The Rise & Fall of Weight Gain On Prednisone

Ten weeks ago I was put on prednisone to treat a relapse of nephrotic syndrome. Ten weeks ago I weighed about 145 pounds (I’m 5′ 2″) and was lamenting (whining?) about how hard it was to lose those last five lousy pounds.


How I long for those days!!! Since being on the prednisone I have gained close to twenty pounds. That’s up two dress sizes in two months. I am not here to bitch and moan, although it kind of looks like I am. I would not insult you like that! Many, many people have much worse health problems than I do and more difficult weight issues than I do. It’s not the degree that’s important. It’s that we all have more in common in our pain and discomfort than not.

On another day I will write about how we reflect on our own story in comparison with other’s, the good and the bad about it, when doing so uplifts us and when it only makes us feel worse. But that’s not for today.

Today is for anyone out there who not only struggles with weight, but struggles with weight on medication that tries its hardest to make you pack the pounds.

Because how we look does make a difference in our self-esteem. As much as I sincerely love and try to practice the “I love the inner me” message, I also like how I looked and felt in a size 8 pencil skirt.

On another day I will write about acceptance. Meaning, there’s been a shitload of ‘nothing I can about it so I better learn live with it in serenity ’cause getting mad just makes it all worse.’ But that’s not for today, either.

Today is meant to inspire us to do what we can to stay in control when the weight-gain undertow is pulling us out to sea.

As much as we hate prednisone, we are grateful for it. We take prednisone for the treatment of inflammation, asthma, arthritis of all kinds, inflammatory bowel disease, sarcoidodis, lupus, kidney disease, skin problems, allergies and more. Without it we would be dealing with a heck of a lot more discomfort than extra poundage.

But the extra pounds are no joke. They are a pain in the self-esteem and when the weight sky rockets, as it can, adding up to 50-60 pounds overweight and more, well, then the weight itself can cause health problems. Talk about vicious circles!

Why does this have to happen?

Prednisone creates the perfect storm of weight gain. It comes at you from four fronts: 1. It slows your metabolism and changes how you process glucose. Avoid sugar. Boo! 2. Fluid retention happens. Avoid salt. Boo! 3. Fatty tissue is redistributed to where, I swear to God, it makes you feel as bad as possible: face (moonface), upper back (buffalo hump) and abdomen. Charming! 4. Makes you hungry all the time for anything in your path. Nothing edible is safe in the sites of a prednisone packing mama!

What can we do about the weight gain? Here is my plan. So far it’s worked for me. In my heart I know I could have gained a hell of a lot  more at this point. I’ve been working hard to just keep the madness down to the occasional Oreo orgy.

1. Start with patient maintenance. This is a most important thing. If your on a high dose of prednisone don’t stress yourself out trying to lose weight. You are taking the stuff because you are sick so pay attention to that. See your doctor, follow directions, take the damn tests, blah, blah, blah… and when you can, pamper yourself. Let others pamper you too.

The best you can do when you are in the higher doses is to keep a food journal just to maintain and keep the habit. Just by writing down what goes into your mouth you subconsciously reduce the amount you eat, even a little. Besides, you will need this habit later so may as well start now if you’ve never done it before. Be honest, which can be hard when what you ate in one day could feed a whole colony of hungry hungry hippos.

2. Choose your food thoughtfully. Avoid salt and simple carbs. Embrace fruits and vegetables. Not only are these foods lower calorie tummy fillers, they are packed with antioxidants, nature’s own anti-inflammatory. When my appetite was at its most wicked worst I binged on stuff like French fries, sure, but there were also occasions when I binged on fruit. Weird but true.

3. Exercise. If you can, if your illness allows it, try to move every day. Twenty minutes to half an hour of some kind of exercise will keep your metabolism revved up and keep your muscles from going to mush. I find mixing up activities, from walking, riding my stationary bike, yoga, weight training keeps me from getting bored. And I’m lucky; my body likes it. You may need to talk with your doctor about this. You may need a physical therapist to recommend a routine. Don’t let this hurdle stop you, though, please. Also don’t do aerobic exercise in the evening. You need your rest.

4. Plan meals, plan snacks, plan mini-meals, whatever your style is – Plan It! The more you plan ahead, and shop accordingly, the less apt you are to succumb to gotcha! eating. Do not have a bag of sea-salted, kettle-fried chips in the cupboard! I do not care how many teenagers are in the house insisting they need this basic food group.

5. Count calories Phase 2. As the dosage is tapered down you will begin to feel more in control of your appetite. Start lowering your calorie budget a little at a time. The app on my iPhone called Lose It! lets me adjust my calorie budget so that I don’t stress myself out restricting my calories beyond what I can realistically manage. My Fitness Pal and Sparks People have similar programs.

The good news is that at the lower doses the insanity of the worst side effects ease their grip. The thing I find the most challenging is to believe that this is temporary. The weight-loss I fought so hard for over the last two years is my permanent, natural place to be. It may take several months, it might be years, but I can’t wait to be whining about those extra five pounds again.

What about you? Have you been dealing with the side effects of prednisone? Have you had any success managing your weight on it? Perhaps you have a completely different perspective. Please share your thoughts.


  • I can sympathize, I felt this way when I took Paxil. I remember waking up at 2 a.m. to eat because I was RAVENOUS. I also know what you mean about the chips…I recently vowed to stop buying fatty snack foods because, if they’re here, I’ll eat them!
    Hang in there!

    • Thank you, Maria! I hope you are doing well these days. I feel badly it’s taken me so long to reply to your comment because I really appreciated it!

      Chips of any kind, brownies and ice cream… can’t have them in the house whether I’m on or off the prednisone! :)

    • Maria

      Thank you so much for your article. I was also 135 lbs before prednisone and gained 25 lbs!!! It hurt my self-esteem but the worst is feeling unable to come back to my real “me” for years! I am still fighting and is helpful to know I’m not the only one. Thanks will all my heart. :)

  • Lindsay

    I too am of short stature (5’3″) and when I was first diagnosed with Rheumatoid Arthritis I lost 30 pounds in 3 months because I was so fatigued and in so much pain that I couldn’t/didn’t want to do anything. As soon as I started taking prednisone my weight started increasing but wasn’t that noticeable. That was 3 years ago… To this day I have gained the 30 pounds I lost and then some and I am the most uncomfortable I have ever been. I wasn’t in great shape when I first lost the 30 pounds and I was happy that I did lose it but I would have much rather lost it by dieting and exercising and then kept it off!

    My RA symptoms are under control now and I have decreased the dosage of prednisone from 5mg two times a day to 2.5mg every 2 days, sometimes I can even go 3.. I have started adding exercise into my routine but only twice a week and I have been eating gluten free for the last 3 months but still haven’t lost any weight.

    Do you have any recommendations?

    • Hi, Lindsay,

      I know it’s been a while and I’m sorry I haven’t responded right away. If your situation is still going on please give me an update. For the last two years the dosage of the prednisone I take has gone down then up again and down as my condition gets better and then relapses. As I write this I’ve been prednisone-free for a few weeks (knock on wood!).

      This is what I’ve done for the last year:

      I engaged the services of a certified nutritionist. Checking in with her now and then, even when I can’t actively lose weight, has been a way of keeping myself honest when it comes to eating as responsibly as I can given the situation. My nutritionist is compassionate and totally understanding of the challenges of maintaining weight on prednisone. She didn’t push me or yell at me if I needed to just chill about the whole thing. In fact she encouraged me not to be so hard on myself.

      When the prednisone dose was high and I was too depressed or my energy was limited and I had to prioritize other things like my work and family, I didn’t sweat it. If I really wanted seconds of ice cream I went ahead and let myself have it and enjoy it! When I could resist it I allowed myself to do that too.

      When the dose of prednisone got low enough, and I was ready psychologically, I started journaling my food intake. I use an iPhone app, Lose It!, to journal what I eat. I find it very helpful and even kind of fun, like a game. At first I journaled just to journal. Now that I’m ready I journal to keep within a calorie budget that is reasonable for responsible weight loss.

      I don’t deprive myself of anything. I understand why people want to go gluten-free and/or lower carbs. If you can do it my hat is off to you. I’m more of a moderation is all things kind of girl, with an emphasis on fruits and vegetables.

      With my nutritionist’s and my doctor’s encouragement, I have upped my activity, too. I walk much more, added yoga to the mix with occasional free weight use. This winter was particularly brutal on the activity side of things. I’m looking forward to walking outside more.

      So far, after doing this for four weeks, I’ve only lost one pound! That is frustrating but my nutritionist and my husband, who is a microbiologist, say that my body is probably trying to hold onto the extra prednisone fat because it thinks that’s the new normal, my current set point. If I want to lose weight, it could mean many more weeks of sticking to my calorie budget and remaining active despite the lack of encouragement from the scale.

      To be honest, even though the scale is a bitch, I do feel better in my body. It’s a small shift, but I can feel it and it feels good.

      I hope this is helpful to you.

  • Teri Krumm

    I have been on prednisone now for 3 months, with a dose as high as 60mg. Right now I am at 40mg. I am doing two things which seem to help me kep from gaining weight. First, I skip a day of prednisone every five days. Second, I am eating low, low carb. If you don’t provide glucose, your body can’t change how it processes glucose. I am on the low carb web-site and others have had good results with this approach. Currently I am trying to keep my carbs less than 10 a day. This is only temporary to persuade my body into ketosis. I lost the 10 lbs. I gained before I started this routine. I try to walk everyday. Once my body has adjusted, I will up my carbs a little each week until I reach a point where my weight is stable. Check out low car friends forum.

    • Hi, Teri, Does the low carb regimen still work for you? I’d love to have an update.

  • Jennonsteroids

    Thank you for this posting. Though it is from a few years ago now it is what I needed to read. I am on a daily dose of 75mg for major inflammation from severe allergies. I guess this is a reminder that I need to just focus on getting better and watching what I eat. Not looking at my weight all the time – easier said than done though!
    Thanks again,

    • Hi, Jenn,

      Yes, this article was written while ago but I am just now getting off the prednisone after being on it for over two years. By balancing being kind to myself, not sweating the weight thing too much, with eating as responsibly as I could and not forgetting to move when I could, I was able to keep my weight gain to the 20 pounds I mentioned in the article. You are on a very high dose, so weight gain is only one of many challenges for you! Take care of yourself! I am so glad the article was a help and I wish you the very best!

  • Dale

    Just found your article on the net although it appeared some time ago, and thought it was very interesting and humorous. I am down to 2.5 of pred. for the next 3 months for my PMR. Hoping the weight gain at this dose will ease off a little. I’ve put on about 10lbs but because I am only 5′ it really shows!
    Best wishes.

  • Christine

    Just found this site today, so wished I could right like you funny.

    I was on a daily dose of 120mg for almost 10 years. I was 32 at the I was put on prednisone for asthma. Weight gain was only one of many side effects I have had. I still have to be on this drug ever now and then and each time it is very hard to watch the changes my body goes through. I have never lost all the weight I gained, but I work at each day. I too use Lose-it app and find it very helpful in the fight. Right now I am stepping down to 10mg tomorrow and am hoping some of the side effect will start to go away.

    I will say this about the weight gain. I am a live, I have turned into a very good healthy cook. I workout doing something everyday. If I slip and have a little more than I should I start a new the very next meal.

    Wish good health

  • Med

    I have an autoimmune hemolytic anemia and I was put on 250 ml of prednisone for 3 years when i was 32 years old. I had a central line that was feeding me liquid form for 1 year and then took it orally for 2 years. with a whole other medication. I gained 150 pounds in those three years. I was 5’7 and 160 pounds and now I am 5’4 and 314 pounds. They had to remove my spleen so now I have no immune system. I’m happy to be alive but it is very hard to loose all this weight. I’m not on any medication any more I have been off for over 6 years now, tried every diet there is but can’t seem to loose the weight. I don’t eat a lot to begin with. 3 small meals a day and lots of water. I swim now that the weather is warmer. All I can do is accept that my body will never be what it used to be. Just keep eating healthy and try and move as much as possible. If anyone knows how to get rid of all this fat that would be great!
    Wishing everyone good health!

  • Colleen

    I just recently found this article. My husband finished his treatment for nephrotic syndrome in March of last year. He gained approximately 50-70 pounds from the treatment and has yet to lose them. He will lose 6 pounds one day and gain it back the next. It is a constant roller coaster with no real change. He is using the Lose it app and recording everything and eats 2200 calories or less a day (he would have to eat 3500 a day to maintain his current weight). Even with this and walking, golfing and strength training, not much is happening. I am at a loss as how to help, outside of healthy eating. Any suggestions would be welcome. Thanks!

  • Jasmine

    Thanks for this! I stumbled across this while looking for re-assurance and maybe some advice on how to tame the prednisone beast! I started taking it March of this year for inflammation around my heart. I was able to finally come off it in July, but got sick again so I’m back on it now. The first round I was diligent on food intake and exercise, and only managed to gain 5 lbs. This time, however, I have not been so lucky. I am not allowed to exercise anymore, and it has been harder to control my appetite. I am doing a slow ween and am finally down to 7.5mg, but still have many months to go before I’m completely off. I have gained about 20 lbs (I stopped weighing myself a month ago because it made me more depressed than I already am).
    I am so very thankful that I am alive and somewhat healthy. Sometimes I read peoples’ stories and feel bad for feeling down on myself. I’m just trying to make it through this round of steroids without losing my mind or another pair of jeans. I was promised that I wouldn’t be put back on them if I got sick again so that I am very thankful for. less than a year ago I was told I was an hour away from being dead, and if I did make it through, I would need a heart transplant. I am alive with MY heart, so I have SO much to be thankful for…. But it is still so hard trying to button my pants everyday.
    Anyway, thanks again for this! I will be going back to it for the advice and the feel-good humor.


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