Arthritis is a common condition that causes pain and inflammation in the joints. There are over 100 different types of arthritis, with osteoarthritis and rheumatoid arthritis being the most prevalent. An estimated 54 million adults in the United States have some form of arthritis.
Many people with arthritis struggle with their weight. While being overweight can increase the risk of developing arthritis, the reverse is also true – arthritis can lead to weight gain. This article explores the complex relationship between arthritis and weight gain.
How arthritis can cause weight gain
There are several ways in which arthritis can contribute to weight gain:
Pain and decreased mobility
The pain and stiffness caused by arthritis can make physical activity more difficult. Weight-bearing activities like walking, running, and exercise may become uncomfortable or even impossible for some arthritis patients. This decrease in activity can lead to muscle loss and a slower metabolism. Burning fewer calories while still eating the same amount will result in weight gain over time.
Medications
Many medications used to treat arthritis can cause weight gain as a side effect. Corticosteroids like prednisone are commonly prescribed to reduce inflammation, but they may increase appetite and promote fat storage in unusual areas like the face and back. Other drugs like methotrexate can cause nausea, which discourages physical activity and exercise.
Inflammation
Chronic inflammation in the body, as seen in inflammatory types of arthritis like rheumatoid arthritis, stimulates the release of certain proteins that change the way the body stores and uses nutrients. This dysregulated metabolism makes weight gain more likely.
Fatigue and depression
Coping with chronic arthritis pain and fatigue can take a toll on mental health. Feelings of sadness, stress, and depression are common in people with arthritis. These factors may decrease motivation for physical activity and make weight management more challenging. Comfort eating associated with depression can also lead to weight gain.
Dietary changes
Some people with arthritis make changes to their diet in an attempt to reduce symptoms. For example, eliminating foods thought to worsen inflammation like nightshade vegetables, dairy, and meat. While dietary changes are usually well-intentioned, restrictions can sometimes lead to overeating other foods, making weight management difficult.
How being overweight worsens arthritis
Carrying extra body weight places greater stress and pressure on the joints, which can aggravate arthritis pain and inflammation. Excess weight is especially problematic for arthritis in the knees, hips, and lower back. Even losing just a few pounds can provide relief from arthritis symptoms and decrease associated disability. Specifically, being overweight contributes to worsening arthritis through:
Increased mechanical stress
The hips and knees support the bulk of body weight. More weight exerts greater pressure through these weight-bearing joints. This extra mechanical stress damages the cartilage that cushions joints and allows smooth movement. Damaged cartilage worsens pain and stiffness in arthritis.
Metabolic changes
Fat cells release proteins called cytokines that promote widespread inflammation and can exacerbate arthritis inflammation and joint destruction. Carrying excess fat also increases the risk of metabolic syndrome, which includes unhealthy changes like high blood pressure, high blood sugar, and abnormal cholesterol.
Less physical activity
People who are overweight or obese are less likely to engage in regular exercise. Sedentary behavior causes weakening of the muscles and other tissues surrounding joints. Strong muscles are needed to properly support joints and prevent painful arthritis flare-ups.
Higher risk of osteoarthritis
Being overweight or obese significantly increases the risk of developing osteoarthritis, the most common form of arthritis, especially in the knees. In the knees, each additional pound of body weight places four extra pounds of pressure on the joint with each step taken while walking.
The link between arthritis medications and weight gain
Many medications used for arthritis can cause unintended weight gain as a side effect. Here are some of the most common culprits:
Corticosteroids
Corticosteroids like prednisone reduce inflammation powerfully, but have notoriously unpleasant side effects with long-term use. These include increased appetite, fluid retention, and fat redistribution to places like the abdomen and face.
Biologics
A class of injectable rheumatoid arthritis drugs called TNF inhibitors like Humira may contribute to weight gain by improving arthritis symptoms and quality of life enough to increase appetite and caloric intake.
NSAIDs
Over-the-counter nonsteroidal anti-inflammatory drugs like ibuprofen may cause fluid retention and bloating in some people. They can also irritate the stomach lining and gastrointestinal tract.
Methotrexate
Methotrexate is another first-line arthritis treatment that can cause nausea and fatigue, discouraging patients from exercising and being active.
Gabapentin
Gabapentin is sometimes prescribed for arthritis nerve pain. Dizziness, fatigue, and increased appetite are possible side effects.
Antidepressants
Tricyclic antidepressants like amitriptyline used for arthritis pain relief may increased appetite and promote weight gain.
Strategies for managing weight with arthritis
While dealing with arthritis and weight can be frustrating, there are things you can do to reach and maintain a healthy weight to improve your symptoms.
Exercise safely
Staying active with arthritis is crucial for managing symptoms and weight. A combination of flexibility, aerobic, and strengthening exercises is best. Focus on low-impact activities like walking, swimming, or cycling to avoid unnecessary joint strain. Avoid high-impact activities like running. Exercise in short bursts with rest periods to prevent overexertion and pain flares. Strengthening exercises build up the muscles surrounding joints to provide better support. Stretching increases range of motion and flexibility. Make sure to talk to your doctor or physical therapist about developing an exercise routine tailored to your specific arthritis condition.
Eat an anti-inflammatory diet
Choosing foods scientifically proven to fight inflammation and avoiding inflammatory foods can indirectly promote weight loss by improving arthritis symptoms and making physical activity easier. Most of these diets emphasize eating plenty of antioxidant-rich fruits and vegetables, whole grains, plant-based proteins like beans and nuts, fatty fish, and healthy fats like olive oil. They limit sugary, processed foods and red meat. An anti-inflammatory diet full of nutrient-dense foods provides satiety with fewer calories compared to the typical Western diet. Losing excess fat will also lower inflammatory proteins.
Get enough sleep
Fatigue from poor sleep worsens arthritis pain and makes weight management challenging. Aim for 7-9 hours per night, and try to go to bed and wake up at consistent times. Making the bedroom dark, cool, and quiet and avoiding electronics before bed all promote restorative sleep. Melatonin supplements can help regulate sleep cycles. Get moving during the day to tire yourself out for better sleep.
Join a weight loss program
The support and accountability of a formal program can increase weight loss success. Look for a program that doesn’t exacerbate arthritis pain with high-impact exercises. Many programs now offer online or virtual options. Consider working with dietitians and occupational therapists knowledgeable about arthritis-friendly nutrition and exercise principles. Some medical facilities offer medically-supervised weight loss programs for people with arthritis.
Consider bariatric surgery
For severely obese arthritis patients, procedures like gastric bypass, gastric banding, or sleeve gastrectomy may be an option if other weight loss attempts fail. Bariatric surgery promotes major weight loss by restricting the amount of food the stomach can hold. Bariatric surgery may dramatically improve arthritis symptoms by reducing mechanical stress on joints and lowering body-wide inflammation. Make sure to discuss the pros, cons, and recovery process lengthily with your medical team.
Adjust your medications
If your arthritis medications are causing stubborn weight gain as a side effect, talk to your rheumatologist about adjusting treatment. Lowering corticosteroid doses, switching to non-steroidal anti-inflammatories, or trying different biologics may provide similar arthritis relief without the weight gain. Never stop or change doses on your own.
When to see your doctor
Talk to your healthcare provider if you experience any of the following:
– Sudden weight gain or loss of more than 10 pounds without trying
– Inability to lose weight despite diet and exercise changes
– New or worsening arthritis symptoms
– Signs of depression or anxiety
– Excessive thirst, urination, or appetite
– New medication side effects
Your doctor can help determine if your arthritis medications need adjustment, provide referrals to arthritis specialists or weight loss programs, and rule out other potential medical causes like thyroid disorders. Ongoing medical supervision is advised when trying to lose weight with arthritis.
The bottom line
The relationship between arthritis and weight is complex. Arthritis can indirectly lead to weight gain through decreased activity, inflammation, and medication side effects. Being overweight typically exacerbates arthritis inflammation and joint damage. Maintaining a healthy weight is one of the most effective ways to manage arthritis. Losing just 10-15 pounds can significantly improve arthritis symptoms. A combination of a nutrient-rich, anti-inflammatory diet, regular exercise, stress management, adequate sleep, and support can help achieve weight loss success. While arthritis can make weight management more difficult, a variety of options are available to safely lose weight and improve your joint health at any size. Discuss your weight loss plans with your healthcare providers to find the right strategies for you.