Are Women Avoiding the Birth Control Pill Over Fears of Gaining Weight?

In a recent study published in Contraception from the Penn State College of Medicine, researchers tried to examine the effects of this perceived correlation, surveying 987 privately-insured, sexually active women about their height, weight, perception of their weight, and contraception use and behaviors, among other things. Their goal was to analyze the way in which anxieties about weight and weight gain may affect women's reproductive choices. "Weight gain is a commonly cited reason for discontinuation of hormonal contraception; thus, weight may play a role in the risk of unintended pregnancy," the study's introduction reads.

According to their findings, overweight and obese women were more likely than "normal-weight" women to use long-acting reversible contraception (LARC) methods, such as IUDs or birth control implants. And, although obese women had greater odds of using nonprescription birth control or no contraception at all, "these findings did not reach statistical significance," the study found.

"Overweight and obese women may be reluctant to use contraceptive methods they believe are associated with weight gain," the study's authors conclude, "but how that affects contraceptive use is unclear."

Renee Engeln, a psychologist and director of the Body and Media Lab at Northwestern University who read over the study with Broadly, says that this could be an inaccurate extrapolation: Just because more overweight and obese women in the study said they use contraception that isn't associated with weight gain doesn't necessarily mean that they chose the method out of body-image-related fear, she warns.

"There's actually no direct evidence in it at all that heavier women are avoiding oral contraceptives because of concerns over weight gain," she says over email. "They didn't even assess whether women in the study were concerned with weight gain, and their assessment of women's weight perceptions weren't significantly related to contraceptive choices."

Cynthia H. Chuang, a professor of medicine and public health sciences at Penn State College of Medicine and one of the study's authors, says that her team's "main motivation was to better understand why women with different characteristics may be drawn to different kinds of birth control methods," citing a recent study by Julia Kohn at Planned Parenthood that reported that obese women were more likely to use LARCs and non-prescription methods. However, she admits that they were "only able to conclude that fear of weight gain might be a motivating factor when deciding on a birth control method."

And, though she acknowledges that they "couldn't prove that was the reason why obese women in [their] study were more likely to use LARCs," several science journals and various media outlets have covered the study's findings as definitive proof that overweight women avoid hormonal birth control due to fears of gaining weight: An article in Shape reads that "women are choosing less-effective birth control because they don't want to gain weight…[which is] particularly true for women who [are] overweight or obese," a message that the Revelist, Refinery 29, and even the PSU press release echo.

Engeln says this conclusion seems "particularly odd, given its implicit assumption that thinner women don't worry about gaining weight, which is patently false." She adds, "It may turn out that weight gain does play a role in these decisions, but this study does not demonstrate that." When asked about this, Chuang agreed, acknowledging women's universal fear of weight gain.

According to studies compiled by Statistic Brain, 91 percent of women are unhappy with their body enough to resort to dieting; even within the Penn State study, the researchers found that, while only 42 percent of their subjects were overweight or obese, half the women believed that they were overweight. Because many women feel anxious about their body image, regardless of their actual body mass index, it's quite possible that that "normal-weight" women, too, are worried about weight gain as a potential side effect of hormonal contraception.

In a press release accompanying the Penn State study, Chuang said that clinicians should be aware that women may be making their contraception decisions due body image–related anxieties, but that this could provide a positive opportunity to "counsel women about LARCs, which are more effective forms of contraception."

Engeln is wary about using women's fears about weight gain to steer them towards certain types of contraception. "Women are entirely capable of weighing the costs and benefits of different health choices" on their own, she says. There are myriad benefits to LARCs, such as higher efficiency at preventing pregnancy when compared to contraceptive pills, patches, or rings, and the fact that they involve no intervention after insertion; there are also some potential side effects. But this is all information a doctor should present a woman with when she's considering her contraception options, regardless of whether she has specific fears about gaining weight on the pill.

There's a long history of trivializing women's medical decision-making faculties, especially when it comes to reproductive health: In one particularly egregious example of this tendency, modern pregnancy testing was invented in 1928, but it wasn't until 1977 that women were given access to at-home pregnancy tests, as some feared that women would use the products "in a state of emotional anxiety" that would keep them from following "the simplest instructions." Similarly, the first women to try hormonal birth control were not told that the pills would keep them from getting pregnant, and many dropped out of the initial study because they couldn't tolerate the side effects we casually associate with certain types of birth control today: bloating and mood changes.

Of course, it isn't necessarily false that women aren't confident in their ability to make healthcare-related decisions: according to a Harvard Business Review study, the greatest impediment to Americans' health care access is the industry's "failure to develop a nuanced understanding of, and commitment to, women as consumers and decision makers." Fifty-eight percent of women surveyed told researchers that they "lack confidence in their ability to make good healthcare decisions for themselves and their families." However, the problem doesn't lie with women but rather with a system that consistently underestimates or overlooks them. The study's authors suggest that doctors solve this systemic issue by "foster[ing] dialogue and provid[ing] clear communication… providing [female patients] with information" that helps them make their own decisions.

In other words, women would benefit most from having doctors who are willing and able to have honest conversations around procedures and prescriptions. In terms of birth control, potential weight gain is one side effect among many others that doctors can and should discuss with their patients, but Engeln cautions that there's no need to stereotype or generalize among women when it comes to recommending LARCs.

"There's no good reason for reproductive health to become one more domain in which women are infantilized by sweeping generalizations about their decision-making abilities," she says.