Does breastfeeding generally help or impede recovery for people with eating disorders?
The degree to which it helps or impedes recovery is dependent on many factors, including their use of symptoms, weight stability, and overall emotional health, both pre-pregnancy and postpartum. One study found that the severity of eating disordered symptoms postpartum was worse than pre-pregnancy for 57% of bulimic patients (Morgan, Lacey, & Segwick, 1999).
Eating disordered behaviors tend to spike during times of change and transition, and moving into motherhood is filled with both. There is struggle to find balance in focusing on both self and baby. If the mother is over-focused on the baby at the expense of self, this can easily feed the eating disorder and often lead to relapse. In one study conducted in Norway, eating disordered symptoms increased in the postpartum and lactation period, per women’s self report (Bulik et al., 2007).
However, breastfeeding can be an amazing opportunity to build relationship and connection, often something that is painfully missing for individuals struggling with an eating disorder. The hormone oxytocin – which stimulates milk letdown in breastfeeding – is linked to a sense of calm and is found to promote bonding between mother and infant. This in turn can positively affect such health measures as glucose, cortisol and other stress-related processes. If a mother is adequately nourished and is managing her eating disorder recovery well, the benefits of oxytocin and the stress mitigation can be quite helpful. Mental health of the mother has been found to be a better indicator of healthy attachment and bonding with the infant, regardless of whether the baby is fed by breast or formula.
Are there risks to breastfeeding if you have an active eating disorder?
When someone is actively struggling with an eating disorder, the stress it places on someone’s body and brain are significant. When a mom is breastfeeding, even more energy (fat, carbohydrate, protein), and hydration are required for adequate and healthy milk production. This means moms will need to eat more food, more often, and with adequate variety and nutrient density – something that would likely present a challenge to someone already struggling with an eating disorder. The nutrient quality of the mother’s milk suffers with inadequate maternal nutrition. Additionally, the mother’s risk for osteoporosis and other nutrient deficiencies increases even further during breastfeeding. In fact, 80% of women who relapse in their eating disorder postpartum reported that focus on weight loss and return to their pre-pregnancy body was the underlying trigger.
Since body dissatisfaction is such a common concern with eating disorders, the anxiety related to the changing body is particularly high during the pregnancy and postpartum period. It can be difficult to give the attention their own bodies require during this time. Believing that breastfeeding can alone be motivation to move someone into recovery is dangerous and misleading.
The most important factor in this equation is having a strong team with a dietitian and therapist each specializing in eating disorders, an OB who is willing to consult with the team, and potentially a specialized psychiatrist. Also, meeting with a lactation consultant who is willing to work on the team, prior to delivery and postpartum, can be a huge help to empower the mother in making the best choice for herself and her baby.
Having women set an alarm to remember to eat and rehydrate every 2-3 hours during the day when breastfeeding is invaluable. I recommend women keep a basket near their breastfeeding “area” with snacks, water, perhaps a book or iPad, and other self-care items to use when they are pausing to nurse. This is often the first time the mom may sit and catch up with herself, and is a great reminder for her to re-fuel and rest.
Takeaway: The conversation about whether to breastfeed or not needs to start during pregnancy and be processed along the way with the new mom feeling she has full permission to change her mind at any point. Happy, Healthy Mom = Happy, Healthy Baby!