Systemic Lupus Erythematosus (Lupus) is a chronic autoimmune condition where the immune system mistakenly attacks healthy tissues, causing widespread inflammation across different organ systems. Individuals managing this condition often experience significant weight fluctuation. While active flares can sometimes lead to weight loss, weight gain is a frequent concern due to a combination of disease activity and necessary treatments. This weight change results from metabolic changes, reduced activity levels, and powerful medications. Understanding the distinct factors that contribute to this gain is the first step in managing it effectively.
Lupus-Related Inflammation and Fatigue
The chronic systemic inflammation characteristic of lupus directly alters the body’s metabolism. Inflammation can disrupt hormones that regulate appetite and fat storage. This heightened immune activity contributes to metabolic changes that make weight management more difficult.
Lupus flares are often accompanied by severe fatigue and painful joint symptoms, which naturally lead to reduced physical activity. When movement is difficult, the body burns fewer calories, creating a caloric surplus that results in weight gain. This reduction in activity compounds the metabolic effects of inflammation. The combination of altered metabolism and decreased energy expenditure establishes a pathway for unintended weight gain separate from medication side effects.
Medication and Fluid Retention Contributors
The most significant cause of weight gain in people with lupus is often the use of corticosteroids, such as Prednisone, which are prescribed to suppress the immune system and control inflammation during flares. These powerful drugs stimulate appetite, leading to increased caloric intake and subsequent weight gain.
Corticosteroids cause a redistribution of body fat, leading to specific physical changes. Fat tends to accumulate centrally around the abdomen and upper back, sometimes called a “buffalo hump.” The face may also become rounder and puffier (“moon face”) due to fat accumulation and fluid retention (edema). This fluid retention can significantly increase the number on the scale.
Fluid retention is also a direct complication of the disease, particularly if lupus affects the kidneys, a condition known as lupus nephritis. When the kidneys are damaged, they struggle to filter waste and maintain the proper balance of fluids and salts, causing excess water to build up. This excess fluid often presents as visible swelling in the legs, ankles, hands, and face, accounting for a rapid weight increase.
Strategies for Healthy Weight Management
Managing weight while living with lupus requires strategies that account for the unique challenges of fatigue and joint pain. Dietary adjustments should focus on nutrient-dense, anti-inflammatory foods, such as those found in a Mediterranean-style diet. It is helpful to limit the intake of processed foods, added sugars, and especially high-sodium items, as salt contributes directly to the fluid retention that is common with corticosteroid use and kidney involvement.
Physical activity should prioritize consistency over intensity, making movement sustainable even during periods of low energy. Low-impact exercises, such as gentle walking, swimming, or yoga, are recommended because they minimize stress on painful joints while still promoting calorie expenditure and muscle maintenance. Breaking activities into short, manageable sessions throughout the day can be more effective than attempting long workouts that risk triggering exhaustion.
Open communication with the rheumatology team is a fundamental part of weight management. Patients should discuss any weight concerns, as their doctor may be able to adjust medication dosages or explore alternative treatments to minimize side effects. Never stop taking prescribed medication, especially corticosteroids, without medical guidance, as these drugs are often suppressing life-threatening disease activity. Your healthcare providers are the best resource for tailoring a comprehensive plan that addresses both disease control and healthy weight maintenance.