Ellyn Satter's rules for eating

The incomparable Ellyn Satter has posted another newsletter to her website, this one (like the previous two) geared toward helping pregnant women figure out how to eat well despite the growing pressure to not gain much weight during pregnancy.

But these rules apply just as much to those of us who are not (and never will be again!) pregnant, so I'm taking the liberty of summing them up here. Then go read the whole thing yourself.

• Encourage each woman to be positive and reliable about taking care of herself with food
• Emphasize pleasure as a guiding principle in food selection
• Teach and support internal regulation of food intake
• Teach and model body trust

Great rules for mothers-to-be, both to help take care of themselves and to make sure that their attitudes toward food and body image are in good shape as they begin the process of raising the next generation.

If only more clinicians and researchers felt this way.

At risk for what?

This just in: Experts are now urging women to watch their weight before pregnancy and get back to their pre-pregnancy weight quickly after giving birth. Their new recommendations include:

* Body mass index should be measured as part of vital signs at routine annual check-ups and all women of child bearing age should be counseled to achieve and maintain optimal BMI.
* Preconception counseling programs should include education regarding the poor maternal and perinatal outcomes among the obese and overweight.
* Women with high BMI planning a pregnancy should be counseled to participate in intensive nutrition programs aimed to achieve optimum BMI prior to conception.
* Encouraging breastfeeding can partially help to decrease childhood obesity and also help mother to return quickly to pre-pregnancy weight.

Why the panic? Because, say these researchers, "maternal obesity" leads to all kinds of terrible things for babies, including higher C-section rates, "less chance" of being breastfed, obesity later in life, and--I kid you not--"high birth weight."

And here I thought low birth weight was the big risk when it comes to babies and weight. After all, low birth weight can contribute to respiratory problems, cardiovascular problems, infections, neurological problems, SIDS, cerebral palsy, and other medical issues.

But never mind all that. As we should all know by now, it's much worse to be fat than any of those.

I guess they never heard of genetics, and have never read the dismal statistics on weight loss, or followed the studies that show that losing weight if you're fat actually increases your health risks on many levels.

As Sandy Szwarc pointed out in a recent post, there are people who think you can be too fat to love a child. I guess you can be too fat to have a child too.

Of pregnancy and fat phobia

Another post from Sandy Szwarc highlights the peculiar and dare I say twisted mentality that comes from living in a culture that's fat phobic in the extreme. Szwarc's talking about the latest media anti-fat media blitz, this one focused on the relationship between weight gained in pregnancy and overweight toddlers. Specifically, according to the study's authors, women who gain even the accepted amount of weight during pregnancy run four times the risk of having a child who's overweight at age 3.

Scary, huh? Apparently much scarier than another finding buried in the study, which received neither headlines nor any media attention: the fact that women who didn't gain enough weight during pregnancy had double the risk of having a baby with intrauterine growth retardation. According to Szwarc, Babies with IUGR are at vastly higher risks of stillbirth and serious medical problems during infancy if they do survive.

This reminds me of the recent study published in the New England Journal of Medicine, which found that being underweight or of "normal" weight (and let's not even go there for now) correlated with higher rates of mortality than being overweight. (Thanks to Paul Campos for writing about this!) This unpopular finding has been scrutinized and rationalized to death, because apparently it's unbelievable that having nutritional reserves (i.e., being fat) could possibly confer any health benefits.

This, in turn, reminds me of the way doctors and therapists who treat eating disorders sometimes fall inadvertently into the language and perspective of those eating disorders. How people with anorexia can walk around at weights that are dangerous, yet no one notices because we've been so conditioned to think that thin = healthy and good.

Apparently we live in a culture where death is preferable to being fat. Even for babies. Even for toddlers.

Some years ago I dealt with this in my own life, after a severe depression sent me into a tailspin (what would have no doubt been called a nervous breakdown 60 years ago). Antidepressants lifted the fog and gave me my life back. They also, over a period of 5 years, led to a 50-pound weight gain. To me it was no contest: I'd rather be sane and happy and fat than thinner and miserable.

I wonder how many people would agree with me?