Impact of Combined Hormonal Contraceptive Use on Weight Loss: A Secondary Analysis of a Behavioral Weight-Loss Trial

Abstract

Objective: This study aimed to perform a preliminary investigation of the impact of combined hormonal contraceptive (CHC) use on weight loss during an 18-month behavioral weight-loss trial.

Methods: Adults (n = 170; 18-55 years; BMI 27-42 kg/m2 ) received a weight-loss intervention that included a reduced-calorie diet, a progressive exercise prescription, and group-based behavioral support. Premenopausal women (n = 110) were classified as CHC users (CHC, n = 17) or non-CHC users (non-CHC, n = 93). Changes in weight were examined within groups using a linear mixed model, adjusted for age and randomized group assignment.

Results: At 6 M, weight was reduced from baseline in both CHC (mean, -6.7 kg; 95% CI: -9.8 to -3.7 kg) and non-CHC (-9.1 kg; -9.1 to -6.4 kg). Between 6 and 18 M, CHC regained weight (4.9 kg; 0.9 to 8.9 kg), while weight remained relatively unchanged in non-CHC (-0.1 kg; -1.8 to 1.6 kg). At 18 M, weight was relatively unchanged from baseline in CHC (-1.8 kg; -7.3 to 3.6 kg) and was reduced from baseline in non-CHC (-7.9 kg; -10.2 to -5.5 kg).

Conclusions: In this secondary data analysis, CHC use was associated with weight regain after initial weight loss. Prospective studies are needed to further understand the extent to which CHC use influences weight loss and maintenance.

© 2020 The Obesity Society.

Figures

Figure 1.

Flowchart of participants included in the current secondary analysis Abbreviations: IUD – intrauterine device; OCP – oral contraceptive pill; CHC – combined hormonal contraceptives aNon-contraceptive oral medications included Activella (Estradiol 0.5-1mg/norethindrone 0.1-0.5mg) ashormone replacement therapy for perimenopause, and Micronized Progesterone 150mg for sleep. bOne participant switched from an OCP to the vaginal ring without interruption in CHC exposure during the study, thus the total from CHC users below is >17 cParticipants were able to report more than one type of contraceptive method, so the totals from the non-CHC Users is >93. dOf 21 IUD users, 13 women were using Mirena® IUD (levonorgestrel-releasing intrauterine system, 52mg), 5 women were using Paragard® IUD (intrauterine copper contraceptive), and 3 women who did not know which kind of IUD she had in place.

Figure 2.

Adjusted means of body weight, waist circumference, and body composition over time a Error bars represent standard error of the mean; CHC: Combined hormonal contraceptives. b Sample sizes for weight are: CHC: n=17 at 0M, n=13 at 6M, n=12 at 12M, n=11 at 18M; non-CHC: n=93 at 0M, n=73 at 6M, n=65 at 12M, n=60 at 18M. c Sample sizes for waist circumference are: CHC: n=17 at 0M, n=13 at 6M, n=12 at 12M, n=10 at 18M; non-CHC: n=93 at 0M, n=73 at 6M, n=65 at 12M, n=60 at 18M d Sample sizes for fat mass and lean mass are: CHC: n=17 at 0M, n=13 at 6M, n=12 at 12M, n=10 at 18M; non-CHC: n=93 at 0M, n=71 at 6M, n=65 at 12M, n=60 at 18M

Figure 3.

Adjusted means of dietary intake outcomes over time a Error bars represent standard error of the mean; CHC: Combined hormonal contraceptives, kcal: kilocalories. b Sample sizes for energy intake and macronutrient composition are: CHC: n=14 at 0M, n=10 at 6M, n=11 at 12M, n=8 at 18M; non-CHC: n=73 at 0M, n=66 at 6M, n=59 at 12M, n=49 at 18M.

Figure 4.

Adjusted means of physical activity outcomes over time a Error bars represent standard error of the mean; CHC: Combined hormonal contraceptives. b Sample sizes for MVPA Bouts and Steps are: CHC: n=15 at 0M, n=12 at 6M, n=12 at 12M, n=10 at 18M; non-CHC: n=88 at 0M, n=71 at 6M, n=63 at 12M, n=58 at 18M.