Skip to main content

Advertisement

SpringerLink
Log in

Body dissatisfaction and disordered eating in the perinatal period: an underrecognized high-risk timeframe and the opportunity to intervene

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

The normal physical changes associated with pregnancy may increase the risk of body dissatisfaction, which is associated with negative mental health outcomes including depression and disordered eating. The purpose of this study was to explore body image and eating concerns among a sample of participants in pregnancy and postpartum and to assess interest and suggestions for a relevant intervention. This was a cross-sectional survey study requiring 10–15 min to complete. Individuals were eligible to participate in the study if they were pregnant or within 1 year postpartum, between the ages of 18 and 45, able to read and write in English, and provided online informed consent. The survey included measures and open-text questions to explore body image, eating behaviors, and related concerns in the perinatal period and to inform the development of an intervention. There were 161 participants, and over 50% were dissatisfied with their body image; 52% were among pregnant participants and 56.2% of postpartum participants. Approximately 80% reported that they would have appreciated the opportunity to participate in a program focused on body acceptance or expectations of body changes in pregnancy and postpartum. We identified intervention preferences as well as commonly reported themes regarding experiences of body image and eating concerns in pregnancy and postpartum. Body dissatisfaction and eating concerns are prevalent issues in pregnancy and postpartum, and our findings underscore an opportunity to tailor an intervention relevant to body image and disordered eating for the perinatal population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The datasets generated and analyzed in this current study are available in the Partners REDCap repository and are available from the corresponding author upon request. The SPSS code used to analyze this data is also available from the corresponding author upon request.

References

  • Aardoom JJ, Dingemans AE, Slof Op't Landt MCT, Van Furth EF (2012) Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eat Behav 13(4), 305-309

  • Ahadzadeh AS, Rafik-Galea S, Alavi M, Amini M (2018) Relationship between body mass index, body image, and fear of negative evaluation: Moderating role of self-esteem. Health Psychol Open 5(1):2055102918774251. https://doi.org/10.1177/2055102918774251

    Article  PubMed  PubMed Central  Google Scholar 

  • Akard TF, Gilmer MJ, Friedman DL, Given B, Hendricks-Ferguson VL, Hinds PS (2013) From qualitative work to intervention development in pediatric oncology palliative care research. J Pediatr Oncol Nurs: Off J Assoc Pediatr Oncol Nurs 30(3):153–160. https://doi.org/10.1177/1043454213487434

    Article  Google Scholar 

  • Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68(7):724–31. https://doi.org/10.1001/archgenpsychiatry.2011.74

    Article  PubMed  Google Scholar 

  • Bardone-Cone AM, Agras WS (2007) Psychometric properties of eating disorder instruments in black and white young women: internal consistency, temporal stability, and validity. Psychol Assess 19:356–362

    Article  Google Scholar 

  • Bartholomew LK, Parcel GS, Kok G, Gottleib NH, Fernandez ME (2011) Planning health promotion programs: an intervention mapping approach. Jossey-Bass, San Francisco, CA

    Google Scholar 

  • Baskin R, Meyer D, Galligan R (2021) Predicting the change in perinatal disordered eating symptoms: An examination of psychosocial factors. Body Image 37:162–171

    Article  Google Scholar 

  • Becker CB, Bull S, Schaumberg K, Cauble A, Franco A (2008) Effectiveness of peer-led eating disorders prevention: a replication trial. J Consult Clin Psychol 76:347–354

    Article  Google Scholar 

  • Bould H, Sovio U, Koupil I, Dalman C, Micali N, Lewis G et al (2015) Do eating disorders in parents predict eating disorders in children? Evidence from a Swedish cohort. Acta Psychiatr Scand 132:51–59. https://doi.org/10.1111/acps.12389

    Article  CAS  PubMed  Google Scholar 

  • Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101. https://doi.org/10.1191/1478088706qp063oa

    Article  Google Scholar 

  • Breithaupt L, Köhler-Forsberg O, Larsen J, Benros M, Thornton L, Bulik C et al (2019) Association of exposure to infections in childhood with risk of eating disorders in adolescent girls. JAMA Psychiat 76:800–809. https://doi.org/10.1001/jamapsychiatry.2019.0297

    Article  Google Scholar 

  • Cheng Z, Perko V, Fuller-Marashi L, Gau J, Stice E (2019) Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Eat Behav 32:23–30

    Article  Google Scholar 

  • Convertino AD, Brady JP, Albright CA, Gonzales M 4th, Blashill AJ (2021) The role of sexual minority stress and community involvement on disordered eating, dysmorphic concerns and appearance- and performance-enhancing drug misuse. Body Image 36:53–63. https://doi.org/10.1016/j.bodyim.2020.10.006

    Article  PubMed  Google Scholar 

  • Creswell JW (2012) Educational research: Planning, conducting, and evaluation quantitative and qualitative research, 4th edn. Pearson Education, Boston, MA

    Google Scholar 

  • Easter A, Bye A, Taborelli E, Corfield F, Schmidt U, Treasure J et al (2013) Recognising the symptoms: how common are eating disorders in pregnancy? Eur Eat Disord Rev 21:340–344. https://doi.org/10.1002/erv.2229

    Article  PubMed  Google Scholar 

  • Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16:363–370

    Article  CAS  Google Scholar 

  • Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. J Am Med Assoc 307(5):491–497

    Article  Google Scholar 

  • Gjerdingen D, Fontaine P, Crow S, McGovern P, Center B, Miner M (2009) Predictors of mothers’ postpartum body dissatisfaction. Women Health 49:491–504. https://doi.org/10.1080/03630240903423998

    Article  PubMed  PubMed Central  Google Scholar 

  • Gordon KH, Castro Y, Sitnikov L, Holm-Denoma JM (2010) Cultural body shape ideals and eating disorder symptoms among White, Latina, and Black college women. Cultur Divers Ethnic Minor Psychol 16(2):135–143. https://doi.org/10.1037/a0018671

    Article  PubMed  Google Scholar 

  • Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  Google Scholar 

  • Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN, REDCap Consortium (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95, 103208

  • Howitt D, Cramer D (2008) Introduction to research methods in psychology, 2nd edn. Pearson Education, London

  • Jones DC (2004) Body image among adolescent girls and boys: a longitudinal study. Dev Psychol 40(5):823–835. https://doi.org/10.1037/0012-1649.40.5.823

    Article  Google Scholar 

  • Kelly L (2007) Lesbian body image perceptions: the context of body silence. Qual Health Res 17(7):873–83. https://doi.org/10.1177/1049732307306172

    Article  PubMed  Google Scholar 

  • Koubaa S, Hällström T, Lindholm C, Hirschberg AL. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol 105(2):255-60. https://doi.org/10.1097/01.AOG.0000148265.90984.c3. Erratum in: Obstet Gynecol. 2008 May;111(5):1217. Kouba, Saloua [corrected to Koubaa, Saloua]

  • LaCoursiere DY, Baksh L, Bloebaum L, Barner MW (2006) Maternal body mass index and self-reported postpartum depressive symptoms. Matern Child Health J 10(4):385–390

    Article  Google Scholar 

  • Larsson G, Andersson-Ellström A (2003) Experiences of pregnancy related body shape changes and of breastfeeding in women with a history of eating disorders. Eur Eat Disord Rev 11:116–124. https://doi.org/10.1002/erv.497

    Article  Google Scholar 

  • Lydecker J, Grilo C (2016) Fathers and mothers with eating-disorder psychopathology: associations with child eating-disorder behaviors. J Psychosom Res 86:63–69. https://doi.org/10.1016/j.jpsychores.2016.05.006

    Article  PubMed  PubMed Central  Google Scholar 

  • Makino M, Yasushi M, Tsutsui S (2020) The risk of eating disorder relapse during pregnancy and after delivery and postpartum depression among women recovered from eating disorders. BMC Pregnancy Childbirth 20(1):323. https://doi.org/10.1186/s12884-020-03006-7

    Article  PubMed  PubMed Central  Google Scholar 

  • Marchi J, Berg M, Dencker A, Olander E, Begley C (2015) Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev 16(8):621-638 4

    Article  CAS  Google Scholar 

  • Micali N, De Stavola B, Ploubidis GB, Simonoff E, Treasure J (2014) The effects of maternal eating disorders on offspring childhood and early adolescent psychiatric disorders. Int J Eat Disord 47(4):385–393

    Article  Google Scholar 

  • Miles MB, Huberman AM (1994) Qualitative data analysis: an expanded sourcebook, 2nd edn. Sage Publications, Inc

  • Nippert KE, Tomiyama AJ, Smieszek SM, Incollingo Rodriguez AC (2021) The media as a source of weight stigma for pregnant and postpartum women. Obesity (silver Spring) 29(1):226–232. https://doi.org/10.1002/oby.23032

    Article  Google Scholar 

  • Ohoka H, Koide T, Goto S, Murase S, Kanai A, Masuda T, Aleksic B, Ishikawa N, Furumura K, Ozaki N (2014) Effects of maternal depressive symptomatology during pregnancy and the postpartum period on infant-mother attachment. Psychiatry Clin Neurosci 68(8):631–639

    Article  Google Scholar 

  • Palsola M, Renko E, Kostamo K, Lorencatto F, Hankonen N (2020) Thematic analysis of acceptability and fidelity of engagement for behaviour change interventions: the let’s move it intervention interview study. Br J Health Psychol 25(3):772–789. https://doi.org/10.1111/bjhp.12433

  • Pettersson CB, Zandian M, Clinton D (2016) Eating disorder symptoms pre- and postpartum. Arch Womens Ment Health 19:675–680. https://doi.org/10.1007/s00737-016-0619-3

    Article  PubMed  Google Scholar 

  • Pike KM, Rodin J (1991) Mothers, daughters, and disordered eating. J Abnorm Psychol 100(2):198–204

    Article  CAS  Google Scholar 

  • Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Siega-Riz AM (2010) Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstet Gynecol 116(5):1191

    Article  Google Scholar 

  • Riquin E, Lamas C, Nicolas I, Dugre Lebigre C, Curt F, Cohen H, Legendre G, Corcos M, Godart N (2019) A key for perinatal depression early diagnosis: the body dissatisfaction. J Affect Disord 15(245):340–347

    Article  Google Scholar 

  • Roomruangwong C, Kanchanatawan B, Sirivichayakul S, Maes M (2017) High incidence of body image dissatisfaction in pregnancy and the postnatal period: associations with depression, anxiety, body mass index and weight gain during pregnancy. Sex Reprod Health 13:103–109

    Article  Google Scholar 

  • Rubin B, Gluck ME, Knoll CM, Lorence M, Geliebter A (2008) Comparison of eating disorders and body image disturbances between Eastern and Western countries. Eat Weight Disord 13(2):73–80. https://doi.org/10.1007/BF03327606

    Article  CAS  PubMed  Google Scholar 

  • Santangeli L, Sattar N, Huda SS (2015) Impact of maternal obesity on perinatal and childhood outcomes. Best Pract Res Clin Obstet Gynaecol 29(3):438–448

    Article  Google Scholar 

  • Shaw H, Rohde P, Desjardins C, Stice E (2020) Sexual orientation correlates with baseline characteristics but show no moderating effects of dissonance-based eating disorder prevention programs for women. Body Image 32:94–102

    Article  Google Scholar 

  • Silveira ML, Ertel KA, Dole N, Chasan-Taber L (2015) The role of body image in prenatal and postpartum depression: a critical review of the literature. Arch Women’s Mental Health 18(3):409–421

    Article  Google Scholar 

  • Solmi F, Hotopf M, Hatch SL, Treasure J, Micali N (2016) Eating disorders in a multi-ethnic inner-city UK sample: prevalence, comorbidity and service use. Soc Psychiatry Psychiatr Epidemiol 51(3):369–381. https://doi.org/10.1007/s00127-015-1146-7

    Article  CAS  PubMed  Google Scholar 

  • Stein A, Murray L, Copper P, Fairburn CG (1996) Infant growth in the context of maternal eating disorders and maternal depression: a comparative study. Psychol Med 26(3):569–574

    Article  CAS  Google Scholar 

  • Stice E (2001) A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect. J Abnorm Psychol 110:124–135

    Article  CAS  Google Scholar 

  • Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 128(5):825–848

    Article  Google Scholar 

  • Stice E, Van Ryzin M (2019) A prospective test of the temporal sequencing of risk factor emergence in the dual pathway model of eating disorders. J Abnorm Psychol 128:119–128

    Article  Google Scholar 

  • Stice E, Whitenton K (2002) Risk factors for body dissatisfaction in adolescent girls: a longitudinal investigation. Dev Psychol 38:669–678

    Article  Google Scholar 

  • Stice E, Marti C, Spoor S, Presnell K, Shaw H (2008) Dissonance and healthy weight eating disorder prevention programs: long-term effects from a randomized efficacy trial. J Consult Clin Psychol 76(2):329–340. https://doi.org/10.1037/0022-006X.76.2.329

    Article  PubMed  PubMed Central  Google Scholar 

  • Stice E, Rohde P, Shaw H, Gau J (2011) An effectiveness trial of a selected dissonance-based eating disorder prevention program for female high school students: long-term effects. J Consult Clin Psychol 79:500–508

    Article  Google Scholar 

  • Stice E, Rohde P, Shaw H, Marti C (2013) Efficacy trial of a selective prevention program targeting both eating disorders and obesity among female college students: 1- and 2-year follow-up effects. J Consult Clin Psychol 81(1):183–189. https://doi.org/10.1037/a0031235

    Article  PubMed  Google Scholar 

  • Stice E, Gau J, Rohde P, Shaw H (2017) Risk factors that predict future onset of each DSM-5 eating disorder: predictive specificity in high-risk adolescent females. J Abnorm Psychol 126:38–51

    Article  Google Scholar 

  • Stice E, Rohde P, Shaw H, Gau J (2018) An experimental therapeutics test of whether adding dissonance-induction activities improves the effectiveness of a selective obesity and eating disorder prevention program. Int J Obes 42(3):462–468. https://doi.org/10.1038/ijo.2017.251

    Article  CAS  Google Scholar 

  • Stice E, Marti N, Shaw H, Rohde P (2019) Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects. Clin Psychol Rev 70:91–107

    Article  Google Scholar 

  • Stice E, Desjardins C, Rohde P, Shaw H (2021) Sequencing of symptom emergence in anorexia nervosa, bulimia nervosa, binge eating disorder, and purging disorder and relations of prodromal symptoms to future onset of these disorders. J Abnorm Psychol 130:377–387

    Article  Google Scholar 

  • Stothard KJ, Tennant PW, Bell R, Rankin J (2009) Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 301(6):636–650

    Article  CAS  Google Scholar 

  • Stunkard AJ, Sorensen T, Schulsinger F (1983) Use of the Danish adoption register for the study of obesity and thinness. In: Kety S, Rowland L, Sidman R et al (eds) The genetics of neurological and psychiatric disorders. Raven Press, New York, pp 115–120

    Google Scholar 

  • Udo T, Grilo CM (2018) Prevalence and correlates of DSM-5–defined eating disorders in a nationally representative sample of US adults. Biol Psychiat 84:345–354

    Article  Google Scholar 

  • Urvelyte E, Perminas A (2015) The dual pathway model of Bulimia: replication and extension with anorexia. Procedia Soc Behav Sci 205:178–183

    Article  Google Scholar 

  • Vaismoradi M, Turunen H, Bondas T (2013) Content analysis and thematic analysis: implications for conducting a qualitative study. Nurs Health Sci 15:398–405

    Article  Google Scholar 

  • Walker L, Timmerman G, Kim M, Sterling B (2002) Relationships between body image and depressive symptoms during postpartum in ethnically diverse, low income women. Women Health 36:101–121

    Article  Google Scholar 

  • Walsh RS, McClean B, Doyle N, Ryan S, Scarborough-Lang SJ, Rishton A, Dagnall N (2019) A Thematic analysis investigating the impact of positive behavioral support training on the lives of service providers: “it makes you think differently.” Front Psychol 10:2408. https://doi.org/10.3389/fpsyg.2019.02408

    Article  PubMed  PubMed Central  Google Scholar 

  • Walther J, Sochacka NW, Kellam NN (2013) Quality in interpretive engineering education research: reflections on an example study. J Eng Educ 102:626–659. https://doi.org/10.1002/jee.20029

    Article  Google Scholar 

  • Watson HJ, Von HA, Hamer RM, Berg CK, Magnus P, Stoltenberg C et al (2014) Remission, continuation, and incidence of eating disorders during early pregnancy: a validation study on a population-based birth cohort. Psychol Med 43:1723–1734. https://doi.org/10.1017/S0033291712002516

    Article  Google Scholar 

  • Watson B, Fuller-Tyszkiewicz M, Broadbent J, Skouteris H (2017) Development and validation of a tailored measure of body image for pregnant women. Psychol Assess 29(11):1363–1375

    Article  Google Scholar 

  • Wei YM, Yang HX, Zhu WW, Liu XY, Meng WY, Wang YQ et al (2016) Risk of adverse pregnancy outcomes stratified for pre-pregnancy body mass index. J Matern Fetal Neonatal Med 29(13):2205–2209

    Article  Google Scholar 

Download references

Funding

This work was supported by a Hickman Research Award from Postpartum Support International.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Ammon-Pinizzotto Center for Women’s Mental Health at Massachusetts General Hospital, Boston, USA

    Rachel Vanderkruik, Kalin Ellison, Margaux Kanamori, Marlene P. Freeman & Lee S. Cohen

  2. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA

    Eric Stice

Authors
  1. Rachel Vanderkruik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kalin Ellison
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margaux Kanamori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marlene P. Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lee S. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Stice
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors were involved in the study’s conception and design, with Rachel Vanderkruik taking the lead. Material preparation and data collection were completed by Kalin Ellison, Rachel Vanderkruik, and Margaux Kanamori. Qualitative data analysis was completed by Kalin Ellison and Margaux Kanamori. Quantitative data analysis was completed by Rachel Vanderkruik. The first draft of the manuscript was written by Rachel Vanderkruik, Kalin Ellison, and Margaux Kanamori. Subsequent versions of the manuscript were reviewed and edited by all authors. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Rachel Vanderkruik.

Ethics declarations

Ethics approval

This study was approved by the Partners Institutional Review Board at Massachusetts General Hospital under the IRB approval number 2020P003267.

Consent to participate

Informed consent to participate was obtained from all subjects included in this study.

Consent for publication

Participants provided informed consent to the publication of their data. All data included for publication have been de-identified.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 34 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vanderkruik, R., Ellison, K., Kanamori, M. et al. Body dissatisfaction and disordered eating in the perinatal period: an underrecognized high-risk timeframe and the opportunity to intervene. Arch Womens Ment Health 25, 739–751 (2022). https://doi.org/10.1007/s00737-022-01236-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-022-01236-6

Keywords

Search

Navigation