Original Studies
Weight gain, adiposity, and eating behaviors among adolescent females on depot medroxyprogesterone acetate (DMPA)

https://doi.org/10.1016/j.jpag.2004.01.006Get rights and content

Abstract

Objective

To identify risk factors for weight gain and explore body composition and eating behaviors among adolescent females initiating depot medroxyprogesterone acetate (DMPA).

Methods

A longitudinal study was conducted in 43 adolescent females beginning DMPA. Data collection at baseline, 3, and 6 months included structured interview; measurement of height, weight, and percent body fat; and assessment of dietary restraint, disinhibition, and appetite.

Results

Black and white subjects did not differ in baseline weight or body composition. At 6 months, black subjects had a 4.2% increase in weight (mean weight gain = 2.9 kg; P = 0.003) and a 12.5% increase in body fat (mean fat gain  = 2.5 kg; P<0.001). In contrast, white subjects had a 1.2% increase in weight (mean weight gain = 0.9 kg; P = 0.32) and a 1.2% increase in body fat (mean fat gain of 0.5 kg; P = 0.54). Baseline weight (P<0.001), study visit (P = 0.005), age (P = 0.006), eating restraint (P = 0.005), eating disinhibition (P<0.001), and other medications (P<0.001) were predictive of weight gain in black subjects. Only baseline weight (P<0.001) was predictive in white subjects. Higher baseline weight (adjusted odds ratio (AOR) = 1.2, 95% confidence interval (CI) = 1.1,1.3) was a risk factor for gaining >2.2 kg the first 3 months. Black race (AOR = 7.8, 95% CI = 1.5, 66.2) and younger age at menarche (AOR = 0.6, 95% CI = 0.3, 0.9) were risk factors for gaining >2.2 kg the second 3 months. Appetite decreased in the study sample reaching statistical significance in black subjects.

Conclusions

Our data suggest that black and white adolescents differ in the quantity, timing, and predictors of weight gain on DMPA. DMPA-associated weight gain is paralleled by increases in total body fat, while appetite decreases on DMPA.

Introduction

Weight gain is reported in up to 54% of adolescents on depot medroxyprogesterone acetate (DMPA)1 and is cited as the primary reason for method discontinuation by 41% of adolescent who use DMPA.2 Nearly one third of adolescents who begin DMPA do not receive a second injection at 3 months, one half do not receive a third injection at 6 months, and three quarters discontinue use by 12 months.3 Only 9% of adolescents who discontinue because of weight gain will restart DMPA, compared to 80% who discontinue owing to missed appointments.3

Strategies to prevent weight gain on DMPA are hampered by a paucity of information about its predictive factors and underlying mechanisms. Moreover, studies examining risk factors associated with weight gain among adolescents are limited. Although the mechanism of DMPA-related weight gain is generally felt to be the result of increased appetite, no formal measure of appetite has been done. One study in adult women evaluated mechanisms of weight gain. DMPA was found to have neither an anabolic nor fluid retaining effect, but rather, weight gain was due to fat deposition, which the investigators hypothesized, was secondary to increased appetite.4

The primary objective of this prospective, longitudinal study was to identify risk factors for weight gain among adolescent females initiating DMPA. Secondary objectives were to explore body composition and eating behaviors of adolescents who do and do not gain weight using validated measures.

Section snippets

Subjects

The study population consisted of female patients aged 12 to 21 years who were seen at an urban, hospital-based Teen Health Center between January 1, 2000, and October 31, 2000, for first-time initiation of DMPA. The Teen Health Center patient population is predominantly urban, impoverished (65% Medicaid), and African-American (65%). Exclusion criteria for subject participation included the following: (1) obesity, defined as body mass index (BMI) ≥30 kg/m2; (2) pregnancy within the preceding

Results

Of the 43 patients who enrolled as study subjects, 26 (60.5%) identified themselves as black, 15 (34.9%) as white, and 2 (4.6%) as mixed black/white. Black subjects were younger by a mean of 1.2 years (P = 0.03) and had a mean appetite score at T0 that was 53% higher (P = 0.05) than white subjects (Table 1). Black subjects were 28% as likely as white subjects to report medication use at T0 (P = 0.02) and, though the differences did not reach statistical significance, were half as likely to report a

Discussion

This prospective, longitudinal study of adolescent females initiating DMPA suggests differences between the two racial groups with regard to the quantity, timing, and predictors of weight gain. Despite no differences in baseline weight, BMI, total body fat or lean body mass, black subjects experienced significant increases in weight and fat during the first 6 months on DMPA whereas white subjects did not. As reported in other studies,4 weight gain in affected individuals was associated with

Acknowledgements

Supported by USPHS Grant Number MO1 RR 08084, General Clinical Research Centers Program, National Center for Research Resources, NIH.

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Synopsis: Black and white adolescents on DMPA differ in the quantity, timing, and predictors of weight gain. Weight gain is paralleled by increases in total body fat and decreases in appetite.

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