Drug-Induced Obesity: A Comprehensive Review of Medications That Can Cause Weight Gain

Drugs have a wide array of uses in medicine. While most of the effects are systemically therapeutic, other less savory effects are possible. There may be bodily changes associated with medication intake. The global health concern of increased weight gain (obesity) among populations is gaining much discussion in the literature. Several reasons are responsible for this obesity epidemic globally. These reasons range from poor physical activity to unhealthy diet and medications. Usually, health experts strive to prescribe medications that have less impact on the body’s weight. However, viable alternatives to these medications are not always present.Obese Person

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Several health issues are associated with uncontrolled weight gain. Knowledge of the drug classes that could cause this drug-induced obesity is vital. Globally, the rate of obesity is rising. With this increase comes a high prevalence of metabolic diseases associated with obesity such as hypertension and diabetes. Generally, excess weight is associated with poorer health status.

While medications are usually needed, the potential adverse effect of weight increase is significant. A challenge associated with medication-induced weight gain is the possibility of drug non-adherence by patients. As such, clinicians strive to create a balance and consider the effects on weight by certain medications.

It is usually hard to define the exact weight effects of drugs. However, several clinical guidelines categorize medications as either promoting weight loss, weight gain, or having a neutral weight effect. With a desire for better health outcomes, some clinicians may overlook the potential for weight gain when prescribing medications. That being said, knowing the medications with the potential to increase weight may prove beneficial in developing other healthier ways to control medication-induced weight gain.

Classes of medications that can cause weight gain

Weight gain or redistribution of body fat is a common side effect of many commonly used drugs. Amounts gained may range from a few pounds to a 10% or higher increase in initial body weight. Weight gain can lead to an increased incidence of metabolic syndrome, type 2 diabetes, and other cardiovascular conditions. In susceptible patients, many drug classes, including receptor antagonists, antipsychotic drugs, corticosteroids, neurotropic drugs, and those used in hypertension therapy, cause significant weight gain and metabolic disturbances. The systemic effects of these medicines, with their therapeutic function, may be visible in weight gain. Several patients undergoing pharmacotherapy are at a loss on some of the adverse effects of their medicine classes. To prevent non-compliance, some clinicians do not discuss the weight gain potential of drugs with patients.

Antidepressants

Although antidepressants do not have a significant weight gain potential when compared to other medications, they carry a higher burden of weight gain globally because of their more frequent prescription than other drug classes. Antidepressants consist of five main classes of drugs with different weight gain potentials. The Tricyclic Antidepressants class has the highest weight increase side effect. Among this group are medications such as Amitriptyline and nortriptyline. Other groups of antidepressants as monoamine oxidase inhibitors (MAOIs) carry potential weight gain effects. In the category of antidepressants, selective serotonin reuptake inhibitors (SSRIs) have the lowest potential to cause weight gain.

Depression has a high global prevalence. As such, there is an increased number of people on antidepressants. With the various drugs under each subcategory of antidepressants having a well-researched weight gain profile, clinicians may consider drug substitutes, among other factors, when prescribing these medications.

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Antipsychotics/mood stabilizers

There is a significant correlation between psychological pathologies and increased weight globally. Compared to the general population, patients with mental health disorders are 2 to 3 times more likely to develop obesity. Antipsychotic medications play a role in weight gain among patients. Clinical studies show up to 70% of patients undergoing a course of treatment with psychiatric medication may develop some weight gain. More significant are some drugs taken for schizophrenia: such as Clozapine. Other medications prescribed for schizophrenia also elicit varying levels of weight gain.

For cases of bipolar diseases, drugs like lithium possess a lower but significant weight gain. Clinicians advocate for a slight combination of these medications with other weight-neutral to weight loss mood stabilizers in treating psychiatric conditions.

Antihyperglycemics

A high prevalence ratio of comorbid diabetes and obesity exists globally. About 80% of diabetes patients are obese. While some diabetic medications are associated with weight loss, a significant number of these diabetes medications can also cause increased weight. The antihyperglycemics used for type 1 diabetes associated with weight gain effects are thiazolidinediones and insulin. Although insulin functions to help the body absorb glucose, it can cause an increased body weight when the cells absorb too much glucose and convert it to fat.

Variations exist in the weight increase profile of insulin. Genetics usually plays a role in insulin effects. Clinicians can also manipulate other factors such as drug administration, dosage, and injection speed release to lower the weight gain potential of insulin. Presently, there are a lot of newer classes of diabetes medications with better weight loss abilities.

Antihypertensives

A common condition associated with increased weight is an increase in blood pressure. Dietary changes, improved physical activity, and weight management give better outcomes for sustained treatment and a better prognosis for hypertension.

However, antihypertensives are still important in controlling blood pressure rise. Although a high amount of antihypertensives are weight neutral, and some lead to weight loss, there are still cases of recorded weight gain with antihypertensives. For example, beta-blockers cause a typical weight gain following usage up to a point. Clinicians, however, believe the amount of weight gain associated with beta-blockers is negligible.

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Corticosteroids

Corticosteroids are a necessary class of drugs for a variety of diseases. Conditions such as asthma, other inflammatory diseases, and rheumatic or autoimmune diseases require corticosteroids.

This class of medication may include cortisone and other glucocorticosteroids. There are no significant body changes in these medications in short-term use. Conversely, the long-term use of corticosteroids such as prednisone and prednisolone is associated with a significantly high weight gain. Although there are variations in the amount of weight gained from these medications, a 10kg increase may occur in some patients.

Oral steroids also reduce insulin sensitivity, resulting in insulin resistance. This resistance, in turn, stimulates appetite by increasing the production of the hunger hormone ghrelin. The stimulation of appetite leads to more food intake and causes a weight increase.

Experts recommend a diet rich in low-glycemic foods such as fruits and vegetables, beans, minimally processed grains, low-fat dairy, and nuts to avoid weight gain while using corticosteroids. These foods are digested slowly and absorbed, resulting in a slower and smaller rise in blood sugar levels.

Managing weight gain from pharmacological sources

The most vital aspect of choosing a pharmacological intervention is to improve clinical indicators and a patient’s health. The choice may require a lot of consideration by clinicians to gain optimal results. Weight gain is a commonly reported side effect associated with different classes of medications. To manage this adverse effect of pharmacotherapy, clinicians ought to prescribe medicines with better weight changes profile whenever clinically possible and without suitable alternatives. It is also necessary to discuss with the patients the possibility of weight gain from these medications. The risk of non-compliance to medication dosage because of weight gain can stop by evaluating the potential side effects with the patients in line with their body goals.

Monitoring the baseline changes in weight is vital to document the effects of medications. Before changing medications, dietary and physical activity changes may counteract the weight gain effects of medicines. Indeed, studies have shown that people who take psychiatric drugs that cause weight gain can still lose a clinically significant amount of weight by participating in a lifestyle intervention without having to change their medication. If lifestyle changes alone do not result in the desired weight loss, medicinal changes can be the last line of action. Before medication substitution, changes to the medication’s dose or delivery method should be attempted whenever possible.

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Conclusion

Weight gain is a massive problem for many people, particularly if they have specific body goals. The likelihood of their medications causing these body changes forces a non-adherence to medication goals, further exacerbating their health challenges. Although clinicians prescribe medicines to get better therapeutic benefits, side effects are not uncommon.

A reduction in these pharmacologically induced weight gain is possible with alternatives such as improved physical activity and a better diet. Despite the potential for weight gain with pharmacotherapy, it may prove more disastrous to abandon following the prescription dosage.

Weight gain caused by medication can be frustrating for both the patient and the clinician. As the use of pharmaceuticals continues to rise, clinicians must consider the weight effects of medicines before prescribing or during treatment. When it is impossible to make medication changes, adjunctive therapies for the patient that may reduce the weight gain potential is beneficial.

References

https://www.ncbi.nlm.nih.gov/books/NBK537590/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393509/

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