It is estimated that 40% of U.S. adults are obese – and this figure is projected to continue growing.
One potential reason for weight gain and a possible catalyst for obesity is use of pharmaceutical drugs (i.e. medications).
Medication-induced weight gain poses a significant challenge in healthcare, affecting both patient well-being and treatment adherence.
Key Facts:
- Over the past decade, there have been 137,370 reports submitted to the FDA Adverse Event Reporting System (FAERS) concerning drug-induced weight gain, highlighting its prevalence.
- Medications most frequently associated with weight gain include antipsychotics like Risperidone (11.55%), immune-modulating drugs such as Adalimumab (3.94%), and antiepileptics like Pregabalin (3.86%).
- Drug-induced weight gain can lead to decreased medication compliance and exacerbate related comorbid conditions, such as cardiovascular disease and diabetes.
- Females have been more commonly affected, making up 63.43% of the reported cases.
Source: Pharmazie (2022)
Top 10 Drugs & Medications That Cause Weight Gain (2022)
A retrospective, descriptive analysis of FDA Adverse Event Reporting System (FAERS) data (2012-2021) was conducted, identifying 137,370 reports of drug-induced weight gain.
- Risperidone (11.55%): As an antipsychotic, Risperidone is primarily used to treat schizophrenia and bipolar disorder. It’s known to cause weight gain by influencing neurotransmitter pathways related to appetite and metabolism. It can also induce insulin resistance, contributing further to weight gain.
- Adalimumab (3.94%): This immunosuppressive drug is used for autoimmune conditions like rheumatoid arthritis. Weight gain with Adalimumab may be due to the reduction in systemic inflammation and improved nutritional absorption, leading to an increase in body weight, especially in patients who were previously underweight due to their illness.
- Pregabalin (3.86%): Commonly prescribed for neuropathic pain and as an anticonvulsant, Pregabalin can lead to weight gain through mechanisms like increased appetite and fluid retention. It might also indirectly affect weight by reducing physical activity due to its sedative effects.
- Aripiprazole (3.10%): Another antipsychotic, Aripiprazole is used in similar conditions as Risperidone. While it has a slightly lower risk of weight gain compared to other antipsychotics, it can still contribute to increased weight through altered metabolism and increased appetite.
- Etanercept (2.72%): As a TNF inhibitor used for treating autoimmune diseases, Etanercept can cause weight gain. This is often considered a positive outcome in patients who have lost weight due to chronic inflammation, but it can be problematic for others.
- Prednisone (2.70%): A corticosteroid, Prednisone is known for causing weight gain, primarily through fluid retention and increased appetite. It can also cause redistribution of fat to the face, abdomen, and back of the neck.
- Levothyroxine Sodium (2.59%): Used for hypothyroidism, Levothyroxine can lead to weight gain if the dose is higher than needed, potentially causing a state of hyperthyroidism, which increases appetite and may alter metabolism.
- Olanzapine (2.18%): This antipsychotic, used for mental health disorders like schizophrenia and bipolar disorder, has a significant risk of weight gain. It acts on various neurotransmitters that increase appetite and can also disrupt metabolic processes.
- Infliximab (2.09%): Infliximab, another TNF inhibitor, is used in the treatment of autoimmune conditions. Similar to other drugs in its class, weight gain can occur as a result of reduced inflammation and a return to a healthier weight, but it may also be due to the drug’s metabolic effects.
- Tocilizumab (2.02%): Used in diseases like rheumatoid arthritis, Tocilizumab can cause weight gain. This is often a reflection of reduced disease activity and improved overall health, but it may also result from changes in metabolism induced by the drug.
Reporter Specifics
- Consumer Reports (62%): The majority of the reports came directly from consumers, indicating a high level of awareness and concern among patients regarding weight gain as a side effect.
- Healthcare Professionals (37.27%): These reports underscore the recognition within the medical community of the significance of drug-induced weight gain as a clinical issue.
Patient Demographics
- Gender Disparity (Females: 63.43%): The higher percentage of reports from females could point towards gender differences in drug metabolism, hormonal influences, or perhaps a greater propensity to report weight gain.
- Predominant Age Group (18-64 years: 68.40%): This age range, typically associated with high levels of activity and productivity, suggests that the impact of medication-induced weight gain could have significant lifestyle and health implications for a major portion of the workforce.
The findings of this study highlight the importance of considering potential weight-related side effects when prescribing these medications.
They also suggest a need for proactive patient education and regular monitoring to mitigate the risks of weight gain, especially in populations more likely to report these issues.
Medication Classes Causing Weight Gain: From Most to Least Problematic
Each class of medication listed here interacts with the body’s systems differently, leading to weight gain through various mechanisms.
Understanding these mechanisms is crucial for healthcare providers to effectively manage and mitigate these side effects, ensuring that patients receive the most beneficial and least harmful treatment regimes.
1. Antipsychotics (e.g., Risperidone, Aripiprazole, Olanzapine)
- Mechanism of Weight Gain:
- Neurotransmitter Alteration: They primarily affect serotonin and dopamine pathways, which can significantly increase appetite and alter satiety signals.
- Metabolic Changes: These drugs can disrupt normal metabolic processes, leading to increased fat storage and insulin resistance.
- Sedation: Some antipsychotics have sedative effects that reduce physical activity, contributing to weight gain.
2. Immunosuppressives/Anti-inflammatory Agents (e.g., Adalimumab, Etanercept, Infliximab, Tocilizumab)
- Mechanism of Weight Gain:
- Reduction in Inflammation: By decreasing systemic inflammation, these drugs can lead to increased appetite and improved absorption of nutrients, sometimes resulting in weight gain.
- Fluid Retention: Some of these medications can cause the body to retain fluid, adding to body weight.
3. Corticosteroids (e.g., Prednisone)
- Mechanism of Weight Gain:
- Appetite Stimulation: Corticosteroids can significantly increase appetite.
- Fluid Retention: They often lead to water and salt retention, contributing to weight gain.
- Fat Redistribution: These drugs can cause redistribution of fat to the face, abdomen, and back of the neck (Cushingoid features).
4. Anticonvulsants (e.g., Pregabalin)
- Mechanism of Weight Gain:
- Increased Appetite: Some anticonvulsants stimulate appetite.
- Fluid Retention: They can lead to water retention, causing increased body weight.
- Decreased Metabolism: There is potential for these medications to slow down the metabolic rate.
5. Thyroid Hormone Replacements (e.g., Levothyroxine Sodium)
- Mechanism of Weight Gain:
- Over-replacement Therapy: If the dosage of thyroid hormone is too high, it can lead to symptoms of hyperthyroidism, including increased appetite, which can result in weight gain.
6. Diabetes Medications (e.g., Insulin, Thiazolidinediones)
- Mechanism of Weight Gain:
- Insulin Regulation: Can increase fat storage due to the anabolic effects of insulin.
- Alteration of Glucose Metabolism: Influences how the body processes and stores glucose.
7. Antihypertensives (e.g., Beta-Adrenergic Blockers)
- Mechanism of Weight Gain:
- Slowed Metabolism: Can reduce metabolic rate, leading to weight gain.
- Fluid Retention: Certain antihypertensives can cause the body to retain fluid.
8. Antidepressants (e.g., Mirtazapine, Paroxetine)
- Mechanism of Weight Gain:
- Appetite Stimulation: Increases appetite, often leading to increased caloric intake.
- Metabolic Alterations: Can change how the body processes and stores nutrients.
Strategies to Prevent and/or Counteract Weight Gain from Pharmaceutical Medications & Drugs
These strategies need to be personalized and discussed with a healthcare provider.
Each individual’s health status, type of medication, and underlying conditions play a significant role in determining the best approach to managing medication-induced weight gain.
- Medication Review & Adjustment: Regularly consult with healthcare providers to review the medication regimen. They can adjust dosages or switch to alternative medications with a lower risk of causing weight gain.
- Use of Adjunct Medications: In some cases, adding another medication can counteract weight gain. For example, metformin is sometimes used alongside antipsychotics to manage weight.
- Splitting Dosages: For some medications, splitting the dose throughout the day, rather than taking it all at once, can help mitigate weight gain side effects.
- Timed Medication Intake: Adjusting the timing of medication can sometimes help. For instance, taking medication that increases appetite during times when you are typically less hungry might help control overall food intake.
- Lowest Effective Dose: Using the lowest effective dose of medication can minimize side effects, including weight gain.
- Short-Term Use When Possible: For medications like corticosteroids, limiting use to the shortest possible effective duration can help minimize weight gain.
- Combination Therapy: Sometimes combining medications can reduce the necessary dose of the drug causing weight gain, thereby lessening this side effect.
- Slow Titration: Gradually increasing the dosage to the therapeutic level can give the body time to adjust, potentially reducing the risk of rapid weight gain.
- Regular Monitoring: Ongoing monitoring of the drug’s effectiveness and side effects can help in making timely adjustments to the treatment plan.
- Intermittent Therapy: In some cases, intermittent use of the medication (on and off therapy) may be an option to manage side effects while still gaining therapeutic benefits.
- Use of Sustained Release Formulations: Some medications in sustained-release form can lower the incidence of side effects, including weight gain.
- Prophylactic Measures: In certain cases, starting a diet and exercise regimen before or immediately upon starting the medication can proactively counteract weight gain.
- Nutritional Supplements: In some cases, dietary supplements might help manage medication-induced metabolic changes.
- Behavioral Therapy: For medications that increase appetite, behavioral therapy can help develop coping strategies for cravings and hunger management.
- Regular Lab Tests: Frequent lab tests can help monitor metabolic changes due to medication and allow for timely interventions.
Have you experienced weight gain from a specific medication?
If you’ve experienced weight gain from a specific medication or drug – feel free to leave a comment discussing it.
Approximately how much weight did you gain while using a specific medication or multiple?
Why do you think you gained the weight? (Metabolism changes, lethargy, appetite increase, fat storage, etc.)
Have you talked to your doctor about adjusting the dosage, switching to a different drug, or adding an adjunct to counteract the weight gain?
Are you 100% sure your gain was from the medication? Or is it possible that other factors contributed more to the weight gain and taking the med is just a coincidence?
References
- Paper: Drug-induced weight gain in the last 10 years: a descriptive study (2022)
- Authors: N J Ahmed et al.