Identify women at risk of weight gain with DMPA
Identify women at risk of weight gain with DMPA
Findings from new research may aid clinicians in identifying women who are likely to gain weight while using depot medroxyprogesterone acetate (DMPA, Depo Provera). Research indicates that DMPA users whose weight increased by 5% within the first six months of use are at risk of continued, excessive weight gain.1
Researchers found that early gainers were more likely to exhibit three major risk factors than women who were not early gainers: a body mass index (BMI) under 30, having children before starting DMPA, and a self-reported increase in appetite after six months of DMPA use, says Abbey Berenson, MD, professor in the Department of Obstetrics & Gynecology and Pediatrics and chief of the Division of Pediatric & Adolescent Gynecology at the University of Texas Medical Branch at Galveston. Berenson served as a coauthor on the current research.
DMPA, a contraceptive injection given four times a year, is a popular form of birth control. Among U.S. female adolescents who ever had intercourse, ever-use of the shot increased from 10% in 1995 to 21% in 2002.2 For women ages 15-44, 17% named the shot in methods most commonly ever used in 2002.3
Obesity, defined as a body mass index of 30 or more, continues to rise in the United States. The proportion of U.S. adults who are obese increased to 26.1% in 2008 compared to 25.6% in 2007, according to a Centers for Disease Control and Prevention (CDC) state-based telephone survey of adults ages 18 and above.4
"Obesity is a major risk factor for many chronic diseases such as heart disease and diabetes," said William Dietz, MD, PhD, director of the CDC's Division of Nutrition, Physical Activity, and Obesity, in a release highlighting the new CDC data. "As obesity increases among all age groups, we are seeing chronic diseases in much younger adults compared to a few decades ago."
Take a closer look
To perform the DMPA study, researchers followed 240 women ages 16-33 who used the contraceptive injection for up to three years. Investigators looked at several potential predictors of weight gain, including age, race, baseline obesity prior to DMPA use, lifestyle variables such as smoking and exercise level, and weight gain at six months. Results indicate women who had gained more than 5% of their body weight within six months, or after just two injections of DMPA, continued to gain significant weight during the next 30 months.
The current study's finding that women with BMI less than 30 were more likely than obese women to experience early weight gain is in contrast with previous reports that overweight girls and young women ages 12-19 are more likely to gain above those of normal weight.5
Authors of the current research point out earlier studies were based on adolescent populations, whereas the new study used a late adolescent-adult population of girls and women ages 16-33. This suggests that age may mediate the relationship between initial BMI and excessive weight gain, authors state.
The researchers say their evidence supports the observation that DMPA users do not all follow the same trajectory of weight gain. While some users will gain minimal amounts of weight, about 25% will gain excessive weight with continued DMPA use. Therefore, clinicians might want to extend contraceptive counseling beyond discussing mean weight gain as a side effect of DMPA, they note.
"If women choose DMPA, clinicians may want to tailor counseling to each individual user and her risk factors in addition to closely monitoring weight gain at every follow-up visit," the researchers state.
For women who have gained weight with DMPA and choose to continue the method, use the following healthy eating and lifestyle suggestions from the National Institute of Diabetes and Digestive and Kidney Diseases to discuss weight control:
- Eat a variety of nutritious foods from the basic food groups and limit your intake of saturated and trans fats, added sugars, salt, and alcohol.
- Be physically active for at least 30 minutes on most or all days of the week. This level of exercise helps reduce your risk for chronic diseases such as diabetes. Set goals for moderate-intensity physical activities, such as walking at a brisk pace, and chart your progress as you increase your activity level.
- If you are trying to lose weight or sustain weight loss, be physically active for 60 to 90 minutes a day. Chart your progress as you increase your activity level.
- Take stairs instead of elevators, park further from entrances, or go for a walk instead of watching TV after dinner. Make sure that you are in a safe and well-lit location when engaging in these activities.
- Keep a food diary. Write down all of the food you eat in a day, what time you eat, and your feelings at the time. Review your diary to find ways to improve your eating habits.
- Serve smaller amounts of high-calorie foods and larger amounts of low-calorie foods such as vegetables and fruits. Compare your portions to the serving size listed on food packaging for a few days so you know how much you are eating.6
References
- Le YC, Rahman M, Berenson AB. Early weight gain predicting later weight gain among depot medroxyprogesterone acetate users. Obstet Gynecol 2009; 114(2 Pt 1):279-284.
- Abma JC, Martinez GM, Mosher WD, et al. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2002. National Center for Health Statistics. Vital Health Stat 2004; 23:24.
- Mosher WD, Martinez GM, Chandra A, et al. Use of contraception and use of family planning services in the United States: 1982-2002. Adv Data 2004; 350:1-36.
- Centers for Disease Control and Prevention. Obesity Among U.S. Adults Continues to Rise. Press release. Accessed at www.cdc.gov/media/pressrel/2009/r090708.htm.
- Bonny AE, Ziegler J, Harvey R, et al. Weight gain in obese and nonobese girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Ped Adolesc Med 2006; 160:40-45.
- National Institute of Diabetes and Digestive and Kidney Diseases. Talking with Patients about Weight Loss: Tips for Primary Care Professionals. Accessed at win.niddk.nih.gov/publications/talking.htm#staff.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.