Words: Annie Ridout
Photo: Barney Beech

Leni White was diagnosed with anorexia at 21, eight years after she first started to experience symptoms. Aged 32, she attempted to conceive her first child but discovered she was infertile. “It wasn’t 100 per cent due to my eating disorder,” she says, “but I’m sure it contributed”. She managed to conceive by IVF and went on to give birth to a healthy baby boy.

A study commissioned by The National Institute for Health and Care Excellence (NICE) found that a large proportion of women meet the diagnostic criteria for an eating disorder during pregnancy, with nearly a quarter of women experiencing ‘high weight and shape concerns or eating disorder behaviours at clinical level’.

Where once anorexia was thought to prevent pregnancy, it seems that increasingly, women are managing to conceive in spite of having the disorder. Bridget Benelam, senior nutrition scientist for the British Nutrition Foundation, explains that “having a very low level of body fat as a woman can lead to irregular periods and prevent ovulation”. However, she says that if women with a BMI of less than 19 can increase their bodyweight, their fertility might improve.

White was delighted to eventually conceive and thought she was in remission from her earlier anorexia, but discovered that her mindset was still in some ways affected by the condition, making pregnancy a confusing time: “I found the combination of having to eat healthily and control alcohol and meds quite challenging. I felt very guilty for the entire time because of that”.

But on the other hand, she felt as if pregnancy gave her a more relaxed attitude towards eating. “It was the only time I felt ‘allowed’ to eat normally, because I wasn’t just doing it for me,” she says, “I was able to just switch that part of my brain off somehow because I knew it was only temporary.”

A spokesperson from Beat, the UK’s eating disorder charity, explains that for many women with eating disorders, who may have been told that their fertility has been affected, “it can be a shock to discover that they are still able to have a family. The feeling of lack of control over their changing body shape can dominate what should be a happy and fulfilling time in their lives

It’s a time when women are in full view and are a source of much attention. Some feel liberated by their changing shape and others feel petrified

“Some people find that becoming pregnant helps them to come to terms with their body for the first time – they can finally understand that it has a real purpose, and they can develop healthy eating behaviours for the baby’s sake. Others find that the sense of their body being ‘out of control’ gets even stronger, and find it much more difficult to cope.”

White felt the loss of control was in some ways a positive: “It felt like control had been taken over by my body,” she says, “it was like having a holiday from the constant intrusive thoughts. I knew people would expect to see my belly grow, so I didn’t need to hold it in anymore like I would normally.”

Counsellor, psychotherapist and body image specialist Holli Rubin says that it is not only those with an eating disorder who find the physical changes difficult during pregnancy. “It’s a time when women are in full view and are a source of much attention. This impacts every woman differently. Some feel liberated by their changing shape and others feel petrified.”

The average UK woman gains 22-26 lbs during pregnancy; this can be particularly tough for those suffering with an eating disorder. Despite knowing the implications of not maintaining a healthy diet, Rubin says that sometimes “[women] are not able to alter their eating habits and do put their babies at risk by not adequately feeding them and consequently affecting their growth and development.”

However, she says that for some, “having a baby can remove the focus from paying too much attention to controlling weight and what is being eaten and positively redirect attention to the newborn and his/her needs, which is to be fed and nourished, especially in those very early days.” She says that if the mother can focus on bonding with her baby, the hope is she can derive pleasure from that experience and not need to fixate on her own weight.

And then there’s the issue of losing ‘baby weight’ after the birth. For White, it was the post-birth period that caught her off guard. “I had a really difficult time with breastfeeding and I also had post-natal depression (PND) so I over-ate massively to distract myself from the guilt. I was disgusted by my body and because we weren’t very successful with breastfeeding I didn’t lose the weight I’d gained, in fact I kept eating and drinking too much alcohol and kept gaining.”

Rubin says that the pressure to snap back into shape soon after giving birth is, in part, associated with celebrities showing us how quickly they managed to do it. But, she notes, they have full time staff, trainers, chefs, et al. For the average woman, the pressure exists but the goal is less realistic. “Women have enough to adapt to,” she says, “the pressure to lose the baby weight is an added one that they really do not need.”

Advice for those affected…

If a woman with an eating disorder finds she is pregnant, Beat advises she to talk to her GP or counsellor and to alert the midwife to her situation.

During pregnancy, there is nothing more important than what you put into your body. It can be a drain on physical wellbeing so it is important to eat a well-balanced meal and stay hydrated with plenty of fluids.

If you have a friend or loved one who you think has a problem – get help, get support and talk to them. Show understanding and empathy, rather than blaming or shaming.

Beat offers support anonymously through their helplines and message boards at
b-eat.co.uk; 0845 634 1414

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