I Want to Get Pregnant, But I’m Terrified of the Weight Gain

Written by Dr. Colleen Reichmann, owner and clinical director of Wildflower Therapy.

I’ll never forget nearly having a panic attack during one specific OB appointment when I was pregnant with my first. “You’re gaining weight a little more quickly than is typical. Well just keep an eye on it, don’t worry!” I felt my ears ringing as I tried to stay calm and present for the rest of the appointment. I tried to deep breathe through the questions about how I was sleeping and if the heartburn was better, but those words were all I could focus on “Hu.” I sat outside for a long time trying to bring my anxiety down after that appointment. I remember thinking to myself. “Huh. Haven’t gotten that worked up about anything to do with weight in a while. But then again, I haven’t ever had to grow a human while fielding comments from doctors that seemed to suggest I needed to exercise control over a totally uncontrollable process. And actually, I hadn’t ever had to relinquish control over my body in such a radical way….” This thought helped me access the self-compassion I needed. Because oh, did I forget to mention that I was years into strong eating disorder recovery when this happened? (And an eating disorder-specialized psychologist to boot.) I had worked for so long at weight neutrality, and felt so damn solid in my recovery that it truly didn’t even occur to me that OB weight commentary might send me into a panic.

I tell that story mainly in the hopes of normalizing the fears and discomfort that can come up around weight gain during pregnancy. You are not alone if the body change aspect of pregnancy feels terrifying. So, so many people who deeply want a child also carry an intense fear of how pregnancy will change their body. (We just don’t tend to share about that fear openly in our society.) And or those with a history of disordered eating, chronic dieting, or an eating disorder, that fear can feel overwhelming, shame-filled, and isolating.

When Wanting a Baby and Fearing Body Changes Exist at the Same Time

You might notice two powerful truths living side by side: a genuine longing for pregnancy and parenthood, and a deep anxiety about weight gain, loss of control, or watching your body change in ways you can’t stop. These fears often don’t come from vanity or superficial concerns. They are usually rooted in lived experience. Years of being praised for thinness- of being taught to fear weight gain. Years of relying on control over food and body size as a way to cope with stress, trauma, or uncertainty.

As an eating disorder and maternal mental health therapist in Philadelphia, I hear this exact fear voiced quietly and often: “I want this so badly, but I don’t know if I can handle what it will do to my body.”

Why Pregnancy Can Feel So Threatening for People With Eating Disorder Histories

For people with eating disorder histories, pregnancy can feel uniquely dauting. The body becomes public, medicalized, commented on, weighed, measured, and discussed. Weight gain isn’t just expected-it’s required. Hunger cues often increase, or become skewed by nausea and other physical symptoms. Food rules that once felt protective may no longer “work.” And well-meaning medical providers can unintentionally reinforce fear by focusing heavily on numbers (while providing a seemingly arbitrary weight gain range that’s acceptable) or weight charts without attending to the emotional impact.

This doesn’t mean pregnancy isn’t possible or safe for someone with these fears. But it does mean that the fear deserves to be taken seriously-not minimized, rushed past, or shamed away.

Many people worry that being afraid of pregnancy weight gain means that they are selfish or unfit for motherhood. In reality, it often means the opposite. It reflects how deeply you care, how much you are trying to prepare, and how aware you are of your own vulnerabilities. Needing support with body image before or during pregnancy is NOT a failure. it’s a protective and loving act for both you and any future children.

Why These Fears Deserve Support, Not Shame

It’s also important to name something gently but honestly: untreated eating disorder thoughts during pregnancy don’t usually disappear on their own. For some, pregnancy temporarily quiets them; for others, the loss of control can intensify them. This is why folks who have struggled with disordered eating often seek out preconception and perinatal support. Working with an eating disorder therapist before getting pregnant can help you build emotional tools, body trust, and coping strategies before the stakes feel higher.

An eating disorder therapist can help you explore questions like: What does weight gain symbolize for you? What fears feel most activated? Loss of identity, loss of control, fear of judgment, fear of permanence? What parts of you believe weight gain is dangerous, and where did those beliefs come from? And these conversations aren’t about convincing you to “just be okay with it.” They’re about creating enough safety that fear doesn’t have to run the show.

For many, this work also includes learning how to advocate for yourself medically. That might mean setting boundaries around blind weights, preparing responses to body comments, or choosing providers who understand eating disorder recovery. It can mean grieving the fantasy of a “joyful, glowing” pregnancy and making room for a more complex, honest emotional experience.

There is also space to talk about ambivalence. You are allowed to want pregnancy and not want what comes with it. You are allowed to feel excited and terrified at the same time. Therapy does not require certainty; it welcomes contradiction.

You Deserve Support

If you’re reading this and wondering whether your fears are “bad enough” to justify reaching out to a therapist, that question itself is often a sign that support could help. You don’t need to be actively restricting, purging, or engaging in obvious behaviors to deserve care. Fear, preoccupation, and distress around body changes are enough.

Pregnancy does not require loving your body every step of the way. It requires nourishment, support, and compassion. Especially when old patterns get loud. With the right eating disorder treatment, many people find they can move through pregnancy feeling steadier, more grounded, and less alone than they expected.

If you are in Pennsylvania and searching for an eating disorder therapist in Philadelphia who understands the intersection of eating disorders, fertility, pregnancy, and reproductive mental health, help is available. You don’t have to choose between your mental health and your desire for a child. With support, it is possible to honor both.

And if nothing else, let this be true: being afraid of weight gain does not mean you are incapable of becoming a loving, attuned parent. It means you are human, shaped by a culture that taught you to fear your body. And brave enough to question that fear before taking a life-changing step.

 Looking for Eating Disorder Therapy or Maternal MentaL Health Therapy in Philadelphia or Pennsylvania?

If this post resonated, our therapists at Wildflower Therapy support children, teens, adults, and families across Pennsylvania who are navigating things like eating disorders, disordered eating, ADHD, body image concerns, anxiety, depression, infertility, and maternal mental health/infertility.

We provide therapy in Philadelphia (and virtually throughout Pennsylvania, New Jersey, Delaware, Florida, South Carolina, Vermont, Virginia, Ohio, and Massechusetts.) We work with children, adolescents, and adults.

If you’re looking for a therapist in Philadelphia or Pennsylvania, we’d be honored to walk alongside you. Please reach out today to book your free consultation call.