Kathy is 17 weeks pregnant, and it’s making her want to vomit.
It isn’t morning sickness triggering her impulse: It is bulimia.
Her eating disorder had begun in college, and for seven years, it ruled her life.
A voice louder than her own good sense and judgment told her, You aren’t worthy of food.
“Purging calmed my mind,” she admits.
She exercised relentlessly to burn off what she did eat.
Depression set inand anxiety.
She couldn’t sleep.
Her stomach hurt from all the heaving.
She hid her problem from her friends and family, drawing herself ever more inward.
During graduate school for social work, Kathy’s obsession with food and weight left little room for studying.
“It was taking up 150 percent of my mental capacity,” she says.
“I thought my eating disorder was going to kill me.
Finally, she got outpatient eating disorder treatment at Park Nicollet Melrose Institute in St. Louis Park, Minnesota.
Even that step made Kathy feel, perversely, like a failure.
“I figured if I were skinny enough, they would have hospitalized me.
Through intensive therapy and nutritional counseling, Kathy slowly got better.
She stopped bingeing and purging, even though she still wanted to.
Soon she met the man who would become her husband.
Getting married made her feel like a normal, healthy person for the first time in her life.
Deciding to get pregnant was another story entirely.
When she got pregnant, Kathy had been in treatment for three years and hadn’t purged for two.
But at 17 weeks, she feels her hard-won recovery is threatened.
She has to choke down even healthy food, like the bagel with peanut butter she eats for breakfast.
“To that, my eating disorder voice says, That’s too many calories, too many carbs.
It will make you gain weight,” she says.
She tries to imagine her growing baby depending on her, even judging her.
“I don’t throw up because the baby would know,” she says.
“Everything I do is influencing that baby, and I want it to be healthy.
[But] the way my body is changing terrifies me.”
Would having a baby make you appreciate your bodyor hate it?
It’s a question many women ponder long before they ever take a pregnancy test.
When women do conceive, manyboth disordered and nondisordered eaters alikeare motivated to eat more healthfully.
“That’s how overwhelming their feelings can be.”
SELF wondered how widespread these emotions are.
But the body-image fears were widespread even in women without that history.
A few even confessed to fasting or cleansing, purging and using diet pills or laxatives.
Fifty-two percentsaid pregnancy made them more insecure about their body image.
Only 14 percent said pregnancy made them more confident.
Seven in tenworried about weight gain.
Women who practice disordered habits do so with hopes of preventing weight gain.
Either way, these habits are a bad idea.
Research shows that despite the risks, about half of doctors fail to assess disordered eating.
And the SELF survey suggests some women aren’t getting basic weight-management advice.
“Doctors report giving more advice than women say they are receiving.”
Women with eating disorders may weigh more than is healthy, too.
Her prepregnancy weight may also impact the baby.
The cause of problems in anorexics is pretty clear: inadequate nourishment.
But why would babies of bulimics and binge eaters suffer, too?
Scientists aren’t sure yet, although they presume it’s tied to what they call nutritional dysregulation.
Many disordered eaters also take up smoking to venture to keep their weight downsome even after they become pregnant.
The encouraging news is that if Kathy does manage to keep on track, she can protect her baby.
Researchers have long believed folic acid is a magic bullet that protected against some of these conditions.
But the Stanford findings suggest it’s only part of the picture.
“In our bodies, nutrients don’t just act in isolation.
They depend on each other.”
Few people knew how poorly Hillary Coggins was eating.
Instead, she says, pregnancy brought on still another disorderbinge eating.
“I took the ‘eating for two’ thing a little too seriously,” she says.
(Even among nondisordered eaters, this attitude is pervasive and problematic, Siega-Riz notes.
Most women need only an extra 300 calories a day.)
A petite 5 feet 3 inches, Coggins weighed 139 pounds at her first prenatal visit.
By the time she delivered her son, she says she topped 200 pounds.
She resisted her strong desire to purge, although a few times she vomited simply because she’d overeaten.
“I’d eat a carton of ice cream, and then I’d throw up.
The weight piled on.
Between weeks 25 and 36 alone, Coggins packed on 30 pounds.
By 37 weeks, she had gained 57 pounds and says she was borderline hypertensive.
But despite the signs of overeating, Coggins says, she received only casual lectures on healthy eating.
The message was: You know what to do.”
Coggins blames herself for her disordered eating.
Like Coggins, they may not understand how dangerous it can be.
Or they may recognize the danger but stay quiet anyway.
“There is still so much prejudice and stereotyping,” Bulik says.
Luckily, Coggins’s son, Jackson, was healthy.
But her disordered thinking continued.
Some women even breast-feed or pumponlyto shed calories, sometimes after the baby is weaned.
This so-called pump purging “is something we have just started to notice,” Bulik says.
Jackson is now 2 1/2 years old, and Coggins weighs 27 pounds more than she did pre-pregnancy.
She wants to trim down, but her disordered eating makes it impossible.
She tends to skip both breakfast and lunch, then “eat everything in sight” around midafternoon.
Now I worry I will never lose all this weight.”
Kathy is in a happier place.
And yet, only two days after she stopped breast feeding, she purged.
It also reminded her to reach out.
When she relapsed after her pregnancy, her husband was an anchor.
“I had all the skills I needed.
I just needed to say out loud my disordered thoughts to a supportive person.
Once I was able to make my rational voice stronger and louder, the symptoms went away.”
Two years later, Kathy has come full circle and is pregnant again.
But the second time around, she hasn’t felt the same urge to purge.
I finally learned how to eat right and to feel at peace with my body as it is.
Life is so much better when my eating disorder voice is quiet.”
All I do is…
Nearly half of women polled use disordered eating to control their weight while preggers.
Exercise too much: 4%.Pregnant women should get 30 minutes of aerobic exercise most days.
But this minority takes it to extremes, risking metabolic effects or injuries that could harm the baby.
Use diet pills or laxatives: 3%.No one should do this, period.
Large percentages of women say that “pregnancy made me more insecure.”
30% of obese women.Big women felt confidence in their baby body.
It depends on what you weigh now.
The Institute of Medicine outlines what’s ideal.
2535 lb for normal-weight women.Got twins on board?
1120 lb for obese women.More than half of obese women polled exceeded the 20-pound limit.
Yet a mere 13 percent of obese women had docs who told them they were gaining too much.
