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Why does prednisone cause weight gain?

Medically reviewed by Sally Chao, MD. Last updated on Oct 7, 2021.

Official answer

by Drugs.com

Prednisone can cause weight gain through:

  • An increased appetite
  • Water retention
  • Fat redistribution.

The majority of patients who take steroids long-term will experience weight gain, even as early as six months into treatment. Prednisone is a synthetic version of cortisol. Cortisol is a hormone made by the adrenal glands to reduce inflammation in your body.

Increased appetite

Prednisone mimics the stress hormone cortisol in the body. It stimulates your appetite by binding in a part of the brain that controls hunger.

Prednisone may also interrupt your sleep cycle, leading to the disruption of the hormones that regulate appetite.

General guidelines on how to manage increased appetite:

The key is controlling the number of calories and the quality of nutrients by eating:

  • Fiber-rich foods (including fruits, vegetables and complex carbohydrates like baked potatoes)
  • Protein with each meal (such as fish, chicken or soy products)
  • Small, frequent meals on an eating schedule.

Drinking water can also help curb appetite, and exercising will help expend some of the calories.

Water retention

Prednisone alters the salt balance of the body maintained by the kidneys. It causes your body to hold onto sodium. Sodium brings water along with it. With more sodium retained, there is more potassium lost. This imbalance leads to swelling in the hands, legs and feet, along with the face.

General guidelines on how to manage water retention:

Aim for a diet low in sodium—no more than 1,500 mg a day—and higher in potassium.

  • Avoid high-sodium foods like canned and processed foods, soy sauce, cold cuts and chips
  • Eat more oranges, grapefruit, bananas, kiwifruit, spinach, collard greens and tomatoes to consume more potassium.

Fat redistribution

Prednisone can change where your body stores fat. Fat can be deposited in undesirable areas in the body, such as the face (moon face), abdomen and upper back (buffalo hump).

General guidelines on how to manage fat redistribution:

Fat redistribution will only go away after tapering off prednisone.

Weight gain is more likely to happen when prednisone is taken in high doses or for a long time. If weight gain is bothersome, talk to your doctor about modifying your drug regimen. Your provider may:

  • Use alternate day dosing (skip every other day) to decrease weight gain
  • Start with a high dose initially, then taper the dose down
  • Prescribe the lowest possible dose for the shortest possible time for conditions that require long-term steroids (e.g., transplant, severe autoimmune conditions).

Also, consider consulting with a dietitian for dietary advice.

Never stop taking medicine on your own. Steroids need to be tapered slowly following your doctor’s directions. Rapid withdrawal of steroids may cause serious effects like:

  • Extreme tiredness
  • Joint pain
  • Muscle stiffness
  • Stomach upset
  • Fever
  • Relapse of the condition being treated.
References
  1. Curtis JR, Westfall AO, Allison J. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis & Rheumatism. 31 May 2006; 55: 420-426. https://doi.org/10.1002/art.21984.
  2. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. All Asth Clin Immun. 15 August 2013; 9, 30. https://doi.org/10.1186/1710-1492-9-30.
  3. Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight loss and maintenance. Am J Clin Nutr. 29 April 2015;101(6). https://doi.org/10.3945/ajcn.114.084038.
  4. McKay LI, Cidlowski JA. Physiologic and Pharmacologic Effects of Corticosteroids. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13780/.
  5. American Heart Association (AHA). How much sodium should I eat per day? May 23, 2018. Available at: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day. [Accessed August 23, 2021].

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