For the obstetrician, the baby takes precedence over the mother's psychological state. Dr. Clarissa Bonanno, an obstetrician who deals with high-risk pregnancies at Columbia University, argues there is a weak correlation between the mother's weight gain and the baby's weight because the baby takes what it needs to grow, regardless of how much weight the mother gains.
Bonanno says eating disorders often go undetected during pregnancy because many patients don't tell and obstetricians don't receive special training on eating disorders in medical school. "We probably grossly under-diagnose it," she says.
Years before she became pregnant Melissa struggled with her eating disorder. She recalled sitting in her car outside a gas station in Kalamazoo, tearing open candy wrappers. As soon as she took the first bite and felt it soften in her mouth, she spit out the intruder.
Chewing up the "bad" food and then spitting it out gave her the taste she craved, but not the satisfaction. From 2006 to 2009, she hid in her car, under her desk and even in an airport bathroom stall to spit out candy and cookies.
It had been over a year since Melissa chewed and spit, but watching the number on the scale increase during pregnancy while she ate and exercised the same startled her. At six months pregnant, she continued to focus on her growing unborn child though some days were a struggle.
"I blame myself for everything I went through," Henriquez says. "My disorder was a mind set, but I knew I needed to change how I thought about things in order to have a baby."
Melissa had a pleasant childhood growing up in Vernon, N.J., as the oldest child of three. Her red hair and heavier build distinguished her from her peers. Her parents would joke that she was born hungry, since she always had food on her mind. As a kid, Melissa ate what she wanted with no regard for counting calories or measuring portion sizes.
She listened to her body by gauging hunger and fullness. Her biggest concern about the food on her plate was how it tasted.
"I sometimes feel as if Melissa thought she had to perform more, or perform better, to make sure she was still recognized," says her mother, Sue Marion.
When she met her soon-to-be husband, Luis, during her senior year in college, Melissa was the heaviest she had ever been at 5 feet 5 inches tall and weighed slightly over 175 pounds. She was grateful Luis appreciated curvaceous women.
But in 2004 Melissa started to change the way she thought about her body. She joined Weight Watchers and began to lose a pound or more a week until she had lost 35 pounds by Christmas that year. She was ecstatic and proud of her weight loss; her hourglass figure had evened out, making her broad shoulders, tiny waist and hips follow a more symmetrical line.
By 2006 she had married and moved to Kalamazoo, Mich. But the stress of moving to a new city, a new marriage and a new job heightened Melissa's anxiety. She felt her Weight Watchers program was no longer providing enough control.
She gradually became obsessive about keeping off additional pounds. She shunned all food but her Weight Watchers portions. She worked out twice a day and missed going out with her friends if it meant losing time at the gym. When Luis surprised her for a weekend getaway one Friday morning, she cried hysterically and refused to go because she had not had a chance to go to the gym that day.