Most people know the “typical” eating disorder patient: adolescent girl, over-achiever, perfectionist. This is an accurate description, since most patients with diagnosed eating disorders and patterns of disordered eating are females between the ages of 10 and 20. Currently, it is estimated that 1% of adolescent girls have anorexia. Nearly 30% of adolescent girls have disordered eating attitudes and behaviors, while not meeting the criteria for diagnosis of an eating disorder.

Women are three times more likely to develop an eating disorder than men. Recent reports indicate that the lifetime prevalence of anorexia is 0.6%, bulimia, 1%, and binge-eating disorders, 2.8%. While most of these cases do occur during adolescence, the face of the eating disorder patient is changing. Women are now experiencing disordered eating and body image issues much later in life — through early adulthood, pregnancy and motherhood, and midlife.

While all eating disorders pose serious mental and physical health risks to the patient, eating disorders throughout pregnancy and motherhood are particularly concerning, since the patterns of disordered eating may also pose health risks to the child. Some women with disordered eating may easily be able to cope with the weight gain and body changes associated with pregnancy, because they are able to put the health of the baby first. Others still may find ways to control their eating and weight gain, risking the health — and possibly life — of their unborn child. Disordered eating during pregnancy may lead to dehydration, cardiac abnormalities, diabetes, depression, and labor complications for the mother. Likewise, the baby may experience slowed development, premature birth, low birth weight, respiratory distress, and feeding difficulties.

Women who are able to maintain healthy eating patterns during pregnancy may still be at risk for disordered eating during the transition into new motherhood. A recent study found that some women with pre-existing eating disorders were “desperate,” according to the survey, to return to their controlled, disordered eating practices. These women chose not to breastfeed their infants, allowing them to return more quickly to restrictive eating and intense exercise routines. Still other women chose to breastfeed for entirely the same reasons; they viewed nursing as a faster way to lose weight and would permit themselves to eat treats that they would not otherwise allow.

Women with a history of eating disorders were also more likely to experience depression in the postpartum period, not just a recurrence of the eating disorder. Postpartum depression, as well as eating disorders, can lead to serious complications for mothers, children, and entire families. Maternal-child bonding is impaired and the child is at risk for insufficient care and feeding.

Even women who did not have symptoms of eating disorders prior to pregnancy may experience eating disorders in the postpartum period. New mothers often experience extremes of stress, emotion, and exhaustion. For many new mothers, this is the first time they have experienced any lack of control over their lives and their bodies and they may find themselves seeking to gain some control through management and manipulation of their eating habits and weight loss. The consequences of disordered eating habits can lead to obvious health problems: malnutrition, dehydration, heart failure, even death. Researchers are now finding that mothers with eating disorders may place their children at increased risk for developing an eating disorder, also.

On the other hand, one study found some women whose eating practices improved after becoming a mother. This was likely due to a decrease in impulsive and self-destructive attitudes seen as women mature and become mothers. However, these same mothers did not have a satisfactory body image, even though they did not exhibit symptoms associated with disordered eating. Still, researchers found that motherhood had an overall positive effect on disordered eating.

The stress of motherhood and the corresponding body changes lead to depressive symptoms for many women, including eating and body image disorders. Add to this the ever-present notion that women should have it all and be it all, and the rail-thin celebrity moms on every television show and magazine cover, and it is no wonder mothers are at risk for unhealthy eating behaviors and attitudes. Health care providers routinely screen for postpartum depression, but providers are critical to the evaluation of disordered eating practices. Unfortunately, there is little research to support standard treatment regimens in pregnant and postpartum women, once diagnosed. The best treatment likely remains a multidisciplinary approach, in which women can be open and honest about their fears, concerns, and anxieties about motherhood and family members and health care providers provide support, encouragement, and education for the new mom.

References

Adair, C.E., Marcoux, G.C., Cram, B.S., Ewashen, C.J., Chafe, J., Cassin, S.E., Pinzon, J., Gusella, J.L., Geller, J., Scattolon, Y., Fergusson, P., Styles, L., Brown, K.E. (2007). Development and multi-site validation of a new condition-specific quality of life measure for eating disorders. Health and Quality of Life Outcomes, 5(1), 23. DOI: 10.1186/1477-7525-5-23

Astrachan-Fletcher, E., Veldhuis, C., Lively, N., Fowler, C., Marcks, B. (2008). The Reciprocal Effects of Eating Disorders and the Postpartum Period: A Review of the Literature and Recommendations for Clinical Care. Journal of Women’s Health, 17(2), 227-239. DOI: 10.1089/jwh.2007.0550

Mazzeo, S.E., Slof-Op’t Landt, M.C., Jones, I., Mitchell, K., Kendler, K.S., Neale, M.C., Aggen, S.H., Bulik, C.M. (2006). Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. International Journal of Eating Disorders, 39(3), 202-211. DOI: 10.1002/eat.20243

Stapleton, H., Fielder, A., Kirkham, M. (2008). Breast or bottle? Eating disordered childbearing women and infant-feeding decisions. Maternal & Child Nutrition, 4(2), 106-120. DOI: 10.1111/j.1740-8709.2007.00121.x

von Soest, T., Wichstrøm, L. (2008). The impact of becoming a mother on eating problems. International Journal of Eating Disorders, 41(3), 215-223. DOI: 10.1002/eat.20493

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