Disordered Eating During Pregnancy: How to Talk to Your OB About What You’re Really Going Through

You deserve care that actually sees you. Here’s how to ask for it.

There’s a specific brand of embarrassment that comes up in the doctor’s office. If you’ve experienced it, you know exactly what I’m talking about.

You’ve been struggling. With food, with your body, with the way pregnancy is stirring up things you thought you’d dealt with or never had to deal with before. Maybe for weeks, maybe for longer than you want to admit. Disordered eating during pregnancy doesn’t always look like what people picture, and it doesn’t always come with a neat diagnosis.

But if something has felt really off around food or your body since you got pregnant, you’re not alone. You’ve been telling yourself that this is the appointment where you’re going to say something. You’ve even rehearsed it a little, come with a set of things to say in the notes app on your phone. And then the nurse asks you to step on the scale, and you feel like a deer in front of headlights. The appointment feels like a whirlwind of reassurances of “that’s normal” and you find yourself telling everyone you feel “fine.”

You are not the only one who finds it impossible to bring up real worries in your prenatal appointments. And it’s not because you don’t want help. Prenatal care is not always designed to hold space for these kinds of conversations. This means that if you want disordered eating support to be part of your care, you’re probably going to have to be the one to open the door.

This post is about how to do that. What to say, when to say it, and how to handle it all.

First: you deserve to be heard, and I mean that in a non-platitude way

A lot of prenatal care is organized around tracking the number on the scale. Simply flagging whether you’ve gained “too much” or “too little.” Never actually leaving time to explore the more important questions, like how are you really doing with food and your body right now. This environment can make it feel like there’s no room to bring up what you’re going through. Or that what you’re going through isn’t a “real” medical concern and you’re just being sensitive.

So let me be really direct: struggles with food and body image during pregnancy are clinically significant.

They affect your nutrition, impact your mental health, and can alter your relationship with your own body during one of the most physically demanding experiences of your life. And they deserve to be treated like a clinical reality, not brushed off as something that will just “blow over.”

You don’t need a diagnosis or a “bad enough” story to say something

If you’ve been hesitating because you’ve never been formally diagnosed with anything, or because you feel like what you’re going through doesn’t quite qualify, this section is for you.

You don’t need a diagnosis. You don’t need to have been hospitalized or treated or even to have a name for what’s happening. If any of this sounds familiar…

• anxiety or dread around eating
• restricting or skipping meals even when you want to do differently
• intrusive thoughts about food or your weight or the way your body is changing
• eating in ways that feel out of control and then feeling a lot of shame about it
• real fear about the weight gain that’s supposed to come with pregnancy
• feeling disgusted by or disconnected from your body
• hiding how you’re eating from your partner

…that’s enough. Noticing that something feels off is enough. You don’t have to have hit some imaginary threshold of “bad enough” before you’re allowed to bring it up.

If you have a history of an eating disorder and you haven’t told your OB yet

This is one of the most common things I hear. “I didn’t want to make it a thing,” or “I thought I was past it,” or “I was worried they’d treat me differently and be weird about it.” Those fears are not irrational. I’m not going to tell you they’re unfounded, because sometimes providers do respond badly, as unfortunate as that is.

And I still want to make the case for telling them, because here’s the thing: a history of an eating disorder changes what good prenatal care actually looks like for you. It’s relevant to how weight changes get discussed, how concerns about nausea or food aversions are handled, whether you get referred to someone like a perinatal dietitian or therapist who can actually support you. Providers who know your history can work with you differently, but only if they know.

You get to decide how much detail to share. “I have a history of restrictive eating” is a complete sentence. “I’m in recovery and pregnancy is bringing up a lot” is enough. You don’t owe your OB your whole story, you’re just giving them the information they need to take better care of you.

For a deeper discussion about navigating prenatal care when you have a history of an eating disorder, this blog is for you.

What to actually say: scripts for real life situations

You don’t need a perfectly rehearsed speech. But having a few words ready, especially when this topic makes you nervous and you tend to go quiet under pressure, can be the difference between actually saying something and walking out of the appointment wishing you had.

Use these as starting points and make them sound like you.

“I have a history of an eating disorder.”

“I want to make sure you have my full history. I’ve struggled with [restricting / binge eating / an eating disorder, whatever language feels right] in the past, and I want that to be part of my chart so we can make sure my care accounts for it. I’d love to talk about what that might mean for how we approach things.”

If you want to add a specific ask while you’re at it:

“I’d also really appreciate it if weight discussions could stay focused on overall trends and my wellbeing rather than specific numbers, that context is a lot easier for me to work with.”

“I’m noticing new struggles with food since becoming pregnant.”

“Something I want to bring up: my relationship with food has felt really off since I got pregnant, and it’s not something I’ve dealt with before in the same way. I’m having a hard time [eating enough / not feeling anxious about food / feeling okay about how my body is changing], and I’m not totally sure what to do with that, but it didn’t feel right to not say something.”

“Weight talk is hard for me.”

“Before we get into the appointment, I want to be upfront about something. Conversations about my weight tend to be really hard for me and can actually make it harder for me to take care of myself between visits. I’m not asking to ignore it entirely, I just want to see if we can approach that part of things in a way that keeps me in the loop without the number being the center of the conversation.”

“I’m not sure what’s happening, but something feels off.”

“I honestly don’t totally know how to describe this, but my relationship with food during pregnancy has been harder than I expected and it’s weighing on me. I’m not in a crisis or anything, I just wanted to say it out loud and ask, is this something we can talk through, or is there someone you’d recommend I connect with?”

What about the scale, and what if that’s the part you’re dreading most?

Okay, let’s talk about this. For people with a complicated food or body image history, getting weighed can set the tone for everything else. And not in a good way.

Here is something your OB’s office may not have ever mentioned to you: you can decline to be weighed. You can also ask for a blind weight, which means you step on the scale backwards and the number isn’t shared with or discussed with you. Both of these are legitimate options, and neither of them requires a lengthy explanation. You don’t owe anyone a justification for asking not to be weighed.

The best time to bring this up is before you’re already standing in front of the scale. Ideally when you check in or when the nurse starts taking your vitals. You can say something like:

“I’d like to request a blind weigh today. I’d prefer not to see or discuss my weight number. Can we do that?”

Or, if you’d rather decline altogether:

“I’m going to skip the weigh-in today. I have a hard time with that part of the visit and it affects the rest of my appointment, so I’d rather just note that in the chart and move on.”

You’re not being difficult when you say these things. You’re communicating a clinical need, clearly and calmly. Any practice that can’t meet you there is giving you useful information about whether it’s the right fit for your care.

What good support actually looks like, and what to do if you don’t get it

If you bring this up and your provider responds with genuine curiosity, adjusts how they talk about weight and food with you, and connects you with a referral, that’s what good care looks like. It exists, and it’s worth asking for.

A referral to a perinatal dietitian who works through a weight-inclusive, non-diet lens is appropriate and warranted (Hi! Work with me!). So is a referral to a perinatal therapist or psychologist who has experience with eating concerns and body image.

“Just try to eat more” is not a care plan, and you are allowed to say so.

If you bring this up and get dismissed, or minimized, or met with a blank stare and a pivot back to your fundal height, that’s not a reflection of whether your concern is legitimate. It’s a gap in your provider’s training, and you have options. You can ask again, more directly. You can ask for a referral to a specialist. You can also seek out that specialist on your own. A perinatal dietitian or therapist can often work alongside your existing OB without you having to switch your whole care team. And you can decide whether this practice is actually the right place for you to be receiving care.

You are the expert on your own experience. Your job is to identify your needs. Their job is to take it seriously. If they’re not doing their job, you are allowed to find someone who will.

If you’re navigating food and body image struggles during pregnancy or postpartum and you want support that’s actually weight-inclusive and ED-informed, that’s exactly the work I do at Nurtured & Well. You can learn more and reach out here.