WEIGHT GAIN: A BITTER PILL TO SWALLOW
If exercising regularly and eating right isn’t shifting the pounds, could your medication be to blame ?
You’ve done nothing wrong. Your doctor advised you to make some lifestyle adjustments – eat well, move more – and you’ve taken it on board by adding more greens to your plate, walking at lunchtime and joining the gym (and using it!). But something’s amiss because the weight is creeping on, not off. So what’s going on ?
We know weight loss can help to ease symptoms in people with chronic conditions. Anyone with arthritis who carries extra weight may find losing it eases the pressure on joints, while those with type 2 diabetes will find weight loss helps control blood glucose levels. In cases of hypertension, sufferers can find weight loss brings those high blood pressure levels down. But in what might be seen as a cruel twist of fate, the medicines for these, as well as for a wide range of other conditions, have been found to cause weight gain.
Unfortunately, as well as getting heavier, medication-induced weight gain increases your risk of chronic conditions such as cardiovascular disease and type 2 diabetes in the same way as weight gained from taking in too many calories.
HOW DO YOU KNOW IF IT’S THE MEDS ?
“The most common culprits are antidepressants and antipsychotics, steroids, anti-epileptics and insulin,” says Healthy Food Guide expert and GP Dawn Harper (see later in the blog). “If your medication is causing weight gain, it will often be quite gradual and occur over the first few weeks and months of taking it. If, however, you’ve been on a drug for many years before your weight changes, it’s unlikely to be due to the medication.”
WHY THE LINK ?
Medication may contribute to weight gain for various reasons, but the causes aren’t always known. We do know antidepressants, such as amitriptyline, or steroids can increase appetite by affecting the areas of the brain that control feelings of hunger and satiety, while people taking insulin may at times end up eating more than they need to prevent blood glucose levels falling too low. Beta-blockers for hypertension can typically make you very sleepy, so you feel too tired to be as active was you need to be. Reassuringly, this doesn’t have to be a permanent problem.
“Weight gain from medication does plateau, and the amount of weight put on varies from person to person,” explains GP Harper. “However, with any patients I drill down to find out when the weight gain occurred. We need to be honest about other factors in our lifestyles, too, and work out whether any changes are occurring that could be the real cause of the weight gain.”
PINPOINT THE PROBLEM
If you suspect your medication is at fault, don’t stop taking it, as doing so could have serious consequences.
“There are certain medicines you should never stop abruptly,” says GP Harper. “Your GP will be able to work out whether your weight gain is down to medication or something else.”
So make an appointment, then go along armed with the facts:
- Check the side effects. By law, all prescription medicines must contain a Patient Information Leaflet (PIL), so you can check if weight gain is a listed side effect. If you don’t have a copy of the leaflet, you can go to medicines.org.uk/emc, search by medicine name, then click on ‘patient information’.
- Keep a food and exercise diary. It will be helpful for your doctor if you have a record of the food you’re eating and the exercise you’re taking, and note down your weight over a few weeks (using the same scales each time).
- This will give your GP an overview of your current lifestyle, which will help with your medication review. Your doctor will be able to assess your situation and may be able to prescribe an alternative medication or reduce your dose.
- They’ll also be able to take into account other factors, such as family history and lifestyle, that could be addicting your weight. If, for any reason, your doctor can’t change the medication you’re on, ask to be referred to a registered dietitian to discuss any changes you may need to make to your diet. Alternatively, find one at freelancedietitans.org or hcpc-uk.org.
HELP WITH MANAGING YOUR WEIGHT
Evidence has shown that dietitian interventions using behavioural therapy are effective in helping people manage weight gained from medication.
“I believe the medical profession needs to become more proactive in addressing instances of medication-induced weight gain,” says dietitian Lucy Jones. “In an ideal world, those behavioural interventions would begin as soon as someone was prescribed a medication associated with weight gain.””There’s a lot of stigma attached to being overweight and it can be frustrating for someone to experience weight gain from medication, especially if they feel it wasn’t their fault.”
There are a number of ways a dietitian can help you manage weight gain from medication, and one of the first pieces of advice will often be to keep on top of hydration levels.
“Being well hydrated can really help to manage your appetite,” says Jones. “Make sure you’re drinking enough through the day. Always carry a bottle of water and keep up your tea intake.”
Dietitian use coaching techniques to help people manage an increased appetite, where medication has affected those messages to the brain. It’s important to recognise the difference between hunger and appetite, explains Jones (in other words, the need for food versus the desire to eat), and which foods can help to make you feel fuller.
The technique used will probably be similar to those used to tackle any unwanted weight gain, she adds. But it’s the support you’re offered by a qualified dietitian that will make managing it easier.
DRUGS THAT CAN TRIGGER WEIGHT GAIN
GP Harper referred to this earlier in the blog, people react to medications in different ways, so there isn’t a definitive list, but those known to cause problems with weight gain in some people include:
AMITRIPTYLINE – for mood disorders
ORAL STEROIDS (CORTICOSTEROIDS) – for rheumatoid arthritis, for example
VALPROATE or GABAPENTIN – for epileptic seizures and migraines
INSULIN, insulin secretagogues or thiazolidinedione therapy – for diabetes
HYPERTENSIVE BETA-BLOCKERS – for high blood pressure
ANTIHISTAMINES – for allergic conditions
If our GP prescribes a new medication, ask about common side effects, including weight gain, if you’re concerned.
Does the pill make you fat ?
Popular belief says there’s a link between the contraceptive pill and weight gain, but it hasn’t been conclusively proved. Countless studies have investigated the variations between hormonal (the pill, patch or ring) and non-hormonal (such as intrauterine devices) contraceptives and weight gain. A 2014 review by the Cochrane Library of 49 separate trials comparing 52 pairs of birth control methods and weight change found there was insufficient evidence to conclude a definite link.
Anecdotal evidence still suggests women find they gain wight as a result of the pill. This isn’t to be ignored, but the interventions are the same as with any other medication: look at your lifestyle and see what else has changed that could be causing your weight gains.
Reference: WebMD (2015). Are your meds making you gain weight ? www.webmed.com/diet/obesity/medication-weight-gain NHS Choices. 9 medical reasons for putting on weight. www.nhs.uk/Livewell/loseweight/Pages/medical-reasons-for-putting-on-weight-aspx Ness-Abromof, R. & Apovian, C.M. (2005). Drug-induced weight gain. Drugs of Today (Barcelona) 41 (8), 547-555. Gallo, M.F. et al. (2014). Combination contraceptives: effects on weight. Cochrane Library.
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