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
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