Can you help solve an argument?

Well, you've done detailed measurements (logging) of what you're doing and what happens. Has she?

In some ways, it could be a tiny bit nuanced, because there is variation in different people's side effects from different medications. In most cases I'm aware of**, the weight gain associated with certain medications come from (1) water retention increases, (2) increased appetite (possibly subtle), or (3) fatigue (possibly subtle) that increases rest/sleep and/or decreases daily life activity and exercise frequency or intensity, thus reducing calorie expenditure.

Someone who is not estimating intake or activity to the best of their ability really has no truly reliable handle on whether they're eating and moving the same amount. We tend not to notice subtle or gradual changes in our own behavior. A 30-pound fat gain over 6 months is around 500-600 calories per day via some combination of increased appetite or decreased activity, or a combination of the two. That's a fair amount, but very much within the realm of possibility to go unnoticed in someone who isn't tracking, IMO.

** I'm not a doctor or anything like it, but have taken some drugs that are commonly believed to affect body weight tendencies. I know the story for those, and have read about a few others, but I certainly admit there could be drugs with different mechanisms of action and different side effects.

I would say it's more nuanced. Some antidepressants are strongly correlated with weight gain. However, it seems like they don't cause weight gain by breaking down physics, or even (for the most part) by altering metabolism - a calorie is still a calorie - but by impacting appetite and non-exercise activity level. Your sister may believe she's no less active, but actually be using fewer calories because she doesn't fidget as much, make that extra trip upstairs to pick up something, and so on. Most people are not very aware of their non-exercise activity level. Likewise, people who don't track calories and weigh food may feel that they are eating the same amount, but a handful of almonds has turned into a big handful, that one slice of roast may be the thick slice of roast now, and the doughnut at office break which before was a random doughnut is now the biggest one in the box. These changes can be subtle, but add up.

If your sister has gained 30 lbs in six months after being put on new meds, and was at a stable weight previously, it seems very likely that her meds are having an effect on her weight, whatever the mechanism is. She may be able to fight back through deliberate exercise and calorie counting, or possibly by asking for a change in meds. It's definitely something she should bring to the attention of her doctor, since excess weight isn't healthy.

Side effects of the medicine should be listed in the documentation that came from it. When a side effect is that it may cause weight gain, it doesn't mean that you can't lose weight but that it may be harder than normal to maintain or lose weight. It's all relative. There are many medicines that affect weight.

So your sister is likely right that she has gained weight while eating and exercising as she normally would with the only difference being the medication. But you are also right that she could lose weight if she starts to eat less or exercise more.

To give you an example of medication effect on weight that I am familiar with: I've recently started taking metformin for insulin resistance, and a frequent side effect is to lose weight compared to if someone with this illness wasn't on the medication. If you look into the science of how our body metabolises energy, and the interactions it has with different hormones and processes, then it is clear that in an ill body it does not just come down to basic understandings of "CICO".

In the case of my illness - insulin resistance - the insulin has a harder time opening fat cells to release the stored energy for the body to use, so it is harder (but not impossible) to lose weight than in a normal healthy body. When the body doesn't think it has enough energy to run at full capacity (even though there may be plenty in storage) it sends signals that it is hungry (tempting people to eat more), and it starts prioritising processes, reserving the energy for crucial life functions, so the body might get cold hands and feet due to restricted blood flow, might get a fuzzy brain as higher order thinking is not considered a necessity, drop in sex drive, drop in motivation, change in mood, the body will feel tired and like resting more to conserve energy, etc. This means the basal metabolic rate can drop even if the person is diligent in eating & exercising the same as normal, which leads to weight gain. The medication tries to correct this dysfunction in the insulin/energy processes, so weight loss becomes easier than without it.

It is impossible for anyone to accurately calculate the "calories out" part of the CICO equation, we are only approximating and assuming based on what is considered "normal" for someone of our gender/age/height/weight/activity level. Illness and medicines can change the processes involved with the basal metabolic rate, satiety, mood, energy levels, etc, which has an effect on weight compared to a person not on the medication or without an illness.

So in your sister's case, the medication might cause her body to burn less energy than normal even if she is eating and exercising the same, or it might encourage the body to store more energy unnecessarily.

Pickle107 wrote: »

Both my sister and I are on anti-depressants. I've been on mine for many years and am 30 lbs from my ideal weight. My sister has been on hers for about 6 months and has put on about the same amount in that shorter time.

I thought that my metabolism from the meds was making it hard to lose weight. But once I started tracking my cals on mfp and setting a low enough calorie goal since I'm bed-ridden a few days a week, I've lost 5 lbs in 4 weeks. So my experience and the main opinion on here is that you need to run at a calorie deficit to lose weight. I was overeating for how inactive I am.

My sister is adamant that the meds are making her gain weight, she's no less active as she's been in an office job for years and that if anything, she's eating less than usual.

I think that that is physically impossible. She strongly disagrees. Neither of us have thyroid issues. Is there a right/wrong or is it more nuanced?

Study after study demonstrates that people are notoriously bad at estimating how much they are eating.

If your sister gets a food scale and logs every morsel, I am convinced she we discover that she is eating more than she thinks.

Some anti-depressants can indeed increase hunger, and that is how people gain weight while taking ADs - from eating more than they burn.

Wellbutrin is an AD that is NOT associated with weight gain. It's about the 6th AD I tried, and the only one I've stuck with. It is also a tiny bit speedy, which I find useful to encourage me to move more.

Luciicul wrote: »

Side effects of the medicine should be listed in the documentation that came from it. When a side effect is that it may cause weight gain, it doesn't mean that you can't lose weight but that it may be harder than normal to maintain or lose weight. It's all relative. There are many medicines that affect weight.

So your sister is likely right that she has gained weight while eating and exercising as she normally would with the only difference being the medication. But you are also right that she could lose weight if she starts to eat less or exercise more.

To give you an example of medication effect on weight that I am familiar with: I've recently started taking metformin for insulin resistance, and a frequent side effect is to lose weight compared to if someone with this illness wasn't on the medication. If you look into the science of how our body metabolises energy, and the interactions it has with different hormones and processes, then it is clear that in an ill body it does not just come down to basic understandings of "CICO".

In the case of my illness - insulin resistance - the insulin has a harder time opening fat cells to release the stored energy for the body to use, so it is harder (but not impossible) to lose weight than in a normal healthy body. When the body doesn't think it has enough energy to run at full capacity (even though there may be plenty in storage) it sends signals that it is hungry (tempting people to eat more), and it starts prioritising processes, reserving the energy for crucial life functions, so the body might get cold hands and feet due to restricted blood flow, might get a fuzzy brain as higher order thinking is not considered a necessity, drop in sex drive, drop in motivation, change in mood, the body will feel tired and like resting more to conserve energy, etc. This means the basal metabolic rate can drop even if the person is diligent in eating & exercising the same as normal, which leads to weight gain. The medication tries to correct this dysfunction in the insulin/energy processes, so weight loss becomes easier than without it.

It is impossible for anyone to accurately calculate the "calories out" part of the CICO equation, we are only approximating and assuming based on what is considered "normal" for someone of our gender/age/height/weight/activity level. Illness and medicines can change the processes involved with the basal metabolic rate, satiety, mood, energy levels, etc, which has an effect on weight compared to a person not on the medication or without an illness.

So in your sister's case, the medication might cause her body to burn less energy than normal even if she is eating and exercising the same, or it might encourage the body to store more energy unnecessarily.

Respectfully disagree- In most cases the medication increases your appetite and/or changes your activity level. This is commonly the culprit for weight gain. Once back to logging diligently, with a food scale, and following your weight trend, you can continue to maintain and even lose weight.

If you look around, the science on this is definitely not settled, and people's experiences vary. From my experience, the medication absolutely impacted my metabolism. I'm sick of people shouting "It's calories in vs. calories out!!!" while pretending that ABSOLUTELY NOTHING can impact the second part of that equation (even though we already know that isn't true).

Until anti-depressants, I had never been overweight in my life. I eat reasonably well and exercise regularly--did then, still do. But after the medication, my weight skyrocketed despite my frantic efforts to stop it. I've gained 20+ lbs in about a year. I have tracked calories, carefully controlled my nutritional intake, and increased my exercise to no avail.

The impact of these medications on our hormones--and therefore all of our bodily processes--is not fully understood, and people insisting they know for sure (without having experienced it themselves) are simply overconfident.

aguilar_k3 wrote: »

tinkerbellang83 wrote: »

aguilar_k3 wrote: »

and yet you stated in another thread that once you reduced your caloric intake you lost weight, SO... it wasn't to no avail, was it?

I think the eyeroll I just did reading this burned a good number of calories, so thanks for that I guess.

Anyhoo, your comment far underestimates my level of Type A major geekery plus a finance degree with an indecent love for spreadsheets. Sick of being dismissed by people such as yourself, I kept a detailed diary that included measuring portions and tracking calorie burn using my Apple Watch. I should have lost about 8 lbs. I added up my numbers in a spreadsheet at the end of each week and tracked the variance from the expectation.

What happened instead was that I started out losing about 4 lbs (yay!), then inexplicably gained 2 back (without going off the diet), and then plateaued. Hopeful that perhaps I was gaining muscle, I also took measurements I found basically the same outcomes. Overall, my weight loss was about 20% of the expected.

Perhaps you have the willpower to maintain an 1100 calorie-per-day diet for life just to maintain your weight--although since you're also a member of MyFitnesssPal, I doubt it--but I cannot.

Weight fluctuates constantly so what you're describing isn't really inexplicable, my own weight varies by as much as 5lb from day to day due to water retention.

How long did you keep the diary before deciding you had plateau'd?

Were you weighing food?

For years I didn't understand how I wasn't losing weight eating 1200 caloriesa day and would yo-yo, usually quitting after about 10 days seeing a rise on the scale (usually from a higher carb or sodium day) - the answer was simples, I was eating more than I thought and I wasn't patient enough. I now lose weight on 2300 calories thank to a food scale and trendweight app.