Welcome to Debate Club! Please be aware that this is a space for respectful debate, and that your ideas will be challenged here. Please remember to critique the argument, not the author.
Medical reasons for weight gain and what they mean
Options
nettiklive
Posts: 206 Member
Okay, so I've been lurking on the site for quite some time, and this question has weighed on my mind, excuse the pun, for a while.
If it's just CICO, what happens in weight gain caused by medications such as steroids, or metabolic disease like thyroid, pituary tumors, PCOS, Cushing's Disease etc?
I'm not talking about simply medications that increase appetite, or conditions like hypothyroid that slow down the BMR. What I'm talking about is the drastic, oftentimes extremely sudden and rapid weight gain experienced with some conditions or meds, which seemingly defies the laws of thermodynamics. Steroids, which cause rapid uncontrollable weight gain and the 'moon face'. I know a girl, 120 lbs all her life, healthy and athletic, who gained 90!!!! lbs in 2 months on steroids - and was having extreme difficulty losing it even six months after going off. Her doctor said they essentially 'shut down' the adrenal glands - though most conventional medicine doesn't recognize that. Or Cushing's Disease, which causes fat gain in a specific pattern like the face and back of the neck. These gains are typically so rapid, with no diet or activity change, that it seems to make no sense - if it's all about cico, where does the body get that energy needed to accumulate that much fat that quickly?
The reason this interests me, aside from the fact that this would essentially be one of my worst nightmares, god forbid, is that I feel that it's an indication that something else goes on in the human body "behind the scenes" of basic CICO, and that the relationship could be extrapolated beyond those with a specific diagnosis, to various variations of hormones and metabolism which could account for weight gain or loss, and why some people struggle so much more and others - and even the same people who could struggle at some periods of their lives and not others.
As a much less drastic example, I can use pregnancy, because I have personally experienced its workings on the metabolism. When I got pregnant with my second child, I, a person who has maintained the same weight and BMI of 19 for the last eight years, got morning sickness and could barely eat anything for the first two and a half months. Like, literally, I could eat a piece of toast, one egg, and three pieces of fruit for the entire day. I didn't gain weight, but I also didn't lose. At around the 12 week mark I finally felt a bit better and started to try and eat a little something, concerned about the baby's health. I still felt kind of sick so I didn't eat much, and definitely not more, if not less, than I was eating previous to the pregnancy. And I started ballooning - way before I started showing, my legs and butt blew up to enormous proportions. I was gaining a lb a day for a couple of weeks. It was terrifying, I felt out of control and worried I'd gain 60+lbs (I gained 30 with my first and it was never that rapid). I was barely eating 1200 cal - my pre-pregnancy norm. Eventually it slowed down and I ended up gaining 35 overall. But for those few weeks, I literally felt and saw my body packing on the fat to protect the baby - I'm guessing in response to not eating much previously. I found scientific research stating exactly that - that for the first two trimesters, a pregnant woman's body slows in metabolism and packs away fat, especially on lower body, to use for lactation and insurance for nutrition to the fetus.
It showed me just how smart our bodies are - and how difficult it is to control your metabolic processes. It's a good thing when they're healthy and work like they're supposed to - like in pregnancy. But what happens when something 'breaks'? If you read literature on the topic, there are theories about gut microbes playing a role in metabolism, and thought to be affected by the meds that cause weight gain. There's also the role of hormones, adrenal glands, etc.
Sorry for the rambling, just thought it would be an interesting discussion topic for these boards.
Thoughts?
If it's just CICO, what happens in weight gain caused by medications such as steroids, or metabolic disease like thyroid, pituary tumors, PCOS, Cushing's Disease etc?
I'm not talking about simply medications that increase appetite, or conditions like hypothyroid that slow down the BMR. What I'm talking about is the drastic, oftentimes extremely sudden and rapid weight gain experienced with some conditions or meds, which seemingly defies the laws of thermodynamics. Steroids, which cause rapid uncontrollable weight gain and the 'moon face'. I know a girl, 120 lbs all her life, healthy and athletic, who gained 90!!!! lbs in 2 months on steroids - and was having extreme difficulty losing it even six months after going off. Her doctor said they essentially 'shut down' the adrenal glands - though most conventional medicine doesn't recognize that. Or Cushing's Disease, which causes fat gain in a specific pattern like the face and back of the neck. These gains are typically so rapid, with no diet or activity change, that it seems to make no sense - if it's all about cico, where does the body get that energy needed to accumulate that much fat that quickly?
The reason this interests me, aside from the fact that this would essentially be one of my worst nightmares, god forbid, is that I feel that it's an indication that something else goes on in the human body "behind the scenes" of basic CICO, and that the relationship could be extrapolated beyond those with a specific diagnosis, to various variations of hormones and metabolism which could account for weight gain or loss, and why some people struggle so much more and others - and even the same people who could struggle at some periods of their lives and not others.
As a much less drastic example, I can use pregnancy, because I have personally experienced its workings on the metabolism. When I got pregnant with my second child, I, a person who has maintained the same weight and BMI of 19 for the last eight years, got morning sickness and could barely eat anything for the first two and a half months. Like, literally, I could eat a piece of toast, one egg, and three pieces of fruit for the entire day. I didn't gain weight, but I also didn't lose. At around the 12 week mark I finally felt a bit better and started to try and eat a little something, concerned about the baby's health. I still felt kind of sick so I didn't eat much, and definitely not more, if not less, than I was eating previous to the pregnancy. And I started ballooning - way before I started showing, my legs and butt blew up to enormous proportions. I was gaining a lb a day for a couple of weeks. It was terrifying, I felt out of control and worried I'd gain 60+lbs (I gained 30 with my first and it was never that rapid). I was barely eating 1200 cal - my pre-pregnancy norm. Eventually it slowed down and I ended up gaining 35 overall. But for those few weeks, I literally felt and saw my body packing on the fat to protect the baby - I'm guessing in response to not eating much previously. I found scientific research stating exactly that - that for the first two trimesters, a pregnant woman's body slows in metabolism and packs away fat, especially on lower body, to use for lactation and insurance for nutrition to the fetus.
It showed me just how smart our bodies are - and how difficult it is to control your metabolic processes. It's a good thing when they're healthy and work like they're supposed to - like in pregnancy. But what happens when something 'breaks'? If you read literature on the topic, there are theories about gut microbes playing a role in metabolism, and thought to be affected by the meds that cause weight gain. There's also the role of hormones, adrenal glands, etc.
Sorry for the rambling, just thought it would be an interesting discussion topic for these boards.
Thoughts?
1
Replies
-
Usually, any unusual or rapid weight gain can be explained by water retention. Otherwise, many conditions/drugs have a direct effect on appetite or energy levels/expenditure and therefore it will still boil down to cico if actual fat is being gained. There's no magic involved.5
-
People overall seem to conflate weight gain and fat gain. Most medication weight gain is water retention. It's been my experience there's very few medications that cause fat gain, and those are ones that screw with satiation and/or cortisol.7
-
Cortisol is what I was thinking. Steroids, Cushing's Disease and others cause very characteristic fat deposits that are said to be almost impossible to prevent, like on the face, back of neck, and around the middle, while at the same time losing fat and muscle from the extremities. It sounds utterly terrifying.2
-
My mom has endogenous cushing's syndrome. It's absolutely awful. It went undiagnosed for many, many years after onset because her doctors dismissed her as a fat hypochondriac. When she was finally diagnosed (diagnosis confirmed at the Mayo Clinic) it was a relief.. but the untreated underlying disease had wrecked havoc with her body in so many ways.
Cushing's causes weight gain in more than one way. First, it imbalances your hormones in such a way that calories are preferentially shuttled into fat metabolism. I want people who read that to think again about that for a moment. If you have Cushing's, your body will use every available calorie to create fat. At the expense of body functions. Thus, weight gain with this problem is not directly related to your food intake.
Second, it upregulates hunger. So you have a one-two punch. There was a helpful review published recently on this topic.
Lee, Mi-Jeong, et al. "Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity." Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease 1842.3 (2014): 473-481.6 -
CI=CO to balance weight. If we want to lose then CI<CO, and to gain we must have CI>CO. It's always going to be true but CO can vary wildly depending on your circumstances.
I had the same situation with my pregnancies. I get very sick for about 4 months, ill several times per day, and I would lose 10-15lbs eating very very little. If I wasn't pg I should have lost more. With my last pg, I gained 20lbs in 1 month once the nausea passed. I was not eating and extra 3000kcal per day. They suspected diabetes but I was perfectly fine at the time.
Fast forward 5 years and I now did have an insulin resistance problem. Once my blood glucose went up, I started gaining weight and quickly. I put on about 15 lbs in under a year while watching my calories. My CO was down though so I gained weight.
So many things affect CO. There is the obvious fitness but health does too. If I have an autoimmune flare up, I start gaining weight. If my blood glucose is high (from carbs or an overactive liver) then I gain weight. If my thyroid is underactive, I gained weight. So many things...
And the reverse was true too. If my immune system is fine, I lose weight. If I cut carbs, I lose weight. It goes both ways.
Just my experience.1 -
CipherZero wrote: »People overall seem to conflate weight gain and fat gain. Most medication weight gain is water retention. It's been my experience there's very few medications that cause fat gain, and those are ones that screw with satiation and/or cortisol.
So much this^^
Most people, especially on these forums, use "weight" and "fat" interchangeably as if they are the same thing. I saw this in a post on another thread just a few minutes ago. And we wonder why people are so confused.0 -
I am on a medication, that while it can make you hungry, even while on a vlcd, a medically monitored diet or a traditional CICO diet, could not lose weight and even gained. It causes metabolic syndrome. Only LCHF and exercise has helped me slowly lose.1
-
CICO is just the mathematical equation...there are things that can effect the equation...but that doesn't invalidate the equation. Certain metabolic disorders like PCOS, etc effect metabolism...so someone in that situation would have a slower metabolism than average...but ultimately it still comes down to consuming fewer calories than required...that's all CICO is.
Most of the medications and whatnot either make one ravenous so they overeat or they cause water retention4 -
Need2Exerc1se wrote: »CipherZero wrote: »People overall seem to conflate weight gain and fat gain. Most medication weight gain is water retention. It's been my experience there's very few medications that cause fat gain, and those are ones that screw with satiation and/or cortisol.
So much this^^
Most people, especially on these forums, use "weight" and "fat" interchangeably as if they are the same thing. I saw this in a post on another thread just a few minutes ago. And we wonder why people are so confused.
The meds I'm talking about generally cause both water retention AND fat gain, as I mentioned, deposited in characteristic places.
What tomteboda said above about Cushing's.
The implications of this is that hormones can mess with metabolism to such degree that it is impossible to create a deficit even on extremely low intake. That defies the argument of some that everyone's metabolism is pretty much the same, give or take 200 calories or so, and that everyone can lose weight on a reasonable deficit (which is technically true but not achievable)0 -
First, it imbalances your hormones in such a way that calories are preferentially shuttled into fat metabolism. I want people who read that to think again about that for a moment. If you have Cushing's, your body will use every available calorie to create fat. At the expense of body functions. Thus, weight gain with this problem is not directly related to your food intake.
Yes.
This I believe is the missing link in many people who struggle to lose weight in spite of cutting calories etc.
My theory is that CO is more than just a simple 'burning' of energy. It's about how and where that energy ends up getting distributed that can likely differ greatly between individuals.1 -
nettiklive wrote: »Need2Exerc1se wrote: »CipherZero wrote: »People overall seem to conflate weight gain and fat gain. Most medication weight gain is water retention. It's been my experience there's very few medications that cause fat gain, and those are ones that screw with satiation and/or cortisol.
So much this^^
Most people, especially on these forums, use "weight" and "fat" interchangeably as if they are the same thing. I saw this in a post on another thread just a few minutes ago. And we wonder why people are so confused.
The meds I'm talking about generally cause both water retention AND fat gain, as I mentioned, deposited in characteristic places.
What tomteboda said above about Cushing's.
The implications of this is that hormones can mess with metabolism to such degree that it is impossible to create a deficit even on extremely low intake. That defies the argument of some that everyone's metabolism is pretty much the same, give or take 200 calories or so, and that everyone can lose weight on a reasonable deficit (which is technically true but not achievable)
when people talk about metabolisms being relatively consistent over the general populous, they are generally talking about otherwise healthy people...medical conditions as well as jacked up hormones can definitely mess with things.
You have to look at CICO as an overarching principal and in the hierarchy of things that are important to weight management, it is numero uno...that doesn't mean other things don't play a roll in weight management. Even high stress can raise cortisol levels and make weight management difficult...but doesn't invalidate the overarching principal of CICO.0 -
Yeah. There seems to be more of a variation than 200kcals or so. Just a month ago my immne system flared up and I was eating more carbs than normal, and I managed to gain about 10 lbs in a month. It wasn't just water (maybe 1 lb was) and I was not eating a 1000 extra calories per day.
I tightened up my carbs once I started to feel better and lost about half of that weight this month, and not using a large deficit either. For example, yesterday included a few coffees with whipping cream, coconut oil and protein powder; hamburger patty, red pepper and asiago cheese dip, marinated steak, caesar salad, macadami nuts, cashews, and a bit of chocolate chips. When I feel good, I can lose, or at least maintain, at that level of calories. When I am ill, I gain at a similar calorie level.0 -
My mom has endogenous cushing's syndrome. It's absolutely awful. It went undiagnosed for many, many years after onset because her doctors dismissed her as a fat hypochondriac. When she was finally diagnosed (diagnosis confirmed at the Mayo Clinic) it was a relief.. but the untreated underlying disease had wrecked havoc with her body in so many ways.
Cushing's causes weight gain in more than one way. First, it imbalances your hormones in such a way that calories are preferentially shuttled into fat metabolism. I want people who read that to think again about that for a moment. If you have Cushing's, your body will use every available calorie to create fat. At the expense of body functions. Thus, weight gain with this problem is not directly related to your food intake.
Second, it upregulates hunger. So you have a one-two punch. There was a helpful review published recently on this topic.
Lee, Mi-Jeong, et al. "Deconstructing the roles of glucocorticoids in adipose tissue biology and the development of central obesity." Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease 1842.3 (2014): 473-481.nettiklive wrote: »Need2Exerc1se wrote: »CipherZero wrote: »People overall seem to conflate weight gain and fat gain. Most medication weight gain is water retention. It's been my experience there's very few medications that cause fat gain, and those are ones that screw with satiation and/or cortisol.
So much this^^
Most people, especially on these forums, use "weight" and "fat" interchangeably as if they are the same thing. I saw this in a post on another thread just a few minutes ago. And we wonder why people are so confused.
The meds I'm talking about generally cause both water retention AND fat gain, as I mentioned, deposited in characteristic places.
What tomteboda said above about Cushing's.
The implications of this is that hormones can mess with metabolism to such degree that it is impossible to create a deficit even on extremely low intake. That defies the argument of some that everyone's metabolism is pretty much the same, give or take 200 calories or so, and that everyone can lose weight on a reasonable deficit (which is technically true but not achievable)
This is like saying, that it's impossible; to starve to death.2 -
cwolfman13 wrote: »
when people talk about metabolisms being relatively consistent over the general populous, they are generally talking about otherwise healthy people...medical conditions as well as jacked up hormones can definitely mess with things.
I wonder though, what percentage of 'chronically' obese people actually have issues with metabolisms.
We know that many normal weight people who don't struggle with weight don't keep strict track of their daily caloric intakes. Their CI probably varies a lot day to day but the body sort of averages it out unless there's drastic consistent over or undereating for a long time. On the other hand, folks trying to lose weight end up having to keep extremely tight tracks on their diet with weighing and measuring down to the last calorie.
Cushing's, insulin resistance, hypothyroid are just some of the hormonal diseases we know about and have learned to diagnose. But it seems to be not a very well researched area and there are likely many other conditions where hormones are disrupted that medicine just hasn't recognized yet. There could be many subclinical conditions that affect metabolism without progressing to full blown disease. Research on the role of leptin and others in weight management is just beginning, as are theories about gut microbes playing a significant part.0 -
nettiklive wrote: »Need2Exerc1se wrote: »CipherZero wrote: »People overall seem to conflate weight gain and fat gain. Most medication weight gain is water retention. It's been my experience there's very few medications that cause fat gain, and those are ones that screw with satiation and/or cortisol.
So much this^^
Most people, especially on these forums, use "weight" and "fat" interchangeably as if they are the same thing. I saw this in a post on another thread just a few minutes ago. And we wonder why people are so confused.
The meds I'm talking about generally cause both water retention AND fat gain, as I mentioned, deposited in characteristic places.
What tomteboda said above about Cushing's.
The implications of this is that hormones can mess with metabolism to such degree that it is impossible to create a deficit even on extremely low intake. That defies the argument of some that everyone's metabolism is pretty much the same, give or take 200 calories or so, and that everyone can lose weight on a reasonable deficit (which is technically true but not achievable)
It's never impossible to create a calorie deficit. But it may be impossible to create a deficit and still eat enough to get proper nutrition and/or not feel hungry most of the time.3 -
nettiklive wrote: »I wonder though, what percentage of 'chronically' obese people actually have issues with metabolisms.
We know that many normal weight people who don't struggle with weight don't keep strict track of their daily caloric intakes. Their CI probably varies a lot day to day but the body sort of averages it out unless there's drastic consistent over or undereating for a long time. On the other hand, folks trying to lose weight end up having to keep extremely tight tracks on their diet with weighing and measuring down to the last calorie.
I wonder how much being obese over long time periods screws with normal metabolic pathways. I'm not saying obesity cause Cushing's (even I'm not that dumb) but how it shifts the entire human ecosystem around, including damaging normal processes to store fat preferentially to other tissue building process.
I'm not smart enough to have anything resembling an informed opinion of that question.0 -
CipherZero wrote: »nettiklive wrote: »I wonder though, what percentage of 'chronically' obese people actually have issues with metabolisms.
We know that many normal weight people who don't struggle with weight don't keep strict track of their daily caloric intakes. Their CI probably varies a lot day to day but the body sort of averages it out unless there's drastic consistent over or undereating for a long time. On the other hand, folks trying to lose weight end up having to keep extremely tight tracks on their diet with weighing and measuring down to the last calorie.
I wonder how much being obese over long time periods screws with normal metabolic pathways. I'm not saying obesity cause Cushing's (even I'm not that dumb) but how it shifts the entire human ecosystem around, including damaging normal processes to store fat preferentially to other tissue building process.
I'm not smart enough to have anything resembling an informed opinion of that question.
I have heard that a person's fat cells form mainly during two main periods in childhood and around puberty I believe; therefore, a child who gains weight at that time will always have those extra fat cells that never go away, only shrink. The thought is that those fat cells release their own hormones that contribute to weight gain, as well as 'demand' food resulting in increased appetite. Don't know how much of that is proven versus a theory.0 -
CipherZero wrote: »nettiklive wrote: »I wonder though, what percentage of 'chronically' obese people actually have issues with metabolisms.
We know that many normal weight people who don't struggle with weight don't keep strict track of their daily caloric intakes. Their CI probably varies a lot day to day but the body sort of averages it out unless there's drastic consistent over or undereating for a long time. On the other hand, folks trying to lose weight end up having to keep extremely tight tracks on their diet with weighing and measuring down to the last calorie.
I wonder how much being obese over long time periods screws with normal metabolic pathways. I'm not saying obesity cause Cushing's (even I'm not that dumb) but how it shifts the entire human ecosystem around, including damaging normal processes to store fat preferentially to other tissue building process.
I'm not smart enough to have anything resembling an informed opinion of that question.
I have heard that a person's fat cells form mainly during two main periods in childhood and around puberty I believe (and then sometimes in pregnancy); therefore, a child who gains weight at that time will always have those extra fat cells that never go away, only shrink or grow. The thought is that those fat cells release their own hormones that contribute to weight gain, as well as 'demand' food resulting in increased appetite. Don't know how much of that is proven versus a theory.
0 -
Need2Exerc1se wrote: »
It's never impossible to create a calorie deficit. But it may be impossible to create a deficit and still eat enough to get proper nutrition and/or not feel hungry most of the time.
But if your fat metabolism is screwed up...like the PP said..I wonder if you could be at a point where even the barest minimum calories you take in to survive will be stored as fat, while the rest of the bodily processes will be shutting down as if you're indeed starving.
Something to think about. Again it makes me think that CICO could be overly simplistic in some cases.2 -
I've never seen a fat person in true starvation. Sure, they may be 'starving' as in they haven't eaten since lunch, but the images I've seen of starving children is where you can see ribs and joints and bones sticking out and practically near death. Their bodies use every last bit of fat available while maintaining essential functions of your heart, lungs, brain and organs until it finally runs out and starts compromising organ function which ends in death. In women, the body will shut off menstruation because it's not a priority but most other life sustaining functions will utilize your available body fat if you're not eating enough.nettiklive wrote: »Need2Exerc1se wrote: »
It's never impossible to create a calorie deficit. But it may be impossible to create a deficit and still eat enough to get proper nutrition and/or not feel hungry most of the time.
But if your fat metabolism is screwed up...like the PP said..I wonder if you could be at a point where even the barest minimum calories you take in to survive will be stored as fat, while the rest of the bodily processes will be shutting down as if you're indeed starving.
Something to think about. Again it makes me think that CICO could be overly simplistic in some cases.
So, no, your body is not stupid enough to take what little food you're eating, store it all as fat, in addition to whatever fat you already have, and somehow choose to NOT use it for energy and instead shut down essential processes. Doesn't even make any sense or the animal kingdom would be extinct.4
Categories
- All Categories
- 1.4M Health, Wellness and Goals
- 391.3K Introduce Yourself
- 43.4K Getting Started
- 259.6K Health and Weight Loss
- 175.6K Food and Nutrition
- 47.3K Recipes
- 232.3K Fitness and Exercise
- 387 Sleep, Mindfulness and Overall Wellness
- 6.4K Goal: Maintaining Weight
- 8.5K Goal: Gaining Weight and Body Building
- 152.7K Motivation and Support
- 7.8K Challenges
- 1.3K Debate Club
- 96.2K Chit-Chat
- 2.5K Fun and Games
- 3.2K MyFitnessPal Information
- 22 News and Announcements
- 911 Feature Suggestions and Ideas
- 2.3K MyFitnessPal Tech Support Questions