Volume CXXXIII, Number 16 February 27, 2004

Freshman Fifteen and birth control pills: no connection
JEFF BENSON, M.D.
DUDLEY COE HEALTH CENTER

Dear Dr. Jeff : I would like to start taking birth control pills, but I am already worried about gaining "the Freshman Fifteen"? What should I do?-V.W.

Dear V.W.: Fear of gaining weight on an oral contraceptive pill (OCP) is widespread. In most studies, nearly half of women who don't want to start OCPs and nearly half of those who do start OCPs but stop after the first month or two, do so because of concerns about weight gain. Fear of gaining the dreaded "Freshman Fifteen" has almost taken on mythic proportions nationwide!

But are these fears well founded? According to the best and most recent studies: no. It has now been clearly demonstrated that today's lower-dose OCPs do not cause weight gain. And it has also been shown that the Freshman Fifteen is in fact a myth.

Let's start with the OCP's. For the most part, older studies using high dose pills (with estrogens of 50 micrograms or more) tended to show about a five-pound weight gain per year. Recent studies, using low dose pills (estrogens in the 20-30 microgram range), have consistently shown that five to ten percent of women who start these OCPs will gain up to five pounds in the first year, but it's the same five to ten percent proportion, and the same five pounds for women who take the placebo control pills. In other words, the weight gain has nothing to do with the OCPs!

One study evaluating the treatment of acne with Ortho Tri-Cyclen showed this same lack of difference in weight gain between OTC and placebo. In this study, in fact, more women taking a placebo discontinued "treatment" prematurely because of weight gain!

The Freshman Fifteen? There was a much publicized study some time ago that showed that college women gained weight 36 times faster than women the same age who did not attend college. Even at that rate, first-year college students only gained an average of seven pounds, not 15. More importantly, there are obvious problems concluding from this analysis that going to college causes the reported differential weight gain.

More recently, researchers in Iowa tracked a large group of first-year college women, monitoring their weight, body fat composition, and attitude about gaining weight. About half of the students did put on weight, but on average less than five pounds. More than one third actually lost weight over their first year. And the students who worried most about putting on weight were the students most likely to think that they had gained weight-even when they hadn't!

These same findings were replicated closer to home in the Tufts Longitudinal Health Study. About half of the students followed over four years gained weight: on average about six pounds for men and four and one half pounds for women.

What about this weight gain, even if smaller than expected and affecting only half of students? To begin with, there are any number of psychological, social, and practical reasons for gaining some weight during one's first year at college.

Very importantly, there are also physiological reasons. It is completely normal, adaptive, and expected to gain some weight during one's late teens/early 20s, especially for women. That's why women in studies gain the same weight on placebo pills as on OCPs.

There are definite pros and cons to taking OCPs, and at the Health Center, we're happy to talk them over with you and help you make the best decision for yourself. Weight gain, though, is not a concern that should be a factor in your decision-making.

V-Day is here, and Eating Disorders Awareness Week begins on Monday. Fear of gaining weight or over-reacting to a small weight gain can trigger disordered eating and compulsive exercising. It's a good time to dispel myths about weight gain. And its an especially good time to challenge a culture which idealizes distorted body images and equally distorted personal expectations.

Be well!

Jeff Benson, M.D.

Dudley Coe health Center

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