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Does birth control really make you fat?

Some side effects are more frustrating than others, especially if you’re worried about gaining weight.

by Robin Wallace, MD

Ever quit taking the pill because your best friend told you her cousin got fat on birth control? I can’t tell you how many times I’ve heard this story. I’m not going to sugar-coat it: there are some side effects from hormonal birth control methods. But chances are they’re not as bad as you think. What I try to explain to my patients is that there are always cousins with bad experiences on birth control, but they are usually the exception, not the rule. All that said, here are three things you should know about birth control and weight gain.

Fact 1: Women on the pill don’t gain any more weight than women not on birth control.

There have been studies about this over and over again, and they all show the same thing, namely that the pill does not make you fat. Many young women are starting birth control for the first time while their body is going through many other changes. Some women gain weight naturally when transitioning from their teens into their twenties. If that happens to be when a woman starts birth control, it’s easy to put the blame on the pill, patch, or ring. The truth is each of these methods can be used without an expected weight gain. So go ahead, buy those new skinny-leg jeans and start your birth control the same day. Trust me.

Fact 2: The shot can lead to weight gain for some women.

Here’s what we have seen: the birth control shot (Depo-Provera) can cause weight gain for about a quarter of users. A recent study showed that, in the first six months of use, 1 out of 4 shot users gained 5 percent or more of their starting weight. (For example, if you were one of these women, you’d start using the shot weighing 170 pounds and gain 9 or more pounds within 6 months.) The women who gained weight in the first six months were more likely to go on gaining weight while they continued to use the shot. However, the majority of women (3 out of 4) didn’t gain much weight, averaging 1.4 pounds in the first year of using the shot. So most women using the shot are able to keep their weight steady with healthy eating and regular exercise. (Things we all should be doing!) However, the shot might not be the best choice if you already have trouble with your weight, particularly as there are many other options that provide excellent birth control and aren’t linked to weight gain (like the implant, an IUD, the ring, the patch and the pill).

Important to know: long-acting methods that also contain progestins, like the implant and the hormonal IUD, do not cause weight gain like the shot.

Fact 3: Healthy choices you make now not only will make you feel better, but also will prevent diseases like high blood pressure and diabetes when you are older.

If you do struggle with your weight, you’re not alone! About 1 in 3 women in the U.S. are obese, and this number is growing. While fashion magazines, with their airbrushed photos, are notorious for setting unrealistic and unhealthy body standards for women and girls, there is such a thing as healthy weight. Talk to your doctor or nurse about the right weight for you. If together you and your doctor decide it’s time to make some changes in how you eat and exercise, there are some simple tips below that can make a big difference in reaching a healthy weight. Make one change at a time, and don’t expect immediate results. Changing everything you eat at once is hard to maintain and often leads to gaining back weight quickly.

  • Carry a water bottle: Drinking water all day instead of sugary drinks like soda or fruit juice will cut out a ton of calories, while keeping you hydrated.

  • Eat breakfast: Even a granola bar or a piece of string cheese will get your metabolism going in the right direction in the morning.

  • Trade out your chips for carrots: Most potato and tortilla chips are fried in oil that your body doesn’t need. Choose baked chips or pretzels—or, even better, carrots or a piece of fruit—for a snack instead.

  • Turn off the TV...and the computer, the iPhone, anything with a screen of flashing lights: Keeping your screen time limited to less than an hour a day inevitably leads to more physical activity. You don’t have to join the track team right now, just start with a walk around the neighborhood with friends.

For more good ideas, check out these tips before your screen time is up for the day!

Robin Wallace, MD, is a Family Physician for the San Francisco Department of Public Health and is currently a clinical fellow in Family Planning at the University of California, San Francisco. As the middle of three daughters in her family, she has always been a passionate advocate for girl power and women's health, and appeared as Captain Contraception for a super heroes party in medical school.

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