Notes By Stage : Postpartum

During pregnancy, your body will grow and change to support the growth and development of your little one. Despite many traditional societal pressures and messaging to “bounce back” as quickly as possible, remember you need time to heal. 

Your body has undergone a remarkable transformation to create something so special, which should be celebrated. First, take plenty of time and space to focus on replenishing nutrients and bonding with your little one before delving into weight loss if this is a goal of yours. 

While navigating the postpartum period, it’s very common for women to start wondering about weight loss. The amount of gestational weight gain varies largely from person to person and can be a very personal and sensitive topic. 

How long is postpartum? 

In its simplest definition, the postpartum period refers to the phase that follows childbirth. It begins after the delivery of your baby. 

The question is, then, how long is postpartum? Or when does postpartum end? You may have heard the guidance of six weeks for a vaginal delivery and eight weeks for a cesarean section (1). Others may extend this time a bit further to 12 weeks, or what is often referred to as the fourth trimester (2). 

If you’ve given birth before, you may agree that this is part of what sets many women up for the pressure and expectation to be rapidly back to their pre-pregnancy selves physically and emotionally. The truth is, this can take months or even a year or more. In fact, a postpartum depression or anxiety diagnosis can occur up to a year after birth.

When we discuss postpartum care inside The Prenatal Nutrition Library, we include the first six to eight weeks, but also extend this discussion beyond this time and well into the first year or more after birth.

Postpartum weight loss patterns

Just like weight gain during pregnancy varies from person to person, weight loss patterns during the postpartum period are also very individualized. No one loses or gains weight in exactly the same way. 

Several variables, including pre-pregnancy weight, weight gain during pregnancy, whether breastfeeding or not, hormonal health and balance, metabolism, sleep patterns, and genetics, will influence weight loss patterns after pregnancy. Some of these variables are within our control, and some are not. 

• Pre-Pregnancy Weight: People in a larger body size pre-pregnancy tend to retain more weight postpartum (3, 4). Research also suggests that women who had an underweight or low body mass index (BMI) before pregnancy may be more likely to retain weight initially in postpartum (5). This could possibly be a protective mechanism by the body to replenish nutrient and energy stores and support recovery.  
• Weight Gain During Pregnancy: Gestational weight gain above the Institute of Medicine (IOM) recommendations during pregnancy has been identified as a predictor of postpartum weight retention initially, at one year postpartum, and beyond (6, 7, 8). 
• Breastfeeding: Breastfeeding burns high amounts of calories (9). Some studies have found slightly greater weight loss at three months postpartum among mothers who exclusively breastfed compared to those who did not (10). However, nursing also coincides with increased calorie needs, as well as higher appetite and hunger levels, for most mothers (11), particularly in the early months of nursing. The impact of breastfeeding on postpartum weight loss amounts and rates seems to be individualized, as research results overall have been mixed (12, 13, 14, 15). 
• Hormone Health and Balance: Pregnancy and childbirth can cause changes in hormone health and balance. For example, postpartum thyroiditis is a fairly common condition during this phase (16). Disruption and changes to hunger hormones, progesterone, estrogen, and prolactin may also impact weight loss. 
• Metabolism: Metabolic rate, or the amount of calories your body burns, varies from person to person. 
• Sleep: We know a quality and restorative night of sleep can be hard to come by in the early stages of postpartum and even longer, depending on the sleeping habits of your unique little one. Both lack of sleep and disrupted sleep can impact our hormones, appetite, cravings, and weight loss and gain (17, 18). 
• Genetics: Genetics can impact how easily and where our bodies store weight. This can make weight loss either more or less challenging. 

How long does it take to lose weight gained during pregnancy? 

The time it takes to lose weight gained during pregnancy varies widely, depending on the individual and factors mentioned above, as well as overall nutrition and activity level (19).  

In general, after delivery, you can expect to lose about 10-12 pounds immediately, which includes the baby, placenta, and some amniotic fluid. It is sometimes unexpected, but your belly will not immediately shrink down after having a baby. 

Some additional weight loss will continue naturally in the first several weeks as the body sheds excess fluid retained during pregnancy. 

Research varies significantly in terms of how long it takes to lose weight after giving birth. One study found that 60% of women returned to their pre-pregnancy weight by one year or twelve months postpartum, while another suggested that up to 75% of women were not at their pre-pregnancy weight within the same time frame (20, 22). 

With the implementation of intentional nutrition and exercise interventions, a greater percentage of women return to pre-pregnancy weight within one year postpartum (54). 

How long after delivery can you start trying to lose weight? 

It takes around 40 weeks to grow a human, yet there has traditionally been a considerable societal pressure to ‘bounce back’ after delivery as quickly as possible.

The truth is, it takes time to heal, recover, and feel like your new, improved version of yourself again. That can be challenging to hear, and there’s no right or wrong way to feel about it. It’s very normal to feel mixed emotions about your postpartum body. 

It’s absolutely okay to have a weight loss goal. However, it is essential to prioritize recovery and healing above all else. Don’t forget to celebrate the fact that your body grew an entire human from scratch. Your body has changed, and it has done this to create something truly amazing. 

The amount of time each person needs to heal and recover before initiating intentional weight loss efforts varies from person to person. 

In general, we’d recommend waiting until at least three months postpartum before focusing on intentional weight loss. After this time, some women begin to feel physically ready and have a more established routine. 

Losing Weight While Breastfeeding

When weight loss is a goal, we need to balance adequate nutrition to support milk supply with the strategies that aid weight loss or body composition changes. 

Does breastfeeding help with postpartum weight loss? 

Maybe, maybe not! Like most things, it depends on the individual. 

It’s estimated that exclusively breastfeeding during the first several months postpartum will require and burn up to an extra 450 to 500 calories per day (23, 52). Theoretically, increasing the calories burned should aid in weight loss. 

However, research results comparing postpartum weight loss in those who breastfed with those who do not are mixed (12, 13, 14, 15, 49). 

Nursing typically coincides with an increased appetite, especially in the early months. Anecdotally, many women report they couldn’t lose “the last 10 pounds” until nursing was weaned. 

Will losing weight while breastfeeding impact milk supply? 

Possibly. 

Losing weight while breastfeeding could impact milk supply. Both the timing and approach to weight loss could have a significant impact on whether this occurs. Alongside frequent and thorough milk removal or feedings, it is essential to consume adequate amounts of calories and nutrition to support milk supply if weaning is not your goal. 

Waiting until breastfeeding and milk supply are well established and regulated, even until your baby has begun to incorporate some solid foods around six months of age, is advisable for some individuals, especially if low milk supply has been a concern.  

A sudden drop or significant calorie restriction may result in dips in milk supply. A very low-carbohydrate diet may also decrease milk supply, but hydration status and overall calorie consumption still play a role (25, 53). 

Alternatively, a more gradual approach to weight loss postpartum while breastfeeding is generally okay. After breastfeeding is well established, a gradual weight loss of up to about one pound per week does not appear to negatively impact milk supply (24, 26). Of course, this is always individual. 

Don’t forget to work with a certified lactation counselor if you have concerns about milk supply. They are invaluable resources on the breastfeeding journey. 

Gentle Weight Loss Support During Postpartum 

It’s okay to want to lose weight or change body composition. A healthy body composition supports overall health and decreases the risk of chronic disease (27). 

However, the approach to achieving a weight loss goal is important. Postpartum weight loss should be approached in a way that allows space for healing and does not sacrifice mental well-being. 

When realistic and sustainable habits and behaviors are implemented to lose weight, these changes can support mood, energy levels, and hormone health. If weight loss is done through very restrictive measures, this can lead to negative impacts on mental health and hormone health, as well as nutrient deficiencies and cycles of weight loss and regain. 

There is indeed no one-size-fits-all approach to weight loss during postpartum or outside of this time, but the following are great foundations for everyone to consider. 

Tip 1: Go Slowly 

First and foremost, before beginning an intentional weight loss goal, wait until you are physically, mentally, and emotionally ready. When you are ready, gradually incorporate habit shifts that support weight loss. 

Attempting an overnight complete lifestyle overhaul rarely sticks. Often, when someone says, “I’m going on a diet,” that inevitably means that, at some point, they will come off of it. Usually, the need to “go off the plan” arises because there are restrictions that don’t leave room for the flexibility needed in life. Especially life with a little one! Your routine should leave room for “life,” like a sleepless night, illness, forgetting a packed lunch, or the human desire and experience to go out and enjoy a favorite treat. 

Alternatively, consistency with small goals that build upon each other and habit stacking are valuable concepts to implement. This will look different for everyone. 

One example could be starting with a goal of having a daily breakfast that contains at least 30g of protein. Once this goal is consistently achieved, your next goal may be to incorporate 20-minute walks into your routine most days. 

While it may sound simple, these are the types of foundations that will make a significant impact when consistently applied. 

Weight loss and maintenance of weight loss happen when these types of habits are consistently integrated into your daily life. 

Tip 2: Eat Enough Protein 

Protein is a key macronutrient for supporting weight loss. Of course, we also need our other two macronutrients and plenty of fiber, but protein is one that many people are under-consuming, especially when it comes to weight loss. 

Protein supports metabolism, maintains balanced blood sugar levels, and promotes lean muscle mass. Additionally, eating enough protein will keep you feeling more satiated, AKA less “hanger” and cravings. 

We don’t necessarily recommend tracking macronutrients or calories because there’s no need to fixate on an exact number or track every gram you consume. With that said, it’s helpful to have some idea of what you’re shooting for with protein. 

Each person’s protein needs depend on individual factors such as activity level and body size. The recommended dietary allowance (RDA) for protein is 0.8 grams of protein per kilogram of body weight. 

However, this is the minimum amount of protein recommended to meet basic nutrition requirements. It does not take into account activity level and is not specifically designed for weight loss or postpartum care. 

Most postpartum women aiming to lose weight would benefit from consuming at least 100g of protein per day, or approximately 25-30g of protein per meal. Alternatively, a calculation of 1.6 grams of protein per kilogram of body weight can be used to estimate protein needs (28, 29). 

Tip 3: Eat Enough Food  

Yes, a calorie deficit is essential for weight loss, but the goal is to create the smallest deficit, or the “minimal effective dose,” needed to see progress. For lasting, sustainable results and improved body composition, it’s just as important to support your metabolism by prioritizing enough protein and building lean muscle along the way.

Major caloric deficits, or undereating, leave us at risk for nutrient deficiency and will eventually slow down basal metabolic rate (30, 31). Undereating refers to not consuming enough calories or nutrients to meet basic energy and nutrient needs.

We need to eat enough calories to support ongoing recovery, hormone health, and continued progress with weight loss. The amount of calories each person needs will depend on multiple individual factors, including activity level, height, nursing status, age, and body weight. 

The Dietary Reference Intake (DRI) recommendation for adult females is 2,000 to 2,200 calories per day (32). The Dietary Guidelines for Americans (DGAs) recommendations for adult females are based on activity level and range from 1,800 to 2,000 calories per day for sedentary individuals and 2,200 to 2,400 calories per day for active individuals. Additionally, the DGAs recommend 450 to 500 additional calories per day when nursing (33).

Again, we don’t necessarily recommend tracking calories or macronutrients. Tracking food intake can contribute to unhealthy obsession over food decisions and lead to feelings of guilt for some individuals. It may take the enjoyment out of eating, and food should be enjoyed! 

For those with a history of disordered eating, tracking intake may lead to unhealthy behaviors and thoughts. It’s a very personal decision whether or not tracking calories would work for you or impact your mental well-being. 

With that said, we don’t generally recommend falling below 1,800 calories per day when losing weight postpartum.  

Within the discussion on calories, diet quality is another important topic. Consuming a variety of whole foods and a balanced mix of protein, fat, and fiber will have a significantly different impact on our health, hunger levels, and weight loss journey than a diet lacking in these essential nutrients. 

Tip 4: Hydrate 

We lose water through breathing, sweating, talking, and urinating. It’s essential to replenish water and fluids throughout the day, every day. More fluids are needed when exercising as well. 

Maintaining adequate hydration and preventing dehydration supports both metabolism and digestive health. 

In addition to water, consider incorporating mineral support with a daily mineral mocktail. Minerals are essential for thousands of reactions and body processes, including the functioning of our metabolism, which converts the food we eat into energy (34). 

Tip 5: Strength Train

There are many long-term and short-term benefits to strength training. Strength training can help us live longer and healthier lives (35). It is also a valuable component of any weight loss program. 

Strength training helps to build and maintain lean muscle mass. The more muscle we have, the more calories we will burn at rest (36). 

It’s also essential to understand that strength training typically doesn’t lead to significant weight loss on the scale. However, with consistency and progressive overload, it can significantly improve body composition and help maintain weight loss over the long term (37). 

Body composition refers to the percentage of fat mass and lean mass (or fat-free mass) in the body. Lean mass encompasses everything except fat mass, including bones, muscles, and organs.

Once you both feel ready and are physically cleared to begin exercise, work with a post-natal certified fitness professional on an appropriate strength training program. 

Tip 6: Set Realistic Expectations 

Although this can vary widely from person to person, on average, it takes at least several months to one year to return to pre-pregnancy weight with intentional efforts. 

Although it may sometimes be easier said than done, it’s essential not to rush the process and to acknowledge that it will take time. 

In general, we do not recommend striving to lose more than about one to two pounds per week (39). Aiming for weight loss that regularly exceeds this rate could set you up for disappointment and lead you down the path of nutrient deficiency and a decrease in milk supply if you’re nursing. 

Also, remember that weight loss is often not a linear process. You will likely find that some weeks you don’t lose weight, and the following week you do the same thing, and you do. That happens and is both normal and expected. 

Remember that consistency and sustainability are key to success. 

Tip 7: Be Kind to Yourself 

Above all else, be kind to yourself. Remember, you just brought a new human into the world. There is a great deal of change and newness happening! This is true whether you’re two weeks, two months, or one year postpartum. 

Negative self-talk will not help you achieve your goal faster. Postpartum weight loss is a gradual process that requires patience and consistency. 

Being kind to yourself reduces pressure and supports mental well-being and a more positive body image. 

Tip 8: Seek Support 

Support is a game-changer for any goal we’re working towards in life. Those who have support are more likely to reach weight loss goals and maintain weight loss (39). 

Support may come from friends, family, community, or certified and knowledgeable professionals in the field, such as a dietitian (hey!), personal trainer, or physical therapist. 

For more personalized support from our team, explore the nutrition services we offer under the “Nutrition Services” tab!

Common Challenges and Considerations

During postpartum, you’re navigating recovery, the addition of a new family member, new routines, and more. Many variables impact the process of losing weight when this is a goal. 

Lack of time and energy 

Whether it’s your first or fourth child, welcoming a newborn changes the routine and dynamic of your daily life. There are often sleepless nights and days filled with diaper changes, bottle washing, and all that comes with caring for your little one. 

Do your best to avoid an all-or-none way of thinking. You don’t have to do it all right from the start. Small changes add up. If you have time for only prioritizing a quality breakfast with protein, start there! It doesn’t have to be a complete overhaul of diet, exercise, sleep, stress, and all the lifestyle changes right out of the gate, or nothing at all. 

Additionally, use food “shortcuts” or conveniences that make your life easier, where possible. For example, options like frozen vegetables, rotisserie chicken, pre-made hard-boiled eggs, and bagged greens. If purchasing these saves you time, that’s great. 

One final tip is that we know meal prep or batch cooking is helpful, but make it work for you. It doesn’t need to be each day and all day’s worth of meals prepped for the week on Sunday. It could be as simple as washing produce for the week so it’s easily accessible, or making an extra portion of a meal when you have time to cook for leftovers the next day, or freezing it for another day. 

Thyroid conditions 

The pregnancy and postpartum journey can lead to changes in hormone and thyroid health (40). Postpartum thyroiditis is a relatively common postpartum condition (41). It is characterized by transient thyroid dysfunction in the first six months to one year after delivery. 

Thyroid health impacts metabolism and weight loss patterns (42). Symptoms of thyroid dysfunction could include weight loss or gain, fatigue, feeling cold, muscle weakness, and constipation. 

Mental health 

Your mental health is most important. Movement and nourishing foods high in nutrients like omega-3s, magnesium, and B vitamins can support mental health (43). 

However, if it isn’t helping you at this moment, do not prioritize weight loss over your mental well-being. It is okay if you don’t have the emotional or mental space to think about a nutrition or exercise goal of any magnitude. These can always serve as goals to revisit later on. 

Prioritizing your mental health and self-care can have a profoundly positive impact on your overall well-being in numerous ways. 

If you feel you could benefit from additional support for anxiety, depression, or other symptoms during this time, reach out to a professional who can offer you additional coping skills and support. You deserve to feel your very best, both for yourself and your baby. 

Common ‘Mistakes’ 

There’s no one best set of exercises, meal plan, or macronutrient recommendations for every person. However, there are a few things to avoid to help make supporting weight loss smoother.  

Mistake 1: Only considering the number on the scale 

The number on the scale doesn’t provide a complete picture of your health or your body composition. This number doesn’t define you. 

Weight is one measure, but there are so many other variables to consider. Even if weight loss is a goal of yours, that doesn’t mean you need to weigh yourself. 

Use multiple markers to measure progress toward your personal goals, including how you feel, your energy levels, your mood, and how your clothes are fitting. Other technical measures, like body measurements or body fat percentage testing, are available if that interests you. 

Just as counting calories is a very personal matter, so is this. We don’t recommend these types of measures if they bring up negative thoughts, worries, or obsessions for you.  

Mistake 2: Comparing your postpartum journey to others 

The urge to compare ourselves to others is so common. You are not alone if you resonate with this. 

The thing is, every postpartum journey is so unique. Each person has a different experience with postpartum sleep, feelings, and recovery. 

Do your best to resist the urge to compare yourself to others or even to your pre-pregnancy self. Your body and life have undoubtedly changed through pregnancy and the welcoming of your new little one. Take it one day at a time and prioritize your mental well-being. 

Mistake 3: Focusing on restriction 

Restricting calories and food groups is often the sole focus of traditional weight loss programs. However, this often leads to the “I’ll start again on Monday” cycle. 

A sustainable way of eating for both health and weight loss allows room for flexibility and your favorite foods. If we continue to focus solely on what to take away, we are often left feeling deprived.  

All food groups can fit into a nourishing diet that supports weight loss goals. Instead of a restriction mindset, try shifting towards an addition mindset. Ask yourself questions like, “What can I add to my plate to make this a more nourishing meal?” For example, adding vegetables, increasing protein, or starting daily walks versus eliminating sugar, bread, and cookies. 

Mistake 4: Starting too soon 

Throughout the postpartum period, particularly in the early stages, the primary priorities are bonding, healing, recovery, replenishment, and nourishment. 

Childbirth, whether vaginal delivery or via cesarean section, involves significant physical demand from your body. If we haven’t emphasized enough, you need time to recover and heal. Jumping into weight loss efforts too soon could lead to physical injury, nutrient depletion or deficiencies, and declines in milk supply if nursing. Putting pressure on yourself to rapidly ‘bounce back’ can also negatively affect mental health and lead to added stress (44). 

During the fourth trimester, also known as the postpartum period, providing your body with the space and nourishment it needs to heal and adjust is crucial. Believe it or not, it will put you in a better physical, hormonal, and emotional state when you’re ready to focus on weight loss efforts in future months, if you give your body the space to heal.

Everyone is on a different timeline for healing, but waiting at least three months postpartum before embarking on intentional and gradual weight loss would be encouraged. 

Resources for Postpartum Exercise 

Exercise positively impacts our overall health. It is also a beneficial component of any program aimed at weight loss or altering body composition. 

Research supports that the combination of exercise and nutritional modifications effectively facilitates weight loss postpartum and helps return to pre-pregnancy weight (50, 51). Exercise burns calories, builds muscle, boosts mood, and improves insulin sensitivity. 

After giving birth, it is essential to wait until your healthcare provider gives you the “green light” before starting an exercise routine or program. Be sure to also listen to your own body. If you’re exhausted, doing 60-minute super high-intensity workouts will likely do more harm than good. 

Wait to start exercising until you have both been cleared by your doctor and you feel physically ready to do so. When you’re ready to start, begin slowly and ease in. Pelvic floor exercises and deep abdominal work are often recommended. 

Exercise combined with healthy nutrition habits can positively support weight loss during the postpartum period. The American College of Sports Medicine recommends accumulating about 150 minutes per week of cardio exercise and at least two days per week of exercises targeting muscle strength for general health and wellness (54). 

Diastasis Recti

Diastasis recti is the technical terminology for abdominal separation during and after pregnancy. The rectus abdominis muscles in the front of the abdomen stretch as the uterus grows and spreads apart during pregnancy. 

The estimates of prevalence vary from about 30-45% of women experiencing some degree of diastasis recti at six months postpartum (46, 47). 

It may cause or contribute to symptoms including a bulge that appears just above or below the belly button, softness around the belly button, pain during intercourse, constipation, abdominal weakness, pelvic floor weakness, urinary leaking with sneezing, coughing, or laughing (48). 

Repairing diastasis recti may require targeted exercises to strengthen the deep abdominal or core and pelvic floor muscles. Work with a certified and knowledgeable exercise professional for specific guidance and exercises. 

Pelvic floor exercises and physical therapy 

Urinary leakage and pain are not uncommon complaints from women who have given birth. Pelvic floor exercises and physical therapy can help with recovery and lay the foundation for progressing your exercise regimen safely and pain-free. 

Pelvic floor physical therapy and exercise help strengthen the pelvic floor muscles and improve their function. And it goes far beyond guidance to just “do your kegel exercises.” 

Resources 

• Mamaste Fit 
• Expecting and Empowered
• Get Mom Strong (Use code: RYANNPRENATAL for a 31-day free trial)
• Deliciously Fit and Healthy (Diastasis Recti Program)
• The Female Athlete (Pelvic Floor Physical Therapy Programs)
• BIRTHFIT Postpartum Programs

The Bottom Line 

1. There has traditionally been a large societal pressure to return to pre-pregnancy weight very quickly after birth. This does not support mom’s healing or mental well-being. Celebrate all that your body has done over the last year, and allow for plenty of time to heal, recover, and bond with your little one. 
2. Weight loss patterns during the postpartum period are individualized and depend on various factors, including pre-pregnancy weight, gestational weight gain, hormonal health, metabolism, sleep patterns, and genetics. No one loses or gains weight in exactly the same way. 
3. Everyone will be on their own timeline, and it is essential to prioritize your healing first and foremost. We generally recommend waiting at least three months postpartum before focusing on intentional weight loss efforts. Additionally, if you are nursing, wait until breastfeeding is well-established to avoid dips in milk supply. 
4. If weight loss is a goal of yours, aim for a gradual weight loss of about one pound or less per week. Support weight loss by incorporating nourishing and healthful habits, including daily movement, regular strength training, adequate protein intake, and plenty of fluids and hydration support. 
5. If you are having difficulty losing weight postpartum, despite consistently implementing positive nutrition and lifestyle habits, consider working with your healthcare team. Changes in hormone health, especially thyroid health and function, can impact metabolism and the ability to lose weight. 
6. Above all else, give yourself grace and prioritize your mental well-being.

Written by: Jorden Edinger, MS, RDN, LDN 

Reviewed/edited by: Ryann Kipping, MPH, RDN, LDN