Weight and Lupus

I've noticed that people who are newly diagnosed with lupus are often concerned with weight. Who wouldn't be? We all know people who have gained lots of weight on prednisone, and it's scary to think that one more thing in our life might spiral out of control. So, understandably, people often ask "Can I stay skinny with lupus?"

The answer is not very satisfying, I'm afraid. Quite simply, it depends. Here are a few ways that lupus can affect weight, both in terms of gaining and losing. Whether you will gain or lose depends on very individual factors such as what medications you're given, how you react to them, etc. But maybe I can make it a little less mysterious.

Weight Loss in Lupus:

1. Gastroparesis: this is a condition in which the stomach becomes partially or completely paralyzed. It's lots of fun, by which I mean it sucks. Because the stomach isn't working properly, the patient will get full very quickly, and may not be able to eat very much, if at all. Understandably, then, patients with gastroparesis tend to lose weight. I certainly lose weight when mine is flaring. That being said, not every patient with this condition is skinny.
2. Chemo: Lupus patients are often given chemotherapy to try to knock out our bat-*$@# crazy immune systems. These drugs have lots of side-effects, including nausea. For a lot of people this results in weight loss.
3. Chronic Fatigue: Quite simply, one can become too tired to eat.

Note that none of these are fun ways to lose weight. They are not "eat all you want and stay thin" methods; they are more "be too sick to keep food down" type of things. So people should not envy lupus patients who have lost weight due to their disease; in such patients weight loss is not a sign of health.

Weight Gain in Lupus:

1. Prednisone/Other Steroids: Steroids can make people gain weight. Lots of weight. They flip on the hunger switch, and it's very hard not to overeat when your body thinks it's starving. So many patients gain weight while taking steroids. Steroids can also make you retain water, which promotes temporary weight gain. That being said, some of us get nauseous from steroids, so it's not a universal thing. And, of course, eating lots of vegetables and avoiding junk foods can help decrease weight gain in anyone, so it's possible to keep some control.
2. Kidney Problems: This may not be considered "real" weight gain, but it can certainly result in the number on the scale going way, way up. Simply put, if your kidneys aren't working properly you may start retaining water. Lots of water. And, since water weighs a fair amount, you will weigh a lot more than you did before your kidneys stopped working well. The good news with this kind of weight gain is that it can be reversed if the kidneys start functioning again.
3. Pain and Fatigue: I know, I said fatigue can cause weight loss. But pain and fatigue can also cause weight gain because they make it difficult/impossible to exercise. Combined with a body that thinks it's starving to death, this may cause weight gain.

As always in lupus, there are no hard and fast rules. Some people with gastroparesis are obese. Some people on steroids are underweight. But the above factors tend to push someone towards losing/gaining weight. So, is it possible to stay/be skinny with lupus? It still depends. To summarize: