Weight Loss Post-Partum

Nutrition Counseling For Helping The Postpartum Woman

Lose Weight

Nutrition guidelines for weight loss postpartum are similar to those for pregnancy for both the breastfeeding and non-breastfeeding woman. The patient is likely to have had nutrition counseling during her pregnancy, so may not need very detailed instruction, but review of the basic nutrition principles and exercise guidelines is important.

Do nutrition and weight evaluation.

The weight goal is to return to the patient’s prepregnancy weight, unless the patient was overweight before her pregnancy and a different goal is agreed upon by the provider or nutritionist and patient. Weight loss should be gradual, about one to two pounds per week or less.

Important to teach on first visit:

Exclusive breastfeeding will help the patient lose weight that was gained during pregnancy, but emphasize to the patient that this isn’t ‘license’ to eat excess – some women make the mistake of thinking they can eat liberally, then they end up gaining weight rather than losing

The woman who is only breastfeeding (without giving formula) is more likely to lose weight more easily than the non-breastfeeding woman, but if the non-breastfeeding woman puts proper attention to diet and regular exercise, she will be able to return to her prepregnancy weight.

Review exercise level - 30 to 60 minutes per day of walking is recommended, most days of the week (unless atypical discomforts or contraindicated by doctor; other types of exercise may be OK; the walking should be in addition to regular chores); it is important for exercise to be regular, and it should be a lifetime habit for overall physical and mental health; regular exercise is important for preventing weight gain, and for preventing diseases such as diabetes, hypertension, heart disease, etc.

Eat 3 meals per day. Don’t skip meals. Snacks between meals are optional for the non-breastfeeding woman, but when exclusively breastfeedingit is recommended to eat 3 meals and 2 or 3 snacks per day

To avoid deficiencies and help with weight loss - it is important to avoid processed foods that are low in nutrition and eat foods that are rich in nutrition (this is also important even if they are already at their desirable weight)

Foods that usually have no nutrition or very little nutrition are sugary foods and sugary drinks. They should be avoided. (point out those eaten on their food recall or food diary)

Also, limit fruit juice to 4 ounces per day or less - fruit juice will ruin the appetite for more nutritious foods (point out any excess fruit juice they drank on their food recall or food diary)

Give them a list of sugary foods and sugary drinks that should be avoided – it is best to keep these out of the house so they are not a temptation:

cakes, cookies, candies ,ice cream, chocolate, sweet breads, lollipops,

popsicles, Jello, flan, sugary cereals, flavoredyogurts,(Hispanic favorites:

’pan dulce’, ‘arroz con leche’),

and sugary drinks:

soda , Gatorade, Koolaid, fruit punch, Sunny Delight , Tampico, Tang,

Caprisun, lemonade, instant iced tea from powder, bottled iced tea,

Powerade, Kern’s, Schnapple,Quik, ‘high energy drinks’,(Hispanic favorites:

‘agua de jamaica’, ‘agua de tamarindo’ , ‘horchata’, ‘maicena’, ‘atole’,

‘champurrado’, ‘Chocomil’, ‘Jackult’ ‘aguas de fruta’,

“and there’s many more”

May be important to teach on the first visit:

Teach the WIC Daily Food Guide for Pregnancy/Breastfeeding (Guia de Alimentacion Diaria) - the guide for how to eat during pregnancy is the same as the guide for breastfeeding: but, if not breastfeeding, reduce by one the number of recommended servings from the grain group and by onethe protein group. Emphasize that these recommended amounts be eaten as a minimum

Refer to servings needed as a minimum on a daily basis

Emphasize avoiding sugary foods and drinks and limiting fruit juices to

4oz per day or less

Healthy foods are divided into 5 different food groups: (point to handout and appropriate columns as you teach the principles i.e. ‘servings needed’ column and ‘serving sizes’ column

Fruits - 2 or more every day

Vegetables - 3 servings or more daily

Grains –7 servings or more daily if breastfeeding (6 servings or more if

not breastfeeding or if transitioning off breastfeeding)

Preferably whole grains –this is not always addressed on the first visit in order not to overwhelm the patient; you can address whole grains on the first visit or on a follow-up visit depending on time, patient’s educational level, etc.

Milk & Milk products---3 servings or more daily

Check and see if they use whole (3.5%), reduced fat (2%),

lowfat (1%) or nonfat milk (0%)

Encourage to change to lowfat or nonfat milk

If low in the milk group, and depending on time, patient’s educational level, etc. discuss the importance of calcium for her bone health/strength for the mother. Ask her if she knows what nutrient/mineral in the milk group (calcium) is important and why it is important. During breastfeeding much calcium is used for milk production - thus, it is important that they consume the 3 recommended servings daily

Protein - 3 servings or moreif breastfeeding (2 servings or more if not

breastfeeding or if transitioning off breastfeeding)

Choose foods lower in fat more often. Ask them if they know which foods are high in fat. Wait for response. Give them examples of high fat foods (butter, oil, cream, margarine, lard, fried foods, red meats) and low fat foods (vegetables, fruits, legumes, chicken, nonfat milk). Use lowfat cooking methods (bake, broil, roast, barbecue, steam, poach) or use only small amounts of fat in cooking.

If you are eating the minimum number of recommended servings on the Daily Food Guide, and not eating sugary foods or sugary drinks or more than 4 ounces of fruit juice per day, and doing the recommended amount of exercise, and still not losing weight, you can further limit fats and high fat foods, or increase the level of exercise. If this still doesn’t result in appropriate weight loss you can reduce the number of grains eaten to 4 to 6 per day (if breastfeeding), or the number of protein group to 2 to 2 ½ per day (if breastfeeding). If not breastfeedingyou can reduce the number of grains eaten to 2 to 5 per day, or the number of protein group to 1 to 1 ½ per day. If you do reduce intake of the recommended amounts on the Daily Food Guide your daily prenatal vitamin or other daily multivitamin with mineral supplements will help reduce the chance for developing nutrient deficiencies

Sugary foods and drinks and too much fruit juice will hamper the goal to

return to prepregnancy weight and may cause further weight gain

(as well as being a major cause of nutrient deficiencies)

Eating the daily recommended 3 servings of vegetables is an important

source of fiber, phytochemicals (plant chemicals), antioxidants, vitamins

and minerals, and helps with weight management

The importance of exercise:

-along with proper diet, it helps to lose weight that was gained during the pregnancy

-helps all the body’s hormones work better, we feel better, and have less chance of developing diabetes, hypertension, heart disease, etc.

-after achieving the prepregnancy weight or other goal weight, exercise is important to help maintain that weight; maintaining a normal weight is important to help prevent diabetes, hypertension, heart disease, etc.

Optional teaching for first visit:

If you avoid sugary foods and sugary drinks and fruit juice, you will have more appetite for the nutritious foods found on the Daily Food Guide (point to all the foods on the handout). That will result in a better health with less chance of infections, discomforts, illness, etc.

Water is the best beverage.

Have fruit available/eat fruit instead of the sugary foods or drinks.

If you are not used to eating vegetables, try different vegetables and different vegetable recipes. If you like only 1 or 2 or 3 types of vegetables, it’s okay to eat the same ones every day.

Eat whole grains instead of processed grains (examples of whole

grains include 100% whole wheat bread, brown rice, 100% rye or 100%

whole wheat crackers, oatmeal, 100% whole wheat pasta, corn tortillas)

Information for the professional:

If they are eating the recommended number of fruits and vegetables every day, they are likely to get a good amount of vitamin C. (you can show them on the Daily Food Guide the section for Vitamin C rich fruits and vegetables)

Dark green versus iceberg lettuce: Iceberg lettuce is mostly water, so it shouldn’t be counted as a serving of vegetables, however dark green leafy vegetables are rich in iron, folic acid, and many other vitamins and minerals including calcium