Dear Doctor,

I had my first child three months ago and it was a natural birth. I have since tried to get back into shape and nothing seems to help the sagging tummy. I try to exercise on a regular basis and watch what I eat, but there are no results. What am I not doing right? Is there anything you can recommend?

Gloria

Dear Gloria,

Women tend to have a big or slightly protruding belly after child birth. This happens due to the belly muscles being stretched progressively during pregnancy and gradually losing their tone. This can change after child birth, duration depending on several factors like number of pregnancies and deliveries, whether breastfeeding or not, diet, level of physical activity, and any other medical disorder. But if somebody is determined, she can definitely regain a flat tummy. It takes six to eight weeks for the uterus to go back in its original location and the abdomen can become really flat after this. 

Apart from pregnancy and child birth, abdominal girth also increases due to advancing age in women. Muscles become hypotonic due to age and hormonal changes. If one is 30 or 35 years plus, this factor also should be kept in mind. 

Brisk walking, light jogging, swimming, are some exercises which help in trimming the belly.  Specific exercises are there to tone up the abdominal muscles, but they should be started after some time, when the uterus is settled in its original place. It is also good to consult one’s physician before starting those exercises.  Being sedentary, i.e. lack of any physical activity contributes to central obesity. If a person exercises daily in the morning and then sits throughout the day, the beneficial effects of exercise done are diminished. Hence, it is important to be active physically, it is good to "move around” as much as possible. Activities such as sweeping the house, gardening, and et cetera, are useful.

Regarding diet, it is useful to take small frequent meals instead of one or two large ones. Small quantity of food taken is metabolised faster and calories do not accumulate. It is better to take plenty of fresh fruits vegetables and lean proteins like fish, beans, lentils, yoghurt, low fat cheese, for example. Drinking adequate amount of water keeps the body cells well hydrated, thus helps to maintain tone of tissues and muscles. 

Abdominal binders are available to bind the abdomen, thus preventing or minimising the belly bulge, after delivery. If the delivery has been normal without any complication, they can be used early within one to two weeks after child birth. It is advised to use the binder for at least 10 to 12 hours every day, that is, most of the waking hours. 

Breastfeeding helps in reducing abdominal fat. Hence, it is good to breast feed the baby as much as possible.

One has to be patient while trying the above measures to reduce the protruding belly. If in spite of adopting the correct diet and exercising regularly, tummy does not reduce even after more than six months, it is advisable to undergo investigations to exclude any medical disorder.     

Dr. Rachna   Pande is a  specialist in internal medicine.