A Healthy Body for a Healthy Beginning: Infertility and Weight Relationship - by Davorka Monti (Winter 2011)

A HEALTHY BODY FOR A HEALTHY BEGINNING: INFERTILITY AND WEIGHT RELATIONSHIP

by Davorka Monti, Registered Dietitian
Winter 2011

When we decided to start a family, we tried for several months and…nothing happened. Everyone around me seemed to be pregnant, and I was not. Some of my friends were having difficulty conceiving, but I didn’t think that could happen to me – my maternal grandmother had twelve children! I started panicking, “What will I do if I cannot become pregnant?”

Then, as many people do, I looked for internal and external causes to see if I could find solutions. I tried to sleep more. I tried to relax. I worked at reducing my stress, which is difficult when you are trying not to worry about the next pregnancy test. A few more months flew by and…still nothing happened. I came to a point where I really needed to be more introspective. As a dietitian, I was trained to counsel people on healthy eating and I just assumed that I was eating well, but was I in for a surprise! When I paid attention to the foods I was eating, I was shocked at how unhealthy my diet was. Although I ate fruit and some vegetables, snacking was a real weakness: cookies, potato chips, chocolate, pretzels, and ice cream had become a habit. I fell into the traps that I was trained to avoid, where snacking becomes as subconscious as breathing. Whenever I was working - I needed something to eat, when I watched TV - I needed a snack, when I was on the phone - I needed food, and when I was bored - I needed to eat. I had gained weight. I felt that with the title “Dietitian”, I would be immune to weight gain, a problem I struggled with my entire childhood.

I started to question whether my unwise eating habits and the compromised health of my body were linked to my inability to become pregnant. I decided to scrutinize what was on my plate and to begin an exercise program. Most importantly, I wanted to be honest with myself. Intuitively, I knew that healthful eating and physical activity were very important; we all do. Unfortunately, many competing factors - not just reasoning or logic - are at work when we eat. After several months of healthy eating and regular exercise, I lost weight…and became pregnant. I maintained that regimen for subsequent pregnancies, and I now believe that my new lifestyle has made a difference every time.

Obviously, healthy eating and exercise are not the answers for all infertility issues, but what if they are yours? Trying to conceive can be stressful, and healthy food plus regular exercise can give you strength during this period as well as for the rest of your life. This is your chance to do something for yourself, and also as a couple. Your journey may not be as straightforward as mine, but it will undoubtedly lead to many lessons in self-discovery.

The evidence in favour of a healthy weight

Research has shown that being overweight can influence the ability to become pregnant by affecting the ovulation process (independent of other factors, such as your age) (Arendas et al. 2008). Dr. van der Steeg (2008) in the Netherlands has found that the more overweight a woman is, the lower her chances of pregnancy. Even small amounts of weight loss can positively influence your ability to reproduce. Overweight males can also negatively affect fertility (Nguyen et al., 2007). Polycystic ovarian syndrome (PCOS), a common cause of infertility, has been linked to problems with gaining and then losing weight. In women with PCOS, a lifestyle change leading to weight loss may help them ovulate (Gurevich, 2009).

Check your weight to determine where it fits in relation to your height using the Body Mass Index (BMI) calculation, which can be found at the Health Canada website (www.hc-sc.gc.ca). If you could lose a few pounds based on your BMI, you may want to talk to your health care provider first. If you are starting a weight loss program, aim for a slow and steady weight loss of 1 to 2 pounds per week. Anymore and you may become too hungry and revert back to old eating habits. Rapid weight loss can also deplete your body of important nutrients it needs.

Nutrition and healthy weight loss – it’s a mind game

In my years of trying to find that one “perfect diet” or that “one perfect food” to help me lose weight, I have discovered that neither one exists. The only thing you can do is to be honest and kind to yourself. Focus on the healthful foods you will be eating and make peace with and see unhealthful foods for what they are. For many people this also means replacing frequent snacking with an activity such as reading, painting, music-making, or, even better, a work-out, etc. Find something that keeps you motivated and committed to healthful eating that works for you; perhaps a catchy phrase you can repeat to yourself or an image in your mind. For example, I use the phrase, “I am more important than these potato chips.” Dietitians and authors Tribole and Resch say in their book “Intuitive Eating” (2nd edition): “You have a right to feel good – and that means not just feeling stuffed, but also feeling satisfied with your food choices, being healthy now and reducing future health risks.”

Portion size

We are surrounded by food everywhere we go – large portions have become the norm. The idea of eating only ½ cup of cooked rice for dinner (one serving according to Health Canada) seems ridiculous. A helpful guide that has been around for a number of years is Canada’s Food Guide to Healthy Eating. This publication may help you determine the right number and size of food portions.

Consider using the healthy plate method used by the Canadian Diabetes Association: half your plate should contain vegetables, one quarter should be filled with starch (whole grain rice, bread or pasta, potatoes), and the remaining quarter should be for protein – meat, poultry, fish, eggs, beans, or tofu. The Canadian Diabetes Association’s website offers many other weight loss tips.

Good food choices

Here are healthy, nutritious foods to focus on when planning your meals:
•   vegetables and fruit
•   whole grain: breads, cereals and rice
•   nuts, seeds, beans; lean meat, poultry, fish and eggs
•   low-fat dairy products
(Nestle, M. 2006)

Don’t worry if you don’t like certain foods in each group. Start with the ones you like and work from there. With any and all foods, pay attention to portion sizes.

Cook at home

When we eat out, we tend to overeat, which means we consume too many calories, fat, and salt. Prepackaged or pre-made meals usually do not fare any better – they are high in calories, fat, salt, and low in fibre. By cooking your own meals, you control the quantity and quality of the ingredients, which means your home-prepared food is better for you. Moreover, sharing in the communal experience of cooking and eating healthy foods together at home can make it easier for you to make those positive lifestyle choices you deem necessary.

Exercise

Healthful eating and exercise go hand-in-hand. Once your health care provider gives you the green light, start to exercise. Aim for being active every day – do activities you enjoy: walking, yoga, running, cycling. Of course you are very busy and can’t imagine how you can fit those exercise sessions into your day; however, if you don’t make time for exercise, it won’t happen. If you become discouraged, don’t give up; try a different activity that you have always wanted to do.

Folic acid supplementation

Remember as you embark on your journey to take a folic acid supplement. Health Canada advises women who could become pregnant and those who are pregnant to take a multivitamin containing 0.4 mg of folic acid every day. Talk to your health care provider to see whether more than 0.4 mg folic acid is recommended for you.

As Marion Nestle (Ph.D.), Professor at New York University and food writer, summarizes beautifully in her book “What to Eat”, “…eat less, move more, eat lots of fruits and vegetables, and go easy on the junk food.” She also goes on to say that in order to do this, you need to recognize and become very alert to the hidden ways over-consumption is encouraged.

Remember, you are what you eat. Enjoy healthy food, the fresh air, and being active as you begin a new chapter in your life.

About the author
Davorka Monti is a Registered Dietician and has spent her 15-year career working with pregnant women and children. She works for a community-based organization called "Healthy Start for Mom & Me".

References:
Arendas, K. et al. (2008). Obesity in pregnancy: Pre-conception to postpartum consequences. Journal of Obstetrics and Gynaecology Canada, 30, No. 6: 477-488. (Accessed September 10, 2010)

Gurevich, R. (2009). The connection between fertility and weight. www.about.com (Accessed September 13, 2010)

Nestle, M. (2006). What to Eat. North Point Press. New York.

Nguyen, R.H.N. et al. (2007). Men’s body mass index and infertility. Human Reproduction, 22, No. 9: 2488-2493. (Accessed September 10, 2010)

Tribole, E. and Resch, E. (2003). Intuitive Eating – 2nd edition. St. Martin’s Press. New York.

van der Steeg, J.W. et al. (2008). Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Human Reproduction, 23, No. 2: 324-328. (Accessed September 13, 2010)