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Prednisone is a potent corticosteroid used to treat many conditions, from asthma to autoimmune diseases. Despite its effectiveness, common side effects, like weight gain, can significantly impact health and self-esteem. [1]
Before weight gain occurs, prednisone often raises blood pressure and blood sugar. [1] These effects are even more apparent after weight gain occurs. Visible changes (such as a “moon face”) can also decrease self-confidence. [2]
- Prednisone can cause weight gain because it increases appetite, causes water retention, and redistributes fat,making weight gain a very frequent side effect of prednisone.
- Higher doses and longer use of prednisone usually lead to more weight gain. Some people may gain only a few pounds, while others may gain an additional 10% or more of their body weight.
- Prednisone weight gain (especially the moon face) often reverses after tapering off; following a healthy diet and getting regular exercise can help manage it.
Does prednisone make you gain weight?
Yes. Weight gain is a well-documented and common side effect of prednisone, especially at higher doses or with prolonged use. [1] Patients often notice increased appetite and fluid retention within days of starting therapy, which may lead to weight gain. Even lower doses can cause some weight gain if taken continuously for months. [3]
How prednisone causes weight gain
Prednisone causes weight gain through multiple pathways. It boosts appetite by altering neuroendocrine hormones which control hunger, leading to less feelings of satiety (fullness), increased calorie intake, and weight gain. [4] In addition, these appetite-controlling hormones, which act on the gut-brain axis, also impact cravings for specific foods and control the feelings of reward associated with higher-carbohydrate, higher-sugar, and high-fat foods. [1][7]
Metabolic changes are other significant factors in prednisone-associated weight gain, although these occur internally and are less visible. Prednisone promotes hyperglycemia (elevated blood sugar), reduced sensitivity to insulin, higher levels of stress hormones, and increased fat storage. [8]
Prednisone also redistributes fat to certain areas of the body (often the nape of the neck and the abdomen), creating characteristic visual changes. [1] Prednisone can promote sodium and water retention, especially at higher doses, adding transient “water weight.” [1]
How much weight gain is typical?
The amount of weight gain is different for every person, dosage of medication, and length of treatment. Mild-to-moderate weight gains are common. For instance, a study of low-dose prednisone (roughly 5 mg daily) found individuals gained only about 2 kg (5 lbs) of extra weight over two years, as compared to patients not taking corticosteroids. [3]
In more practical terms, one person might gain just a few pounds, while another individual could gain 20 or more pounds over several months of therapy. There are many factors that likely impact the amount of weight someone gains on prednisone: age, dose, duration, body weight, body composition, diet, activity level, other metabolic risk factors, and additional health conditions. [5]
Fortunately, prednisone weight gain often significantly slows or plateaus after the first few months on a stable dose.
Who is most at risk and what factors affect severity?
Several factors make prednisone weight gain more likely or more severe:
- Higher doses & longer use: On higher doses, the weight gains tend to be larger: An extensive cohort study reported ~40% of long-term prednisone users gained more than 2 kg, and about 10% of users gained over 10% of their body weight. [1][5]
- Younger & female patients: Younger people, especially women, tend to gain more weight on steroids than older or male patients. [5]
- Previous steroid use: Prior courses of prednisone have been shown to potentially prime the body so that weight may be gained more readily with subsequent treatments. [5]
- Beyond dose and duration, the illness being treated can independently drive changes in weight; its symptoms (such as rheumatoid-arthritis pain, COPD-related breathlessness, and associated inflammation) often lower activity levels and alter appetite, so the combined effect on weight can be greater than the drug alone. [3][5]
Fat redistribution and prednisone & "moon face": The visible signs
One hallmark of steroid weight gain is its impact on one’s appearance. “Moon face” refers to the characteristic round, puffy face that develops as fat builds up in the cheeks and neck, and as the facial skin retains fluid. Similarly, fat can deposit around the back of the neck (creating what is known as a “buffalo hump”) and in the torso and abdomen, while the legs and arms may actually slim down. [6]
This Cushingoid fat redistribution is directly caused by prednisone’s hormonal effects on fat storage and arrangement. [1]
How long does it take for moonface to go away?
The good news is that these changes in fat distribution may be temporary. As the prednisone dose is lowered and eventually stopped, the face and body often return to their normal shape over time, although others find it difficult to lose the extra pounds of weight.
Many people find that the facial puffiness starts to go away within a few months of coming off steroids, largely from effective diuresis of the retained fluid. Coping with the moon face and other body changes can be emotionally challenging. Remembering that it’s not your fault (rather, that it is a side effect of the medication) can help. Such visible changes can be distressing. [2]
If you feel self-conscious, talk with your doctor for support; they can reassure you that it remains possible to reverse the effects. Remember that treating your underlying condition is the priority, and the cosmetic changes may only be temporary.
Preventing and managing weight gain while on prednisone
While on prednisone, you can take steps to minimize weight gain:
- Use the lowest effective dose for the shortest time (according to your doctor’s plan to appropriately treat your condition). [1]
- Eat a balanced, calorie-conscious diet. Emphasize lean protein, vegetables, and fiber, and limit sugary foods. Listen to true hunger cues and fullness signals to avoid overeating. Reduce your sodium intake to help curb water retention and bloating. [4]
- Engage in regular physical activity (such as walking, biking, interval training, and resistance training) if your condition allows. Exercise helps burn calories, improve body composition, and boost your mood, counteracting some of the negative side effects of steroid use. If your mobility is limited, even gentle exercises or physical therapy can help maintain strength and reduce muscle loss. [9]
- Weigh yourself periodically and watch for signs of fluid retention (such as ankle swelling). If you suddenly gain a lot of water weight, consult your healthcare provider, as sometimes a temporary diuretic can be used to relieve edema. [4]
- Get sufficient good quality sleep and aim to manage stress. Understand that weight gain is a common side effect and not your fault. Consider talking to a dietitian or joining a support group for extra encouragement.
Long-term outlook: Is weight gain reversible after prednisone?
In many cases, the weight gained on prednisone is reversible over time. Once you taper off and stop prednisone, your appetite and metabolism will improve, helping your body to begin to lose excess fluid and fat. However, for many people, this takes considerable effort. After being accustomed to eating larger portions and/or more frequently and after prednisone-associated fat gain, it requires diligent efforts of a healthy diet and regular exercise to help lose the extra weight stored as fat.
Many people lose the steroid-related water weight relatively quickly. It often takes a few months to lose the extra fat with diet and exercise. Typically, much of the extra weight comes off in the first 6–12 months after stopping prednisone. [4]
Be sure to follow your doctor’s instructions when tapering off. Never stop prednisone abruptly, even if your weight gain bothers you, as this can have dangerous physical effects. With patience and healthy habits, your weight and body shape should gradually return close to your pre-prednisone baseline.
Mental health and recovery considerations
Prednisone-related body changes can take a toll on mental health. Rapid shifts in weight and appearance, especially a moon face and increased fat deposition, can trigger anxiety, depression, or low self-esteem. Knowing these changes are common and temporary can help you cope. [2]
Providers are encouraged to discuss these effects in advance with patients and offer support during treatment. [2] If you're struggling, speak with your doctor or a counselor—body image concerns have been linked to poor treatment adherence. [2] You're not alone, and with time, as your body recovers, confidence usually returns.
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