Ask the Nutritionist

Hi Sue,

I'm 12 weeks pregnant and substantially overweight at 5'11" and 300 pounds. I want to follow the nutrition guide given to me by my OB nurse as I want to stay within the 15-20 pound weight gain during this pregnancy, but I must admit that I'm terribly confused.

I've been trying to eat according to the pyramid plan, but find at the end of the day my calorie intake is VERY low. I also have a lot of trouble meeting the dairy and fruit categories. I'm not much of a milk drinker at all, and I don't enjoy fruit either.

Another problem I'm having is that the nurse recommended staying away from "the whites": Sugar, bread, potatoes, rice and pasta. I'm not sure how this fits into the pyramid plan calls for at least 9 servings from the bread group daily.

At this point I'm wondering if it wouldn't simply be easier to count calories instead while trying to maintain a healthy balance of fruits, vegetables, breads, etc. If so, what would be an appropriate amount of calories per day?

Thanks for any and all help you could give me.

One of the pitfalls of the  pyramid is that it doesn't make clear that the grains should be whole grains, not processed grains like white bread, white rice, highly processed and sugared cereals. Any grain intake should be of whole grains such as 100% whole wheat bread, brown rice, oatmeal, etc. 

Normally following the pyramid and the serving size suggestions is a good idea since it will automatically take care of calories for you.  However, the pyramid is not really good for pregnant moms since it doesn't take into account some of the unique needs of a pregnancy....like extra calcium, a little extra protein, high iron foods, etc. Therefore, I recommend that you refer instead to a book called Nutrition for a Healthy Pregnancy by Elizabeth Somer.  It will provide you will a guide to what and how much you should eat.

However, because of your weight, you are at a much higher risk for prenancy complications and therefore, calorie intake is improtant, and you should limit your calorie intake more than a normal weight pregnant woman.  To do this, you will need to be extra vigilant in making sure you get the proper nutrients in the smaller amount of foods that you should be eating.  To do this properly, you can study the book and be super vigilant about it yourself, under the guidance of your doctor, or you could meet with a dietitian for some initial guidance then continue on your own with frequent check-ins.

Best wishes for a happy and healthy pregnancy.