Through my work as an eating disorder therapist practicing in Los Angeles, I have helped many women in different stages of eating disorder recovery. I am always amazed by the strength of my clients who challenge their thoughts and behaviors and eventually beat their eating disorders for good.

For many clients, creating a family is a primary goal of recovery. However, weight gain during pregnancy and the postpartum period pose a real challenge for them. Their ongoing struggles with body image, feelings of loss of control, and stress might lead them to remission or exacerbate their symptoms.

A few months ago, I met Jana (not her real name) for the first time in my Torrance counseling office. She was a vibrant young woman in her early 30s with an executive job at a law firm. When we first met, Jana was 7 weeks pregnant. She told me that she wanted counseling for personal growth and did not mention a specific goal for our work. Jana did, however, share with me her excitement about becoming a mother. Besides some common miscommunications with her husband, she did not disclose any concerns during her pregnancy.

It wasn’t until our fourth session that Jana spoke of a darker part to her pregnancy. Shortly after conception, her eating disorder thoughts returned, stronger than ever. The first trimester was the most challenging time of her life, due to her rapid weight gain. She was in tears telling me how ashamed she felt, obsessing about restricting during this supposedly “joyful” period of her time.

Jana had struggled with anorexia nervosa throughout her adolescent years. She was hospitalized for medical stabilization when she was 17 and recovered in her early twenties, after years of treatment. She was shocked to witness how her eating disorder thoughts were coming back after years of recovery. She hasn’t relapsed yet but she told me she was obsessed with calories and how much she was eating.

Prevalence of Eating Disorders During Pregnancy

Jana is not alone in struggling with eating disorders during pregnancy. A study published by European Eating Disorder Review found that 7.5% of women meet diagnostic criteria for eating disorders during their pregnancy. This number is probably an underestimation. Many women are reluctant to share their eating disorder behaviors due to the stigma associated with having a mental illness.

During pregnancy, 23.4% of women have serious concerns about their shape, 8.8% struggle with binge eating, and 2.3% engage in regular compensatory behaviors. The first trimester is quite difficult for many women with a history of eating disorders. It is normal to gain appetite during the first trimester, but it might trigger an out-of-control feeling in women with a history of an eating disorder history.

Risks of Eating Disorders During Pregnancy

Having an unmanaged eating disorder during pregnancy may have several physical and psychological implications for the mother and the fetus. Mothers with anorexia nervosa and bulimia nervosa have an elevated risk of unplanned pregnancies and birth complications. Those with anorexia nervosa have a higher risk of premature delivery. Scientific studies show that calorie restriction and the binge/purge cycle during a woman’s pregnancy may impact her child’s development and health.

Suffering from a binge eating disorder during pregnancy is tied to excessive gestational weight gain. Finally, women with eating disorders are at a greater risk of miscarriage than other mothers.

Strategies to Manage Eating Disorders During Pregnancy

For all these reasons, it is important to be proactive about your eating disorder thoughts and behaviors before or early in pregnancy. Your first step is to talk to your physician openly about your eating disorder and your current concerns. Many women hide their worries from their physicians because of their fear of not getting good medical care if they disclose their vulnerability. However, accurately describing your behaviors will allow your doctor to provide you with the care required to ensure your success on your journey. Talking about your eating disorder rather than acting on it will help you process your emotions.

In fact, this would be an ideal time to resume therapy to receive additional support from an eating disorder therapist. Together with them, you can come up with a list of potential triggers. One might be your periodic physical examinations. You can also explore potential solutions. For example, many of my pregnant clients that I see in my office in Los Angeles do not want to know their weight. Hearing their weight during prenatal visits triggers their eating disorder thoughts. When they know the reasons behind your not wanting to know the weight, many physicians will honor the request. You can tell your doctor to let you know if there is a concern but otherwise not to share the number with you.

If you feel uncomfortable disclosing your eating disorder to your doctor, you may ask your eating disorder therapist to advocate for you.It is essential to tell your partner about your eating disorder thoughts. You must be explicit about the support you might need from them. Many people do not have a clear understanding of eating disorders and recovery. They might not be able to support you constructively if you are not explicit about your needs. If purging is an issue, you might ask them to engage in a distracting activity for about an hour after each meal. To help address Jana’s urge to restrict, we invited her partner to join a session. We informed him of the strength of Jana’s eating disorder thoughts and explored how he could support her throughout her pregnancy. He offered to prepare and serve most meals to her to make sure that the eating disorder would not take charge of her pregnancy. Jana reported that eating with him reassured her that her eating disorder would not dictate her eating habits.

Above all, make your emotional well-being a priority. Many women I work with notice an increase in binge eating behaviors from emotional hunger, not physical hunger. It is important to ask yourself whether you are hungry every time you feel like eating. People often eat to manage their anxiety, fatigue, or excitement. By addressing the true need, you can meet it without triggering your eating disorder.