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7 medical reasons you may be gaining weight

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7 medical reasons you may be gaining weight


The answer to why you're putting on the pounds may not be as simple as you think. Unexplained weight gain is one symptom or side-effect or each of these medical conditions or treatments.


By Astrid Van Den Broeck



Now, where did that come from, you wonder, zipping up your favourite fuchsia skirt only to see a roll of flesh escape over the top of the waistband. Actually, it's not the first time you've suspected you're dragging around a few extra pounds. Your snuggly pj's are too snug lately, and the buttons across the bust on your khaki shirt hang on to each other for dear life.


What gives? (Clearly, not your jeans.) Your eating habits haven't changed, and you're still making it to your weekly Ashtanga classes. Is it those antidepressants you just started taking? Could be. Here we review eight medications and conditions that can stealthily lead to weight gain even as they cure the more serious health problem underneath.



1. Hypothyroidism

What is it? A condition affecting mostly women (especially in middle age) in which the thyroid gland, found at the bottom of the neck, isn't making enough thyroid hormone, which is key in balancing our body's metabolism. As well as gaining weight, those with it feel cold constantly and suffer from fatigue, constipation, irregular menstrual cycles, reduced sex drive and other symptoms. "It's the most common disorder I see that's a cause of weight gain," says Dr. John Dornan, head of Active Living Clinic in Saint John, N.B., and an expert in thyroid-related conditions.


The gain explained: "Hypothyroidism slows the metabolic rate. It can also cause fatigue, and sometimes when people are tired, they think if they have something to eat, they might feel better," says Lorraine Watson, associate professor in the faculty of nursing at the University of Calgary and a weight-management expert.


What now? If your physician suspects you have hypothyroidism, she'll order a test to measure how effectively your thyroid gland is working. If diagnosed, you might be prescribed a medication such as Thyroxin, a thyroid replacement hormone. Once you're on that, Watson says the gain will likely level out. But you will still have to shed the pounds you've accumulated. "So if your thyroid levels are properly aligned, you need to figure out how to increase your activity level and lower your caloric intake," she says.


2. Polycystic ovary syndrome

What is it? Polycystic ovary syndrome (PCOS) is a hormonal imbalance that is associated with cysts, or sacs filled with fluid, in the ovaries. Affecting women mostly during their childbearing years, it can seriously complicate ovulation; it is also associated with increases in weight, menstrual irregularities, infertility, facial hair growth and sometimes acne, says Dornan. "And it's associated with insulin resistance." That insulin factor tenuously links it to another condition associated with weight gain: type 2 diabetes (a family history of that could mean future female members have PCOS).


The gain explained: While the link between PCOS and weight gain is still a bit foggy, what experts do know is that people with PCOS can have high levels of insulin, and those high levels are tied to other health risks such as obesity and high blood pressure. "The weight gain is around your abdomen," says Watson. "When you have excessive fat tissue in your abdominal area around the organs it is more detrimental to your health (than fat clinging to other areas, such as your rear end or upper thighs)." Apple-shaped people with abdominal fat are at higher risk for a heart attack than pear-shaped people, reports a 2005 Interheart study from McMaster University in Hamilton. PCOS-induced weight gain can also be fast and significant despite attempts to exercise.


What now: Medication options include Metformin, which regulates your metabolism again and balances the hormones, says Dornan. Or you may be prescribed a birth control pill as well, he says, to offset unfortunate side-effects such as acne and facial hair growth. "Sometimes the treatment is similar to that for diabetes: lifestyle changes, diet and weight loss, as well as a medication," says Dornan. Given the intricacies of PCOS, a dietitian might help you find a personalized calorie-reduced (and often insulin-balanced) diet.


3. Cushing's syndrome

What is it? Also known as hypercortisolism, this rare condition means there is too much of the hormone cortisol in the adrenal glands. Cortisol normally helps regulate blood pressure and metabolism. While weight gain is a big red flag, tiredness and troubles with the skin (bruises last longer than usual, for example) are also signs. While both children and adults can develop hypercortisolism, it's more common in women aged 25 to 45 years.


The gain explained: The weight gain tends to occur in the upper body and particularly around the face and neck area, similar to if you were receiving corticosteroid injections, says Watson. "A roundish face, an apple-shaped upper body, that's where the gain would come in," she says.

What now: There are a variety of reasons for too much cortisol in the body - you may have been taking medications for another condition, such as asthma, or there could be a noncancerous tumour causing the oversecretion. So treatment will vary and may include surgery, radiation or taking cortisol-inhibiting drugs. This levelling out will help regulate symptoms; losing the weight comes down to hard work. "There are no drugs that you can just give to counter the weight-gain effects," says Dornan. Instead, it's incorporating healthful meal choices - lean proteins, whole grains, fresh produce - and increasing your activity options whenever you can. Check out Health Canada's website (www.hc-sc.gc.ca) for easy activities you can do at home, work or outside.



4. Oral contraceptives

What are these? Our old friend "the pill," these medications are pills combining two hormones - progestin and estrogen - and together they prevent ovulation with an almost 99 per cent effectiveness rate (when taken correctly). While they're generally used to prevent pregnancies, they are also prescribed for conditions such as severe acne or to regulate heavy or irregular periods that come with conditions such as endometriosis.


The gain explained: "There's a mild weight gain associated with contraceptives. It's not any real mystery," says Dr. Michael Rieder, a professor in the physiology and pharmacology department at the University of Western Ontario in London, Ont. "Most of the medications causing weight gain do so because they're appetite stimulants. They make the brain think we're not actually full and that we need to eat more." But Rieder says only about 20 per cent of women on the pill gain weight (and it's fairly unpredictable as to who will and who won't gain).


What now: While many think the answer to the gain is to switch the pill you're on, Rieder says think again. "People are too laissez-faire with hormonal birth control. They don't think of them as medications with side-effects," he says. "Switching pills is rarely the answer. It's my personal observation that if people gained weight on one medication, they'll do so on another." He does note you could try a nonhormonal form of birth control, such as a diaphragm or sponge, if you suspect the pill is the problem. But note: Generally these methods don't work as reliably as the pill for contraception.


5. Steroids

What are these? Not to be confused with anabolic steroids (the kind weight lifters and athletes take), corticosteroids, the kind you inject or swallow, are used for conditions such as rheumatoid arthritis and generally lessen any painful inflammation.


The gain explained: "Steroids make you ravenously hungry; I've seen patients on steroids pack on 20, 30,

40 pounds. Steroids, such as prednisone, are catabolic so it gives the impression the body is burning itself up and wants to get more food to replace it," says Rieder. "You can really put on pounds."


The weight gain also tends to be fairly localized. "It's mostly around the abdomen, and less so the arms or legs. It's called centripetal obesity, and a person's face looks rounder. You can almost tell, especially with kids, when they are on steroids because they look very similar," says Dornan.


What now: "Steroids often are prescribed for diseases for which weight gain isn't such a great thing. And it's hard because people get really hungry," says Rieder. He recommends focusing on the health problem that you're taking the steroids for first by following the course of medication; once that's relatively under control, focus on losing the weight through diet and especially exercise.


6. Antidepressants

What are these? Antidepressants, which are prescribed, alter the chemicals in our brain to relieve symptoms of depression (which include feeling sad all the time, decreased energy, insomnia, irritability and loss of interest in hobbies). There are different generations of antidepressants, and the newest - selective serotonin reuptake inhibitors (SSRIs) - reportedly are more effective at treating depression, but they come with side-effects such as weight gain.


The gain explained: "One theory is that people on antidepressants are in better moods, so they move more and eat more. But, like many of the drugs, they seem to also be appetite stimulants," says Rieder. "It's really quite variable who gains weight and who doesn't. But the people who gain weight can gain 20 pounds without a lot of trouble."


What now: If you're about to start taking them, Rieder says education up front is needed about possible weight gain. "Especially with chronic therapy such as this. Depression can go on two, three, four years or maybe the rest of your life," he says. Knowing weight gain is possible, you can plan for it by starting to eat less and move more.


And, unlike the pill, switching drugs is an option. "Prozac seems to be the antidepressant that, on average, creates less weight gain than other antidepressants for some people," says Dr. Denis Prud'homme, the dean of health sciences at the University of Ottawa. The effectiveness of one antidepressant to the next can really vary, adds Rieder. "The risk is that the alternates don't work as well." Talk to a physician about finding the best balance for you or investigating nondrug therapies for mild depression.


7. Estrogen

What is it? As women reach menopause, levels of the hormone estrogen dip dramatically. While the health risks and benefits of estrogen replacement therapy are still controversial, many women suffering from hot flashes and night sweats are still prescribed this option.


The gain explained: Hormones used to replace estrogen can trigger fluid retention, or water weight. "The weight gain could depend on the dose," says Watson. "Plus, as a woman ages, her metabolic rate slows, so she is more inclined to gain weight. Unfortunately, that's usually the population taking that hormonal replacement."


What now: "A lot of people are trying to encourage non-estrogen approaches," says Rieder. Be sure to talk to your physician about what might work for you. And for much more on these options, check out our Summer issue: we'll investigate natural ways to reduce hot flashes and other symptoms.


Solving a weight-gain mystery

"You're just not a very ambitious young woman, are you?" These words echo in Christy Zacharias' ears every time she finishes a race, sweat dripping into her eyes. They're painful words her doctor, looking her straight in the eye, said to her 10 years ago. She'd gone to him for help with a growing problem. Literally. In the two years since she'd gotten married and stopped taking the pill, pounds were piling on. Her period had disappeared and, embarrassingly, she'd started growing a small beard. "I felt a great deal of shame because my body was so out of control," says Christy, now a 32-year-old stay-at-home mom in Martensville, Sask. When he flung those painful words at her, she believed them and turned her blame inward for her weight gain.


Then, six years later, still worried and now 60 pounds heavier, she tried her obstetrician/ gynecologist. "I started to cry. I said there is something wrong with me," she says. He asked if she'd ever heard of polycystic ovary syndrome (PCOS), which she had (she had shown an article to her previous doctor, and he told her to leave the diagnosing to him). Her new gynecologist felt her symptoms were evidence enough to get her tested, and shortly afterward, she was diagnosed with PCOS.


"I felt so alone going through that," says Christy. "Looking back at pictures of myself, I look like a linebacker. It's amazing a doctor didn't look at me earlier. PCOS just robbed me of my femininity."


Christy started taking 1,500 milligrams of Metformin daily; it was a year before her symptoms began to subside. Her weight, meanwhile, stabilized, but she wasn't losing any of those 60 gained pounds. "I realized that PCOS is connected to insulin, and I thought if I could keep my insulin under control, I'd have a better chance of losing weight," she says. "When I started the insulin resistance diet with the medication and exercise, it flipped a switch in my body. That's when I got control."


Now, four years after her diagnosis, Christy is 60 pounds lighter, weighing in at a more comfortable 126 pounds on her five-foot-three frame. Out are her beloved big bowls of cheesy pasta, and in are smaller servings of whole grain pasta with lean meats and vegetables. Walking,

in-line skating and running - not to mention those ambitious races - are personal passions now.


Diabetes dilemma: Which comes first?

Type 2 diabetes, which begins slowly, usually in adulthood (unlike type 1, or juvenile-onset or gestational diabetes), is on the rise. That means more and more people's bodies aren't producing enough insulin, or their bodies are resisting insulin (insulin metabolizes carbohydrates). But when it comes to weight-gain issues, diabetes can be a chicken-and-egg scenario.


"Eighty per cent of the time type 2 diabetes is caused by weight gain and the other 20 per cent it's genetic," says Dr. John Dornan, head of Active Living Clinic in Saint John, N.B. "Weight increase causes the diabetes because the weight contributes to insulin resistance."


But some of the medications for type 2 diabetes, such as sulphonylureas, offer a classic catch-22. "A number of these treatments are associated with even more weight gain," says Dornan. "It's troubled us as diabetes specialists for years; we say your sugars aren't good because of your weight and here's a drug that may increase your weight further."


Your best action plan if you have type 2 diabetes is changing your lifestyle: eating healthier, limiting fruits, sweets and many carbohydrates, and exercising. But not just any exercise. "One study showed that the most efficient treatment for weight loss and improvement in terms of a person's glycemia was aerobic exercise and resistance exercise. That's the exercise prescription that someone with type 2 diabetes should have," says Dr. Denis Prud'homme, the dean of health sciences at the University of Ottawa, who has studied extensively the effects of activity on obesity.


One bright note: ditching the extra pounds can bring your blood sugar back to normal.

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Thank you Mary!


This is exactly what Oprah and Dr Oz should do a show on! Maybe not devote an hour to Cushing's (since it is to rare, NOT) but an hour to explain that if you have honestly tried to lose weight and have these other symptoms, see your doctor, your health my be at risk.


Hello, Oprah?

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Thanks for sharing this information.

Concerning the Estrogen replacement causing weight gain...I wonder if this applies to the bioavailable Estrogens?

Just a thought that I will follow through on by googling it...

But if anyone knows...please post some information.


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