Occasionally we take on a personal training client who is on steroids. Their GP has said to them that weight loss is impossible while taking steroids, and that they should just wait until their course of medication is over.
It can be very difficult to lose weight on steroids and in some cases frustrating to the point that it might indeed be better for a client to just try to maintain weight, from a psychological point of view. Prolonged discouragement and demoralisation can hang over past the medication period and create future negativity about weight loss and its achievability.
However it is not impossible to lose weight on steroids and weight maintenance is certainly an achievable goal before pressing on after the course of steroids is completed.
What are they?
Steroids, or corticosteroids to give them their technical term, are synthetic versions of cortisol. Cortisol is a hormone that not only triggers fight or flight reactions when we are under stress but is also used by the body to heal damage and inflammation. This is why a cortisone injection can often suppress or heal many soft tissue injuries. Corticosteroids are used to treat many inflammatory conditions such as arthritis, lupus, Crohn’s disease, rashes and other inflammation based illness and injuries. The most commonly prescribed steroids are:
Why are steroids associated with weight gain?
As well as helping us heal, steroids are associated with negative side effects, including weight gain. According to one US study, weight gain was the most commonly reported adverse effect of steroid use, affecting 70 percent of those prescribed the drugs.
Steroids cause weight gain by changing our electrolyte and water balance, as well as our metabolism — the way we store and use fat, amino acids, protein, carbohydrates and blood sugar, among other things. These factors change how and where we store fat, but the main driver of weight gain on steroids is increased appetite – clients report that they are constantly starving despite having eaten enough.
Many people on steroids notice increased fat in the abdomen, face, and neck. Even if you successfully control steroid-induced weight gain (which you can), you may still look heavier while on these drugs because of this fat redistribution.
Generally, the higher the dose of the steroid and the longer you’re on it, the more likely you are to experience weight gain. Short courses of a few days to a couple of weeks are less likely to produce many side effects, including weight gain.
So how do I prevent steroid induced weight gain?
Many of the strategies that we would implement with normal clients for weight loss are equally relevant for those on steroids. One of the main focuses should be on controlling appetite as well as keeping calorific intake at or below that required for weight maintenance.
1 – Choose filling (yet low-calorie) foods like fresh fruits and vegetables – the more fibre the better.
2 – Stave off hunger by eating six small meals a day versus three large ones – even if you are eating the same amount, it can feel like more when spread out like this.
3 – Choose natural, fibre filled and slower digesting complex carbohydrates versus refined ones. Swapping white rice for brown rice and normal pasta for wholegrain pasta is a good start. But beans and pulses are an even better, low GI source of carbohydrate that will really fill you up. Most UK supermarkets have a good choice of these ready to eat or heat up in a microwave. Merchant Gourmet have a great selection.
4 – Include protein with every meal (meat, cheese, legumes, etc.). A study published in the American Journal of Clinical Nutrition found that meals that contain 25–30 grams of protein will be the most effective at filling you up and making you feel sated for longer.
5 – Drink enough water. Drinking water not just between meals but also while eating can have multiple benefits, principally in helping you to feel fuller. Water between meals will sate any nagging feelings of hunger, while water during meals will allow your hormones to catch up with your eating. Usually, as we become full, we release the hormone Leptin that tells us to stop eating. If however we have been eating too quickly or non-stop, then the leptin doesn’t have time to get to the brain and stop you eating. So water will not only increase feelings of satiety but allow your hormones to regulate your eating as they should.
6 – Stay active. This is sometimes hard to do when you don’t feel well. Having a workout buddy can help, as can choosing an activity you enjoy. More than ever a personal trainer will prove their worth. Just as with eating, the usual exercise recommendations apply to those on steroids – strength training is vital to maintain muscle mass and metabolic rate. This will really help you to progress after you have finished your course of steroids. Some steady state cardio work will also help to reduce visual fat that has been redistributed by the steroids.
So although it’s not impossible to lose weight on steroids, it is challenging. A focus on maintenance might be the best goal. With this as your target along with correct exercise and nutrition, you will be in a great position to lose weight after you stop taking your steroids. However if you are very determined and careful then weight loss is still possible – go for it!