Christie Caggiani, RDN, CEDRD-S Discusses Breastfeeding and Eating Disorders

Christie Caggiani, Registered Dietitian and Eating Disorder Specialist at Therapeutic Oasis contributed to this story in the Washington Post.

October 14, 2019 Washington Post

Breast-feeding is helping me face my decades-long struggle with hating my body

About 30 hours after I gave birth to my daughter, while I was still in the recovery room at the hospital, I saw my postpartum body for the first time. In the mirror of the cramped bathroom, I took in my reflection — my softly bulging belly and loose skin — and I was shocked. But most shocking was that, despite my decades-long struggle with anorexia, this new body didn’t disgust me. I was curious and fascinated. I took a selfie.

A few factors contributed to this placid acceptance of my postpartum shape: the euphoria of having just birthed a human; the hazy gloss of sleep deprivation from laboring overnight; and, most importantly, the fact that my baby now desperately needed nourishment from me. In that moment, the only thing I judged my body on was its ability to feed Audrey.

In the days and weeks that followed, this mind-set held. I wasn’t surprised that my anorexic thoughts didn’t appear. I didn’t even register their absence. I’d heard about the high caloric needs of breast-feeding women, and I ate. I did things that I never would have if my anorexia weren’t dormant. I ate immediately upon waking, rather than making myself “earn” food first. I ate in bed. I ate doughnuts. Years of experience had conditioned me to expect self-flagellation after such indulgences. Normally, I would’ve forced myself to wear my skinniest pants afterward, both to prove that I could still fit into them and as penance, the feeling of the waistband digging into my flesh acting as a reminder that I had erred. Instead, I wore flowy dresses and didn’t think to scrutinize my profile in reflections.

My new attitude was rewarded with each pediatric checkup, as our daughter grew in pounds and inches, her percentiles steadily rising. She started to fit into her baby clothes, and what clothes I fit into was of no importance. I looked in the mirror and saw a mother, a woman providing vital nutrition to her child. I didn’t poke the soft flesh of my stomach. I forgave my thighs for touching one another in bed. I chuckled at my suddenly enormous breasts. My baby was growing, my milk was flowing and that was what mattered.

This sudden freedom from the tyranny of anorexia may have been brought on by the breast-feeding itself. According to Christie Caggiani, a Florida-based dietitian and therapist specializing in eating disorders, the hormone oxytocin, which stimulates milk letdown, is linked to a sense of calm that can be helpful in mitigating eating disorder-related stress. She also says that breast-feeding provides an opportunity for building relationships and connection, something that’s often “painfully missing” for those struggling with eating disorders.

I’d like to say that breast-feeding, and being a mother, was a permanent cure for my anorexia. But after a few months, things changed. The metabolic requirements of breast-feeding outran my food intake and I started to lose weight. This is a well-documented phenomenon — many mothers cite accelerated weight loss as a breast-feeding benefit — but for someone with an eating disorder, it’s not an innocuous side effect.

Suddenly, I fit into my pre-pregnancy jeans. Strangers commented that they couldn’t believe I’d just had a baby. My anorexia woke up. I began scrutinizing what I’d been doing effortlessly for months, and questioning whether I really needed to be eating so much, gradually subtracting food and adding exercise. Before long, the pre-pregnancy pants didn’t just fit me; they fell off me.

The potential reasons behind this shift are manifold. I now had to convince myself to eat for someone who was outside my body, a much more difficult notion to internalize than eating for a human I was growing inside me. Caggiani also says that eating disordered behaviors tend to spike during times of transition, and let’s just say that going from a responsibility-free life in Brooklyn to motherhood in Sacramento was not an imperceptible change for me. Carla Manly, a California-based clinical psychologist, told me that “the anxiety-inducing periods of pregnancy and postpartum” often worsen an eating disorder, despite a mother’s best efforts to prioritize her newborn.

My husband raised concerns, and I scheduled a call with my old dietitian, in the hopes that she could talk some sense into me. She did, to a certain extent, scaring me straight by telling me that breast-feeding while underweight could set me up for osteoporosis later in life, and that even if I produced enough milk, doing so at a low weight meant the milk could be leaching harmful elements such as mercury from my body.

But at that point, the train was out of the station. I’d decided, with the absurd but impenetrable logic of a person with an eating disorder, how many calories I could eat per day, and I would not exceed that number despite my ravenous hunger, fatigue or loose clothes. That old anorexic exceptionalism exhorted me: you can do both. You can lose weight, exercise through hunger, fit into the smallest size and still give your baby the sustenance she needs.

And for a while, I could. Until I couldn’t. When my daughter was just over five months old, my milk production plummeted. There are any number of reasons it happened. We cut out night feedings. We took a five-day trip without my pump. Or maybe it was just my body’s natural time to stop — there’s no “normal” when it comes to how long a woman produces milk postpartum. Regardless, it became clear that my daughter was not getting the food she needed. When she wouldn’t take formula, I panicked. Instantly, the cacophony of eating disordered thoughts silenced and the important things came into stark relief. It didn’t matter that my arms looked skinny in a photo — my baby had been hungry. I longed for the poochy bulge of my postpartum belly. I resolved to eat an enormous dinner, as if that would fix everything.

We soon found a formula my daughter took, but those two days of panic made it clear that anorexia had distorted my priorities. As Caggiani says, “believing that breast-feeding alone can be motivation to move someone into recovery is dangerous and misleading.”

It is, of course, fine to taper off breast-feeding at five months. Many women never breast-feed, and their babies grow into vibrant, healthy adults. Still, I’m working to get back to the place where I was when my daughter was born, when maternal love and responsibility swept away the clutter of eating disordered thoughts.

I may never get my milk supply back up, and she may never again be dependent on me for sustenance, but if I want my daughter to love and respect her own body, I need to do the same to mine.


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