
soda , Gatorade, Koolaid, fruit punch, Sunny Delight , Tampico, Tang,
Caprisun, lemonade, instant iced tea from powder, bottled iced tea,
Powerade, Kern’s, Schnapple, Quik, ‘high energy drinks’, (Hispanic favorites:
‘agua de jamaica’, ‘agua de tamarindo’ , ‘horchata’, ‘maicena’, ‘atole’,
‘champurrado’, ‘Chocomil’, ‘Jackult’ ‘aguas de fruta’),
“and there’s many more”

Review exercise level - 30 minutes of walking is recommended per day unless atypical
discomforts or contraindicated by doctor (other types of exercise may be OK; the walking
should be in addition to regular chores); if needed, discourage excess exercise or
inappropriate exercise for pregnancy
May be important to teach on the first visit:

Aim for WIC (Women, Infants, and Children Supplemental Food Program) Daily Food Guide
recommended number of servings for all food groups as a minimum (this is especially
important to teach if they are afraid of weight gain and are not eating enough)

Recommend lowfat or nonfat milk instead of regular milk (this may be addressed on a followup visit)

If a pregnant woman loses weight, she is at risk for developing ketone bodies in her blood
(from the breakdown of body fat), which is dangerous for the baby, and can affect the baby’s
intelligence.
Optional teaching for first visit:

Choose foods lower in fat more often. Ask them if they know which foods are high in fat.
Wait for a response. Give them examples of high fat foods (butter, oil, cream, margarine,
lard, fried foods, red meats) and low fat foods (vegetables, fruits, legumes, chicken, nonfat
milk). Use lowfat cooking methods (bake, broil, roast, barbecue, steam, poach) or use only
small amounts of fat in cooking.

Adding extra fats to foods instead of sugars is not likely to stimulate cravings for fats, but
consuming high sugar foods can stimulate the desire for more sugars immediately and
during the next 2 or 3 days.

Water is the best beverage.

Have fruit available/eat fruit instead of sugary foods and drinks.

If you are not used to eating vegetables, try different vegetables and different vegetable
recipes. If you like only 1 or 2 or 3 types of vegetables, it’s okay to
eat the same ones every day.

Eat whole grains instead of processed grains (examples of whole
grains include 100% whole wheat bread, brown rice, 100% rye or 100%
whole wheat crackers, oatmeal, 100% whole wheat pasta, corn tortillas)

The benefits of exercise during pregnancy are:
- along with proper diet, it helps prevent excess weight gain
- less discomforts in pregnancy – for example, less chance of back pain because
abdominal and back muscles are stronger
- helps all the hormones work better, so we feel better and have less chance of
developing diabetes during pregnancy (better control of blood sugars)
- delivery is usually easier for those who have exercised regularly during the pregnancy
Information for the professional:

Possible causes of excess weight gain in pregnancy:
- too much juice
- sugary foods and sugary drinks
- lack of exercise
- high intake of high fat foods
- eating out frequently
- recent weight loss or inadequate weight gain during the pregnancy
This happens if a woman initially lost weight in her pregnancy, or didn’t gain enough
(due to nausea/vomiting or fear of weight gain or other reason), then her appetite
returns. This high rate of weight gain is called “catch-up” weight gain and is considered
acceptable (this patient should also be counseled regarding exercise and to avoid
sugary foods and sugary drinks, and to limit fruit juice to 4 ounces per day or less)
- previous high weight before the pregnancy
in some cases the patient is following all of the recommendations to avoid excess
weight gain, and still gains too much weight. This is typically because in her past she
used to weigh more, then lost weight (in other words, her pre-pregnancy weight was
lower than her highest non-pregnant weight). Her body is trying to recoup the weight
that was lost in the past. Explain this to her while giving guidance to optimize diet and
exercise. Emphasize the importance of eating the recommended number of portions
from the Daily Food Guide as a minimum, choosing lower fat foods more often.
Counsel her that she may continue to gain weight at a greater rate than expected even
if her diet and exercise are excellent. At this point it is not recommended to cut back on
the amount of food eaten, but, rather, to wait until after delivery to begin a weight loss
plan.

Encourage patient to avoid juice and foods high in sugar, particularly if there is any family
history of diabetes and if the client has had gestational diabetes in a previous pregnancy.

Intake of diet soda and other use of artificial sweeteners in pregnancy may be permitted in
moderation i.e. saccharin (Sweet and Low), aspartame (NutraSweet or Equal), or
Splenda, but artificial sweeteners are not ideal and are best avoided. The use of artificial
sweeteners for control of weight gain during pregnancy should not be encouraged.

Excessive weight gain can increase the chance of developing gestational diabetes or high
blood pressure, or of having a bigger (large for gestational age) baby, and potential problems
with delivery.

Women who don’t gain enough weight during pregnancy often have smaller babies, and
smaller babies often have more health problems.