Trying to lose weight is overwhelming enough when there are conflicting messages all over the internet, but add medication into the mix and things can really start to feel out of your control. The good news is you don't have to throw in the towel and give up on trying to maintain a healthy weight or lose weight if you're taking medication that makes it hard. We talked to Dr. Alexandra Sowa, MD, a dual-board certified doctor of internal and obesity medicine, clinical instructor of medicine at NYU Langone and founder of SoWell Health, to learn which medications can lead to weight gain and what to do if the scale starts to creep up.
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Which medications can cause weight gain?
Medications that might lead to weight gain include some over-the-counter (OTC) medications, like sleep aids and allergy medications; selective serotonin reuptake inhibitors (SSRIs), which are used to treat anxiety and depression; and steroids.
"Sleep aids and allergy medications both contain antihistamines, which in prolonged doses can increase hunger and lead to weight gain," says Dr. Sowa. "SSRIs affect weight but in a very personal and specific way. Some medications are more weight gaining versus others that are more weight neutral, but really it's just about having a conversation with the doctor prescribing the medication and being on the lookout for weight gain because not everyone responds in the same way."
Steroids can alter hunger and metabolism. "But the good news," says Dr. Sowa, "is that steroids are generally used for a short period of time so you can use proactive tips to avoid weight gain. If it's a medication that you have to be on much longer, talk to your doctor about how to offset gain or if gain happens, how to be proactive in taking it off."
What you can do to maintain a healthy weight or lose weight in the long run
1. Be proactive
First, be proactive and advocate for yourself. "Often doctors who are writing prescriptions for medications do not warn patients about the potential for weight gain," says Dr. Sowa. So ask questions, she says. For example, "Is this medication really necessary? Are there any non-weight gaining alternatives? And what can we do together if I do begin to gain weight?"
Also, "Talk to your doctor about whether the specific type of medication is necessary, including the dosage. Have the conversation before weight gain might even happen, and be on the lookout for it. Often, some of the weight gain associated with these medications is very subtle and can be counterbalanced with closer attention to nutrition, increased exercise and good sleep," says Dr. Sowa.
Don't stop taking a medication just because you heard or read that it leads to weight gain, she warns. Because different people respond differently to medications, "You should always work with the prescribing doctor to help either titrate off, find a new agent or to come up with another plan to help with the weight gain."
2. Establish healthy habits
Dr. Sowa also recommends enacting a self-monitoring system, including writing down your food and weighing yourself regularly. These habits are key if you are trying to not only prevent weight gain but also lose weight. Research shows that those who track their food are the most successful with losing weight and keeping it off. That doesn't mean you have to count calories. Write down what you eat in a food journal or take pictures of your meals. This helps you become more aware of what and how much you are eating. And it doesn't mean you need to do it forever. Doing it for even a short period of time can help you identify habits that could be altered to help you achieve your health goals.
Work with a registered dietitian who can teach you which nutrients to be aiming for at each meal, how to exercise smarter—not harder—and how to create a small calorie deficit over time, so you can lose weight without feeling deprived. If you feel like your medication is making you hungry and the dose can't be changed, a dietitian can help you come up with meals that are filling but low in calories. Think lots of fruits and veggies, lean protein and fiber-rich whole grains.
See More: Recipes for Healthy Weight Loss
While you may not love the scale (who does?), Dr. Sowa recommends weighing yourself regularly. "If a medication causes weight gain, you'd rather catch it at five pounds than 25 pounds. Some people take the approach that they'd rather not know but often it can be more overwhelming to have to undo that weight gain than if you knew from the beginning," she says. Weighing regularly is also important if you're trying to lose weight.
If the scale isn't moving but you feel like you're doing all the right things, you can talk to your doctor about your medication. Remember, however, that sustainable weight loss takes time and the scale fluctuates daily and weekly, since it measures everything in your body, not just fat.
3. Talk to your doctor about other medication options
Chances are you'll find success with tweaks to your diet, exercise and sleep habits, but if you're still finding it hard to lose weight or even just maintain your current weight is ask your doctor if you are eligible for any of the FDA-approved medications for weight loss. "For many people being on a medication is necessary and there are no alternatives and they must continue to be on it," says Dr. Sowa. "We do have medications in the field of metabolic health and obesity medicine that can help counterbalance that gain, so if you are eligible, you might be able to concurrently go on an FDA-approved medication for weight loss."
These weight-loss medications are typically reserved for cases where weight gain gets to the point that it's becoming dangerous and causing other health problems. And it should be noted that these medications have their own side effects, so it's not necessarily the quick and easy fix everyone wishes it would be.
In order to lose weight and keep it off, you need to create a small calorie deficit over time without feeling restricted or deprived. If you are taking medication that is causing weight gain or making it hard to lose weight, talk to your doctor about changing the dose or switching medications. Focus on healthy habits like eating healthy, exercising, stressing less and getting adequate sleep. Self-monitor by tracking your food and stepping on the scale occasionally. Finally, consider working with a dietitian who can help you stay accountable to making healthy changes that last.