The Complicated Link Between Breastfeeding, Postpartum Weight Loss
When it comes to postpartum sartorial goals, fitting into a pair of pre-baby jeans tops most new mums’ lists. Even body positivity advocate Anne Hathaway admitted to feeling “pretty good” about doing so.
In her introduction to Rujuta Diwekar’s Pregnancy Notes: Before, During and After, Bollywood actress Kareena Kapoor Khan writes that being body shamed on social media made her realize “how insensitive people can be even if a woman has just delivered.”
For celebrity and everyday mothers alike, the pressure – external or internal – to get back into shape after a pregnancy is real; this psychological aspect is understood and used as an additional incentive in the case for breastfeeding, which is considered a natural mechanism for dropping post-pregnancy pounds. But does breastfeeding really help in weight loss?
The calorie math
An exclusively breastfeeding mother requires approximately 600 calories of energy to produce around 750ml of breast milk per day. That’s roughly the level of energy expended during a 30-minute cardio workout routine. Theoretically, the breastfeeding-aided weight loss hype checks out, but reality can be very different for many mothers.
“Around six weeks after childbirth, I faced some stress on the professional front. I am uncertain if that was the reason, but my milk supply dropped. I was given tablets, shatavari kalpa, an Ayurvedic medicinal herb, and all the homemade food considered good for lactating mothers. I was not ‘eating for two’, but it was after this period that I put on an unreasonable amount of weight, and it was really tough to lose it,” says Nishitha Shrivastava, 36, an NRI who was based in Porvorim, Goa, at the time of her delivery.
A review of multiple observational studies revealed that while prolonged breastfeeding enhances the rate of postpartum weight loss, its effect is relatively small. Over a span of 12 months post-birth, breastfeeding mothers lost between 0.6kg and 2kg more weight than those who didn’t breastfeed.
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Dr. Mugdha Joshi, a lactation consultant at Mumbai’s Holy Family Hospital, Lilavati Hospital and Hinduja Healthcare, says that while postpartum weight changes and related struggles are common, it’s hard to isolate a link to breastfeeding. “Pre-pregnancy weight, diet, physical activity levels, lifestyle and overall genetic composition, all impact weight loss after birth,” she says.
Supriya Arun, a wellness consultant in Mumbai, explains that most nursing mothers are recommended to consume an extra 350 calories per day, an amount lower than what’s expended during lactation. Any additional breastfeeding-related energy requirements are ideally met by dipping into the aforementioned fat stores that the body lays down during the final trimester of pregnancy.
However, in present-day, resource-rich environments, where a common misconception is that a pregnant or lactating woman needs to eat for two, this fat reserve goes untapped.
Dr. Joshi says that many mothers with whom she consults are pressured to eat more in order to produce a better quality and quantity of breast milk. Traditionally Indian lactation foods are high in sugar and fats. Moreover, in desperation to keep up breast milk supply, many mothers eat processed, sugar-rich galactagogues and buy into the myth that additional animal milk consumption (2-3 glasses per day) will aid lactation.
Unfortunately, there are no specific medical guidelines issued by an Indian obstetric association regarding weight gain benchmarks during pregnancy, let alone postpartum weight loss.
Some mothers tend to gain weight after the WHO-recommended, six-month exclusive breastfeeding period. “Once her baby starts complementary feeds, the calories expended by the mother reduce but her appetite is still ravenous because her stomach size has expanded,” says Dr. Joshi.
The hormone effect
Breastfeeding being a hungry business, marked by appetite swings, doesn’t help the cause. Mumbai-based health and wellness coach Meghna Joshi highlights the role of prolactin, the hormone responsible for milk production, in the breastfeeding-weight change dynamic. Kicking into gear during pregnancy, prolactin levels surge post childbirth and at every breastfeed thereafter.
Simultaneously, the hormone stimulates appetite, and reduces lipid (fat) metabolism – an adaptive function that serves to preserve fat reserves in adverse conditions. This could explain why breastfeeding frequency can be inversely related to weight loss. “It is true that higher [prolactin] production slows down your metabolism. It doesn’t prevent weight loss; but some women reach a plateau,” says Meghna Joshi.
Incidentally, a thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden, observed that abnormally raised prolactin levels, in individuals who are neither pregnant nor lactating, may be the result of stress, certain medications or benign brain tumors. Science also recognizes a link between the hormone and obesity, among other health complications.
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In Pregnancy Notes: Before, During and After, Diwekar, a nutrition and science expert based in Mumbai, describes pregnancy as “a huge surge and then an equally sharp drop in some of the most anabolic hormones of the body” — anabolic hormones being one type of hormone involved in metabolism. Relatedly, observational studies suggest that the metabolism changes of pregnancy end with weaning, rather than delivery. And lactation is also associated with reduced risk of metabolic disease.
Both Diwekar and Meghna Joshi emphasize the importance of rest and recovery in the body’s adaptation response, better fat burning, lactation and overall well being. “It’s easier to break people’s resolve after a few nights of no sleep, even if it’s simply a resolve to eat right, stay active and get some exercise,” writes Diwekar in her book.
Arun adds that sleep deprivation, a common scenario for new mothers, skews the balance of hunger-related hormones: leptin (the appetite-control hormone) and ghrelin (the hunger hormone). It triggers sweet and salty food cravings, which if met, offer a quick energy fix but can be addictive. Studies have shown that sleep deprivation may stimulate appetite in a way similar to marijuana – it increases the hedonistic aspect of eating, thus resulting in a mismatch between energy requirements and food intake.
The chain reaction doesn’t end there. Lack of sleep can be a major source of stress on new mothers who are often overwhelmed to begin with. “The hormones go for a toss; imbalances cause weight loss or gain, depending on the person,” says Meghna Joshi.
The slow burn
While biology may seem counterproductive, experts agree that the individual’s attitude is a big factor in postpartum weight loss. Shrivastava, who exclusively breastfed for six months, says, “I did not feel any pressure, but I was not happy about being terribly overweight.” She credits her weight loss, within a year of childbirth, to an active lifestyle and healthy eating during and after her pregnancy.
Arun says gradually working up to pre-pregnancy fitness routines will ensure the body is not overburdened and the milk supply isn’t affected; research suggests that high-intensity workouts can sour breast milk due to a lactic acid buildup, possibly making it undesirable to babies.
Meghna Joshi draws on her own experience losing 15kg after her second pregnancy, despite being diagnosed with Hashimoto’s Disease (an autoimmune disorder that can cause weight gain) at the time. “The trick to raising your metabolism involves clean eating and regular exercise … the earlier you start getting back on track, the better,” she says.
Diwekar warns in her book against insensible crash diets that may yield quick results but create future complications. The additional fat makes mothers more vulnerable than they were pre-pregnancy to lifestyle diseases such as insulin resistance, diabetes and obesity.
Given the variables involved, most experts don’t recommend counting calories. “The mother is the best person to decide how much to eat. Traditional lactation foods do make a difference, but there has to be portion control,” says Meghna Joshi.
Arun focuses on nutrient-dense foods, adding that calorie-rich ones will limit variety and quantity.
Much like pregnancy pounds don’t accumulate overnight, postpartum weight loss is a process. Its success will depend on “whether we are sensible enough to be patient, and fearless enough to eat in such a way as to rebuild bone and muscle density, and support the fat-burning processes of the body,” writes Diwekar in her book.