Does prednisone make you gain weight?

Key Points

• Prednisone is a common corticosteroid prescribed to treat inflammatory and autoimmune conditions like asthma, rheumatoid arthritis, and lupus
• Prednisone can make you gain weight by increasing appetite and fluid retention and changes in fat distribution
• Diet changes, along with regular exercise, can help manage prednisone-related weight gain
• Working with a registered weight loss dietitian can provide personalized strategies to slow down weight gain on prednisone

When you take prednisone, you may start to notice puffiness in your face and bloating around the belly. Your clothes may not fit as they once did. This isn't your imagination.

Prednisone is a common medication prescribed to treat inflammatory conditions like arthritis, rheumatoid arthritis, asthma, and autoimmune conditions like lupus. However, it has side effects. Notably, it alters how you metabolize food, store fat, and process fluids.

Understanding why you gain weight on prednisone can help you manage it.

Does prednisone make you gain weight?

Prednisone is known to cause weight gain. It’s synthetic cortisol, a stress hormone naturally produced by your adrenal glands. When it’s taken as a medication, it mimics the effects of cortisol in your body but at much higher levels than your body would normally produce.

"Elevated cortisol levels can make weight gain more likely by increasing appetite, changing how your body stores fat, and slowing down fat burning. It can cause more fat to be stored around the belly and face while also making your body less responsive to insulin, which encourages fat storage and inflammation. Over time, these effects make it easier to gain weight and harder to lose it, but with the right diet and lifestyle adjustments, you can help counteract them," Angela Peralta, Registered Dietitian, RD.

How much weight do you gain on prednisone?

The amount of weight gain on prednisone varies from person to person, but research shows some general patterns.

• One study shows that patients taking low doses of prednisone experience a 4-8% increase in their total body weight over a two-year treatment period. For someone weighing 150 pounds, it amounts to a 6-12 pound weight gain.
• Another long-term study examined people who had been taking glucocorticoids (prednisone is one type of synthetic glucocorticoid) for more than three months. Here, 10% of those taking prednisone or prednisolone gained more than 10% of their body weight (prednisolone is what prednisone converts into after the liver processes it).

Overall, the long-term study found that young women between 18 and 39 years old had the highest weight gain, averaging 8 lbs. People who ate a poor diet and did not get regular physical activity were also at risk for weight gain.

How does prednisone cause weight gain?

This elevated "cortisol-like" effect from prednisone triggers different changes in the body that contribute to weight gain. These include:

1. A greater appetite

Prednisone stimulates the appetite center in your brain, making you feel hungrier more often. When you’re hungry, you want to eat. So, you may end up consuming more calories than you need without realizing it.

2. Fluid retention

When you take prednisone, it changes how your body handles salt and water. Prednisone makes your body hold onto salt while losing potassium, which causes extra water to build up in your tissues.

This extra fluid shows up as temporary weight gain on the scale, often known as “water weight.”

Over time, excess fluid retention can lead to swelling in the face, ankles, hands, and feet. It also places a strain on the heart because it works harder to pump the fluid out and raises blood pressure over time. Sometimes, fluid accumulation in the joints can also cause discomfort and even impact the quality of sleep.

3. Redistributed fat

One of the most visually noticeable effects of prednisone is the redistribution of fat to specific areas of the body:

• Face (commonly known as “moon face”)
• Back of the neck and shoulders
• Abdomen

These noticeable changes can affect your appearance and self-confidence, even if the number on your scale doesn't change much.

4. Changes your metabolism

Prednisone disrupts how your body turns food into energy and makes it harder for your cells to use sugar properly (insulin resistance). This can lead to more calories being stored as fat.

As a result, people find it difficult to maintain their weight while on prednisone, even with mindful eating and exercise.

What factors can affect weight gain on prednisone?

Your genetics, pre-existing health conditions, diet, activity levels, other medications you’re taking, and more may influence how your body responds to prednisone.

Your weight gain may also depend on how long you take prednisone. Studies show that short-term use typically causes less weight gain than long-term treatment (months).

Always report any concerning symptoms to your healthcare provider. Never stop taking prednisone suddenly without medical supervision, as this can be dangerous.

Can you prevent prednisone weight gain?

While some weight gain may be inevitable for many patients, there are strategies that can help minimize it.

1. Your diet is important

"When you're on prednisone, managing weight can feel like an uphill battle—it changes how your body processes fats and proteins. The good news? The right diet can make a big difference. A high-protein, lower-carbohydrate approach helps support muscle, curb cravings, and keep blood sugar stable. Another great option is the DASH diet, which focuses on whole, unprocessed foods and can help manage fluid shifts and blood sugar, making it easier to stay on track while on prednisone," Peralta, RD.

Consider these dietary changes to help:

• Eat smaller, more frequent meals to help control hunger
• Include protein at every meal to help you feel full
• Choose high-fiber foods that help you feel fuller longer
• Keep tempting high-calorie snacks out of sight to reduce food cravings
• Practice mindful eating by eating slowly and without distractions
• Limit simple carbohydrates like sugary foods and beverages
• Avoid highly processed foods, which often contain excessive sodium
• Choose complex carbohydrates like whole grains, legumes, and vegetables

If managing your diet feels like too much while dealing with your health and medication side effects, don't worry about going it alone. Consider working with a professional.

A registered dietitian who specializes in weight management can create a custom plan based on how prednisone affects your body.

2. Exercise matters

Regular physical activity can help counteract the metabolic effects of prednisone:

• Aerobic exercise: Even moderate walking can help burn extra calories and improve insulin sensitivity.
• Strength training: Building muscle mass helps counteract the muscle-wasting effects of prednisone and increases your metabolic rate.
• Flexibility exercises: Gentle stretching or yoga can help maintain range of motion and reduce stiffness.

However, be careful not to overdo it. Always consult your healthcare provider about exercise recommendations that are appropriate for your specific condition, as certain inflammatory disorders may require modified approaches to physical activity.

3. Manage sleep and stress

Don't underestimate the impact of good sleep and stress management when you're taking prednisone.

When you're sleep-deprived, your body naturally produces more cortisol, which could make the medication’s appetite-stimulating effects worse. To improve your sleep quality, try to establish a consistent sleep schedule and create a relaxing bedtime routine.

Similarly, finding effective ways to manage stress is crucial since stress hormones can compound prednisone's effects on your metabolism and appetite. Whether it's through meditation, gentle yoga, deep breathing exercises, or simply taking time for activities you enjoy, reducing stress can make a meaningful difference in your weight management journey while on prednisone.

How a registered dietitian can help

Managing diet and weight while on prednisone may present unique challenges that could be difficult to manage alone.

A dietitian specializing in weight management can be extremely helpful during or after prednisone treatment. Most insurance plans cover nutrition services with registered dietitians, especially for medical conditions, making them more affordable.

A dietitian can:

• Create a personalized nutrition plan that accounts for prednisone's effects on your metabolism and appetite
• Help you develop meal strategies that minimize fluid retention and fat gain
• Monitor your progress and make adjustments as your medication dosage changes
• Provide accountability and support when facing difficult choices or fighting cravings
• Offer practical strategies for grocery shopping, meal preparation, and eating out while on medication

Final thoughts: prednisone and weight gain

Prednisone-related weight gain is common but manageable with the right approach. By understanding the mechanisms behind this side effect, you can take proactive steps to minimize weight gain and benefit from the medication’s effects for health-related issues.

Work closely with your healthcare team and a registered dietitian to find the balance between effectively treating your condition and managing side effects.

Manage weight gain on prednisone. Find a registered dietitian who accepts your insurance.

Frequently Asked Questions (FAQs)

1. How fast does prednisone cause weight gain?

Weight gain on prednisone varies between people. Some notice changes within weeks, while others only after longer use.

Treatment length matters. Treatments lasting more than two weeks are more likely to cause weight gain, while short courses might have minimal effect.

If you're worried about gaining weight, speak with your healthcare provider. Plus, a registered dietitian can help you manage prednisone weight gain.

2. Will I lose weight if I stop prednisone?

What happens after you stop the medication really depends on what kind of weight you gain. Weight from fluid retention may resolve quickly, while actual fat gain or the distinctive "moon face" and fat redistribution, particularly in the abdomen, takes longer to reverse.

If you have been prescribed prednisone to treat a medical condition, it’s important that you do not stop your medication or change your dose without speaking with a healthcare provider. If you are concerned about your weight gain, discuss potential alternatives with them or consult a registered dietitian to help you with managing your weight.

3. How can I avoid weight gain on prednisone?

While some weight gain may be unavoidable, you can minimize it by limiting sodium intake to reduce fluid retention. You could also follow a high-protein, low-carbohydrate diet, engage in regular physical activity, get adequate sleep, and manage stress. Working with a registered dietitian can provide personalized diet strategies based on your specific needs and health condition.

Find a weight loss dietitian who accepts your insurance.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.