I hear and see a lot of mention of weight gain as a side effect of some medications. I believe it happens but I’ve never understood how it works. For example, could an athlete who eats perfectly still be struck by weight gain as a side effect? What’s the biological mechanism that would make weight gain happen in a person with a healthy balanced diet?
I’ve taken a medication for years that a doctor just told me they’d rather never raise the dose on because it can cause metabolic syndrome. My A1C, cholesterol, and virtually the rest of my labs were in the healthy range, but I have noticed some weight on me that seemed oddly persistent. My diet ranges from average to healthy nowadays and I’m moderately active. Yet I can think back to a time before the medication when I was eating horribly, never exercised, smoked and drank nonstop, and my labs were looking nasty – yet my extremely consistent max weight was a solid 20lbs under what it is today which a noticeably better lifestyle all around. I’m by no means the athlete in the perfect diet example, I’m more fascinated by how something like that is even possible. Definitely interesting.
In: Biology
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If you’re looking for an answer besides medication being able to affect metabolism or water retention it’ll go beyond Eli5 and I suggest another sub that can explain open the intricate biochemical processes going on in your body and how certain substances can affect that. It’s very complex though so be ready to google a lot of the terms people will use
Basically certain meds mess with your hormones and metabolism, making your body hold onto more calories than usual. It’s like your body’s thermostat for weight regulation gets a bit off. Even if you’re doing all the right things like eating well and staying active, the medication might still cause your body to store extra weight.
Increased or decreased appetite and interest in doing activities.
There’s really no other magic things involved except some medicine might change water retention but that cant explain such large weigh changes.
A healthy balanced diet is usually one involving “healthy” food and using appetite to control food intake, so if your appetite changes that changes how much you eat and thus your weight
One medication I took made me gain 20 pounds in about 3 months. I was pissed off because I had worked really hard to lose that weight and was going a great job with eating less and exercising. My doctor prescribed this new drug and I just could not stop eating. I was constantly hungry and thinking about food and craving food and just wanting to snack all the time. It was maddening. I couldn’t stop. I finally got off the medicine and all those constant cravings and urges to eat stopped as well. Unfortunately, it took me over two years to drop about 10 of those pounds and I haven’t lost the rest of it due to other illnesses.
My mom was put on the same medication and had no weight gain or negative side effects at all.
Broadly three main ways
1.) Cauase the body to remain more water and salts
2.) increase appetite or decrease energy and thus activity levels.
3.) decrease metabolism. These are mostly neuromeds that reduce the energy your brain uses but there are others.
If you were on a pro athlete regime and tracking everything you could account for two and three by altering your diet. Might feel awful and or constantly hungry doing so though.
There are medications that impact your metabolism (looking at you antipsychotics), some lead to water retention and some make you more hungry or crave certain type of foods that are highly caloric or make you feel more fatigued or lethargic so you become less active and may increase food intake to try and increase energy or impact mood.
It is not always calories in vs calories out. Some medications only impact weight whilst taking them or initially whilst you adapt to them but there are some that permanently affect your metabolism and even if you stop them you will still have lifelong consequences (again, looking at you antipsychotics).
There is a fair amount of research around the impact of antipsychotic medications on metabolism and weight, we know it happens but don’t really know why. Although at least a part does seem to attributable to impaired glucose uptake.
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30416-X/fulltext
Prednisone is a life saving medication that also makes me feel ravenous all the time. It’s impossible for me to fight. I think it messes with blood sugar with long term use. I periodically need it for a few weeks at a time, and all my work to lose weight goes out the door. And even though it energizes me, I’m usually too sick to be active when I’m on it. But it allows me to breathe, so a miracle drug along with being a nasty drug.
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I’m an athlete that’s eats relatively clean and tracks my food. I started on Latuda and almost instantly gained weight, and only in my belly. Nothing makes it go away…
Prednisone. I’ve been on it for years and don’t know if I will ever be rid of it. It has caused all sorts of problems but weight gain is the one I’m currently struggling with. It is a specific sort of weight gain. You can see it in a persons face, belly, upper back. “Hey, that person looks like they are on prednisone”. Yep, I’m prednisone fat.
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