“You can’t lose weight while on Prednisone”….Yes you can
relayed by Irwin Lim, Rheumatologist
This morning, I received a typed note from a patient. It was unexpected and such a pleasant way to start the day, that I had to ask her to allow me to share it with you.
The following words are Leonie’s:
Imagine my frustration when prescribed Prednisone for my Polymyalgia Rheumatica. I had just finished a course of Prednisone for a respiratory problem, and I was aware that, in spite of its undoubted spectacular effectiveness, it would just continue to add to my burgeoning weight problems.
After breast cancer, I had put on 15 kg in three years, and that was just part of the continuing steady weight gain over the years. I was now aged 75 and tipped the scales at 117 kg. It was difficult enough I figured, to control my weight at this age while having mobility problems.
I knew (doesn’t everyone know?) that nobody can lose weight while on Prednisone. Not only that. I knew that I would continue to pile on the kilos while on this wonder drug. I say that is what I KNEW. In reality, that is what I BELIEVED…erroneously!
I knew that I had to accept the challenge given to me at this time by Dr Irwin Lim.
After all, there were other crises happening in my health life at this time, all of them somehow weight related. In the space of a few weeks, I was diagnosed with Atrial Fibrillation, Type 2 Diabetes, moderate kidney failure, as well as Polymyalgia Rheumatica.
But it was a huge challenge. And after consulting with Alison, the dietician, and Suzy, the exercise physiologist, both on the team at BJC, I started on the long road to recovery through change. Not easy, but not impossible.
Initial success helped me to unlearn my beliefs. Although I discovered that Prednisone complicates control of blood glucose levels, I also discovered that, with care, weight gain can be controlled while on Prednisone. Patient encouragement from Suzy and Alison saw me gradually taking control of my own destiny.
Now… where am I?
Now nearly three years down the track, I am taking almost nil Prednisone. But what has happened? Diabetes is under excellent control with exercise and no medication. Blood Pressure is under control. Atrial Fibrillation is under control. Kidney Failure is no longer a problem. And my joints and muscles are more or less in working order at last.
Now aged 78, my weight is 80kg and continuing to fall slowly. I value and appreciate the weekly sessions at the gym with Suzy. And I look forward to an active old age, but not yet.
Leonie is a patient at BJC Health. BJC Health provides coordinated, comprehensive, and colocated multidisciplinary care to achieve effective solutions for patients. We call this model of care, Connected Care. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.
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Dr. Lim,
Thanks for this inspiring post. A related question, if you don’t mind my asking. I saw my endocrinologist a few weeks ago to check on my thyroid levels and she said they were finally normal (I had been hypothyroid for the past year or so, and the tip off was the associated unexplained weight gain). I asked why I wasn’t seeing any weight loss if my thyroid levels were ok, and she replied that until the inflammation related to my RA was better controlled, it would be very difficult for me to lose weight, even if I restricted my caloric intake and tried to increase my activity level. This is the first time I had ever been told this by a physician. I was wondering if this was an opinion also shared by rheumatologists. Can you comment generally on the theory that inflammation inhibits weight loss?
Thanks for the comment, Tracy. The more common scenario is that patients with systemic inflammation gain weight due to inactivity & drugs such as Prednisone. In patients severely affected by autoimmune disease/inflammation such as vasculitis, weight loss can be seen. In some of these patients, when you then treat/reduce the inflammation, the patients gain weight.
I am not sure what the evidence is that inflammation inhibits weight loss.
Weight loss is not an easy thing as I’m sure you’ll agree. While we like to make it simple by suggesting we should just eat less & burn off more energy, the type of food & timing of eating matters just as the type & timing of exercise matters. It’s why I work with great dieticians & exercise physiologists.
Good luck with it all.
Thanks for your response, Dr. Lim. I suspected that I probably could not use inflammation as an excuse for my inability to lose weight!
On a more serious note, your patients are lucky that you and your colleagues offer coordinated care.
I also appreciate the fact that you share your thoughts and ideas on this blog as well as on other social media sources. You are educating and influencing a lot of people. Please keep it up!
Thanks for your kind comment. It’s very much appreciated and keeps me going.
I loved hearing from Leonie, It goes to show that if we are totally commited we can accomplish so much at any age. I have the same diagnosis as Leonie, and I have been able to work my way through some issues, by exercising one hour every day. It controls the blood sugar, blood pressure and also the weight problem. Its not easy. but oh so worth it. I do 30 minutes of cardio, followed by 15 of biking, and 15 minutes of matt exercises. I am 69 years old and feel stronger than I have in a long time. Keep plugging folks, I feel for your problems and know how tough it can be. lets keep smiling and encouraging one another, that’s what life is all about. God bless all of you with the struggles you are facing.
Great to receive your comment. Many, many patients suffer the effects of Prednisone and this drug is often blamed for a lot of weight gain. However, regular exercise and an appropriate diet does help greatly. It’s of course hard work so I commend you on this.