Why Am I Gaining Weight with Lupus? Understanding the Connection

Living with lupus is a constant balance of managing inflammation, dealing with unpredictable flares, and navigating complex treatments. For many, an unexpected and frustrating challenge is unexplained weight gain.

If you're finding the scale creeping up while managing your lupus, know that you’re not alone. The weight gain associated with lupus is often a direct result of the disease itself and the medications used to treat it, rather than just changes in diet or activity. It is something that, of course, does not define you, but, unfortunately, societal pressures (and a billion-dollar health and wellness industry) make it incredibly frustrating at times to emotionally and physically navigate.

Here's a breakdown of the main culprits behind weight gain in lupus, along with practical strategies to help manage it.

The Main Culprits Behind Lupus Weight Gain

Weight gain in lupus is often multi-factorial, stemming from three primary areas: medication, disease activity, and the resulting change in lifestyle.

1. Corticosteroids (Prednisone) 💊

This is arguably the single biggest cause of weight gain for people with lupus. Corticosteroids like prednisone are highly effective at controlling severe inflammation and stopping flares, but they come with significant metabolic side effects:

• Increased Appetite: Steroids can make you feel constantly hungry, often leading to a higher calorie intake.

• Fluid Retention: Steroids cause your body to retain salt and water, which instantly adds pounds. This is often the first type of "weight" you notice.

• Fat Redistribution: They can change where your body stores fat, often leading to increased fat accumulation in the face ("moon face"), back of the neck ("buffalo hump"), and abdomen. This change in body shape is often more distressing than the number on the scale.

• Insulin Resistance: Steroids can elevate blood sugar levels, sometimes leading to temporary or even chronic, steroid-induced diabetes, making it harder for your body to process food effectively.

2. Chronic Inflammation and Fatigue 🔥

Even without steroid use, active lupus disease can lead to weight gain:

• Inflammation: Active inflammation from lupus can interfere with metabolism and hormone regulation. The inflammatory chemicals (cytokines) that drive the disease can also affect the body's ability to burn calories efficiently.

• Lupus Fatigue: The extreme, debilitating fatigue and joint pain common in lupus make exercise and even normal daily movement (which burns calories) incredibly difficult. When activity levels drop significantly, calorie burning decreases, and weight increases.

3. Kidney Involvement (Lupus Nephritis) 💧

If lupus is affecting your kidneys (lupus nephritis), weight gain can occur due to fluid buildup:

• Edema: Damaged kidneys may not be able to effectively filter out excess fluid and sodium, leading to significant swelling, particularly in the legs, feet, and around the eyes. This retained fluid registers as weight gain.

Practical Strategies to Manage Weight

Addressing weight gain requires a holistic approach that focuses on minimizing medication side effects and maximizing energy conservation. Always consult your rheumatologist and care team before making significant changes to your diet or exercise routine.

1. Master the Prednisone Diet

If steroids are the cause, focus on counteracting their effects:

• Minimize Sodium: To combat fluid retention, drastically reduce your intake of salt and high-sodium processed foods. Focus on fresh, whole ingredients.

• Balance Blood Sugar: Since steroids can spike blood sugar, choose complex carbohydrates (whole grains, vegetables, beans) over simple sugars and refined white flour. Pair carbs with protein and healthy fats to slow down glucose absorption.

• Eat Mindfully: Acknowledge the steroid-induced hunger. Pre-portion meals, drink water before eating, and focus on high-fiber foods to feel full longer.

2. Prioritize Low-Impact Movement 🚶‍♀️

While fatigue is a hurdle, complete inactivity can worsen stiffness and mood. The goal is to conserve energy while staying active:

• Pacing is Key: Instead of one long workout, try three 10-minute bouts of activity spread throughout the day.

• Choose Gentle Exercise: Opt for low-impact options that are easy on the joints: swimming or water aerobics, walking, yoga, or stretching.

• Use Good Days Wisely: Don't overdo it on a "good day" and trigger a flare. Maintain a consistent, gentle routine.

3. Partner with Your Doctor and Dietitian 🤝

Self-managing lupus-related weight gain can be frustrating; professional help is your best tool:

• Discuss Tapering Steroids: Work with your rheumatologist to get on the lowest effective dose of prednisone or explore steroid-sparing drugs that allow you to reduce your prednisone dose.

• Check for Other Issues: Ask your doctor to check for vitamin D deficiency and thyroid function, as both can cause fatigue and contribute to weight gain in lupus patients.

• See a Registered Dietitian (RD): An RD who understands lupus can help you create a sustainable, anti-inflammatory, and low-sodium meal plan that supports your medication needs without sacrificing essential nutrients.

• Discuss the possibility of GLP-1 medications if your glucose levels and A1C are being impacted by chronic steroid use or other medical conditions.

4. Consider these Suggestions if You Have Lupus Nephritis

   - Eat less sodium (salt) to help control your blood pressure and reduce swelling

   - Eat smaller portions of foods with a lot of protein, like meat and dairy

   - Cut back on foods with saturated fats, like butter and fatty meats

   - If you drink alcohol, drink only in moderation

   - Work with your doctor to control your blood pressure, diabetes, or high cholesterol (courtesy of the Lupus Foundation of America)

As discussed in another recent blog, a recent study sponsored by the NIH suggests that women with lupus are likely to be impacted by obesity than the general population. The study also shows that women who were diagnosed with both lupus and obesity have more limitations in their daily lives, are more likely to suffer from a disability, and are less likely to be employed than women who are not obese.

Carrying excess weight can impact a person's physical and emotional well-being, worsen lupus symptoms, and increase the risk of serious health problems, including heart disease—a concern already heightened for many with lupus. This makes effective weight management a key component of overall lupus care.  Cardiovascular disease is one of the top reasons for early mortality with lupus, and something that can be managed if steps are taken to improve a person's lifestyle choices, diet, and maintain a healthy BMI. 

During periods of lupus weight gain, it is important to be mindful of how your self-perception may shift. Breaking the link between your weight and your self-worth is a crucial step toward a healthier and more fulfilling life.

Here are a few ways to start:

• Focus on what your body can do. Instead of obsessing over how your body looks, appreciate its capabilities. Your body allows you to hike, dance, hug a loved one, and experience the world. Celebrate its strength and resilience.

• Identify other sources of value. Create a list of all the things that make you "you." Are you a good friend? A creative artist? A compassionate listener? A dedicated professional? Spend your time and energy nurturing these qualities.

• Challenge negative self-talk. When you hear that inner voice criticizing your body, pause and question it. Ask yourself, "What would I tell a friend in this situation?" or "Is this thought based on fact or a feeling?" Replace a negative thought with a positive one, like "I am a good person who is working to be healthier," or "I am grateful for my body's strength."

• Practice self-care that feels good. Move your body in a way that you enjoy—whether it's yoga, dancing, walking in nature, or lifting weights. Nourish yourself with foods that make you feel energized and well. These actions should be an act of kindness to yourself, not a punishment for what you ate or what you weigh.

• Surround yourself with support. Seek out people who appreciate you for who you are, not for how you look. Distance yourself from those who engage in constant body shaming or diet talk.

Weight management with lupus is complex, but by understanding the influence of your disease and your treatments, you can take informed steps toward a healthier, more balanced life.

Compiled by:

Kelli (Casas) Roseta

**All resources provided by this blog are for informational purposes only, not to replace the advice of a medical professional. Kelli encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site and in this blog are owned by morethanlupus.com. This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus 2025.

Sources:

• MyLupusTeam: Does Taking Prednisone Make You Gain Weight?

• Johns Hopkins Vasculitis Center: Prednisone

• Lupus Foundation of America: Managing side effects of steroids

• GoodRx: Does Lupus Make You Gain Weight? Here's What to Know

• Banner Health: Weight Management Challenges for People With Lupus

• LupusCorner: Fluid Retention and Lupus

• Health.com: Can Lupus Cause You To Gain Weight?

• UCSF Health: ILD Nutrition Manual: Prednisone and Weight Gain

• WebMD: What to Know About Prednisone and Your Diet

• Lupus Foundation of America: A low-impact exercise routine for lupus

• Healthline: Exercising with Lupus: 12 Things to Try or Avoid

• Johns Hopkins Lupus Center: Treating Lupus with Immunosuppressive Medications

• Johns Hopkins Lupus Center: Lupus Signs, Symptoms, and Co-occuring Conditions