Following nine months of pregnancy, marked by hormonal fluctuations and significant body changes, many new mothers feel pressure to quickly shed the baby weight. While social media often showcases unrealistic standards set by celebrities and influencers, understanding realistic expectations for postpartum weight loss is crucial.
Understanding Postpartum Weight Loss
Realistic Expectations
Despite what is often portrayed on social media, losing baby weight takes time. Over 75% of women are heavier one year after giving birth than pre-pregnancy. However, many women tend to lose over 10 pounds over the next 1 - 2 years. This is dependent on how much weight you gained during pregnancy. With proper nutrition and an appropriate exercise plan, returning to a healthy weight is achievable.
Breastfeeding: Not a Guaranteed Diet
While breastfeeding burns calories, it isn't a guaranteed weight loss method. In the early stages, when breastfeeding is the baby’s primary nutrition source, caloric intake may need to increase by 400 - 500 calories per day to support milk supply. Consequently, significant weight loss may not occur in the first three months. Exhaustion from nighttime feedings and building milk supply can also limit time and energy for physical activity. However, a healthy, balanced diet can lead to a loss of about one pound per week while breastfeeding.
The Pitfalls of Crash Diets
Crash diets, characterized by very low-calorie intake for rapid weight loss, are not advisable postpartum. The body requires nutritious food to heal and recover after birth. Breastfeeding mothers need even more calories. Crash diets can result in fatigue and reduced energy levels, which is detrimental when caring for a newborn. Moreover, restricting calories can negatively impact milk supply. A safe approach involves reducing caloric intake by 500 calories a day, resulting in a loss of 1 pound a week, especially while breastfeeding or pumping.
The Impact of Weight Gain During Pregnancy
Most pregnant women gain around 22 to 26 pounds (between 10 and 20 kg), with most of it accumulating after the 20th week. This weight comprises the baby's weight, fluid in the uterus, the placenta's weight, and stored fat for breast milk production. While about 13 pounds are typically lost during childbirth and another 5 - 15 pounds in the first six weeks due to water loss, the fat stored during pregnancy requires more time to shed. The more weight gained during pregnancy, the longer it takes to lose it.
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Exercise Precautions After Birth
The desire to return to a regular exercise routine after childbirth is common. However, the pelvic floor muscles, which support the uterus and bladder, may have weakened due to the baby's weight and the hormone relaxin. Start by strengthening the pelvic floor, followed by daily walks, gradually increasing from 15 to 30 minutes. Assuming no complications or C-section, 150 minutes of exercise per week can be incorporated after six weeks postpartum. While core work is important, avoid sit-ups or crunches initially, especially if diastasis recti is present, as these can strain the pelvic floor. Mommy-and-me fitness classes offer the dual benefit of exercise and quality time with the baby.
Weight Loss Injections: An Alternative Approach
Weight loss injections offer a hormone-based approach to shedding excess pounds. They can be a viable option for those who find traditional weight loss methods challenging, providing an effective tool for long-term chronic weight management.
How Weight Loss Injections Work
Weight loss injections, such as semaglutide, increase insulin levels and regulate blood sugar, controlling appetite and cravings. They primarily mimic the effects of GLP-1, a hormone released after eating that regulates blood sugar and signals fullness to the brain. By delaying gastric emptying, these injections prolong fullness, reducing post-meal hunger.
Types of Weight Loss Injections
- Wegovy: FDA-approved for adults with obesity (BMI of 30 or higher) or overweight individuals with weight-related health conditions. It is administered as a weekly injection, starting at a dosage of 0.25 mg, gradually increased over 16 to 20 weeks.
- Saxenda: Another FDA-approved medication that decreases hunger and increases fullness signals. Approved in December 2014, Saxenda is administered as a daily injection, starting at a dosage of 0.6 mg and increasing up to 3 mg daily.
- Zepbound: Approved in November 2023, targets adults with a BMI of 30 or higher. Administered weekly, it activates GLP-1 and GIP receptors, which helps reduce appetite and slow digestion.
- Mounjaro: Contains tirzepatide and acts as both a diabetes management solution and a weight loss tool by mimicking the actions of GIP and GLP-1 hormones.
- Ozempic: Primarily prescribed for managing type 2 diabetes but has gained popularity for its off-label use in weight loss due to its efficacy in managing hunger and appetite.
Benefits of Weight Loss Injections
Injectable weight loss medications generally result in greater weight reduction compared to oral medications or lifestyle changes alone. Patients can expect an average weight loss between 8% to 15% within a year and a half of starting injectable treatments. These injections offer substantial benefits, such as increased energy levels, improved overall health, and better management of type 2 diabetes and cardiovascular risks.
Risks and Side Effects
Weight loss injections can lead to common side effects like nausea, vomiting, and diarrhea, as well as more serious risks including severe allergic reactions, increased heart rate, and potential kidney damage.
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Cost of Weight Loss Injections
Weight loss injections typically cost between $429.65 and $1,430.01 per month without insurance, with potential savings through manufacturer programs or platforms like GoodRx.
Who Can Benefit from Weight Loss Injections?
Weight loss injections benefit individuals with a BMI over 30, or over 27 with related health issues. Patients with diabetes, high blood pressure, or sleep apnea can see significant health improvements.
Breastfeeding and Weight Loss: Examining the Connection
Of all the benefits breastfeeding brings to babies and their mothers, the potential to lose the extra weight pregnancy brings may be on the top of the list for many. Various studies validate that mothers who exclusively breastfeed their infants return to pre-pregnancy weight more quickly than those who don't.
Weight Gain During Pregnancy: A Necessary Process
Weight gain is a natural and recommended part of pregnancy. Healthcare providers recommend a gain of 25-35 pounds while pregnant with one baby and up to 45 pounds for twins. It's not all just baby weight either, and the following list provides average weight changes during pregnancy:
- Baby = 7.5 pounds
- Amniotic fluid = 2 pounds
- Blood = 4 pounds
- Body fluids = 3 pounds
- Breasts = 2 pounds
- Fat, protein, and other nutrients = 6 to 8 pounds
- Placenta = 1.5 pounds
- Uterus = 2 pounds
So much is at work behind the scenes bringing growth and life to your baby. Unfortunately, only 6-8 pounds of that is made up of extra fat that one would hope to lose post-birth!
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The Science Behind Breastfeeding and Weight Loss
Studies indicate that a woman who is exclusively breastfeeding requires an average of 670 extra calories a day because the body is hard at work creating all the nourishment your baby needs to survive and thrive. Therefore, dieting and restricting intake are not recommended while breastfeeding so the body can keep up with its caloric needs. In fact, consuming up to 500 extra calories a day while lactating is recommended. Mothers should consume a high-quality diet full of whole and fresh foods and drink to quench their thirst; it's normal to feel thirsty when nursing! Prenatal vitamins should also be continued while breastfeeding to cover the body's micronutrient needs. However, a caloric deficit often occurs due to the energetic demand of making milk, getting you back to pre-pregnancy weight faster than those who don't breastfeed.
One study compared women who did not breastfeed or breastfed non-exclusively to those that exclusively breastfed for at least three months and found that exclusive breastfeeding resulted in an average of 3.2 pounds more weight loss at 12 months postpartum. Other research also shows that breastfeeding helps with long-term weight loss retention, so the weight isn't as likely to return.
Factors Affecting Breastfeeding and Weight Loss
Some research also suggests that the link between exclusive breastfeeding and postpartum weight loss isn't so clear. There is a multitude of factors that could contribute to a slower weight loss pattern after birth. For one, many women report a significant increase in hunger and appetite while lactating. If they compensate for the energetic demand lactation is generating and no caloric deficit is present, weight loss won't occur. Sleep disturbances and deprivation can also significantly affect your body's metabolism. Moms that exclusively breastfeed typically wake to latch their baby or pump their breasts every 3-4 hours for the first few months of the baby's life, which causes significant disruptions to a natural sleep cycle.
Dietary Intervention and Weight Management in Obese Women
Postpartum weight retention (PPWR) is an important target to improve metabolic health. Women who do not lose weight at this point usually have high BMI later in life. In some women, breastfeeding can support weight loss due to the excessive energy requirements for milk production. In these women, a loss of about 0.5 kilograms (kg) every week does not disrupt lactation. Earlier research has shown the efficacy of dietary interventions such as Lifestyle for Effective Weight loss during Lactation (LEVA) in the postpartum period, even at the primary care level.
The LEVA Study
A study by Ohman, E. A., Fossli, M., Ottestad, I., et al. (2023) examined the effects of dietary treatment postpartum in women with obesity. The study included a small group of 29 women with an average BMI of 40 kg/m2. About 86% of the study cohort were breastfeeding, 59% of whom were exclusively breastfeeding and 28% were partially breastfeeding.
Study participants were assessed at about eight weeks postpartum and after a 12-week period of dietary treatment or control intervention beginning at eight weeks. Regular foods were replaced with similar products containing less sugar and fat. Study participants were also encouraged to participate in exercise using the example of 45-minute walks with the stroller four times every week.
Results of the LEVA Study
By 22 weeks postpartum, 17% of breastfeeding mothers were still exclusively breastfeeding, 57% were partially breastfeeding, and 26.1% stopped breastfeeding. The dietary treatment group lost an average of about 2.3 kg as compared to a gain of about 1.7 kg in the control group at the end of the 12 weeks. In the treatment group, waist circumference and PPWR were also reduced. At one year, fasting blood sugar levels were also lowered.