Question

I have taken steroids for 10 years because of health problems and am on a daily dose of 10 mg prednisone. I am 5' tall, and before I started taking the steroids, my average weight was around 115 lb. Now I weigh about 187 lb. How can I lose weight, and should I come off the steroids just occasionally?

Answer

Prednisone is metabolised to prednisolone in the liver and one of the side effects is weight gain. However it can also cause fluid retention, and it would be important to know that some of your weight was not due to that, which could be counteracted by reducing your salt intake and/or by taking a diuretic.

If the steroids are causing weight gain and this is not due to fluid, then it is due to increased adipose tissue. That will not occur even on steroids if your dietary intake is 500-1000 kcals per day less than you require. We are sure that you have tried diets, but perhaps we could give you a little advice. Try to avoid the food items that provide energy but little else of nutritional importance, such as sucrose and alcohol. Restrict the intake of fat, particularly saturated fat, because it is a concentrated energy source and because fat has a lower satiating capacity than carbohydrate or protein (i.e. you will feel fuller sooner with carbohydrates or proteins than with fats). You can eat any amount of fruit, vegetables and whole grain cereals. It is important that your protein intake is adequate to avoid loss of lean tissue.

Most of us eat more or less automatically, and it may be well worth while keeping a food diary. Dieticians find that we eat less when we are required to pay attention to what we eat, and also the food diary can perhaps give you a good indication of certain situations which precipitate binge eating. Weight loss groups are an important means of losing weight for some people.

Finally we should mention exercise. Although we do not advocate exercise for weight loss, it is important for energy expenditure, physical fitness and a feeling of well being. You should take as much exercise as you can and you will find that the more you take, the more you are able to take. However, exercise alone is not an effective method for achieving weight loss.

You mention stopping the steroids periodically, but that would seem unwise to us, given your health problems. Perhaps a very gradual reduction might enable you to achieve a lower maintenance dose. For example, we would suggest perhaps reducing by 1 mg every month. If your symptoms got worse during that time, you would know you would need to return to the higher dose, but if you were quite all right after 1 month you might reduce by a further 1 mg.