Depo-Provera

Q: I'm a 21-year-old college student who is 5-foot-4 and weighs 165 pounds. I have been on the DEPO-PROVERA birth-control shot since I was 17 and have gained weight every year since. Is this because Depo-Provera slows your metabolism? What can I do to lose the extra pounds?

A: The weight gain associated with Depo-Provera, a progesterone shot given every 13 weeks, is caused by an increase in appetite, not a decrease in metabolism, says Catherine M. Lynch, M.D., director of the division of general obstetrics and gynecology at the University of South Florida College of Medicine in Tampa. "We don't know the exact mechanism, but progesterone tends to stimulate the appetite. The weight gain is an issue of calories."

In clinical trials, two-thirds of women who used Depo-Provera gained on average about 5 pounds the first year. As to women who stay on it for longer than one year, a large study showed the average weight gain was 8.1 pounds after two years, 13.8 pounds after four years and 16.5 pounds after six years. "There are plenty of people who are on Depo-Provera who don't gain weight, but the more common thing is to gain weight," Lynch says.

If you watch your portion sizes carefully and increase your exercise, you should be able to lose weight, Lynch says. She suggests keeping a food diary and visiting your campus dietitian for advice on how to cut calories. Or you can consider other birth-control methods, such as the pill, which generally does not cause weight gain.

Q: If you've had a weekend of overeating, is it OK to fast on Monday to let your body finish processing all that food?

A: No. "It sounds like a logical idea, but it's going to backfire," says Marcia Herrin, Ed.D., M.P.H., R.D., co-director of the eating-disorders program at Dartmouth College in Hanover, N.H. "We imagine that fasting is good for our bodies, that it's cleansing us and giving our bodies a rest, but it actually does none of those things." In fact, fasting interferes with your body's normal processes. "Your blood sugar, metabolism and energy level go down, but what usually goes up is your interest in food," Herrin says. Fasting only sets you up for more overeating.

Instead of fasting, simply eat a smaller breakfast than usual, and listen to your body all day. You may also feel like eating a small lunch, but don't skip meals. Always make your food choices on the basis of hunger and fullness, Herrin says, not on the basis of what you ate the day before or how much you think you should eat.

Q: I can't seem to eat a meal at my in-laws' home without getting into a fight. They're strictly meat and potatoes, and I'm a vegan, for ethical and health reasons. If I bring a veggie burger to eat instead of the steak they're serving, they ridicule me. How can I normalize relations between us at mealtimes?

A: 'Don't make a battle over the meal," says Cindy Moore, M.S., R.D., director of nutrition therapy at the Cleveland Clinic in Ohio and a spokeswoman for the American Dietetic Association. Instead of isolating yourself by bringing your own dinner, offer to bring a tasty dish or two the whole family can enjoy, such as a fruit salad, a vegetable dish or pasta salad. "Don't introduce it as a vegan dish," Moore suggests. "And stick with foods the family can identify with, such as fruits, vegetables and nuts, instead of a soy burger or tofu casserole."

Accept the fact you're not going to convert them to your viewpoint, and avoid a discussion of the ethical issues, Moore suggests. If pressed to explain yourself, Moore says, politely mention the healthy aspects of your eating habits, such as a high fiber and antioxidant intake and a low intake of saturated fat (and whatever other reasons you feel compelled to speak about). It may also help to concede that the vegan lifestyle isn't the only healthy way to eat and that it's not for everyone but it works for you.

Q: My 11-year-old daughter is 5 feet tall and weighs 140 pounds, and her doctor says she needs to lose weight. I know she is unhappy about her size, but she doesn't seem motivated to diet or exercise. How can I help? If she lost 20 pounds, I would be so happy.

A: Your concerns about your daughter's weight are valid--certainly overweight children are at higher risk for early-onset diabetes, high blood pressure and other serious health problems. But putting her on a diet and exercise regimen is not the answer, says Dartmouth's Marcia Herrin, Ed.D., M.P.H., R.D., co-author of The Parent's Guide to Childhood Eating Disorders (Owl Books, 2002). "That's the sort of thing that could launch anorexia, bulimia or binge-eating disorder," Herrin says. Often, parents of overweight children place too much emphasis on their child's weight problem, inadvertently giving the impression that "their love and respect are contingent on the child losing weight. It's very important your daughter knows she's OK and the weight issue has nothing to do with her value as a person."

Rather than focus on your daughter's weight, help her gradually develop better eating habits. "A 20-pound weight loss is not healthy for a growing child," Herrin says. "Instead, every effort should be made to keep her from gaining more, and let height take care of it."

Herrin suggests you see a registered dietitian who specializes in overweight children. Make the first visit without your daughter so you and the dietitian can discuss which one of you is best suited to guide your daughter through the process of improving her habits. "It can be very empowering to the child to start working on these issues with a third party," says Herrin.

A nutritionist also can help you address the causes of your daughter's weight problem. Is she overeating because she's bored after school? Is she snacking on high-calorie foods? Does she binge eat? Whatever the issues are, ask for your daughter's input. "Maybe there's something you could do together to manage food differently at home," Herrin says. "Usually, these kids have wonderful ideas. If you involve her in the solutions, she will feel like she's a worthwhile person."

Don't look at your daughter's weight as her problem alone, Herrin says. "This is a wake-up call to the whole family. Do you eat dinner together? Is everyone eating breakfast?" Get the family involved in doing physical activity together. "Be careful that you don't turn your daughter off to exercise. Kids don't want to go out jogging, but they like going on hikes or bike rides or walking around the mall."

Q: A friend of mine drinks vinegar after each meal, and another friend takes apple-cider vinegar pills. Both say that vinegar helps break down fat and helps you lose weight. Is this true?

A: No, vinegar does not have magic powers, says Cleveland nutritionist Cindy Moore. "There's this idea that acid can eat through just about anything," Moore says, but vinegar and other acidic foods, such as grapefruit, have no effect on fat. No pill, powder or potion can negate what you just ate. So rather than worry about how to compensate for extra fat you may have eaten, Moore suggests, "think about the outcome before you eat. Be mindful of portion sizes and the food choices you make."

Suzanne Schlosberg is the author of Fitness for Travelers: The Ultimate Workout Guide for the Road (Houghton Mifflin Co/Mariner Books, 2002).

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