Donald advises postpartum women to relax and adjust to life-style changes before embarking on a weight-loss program. "The first month after you get home from the hospital is (devoted to) pure survival," he said. "Don't worry about body image right away."
When he thinks they're ready, Donald gives his patients a three-point plan for weight loss: "Eat normally, exercise normally and breast-feed."
Breast-feeding is often recommended as a way to lose weight more quickly while giving an infant important nutrients. "You burn off 50 calories per pound of a baby's weight" when you breast feed, Donald said. "A 10-pound baby costs you 500 calories a day in breast milk. You'll drop 3,500 calories a week, and so you'll (theoretically) lose a pound a week breast feeding."
But breast-feeding isn't an effortless route to weight loss, as studies suggest and some women can attest. In fact, the weight loss that accompanies breast-feeding may be more gradual than generally assumed, found Nancy F. Butte, a nutritionist and assistant professor of pediatrics at Baylor College of Medicine in Houston.
She studied 45 lactating women for four months to examine milk production, dietary intake and body composition. Weight loss "is quite variable," said Butte, who published her findings in the American Journal of Clinical Nutrition. The mean weight loss during the first postpartum month was about 8 pounds; the mean loss for the next three months was 1.5 pounds per month.
"It may be that women who breast-feed for longer periods, say nine months to a year, are going to tend to lose quite a bit more weight than you would predict," Greene said. "But there may be a rebound phenomenon (of weight gain) when you wean the child."
Resume Exercise Slowly
Exercise programs after delivery should be resumed slowly.
"Laxity of the joints and ligaments can persist as long as three months," said Dr. Raul Artal, an associate professor of obstetrics and gynecology and exercise sciences at the USC School of Medicine. For that reason, new moms should get their doctor's approval before beginning a program and may want to rejoin their prenatal exercise class, where the pace is slower.
"Stay in special programs for at least six weeks," said Rote, who finds that lightheadedness during exercise is not uncommon for a month or longer after delivery.
"I would recommend avoiding the type of exercise that may affect joints and ligaments such as weight lifting, ballistic movements, and action that requires sudden changes in direction," Artal added.
Exercising after breast-feeding is best, he said, because full breasts can make physical activity uncomfortable and "fat-burning during exercise may result in more acidity of the (breast) milk."
The weight-loss program should depend on how much a woman has to lose, Greene suggested. "If it's 5 or 10 pounds, it's relatively easy to accomplish" simply by increasing activity and restricting calories with a physician's approval, he said. If a woman has 40 or more pounds to lose, a formal program is advised, including input from a registered dietitian. The more rigorous the caloric restriction, he said, the closer the child's weight should be monitored if the mother is breast feeding.
Instead of counting calories, dietitian Thouin suggests cutting fat, sugar and low-density nutrients. "I rarely give anyone a calorie level," she said.
Weight loss should be slow, generally 2 to 4 pounds a month, experts agree.
How long should it take to shed pregnancy-related weight?
Experts say most women have unrealistic expectations of how quickly they should regain their figure. "I have seen women look great in three weeks," said Rock, "but I believe they're in the minority." Others said postpartum shape-ups can take from three months to a year.
After childbirth, some women learn to accept heavier versions of themselves, Donald said. That's better and more healthful, he believes, than yo-yo dieting. His advice: "Either accept the fact that you're 10 or 15 pounds heavier or accept that it's going to be painful (to take it off)."
Some women are able to do just that, Rock said. "Before they have a child, some women's entire ego strength is dependent on weighing 110. But once they have a child, they realize the world won't end if they weigh 130."