Postpartum Diet Culture: How Ideals of Thinness Are Increasing Stress and Postpartum Weight Retention for Minority Birthing Populations

For the last century, global stigmatization of heavier body types has progressively worsened. As a result, women of all age, race, ethnicity, and religion continue to face unrelenting pressures to meet social ideals of thinness. This often leads them to adopt hurtful social messages that associate weight gain with “failure, weakness, gluttony, laziness and other moral failings” [1]. Internalization of these societal expectations for body type is linked to damaging psychological and physical health outcomes. 

Idolization of ultra thin body types poses a significant risk for pregnant women, who experience gestational weight gain. Despite the fact that pregnant women spend nine months eating for two, mothers are continuously told they aren’t dropping their postpartum weight fast enough. In addition to adjusting to life as a new mother, birthing women experience greater “depressive symptoms, daily stress, and maladaptive dieting behavior” as a result of these pressures [2]. In a survey of 501 pregnant and postpartum women in 2017, the number of sources of weight stigma endorsed was significantly associated with depressive symptoms and perceived stress. These stress-inducing stigmas were also shown to have a direct association with more emotional eating behavior, making it even more difficult for mothers to lose weight the year following delivery. This goes to show that postpartum diet culture may actually be the cause of higher rates of postpartum weight retention (PPWR) in our generation. 

However, stress regarding postpartum diet culture does not seem to be uniform across the diverse population of birthing women. In a study conducted by Jacqueline Kent-Marvick and her colleagues at the University of Utah, they found that race and education level were two of the most prominent structural determinants predicting postpartum weight retention [3]. Higher weight retention was specifically observed in African American populations and among individuals with lower levels of education. This can be attributed to a variety of factors, including access to healthy and nutritious food as well as access to outdoor spaces for physical fitness. Another contributing factor may be the deeply rooted medical distrust among African American patients, stemming from the historic mistreatment of minority women in obstetric care. This highlights the need to address racism as a chronic and persistent stressor linked to high PPWR [4].

The psychological risks driven by postpartum diet culture also impact hormone systems, which are closely associated with increased morbidity. Stress and glucocorticoids, for example, are directly linked to food consumption patterns, particularly choices high in fat and sugar content [5]. In turn, these stress-induced spikes in cortisol levels for postpartum women elevate the risk for obesity-related conditions such as high blood pressure, type 2 diabetes, and ischemic heart disease [6].

Pregnant women, who are already a vulnerable population, deserve support through societal efforts to confront demographic stressors that contribute to weight retention, rather than being burdened by unrealistic postpartum weight loss standards. This support can take many forms, including subsidized nutritious foods, greater access to postpartum psychiatric care, and the integration of telehealth nutritionists for both pre- and postpartum patients. By shifting the focus away from idealized standards of thinness, we can mitigate the negative effects of postpartum diet culture and reduce stress-related postpartum weight retention, ultimately promoting better mental and physical health outcomes for mothers worldwide.

Reviewed by Makalya Gorski

Graphic by Monic Rashkov

References

[1] Li, M., Yu, X., Zhang, W., Yin, J., Zhang, L., Luo, G., Liu, Y., & Yang, J. (2023). The association between weight-adjusted-waist index and depression: Results from NHANES 2005–2018. Journal of Affective Disorders, 347, 299–305. https://doi.org/10.1016/j.jad.2023.11.073

[2]  Rodriguez, A. C. I., Schetter, C. D., Brewis, A., & Tomiyama, A. J. (2019). The psychological burden of baby weight: Pregnancy, weight stigma, and maternal health. Social Science & Medicine, 235, 112401. https://doi.org/10.1016/j.socscimed.2019.112401. 

[3] Kent-Marvick, J., Cloyes, K. G., Meek, P., & Simonsen, S. (2023). Racial and ethnic disparities in postpartum weight retention: A narrative review mapping the literature to the National Institute on Minority Health and Health Disparities Research Framework. Women's Health, 19, 17455057231166822. https://doi.org/10.1177/17455057231166822. 

[4] Chatlani, S. (2024). Focusing on maternity and postpartum care for Black mothers leads to better outcomes. Monitor on Psychology, 53(7). https://www.apa.org/monitor/2022/10/better-care-black-mothers.  

[5] Hewagalamulage, S. D., Lee, T. K., Clarke, I. J., & Henry, B. A. (2016). Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domestic animal endocrinology, 56 Suppl, S112–S120. https://doi.org/10.1016/j.domaniend.2016.03.004

[6] Vicennati, V., Pasqui, F., Cavazza, C., Pagotto, U., & Pasquali, R. (2009). Stress‐related development of obesity and cortisol in women. Obesity, 17(9), 1678–1683. https://doi.org/10.1038/oby.2009.76

Cereal Offenders: Exposing Gluten's Health and Societal Impact

Let's put a protein on the stand: gluten. This composite found in wheat, barley and rye, has become the topic of focus surrounding health and nutrition. With the rising cases of allergies and a third of Americans adopting less gluten in their lifestyle, we need to understand the implications of this abundant substance [3].

First, let's examine the different faces of gluten-intolerance:

Celiac Disease is an autoimmune disorder where ingestion of gluten leads to small intestinal damage. This damages nutrient absorption and leads to symptoms like weight loss, fatigue, and diarrhea. The only effective treatment is a strict, lifelong gluten-free diet [1].

Wheat Allergies involve an allergic reaction to proteins found in wheat. These symptoms can range from hives and nasal congestion to anaphylaxis [1].

Non-Celiac Gluten Sensitivity (NCGS) is described through gastrointestinal symptoms related to gluten ignition for individuals that don't have celiac disease or a wheat allergy. Symptoms may include abdominal pain, bloating, fatigue, and headache. NCGS doesn't cause intestinal damage and we don't quite understand its pathophysiology [2].

Recently, research has found the potential role of the nocebo effect — the phenomenon where negative expectations of a substance cause adverse effects — in NCGS. A Lancet study explored the influence of expected versus actual gluten intake on the symptoms of patients with NCGS and found that negative expectations of gluten can exacerbate symptoms leading to a nocebo effect. Yet, future studies are needed to determine the exact role of personal expectations in promoting NCGS prevalence [2].

The increase in allergies related to gluten sensitivity has left healthcare professionals stumped while simultaneously popularizing the gluten-free diet [5]. The significant rise in Americans adopting gluten-free diets has been driven more by misconceptions of health benefits than by medical necessity. While medical professionals and scientists continue to investigate the reasons behind the recent surge in gluten sensitivities, marketing and advertising have capitalized on the increase in gluten allergy symptoms by promoting gluten-free foods as healthier alternatives. This trend reflects societal diet culture dynamics, where products are marketed as healthy through word of mouth and advertising, often outpacing the scientific community and data-based evidence [3].

Though gluten-free foods are becoming popular, accessibility and availability has not been uniform across all communities. Areas with limited food access lack gluten-free options and often portray the gap in food inequities which make it challenging for individuals with celiac disease or gluten disorders in underrepresented regions to obtain their dietary needs. This coupled with the rising expenses of gluten-free products due to the demand, places a financial burden on those who medically require these alternatives [4].

While gluten is a harmless protein for the majority of people, it poses significant challenges for individuals with celiac disease, wheat allergy, or NCGS. The potential influence of the nocebo effect in NCGS individuals highlights the need for a greater understanding of the effects that gluten can have on the body, as well as the importance of studying cultural dietary choices  and their impact on human health. As gluten-free foods are becoming more prevalent, we must critically address existing food inequity issues to ensure all individuals have access to the dietary options needed for their well-being.

Reviewed by Nick Hoffmann

References

1. Leonard, M. M., & Vasagar, B. (2014). US perspective on gluten-related diseases. Clinical and Experimental Gastroenterology, 7, 25–37. https://doi.org/10.2147/CEG.S57816

2. de Graaf, M., et al. (2016). Gluten and non-coeliac gluten sensitivity: The nocebo effect and future avenues. The Lancet Gastroenterology & Hepatology, 1(2), 86–94. https://doi.org/10.1016/S2468-1253(16)30087-5

3. NYU Langone Health. (2015). One-third of Americans are trying to avoid gluten—but is it the villain we think it is? NYU Langone News. Retrieved from https://nyulangone.org/news/one-third-americans-are-trying-avoid-gluten-it-villain-we-think-it-is

4. The Sun. (2023). Aldi issues urgent 'do not eat' warning and urgently recalls hundreds of tins over dangerous health risks. The Scottish Sun. Retrieved from https://www.thescottishsun.co.uk/health/13693999/aldi-tuna-fish-recall-gluten-coeliac-disease/

5. Leonard, M. M., & Vasagar, B. (2014). US perspective on gluten-related diseases. Clinical and Experimental Gastroenterology, 7, 25–37. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3908912/#:~:text=The%20incidence%20of%20allergy%20and,related%20disorders%20are%20no%20exception

Gut Health in Full Vibrancy: Colorful Food, Colorful Health

At Duke, we’re constantly exposed to cutting-edge research that reshapes our understanding of health. One area that has gotten significant attention recently is the gut microbiome. The gut microbiome is a complex community of bacteria, fungi, and viruses in your digestive tract. These microorganisms play an essential role in everything, from digestion and metabolism to your immune system and mental health. Taking care of your gut is key to feeling your best, and it turns out that one of the easiest ways to support a healthy gut is by eating colorful foods.

Here, we’ll explore how eating a variety of colorful fruits and vegetables can nurture your gut microbiome and promote overall health.

What’s the Gut Microbiome and Why Does It Matter?

The gut microbiome is often referred to as your “second brain” because of its incredible influence on your body. It’s made up of trillions of bacteria and other microorganisms that help digest food, produce vitamins, protect against harmful microbes, and even influence mood and cognitive functions (Gibson, Hutkins, & Sanders, 2017). Think of it as a busy ecosystem inside your digestive system where bacteria interact, grow, and produce substances that are vital for your health.

When your microbiome is in balance, it promotes good digestion, strengthens your immune system, and helps you maintain a healthy weight. However, when it becomes imbalanced, often due to poor diet, stress, illness, or medications, it can contribute to various issues such as bloating, gas, poor digestion, weight gain, or even anxiety and depression (Gibson et al., 2017). 

That’s why looking after your microbiome is crucial, and one of the simplest ways to do that is through your diet. The more diverse and colorful the foods you eat, the better you’re feeding your gut bacteria, which in turn boosts your overall health. Let’s dive into why colorful foods are so beneficial for your microbiome.

Eating the Rainbow: Why Colorful Foods Matter for Gut Health

The phrase “eating the rainbow” isn’t just a catchy saying, it’s a powerful concept that can help you improve your gut health. Each color in fruits and vegetables represents a different set of nutrients and antioxidants that support your body in unique ways. By incorporating a variety of colorful foods into your diet, you’re giving your gut a wide range of nutrients that help different strains of bacteria thrive. Here’s a closer look at how some colors specifically benefit your microbiome.

Red and Orange Foods: Antioxidants and Inflammation Fighters

Red and orange foods like tomatoes, bell peppers, carrots, and sweet potatoes are full of antioxidants, particularly beta-carotene and lycopene. These compounds help protect your gut from oxidative damage and inflammation, both of which can disrupt the delicate balance of your microbiome (Zhao, Yang, & Liu, 2014). Lycopene, for example, found in foods like tomatoes and watermelon, has been shown to reduce gut inflammation, which is linked to various chronic conditions like inflammatory bowel disease (IBD) (Srinivasan, Zhang, & Reynolds, 2015). Beta-carotene, which is abundant in foods like carrots and sweet potatoes, is similar to Vitamin A, which helps regulate the immune system and maintain the integrity of the gut lining (Staudinger, Georgieva, & Sadeghi, 2020).

Eating red and orange foods doesn’t just support your gut microbiome, it also encourages the growth of beneficial bacteria that help your body absorb nutrients and fend off harmful microbes. The increased diversity of your gut flora boosts immune function and overall health, which is crucial for preventing digestive issues and supporting your general well-being.

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Green Foods: Fiber and Gut Healing

Green vegetables like kale, spinach, broccoli, and brussel sprouts are often referred to as “superfoods” for good reason. These foods are packed with fiber, a feast for the bacteria in your gut, particularly those that break down plant-based food. These bacteria, such as Bifidobacterium, thrive on fiber, which promotes a healthy and diverse microbiome.

But it’s not just fiber that makes green vegetables so important for gut health. They also contain chlorophyll, the pigment that gives them their color. Chlorophyll has been shown to reduce inflammation in the gut and support the growth of beneficial gut bacteria, improving digestion and immune response (Franzosa, Sirota-Madi, & Avila-Pacheco, 2019). By eating more leafy greens, you're supporting a healthy gut environment that’s crucial for nutrient absorption and a well-functioning immune system (Basu, Rhone, & Rhone, 2017).

Purple and Blue Foods: Potent Antioxidants for Protection

Purple and blue foods like blueberries, purple cabbage, eggplant, and plums are loaded with anthocyanins, a class of powerful antioxidants that have anti-inflammatory effects and help protect your gut lining. Anthocyanins give these foods their vibrant colors, and they play a vital role in reducing oxidative stress and promoting gut health (Basu et al., 2017).

Research has shown that these antioxidants not only protect your digestive system from harmful free radicals but also encourage the growth of healthy bacteria like Lactobacillus and Bifidobacterium, which play important roles in digestion, immunity, and gut barrier function. Regular consumption of blue and purple foods has been linked to improved gut health and a reduced risk of gut-related diseases such as irritable bowel syndrome (IBS) and colorectal cancer (Gao et al., 2019).

By adding more blueberries, purple cabbage, or eggplant to your diet, you’re not only enhancing the diversity of your gut microbiome but also taking steps toward preventing long-term gut damage.

White and Brown Foods: Supporting Good Bacteria

While colorful fruits and vegetables often steal the spotlight, foods that are white or brown—like garlic, onions, and mushrooms—are equally important for gut health. These foods are rich in prebiotics, which are special types of fiber that feed the good bacteria in your gut. Garlic and onions, for example, contain inulin, a type of fiber that supports the growth of beneficial gut bacteria like Bifidobacterium and Lactobacillus.

Mushrooms, especially varieties like shiitake and maitake, contain compounds called polysaccharides that not only help regulate the immune system but also support gut health by promoting the growth of healthy bacteria. Including these foods in your diet will help maintain a balanced and thriving microbiome.

The Bottom Line: Eat Colorful Food for a Healthy Gut

So, what’s the takeaway? Eating a variety of colorful fruits and vegetables is one of the simplest yet most effective ways to nourish your gut microbiome. Each color offers different nutrients and antioxidants that support a healthy, diverse population of gut bacteria. By feeding your gut with the nutrients it craves, you’re helping it stay balanced, resilient, and efficient– leading to better digestion, improved immunity, and a happier, healthier you.

Next time you’re planning your meals, remember to keep the mentioned colors and foods in mind. Your gut, body, and mind will thank you for it.

Reviewed by Alec Vazquez-Kanhere

Graphic by Monica Rashkov

References

[1] Basu, A., Rhone, M., & Rhone, J. (2017). Blueberries and anthocyanins: Implications for human health. Journal of Nutritional Biochemistry, 49, 72-79. https://doi.org/10.1016/j.jnutbio.2017.02.007 

[2] Franzosa, E. A., Sirota-Madi, A., & Avila-Pacheco, J. (2019). Gut microbiome structure and function are correlated with diet and health in the US population. Nature, 570(7762), 466-471. https://doi.org/10.1038/s41586-019-1367-1 

[3] Gao, Y., Yang, Y., & Zhang, J. (2019). The role of anthocyanins in gut microbiota health and inflammation: A review. Microorganisms, 7(8), 255-264. https://doi.org/10.3390/microorganisms7080255 

[4] Gibson, G. R., Hutkins, R., & Sanders, M. (2017). The microbiome and health: A review of current science. Nutrients, 9(9), 937. https://doi.org/10.3390/nu9090937 

[5] Srinivasan, M., Zhang, J., & Reynolds, M. (2015). Carotenoids and their impact on gastrointestinal health: Mechanisms and clinical relevance. Journal of Clinical Gastroenterology, 49(2), 97-107. https://doi.org/10.1097/MCG.0000000000000335 

[6] Staudinger, J., Georgieva, M., & Sadeghi, N. (2020). The role of vitamin A in gut health and immune function. Nutrients, 12(11), 3436. https://doi.org/10.3390/nu12113436