A Guide to Postpartum Weight Loss: Diet and Lifestyle Changes That Work

Author:

Dr. Jenny Stanford, MD, FAAFP, DipABOM

Experienced Physician, Board-Certified in Obesity Medicine and Family Medicine

Weight gain during pregnancy

Pregnancy is a proinflammatory state that promotes weight gain, in order to sustain the growth of the unborn baby and to prepare for breastfeeding after delivery. Following pregnancy weight gain, postpartum weight loss is universally important to prevent complications. We know that after pregnancy, the focus often shifts entirely to caring for your baby. However, it’s equally important to take care of yourself during this time. Losing weight post pregnancy has profound impacts on mental and physical wellbeing. There are many strategies and considerations effective for postpartum weight loss, but it is important to remember that adopting a personalized, holistic approach has the highest likelihood of success. Let’s consider the hormonal changes involved, how to make dietary changes, and how to apply lifestyle modifications. In another article titled The Role of GLP-1 Receptor Agonists in Postpartum Weight Loss, we discuss the potential role of medications in reaching optimal postpartum weight loss.

Why weight loss important is important after childbirth?

Studies show that losing weight after childbirth is imperative to restore overall physical and mental wellbeing. Retaining excess body weight increases the risk of overweight and obesity long-term, which predispose to coronary artery disease(heart disease), type 2 diabetes(elevated blood sugar levels), metabolic syndrome, and others. The risk is especially higher in people who have family history of these conditions or who had gestational diabetes. Studies suggest that postpartum weight retention is associated with an increased risk of obesity as soon as one year and elevated cardiovascular disease risk within five years after delivery. For many people, the postpartum period is the preconception period for the next pregnancy, so poor metabolic health postpartum can lead to negative pregnancy outcomes, like gestational diabetes, gestational hypertension, and more.

What happens postpartum?

Hormone changes

The hormone changes that occur postpartum are the largest hormone fluctuations that occur in the life cycle in the shortest amount of time. Estrogen and progesterone levels drop dramatically, Prolactin levels soar to support breastfeeding. These hormone fluctuations significantly impact metabolism and weight regulation. Thyroid hormones closely regulate metabolism, and thyroid hormone imbalances can occur postpartum, which can have profound effects on weight. 

Mental status changes

The substantial hormone shifts postpartum can predispose to postpartum depression, anxiety, and psychosis. Not losing weight postpartum also makes these mental health conditions more likely.

How to lose weight postpartum

Diet approaches

Dietary changes are the cornerstone of postpartum weight loss. However, nutrition needs vary widely, whether or not patients are lactating. While calorie control is important, optimal macronutrient composition can make weight loss more successful. Following a personalized approach to diet postpartum allows for the most weight loss success.

High Protein, Lower Carbohydrate Diets

Pregnancy induces a state of insulin resistance, which gradually improves to pre-pregnancy status after delivery. This helps explain why following a high-protein diet temporarily postpartum helps promote postpartum weight loss. A high-protein, lower carbohydrate diet usually includes 30-40% of calories from protein, about 40% of calories from carbohydrates, and about 20-30% of calories from healthy fats. This macronutrient ratio enhances insulin sensitivity and increases the release of weight-loss-promoting neuroendocrine hormones like glucagon-like peptide-1, glucose-dependent insulinotropic peptide, somatostatin, and others.

Not only do higher-protein, lower carbohydrate diets lead to weight loss but also improve body composition by maintaining lean body mass. Protein helps increase metabolism in several ways. It requires more energy to metabolize (referred to as the thermic effect of food), and it helps maintain lean body mass, which burns more calories at rest. Protein increases fullness, helping to reduce overall calorie intake, which leads to weight loss.

When you follow a high protein diet, prioritize not only the quantity of protein but also the quality. Focus on lean meats, fish and seafood, nuts, and plant-based proteins, which provide not only lean protein but also healthy fats. Be sure to include complex carbohydrate sources that are rich in fiber and polyphenols, including fruits, vegetables, whole grains, and legumes, which are dense with nutrients your body needs.

Mediterranean Diet

The Mediterranean diet has been shown to have many health benefits, including weight loss and improved insulin sensitivity by increasing levels of the neuroendocrine hormones glucagon-like peptide-1 (GLP-1) and oxyntomodulin. Studies suggest the Mediterranean diet effectively promotes weight loss postpartum. The Mediterranean diet focuses on whole, real foods, prioritizing fruits, vegetables, whole grains, fish, seafood, nuts, seeds, and extra virgin olive oil. It recommends minimal intake of added sugars, processed foods, and red meat. Be sure to monitor total calorie intake while following the Mediterranean diet, as many foods like nuts, seeds, and olive oil tend to be higher in calories.

Intermittent Fasting and Time-Restricted Feeding

Fasting within intermittent fasting and time-restricted feeding strategies has demonstrated positive effects of increasing metabolism, controlling insulin release, and regulating other anorexigenic neuroendocrine hormones like GLP-1 and oxyntomodulin. Further evidence is needed regarding their impacts in the postpartum period, but they appear to have promising benefits for weight loss.

Breastfeeding

Breastfeeding uses significant energy, and it has been shown to promote postpartum weight loss. Many nutrient and fat stores are maintained during lactation to ensure adequate nutrition for breast milk, and the amount of weight loss during breastfeeding varies between individuals. Lactation significantly impacts nutrient requirements, so be sure to consult with a knowledgeable healthcare professional for advice on the best diet to promote postpartum weight loss while supporting lactation. 

Lifestyle modifications

In addition to diet, lifestyle modifications have a significant impact on postpartum weight loss. Diet modifications plus regular physical activity have been shown to be more effective in promoting postpartum weight loss than physical activity alone.

Incorporate Physical Exercise

To incorporate physical exercise postpartum, be sure to obtain the go-ahead from your physician or postpartum physical therapist. Then, follow a graduated return to physical activity based on your exercise tolerance. Start with low-impact activities, like walking, swimming, and core-focused strength training exercises. Gradually increase time and intensity of exercise, with the goal of at least 150 minutes of moderate-intensity exercise per week. 

Get Adequate Sleep

In the postpartum period, sleep can be elusive. From significant hormone shifts to the needs of a newborn baby, it is difficult to prioritize adequate sleep. Adequate time and quality of sleep has profound impacts on hormone levels, hunger, and metabolism. Not enough sleep increases concentrations of ghrelin, an appetite-stimulating hormone that promotes weight gain. Inadequate sleep also promotes insulin resistance, which is a significant focus in postpartum weight loss already. Poor sleep makes postpartum weight loss harder to achieve. Aim for 7-9 hours of sleep each night. Because this sleep will likely be interrupted, try to take short naps during the day. If you have help at home, try to delegate some of the nighttime newborn care responsibilities if possible. 

Manage Stress

Managing stress in the postpartum period is important for postpartum weight loss. Chronic stress can cause weight gain and make it harder to lose weight. Find healthy ways to manage stress, like deep breathing exercises, mindfulness, meditation and prayer, enjoyable hobbies, and spending time with family and friends.

Highlights

When it comes to postpartum weight loss, it is essential to understand physical and hormone changes that occur in the pregnancy and postpartum periods. Taking these into consideration, you can apply effective diet and lifestyle strategies to promote healthy postpartum weight loss and avoid long-term health consequences associated with overweight and obesity. Applying personalized, holistic approaches to a postpartum diet provides the most successful long-term weight loss.

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