How to Moderate Weight Gain When Taking Steroids for Polymyalgia Rheumatica

Corticosteroids are the first-line treatment for polymyalgia rheumatica (PMR). They work quickly and effectively for most people to reduce the pain and stiffness that define this inflammatory condition.

Not everyone experiences these changes in the same way, which can make it hard to know what to expect. But if weight gain is a concern, there are practical ways to manage these side effects while staying on track with your PMR teatment.

Steroid-related weight gain is driven by a mix of biological effects that can play out differently depending on dosage and how long you’re on the medication, according to Neal Birnbaum, MD, a rheumatologist and past president of the American College of Rheumatology who’s been practicing for 48 years in San Francisco. He was also diagnosed with PMR in 2000 and was treated with prednisone for almost two years.

These biological effects include:

• Increased Appetite One of the most immediate changes people notice is they feel hungrier than usual. Steroids can affect appetite signals in the brain, making it easier to overeat and reach for more high-calorie foods.

  [2]

• Fluid Retention Steroids can also cause the body to hold onto sodium and water, leading to temporary weight gain as your body retains fluids.

  [3]

  This can show up as puffiness, particularly in the face, hands, or midsection.
• Changes in Fat Distribution With longer-term use, steroids can alter how and where the body stores fat. Some people might notice more weight around their waist or a rounder face. But these changes are tied to how steroids affect metabolism and fat storage — not just from increased calorie intake.

  [4]

“There are any number of potential prednisone side effects — anything from weight gain, round face, easy bruising, tendencies to increase your blood pressure, blood sugar, and cholesterol,” Dr. Birnbaum says.

“No one’s going to put on 20 pounds (lb) from a week or two of prednisone. As long as the doses are kept low, the risk of weight gain and other side effects is usually pretty low,” Birnbaum says.

“Steroids can lead to intense hunger that is persistent and may feel difficult to manage,” says Alexander LeRitz, RD, a registered dietitian at JM Nutrition in Toronto, where he focuses on nutrition as treatment for chronic disease.

LeRitz says that for those who do experience increased appetite, the goal isn’t to fight the hunger, but rather to manage it strategically, with the following steps.

• Eat smaller, more frequent meals throughout the day. This helps stabilize blood sugar levels, which can reduce hunger spikes, LeRitz says. Intentionally plan for smaller meals every three to four hours to keep hunger and cravings at bay.
• Build volume into your meals. “Don’t starve yourself, but eat things that provide bulk and increase fullness but are lower in calories,” Birnbaum says. This could look like large salads with lots of nonstarchy vegetables, grain bowls built on a base of leafy greens, or vegetable-heavy soups and stews, LeRitz says.
• Prioritize protein and fiber. These nutrients support satiety and digestion and help keep blood sugar stable.

  [7]

• Don’t skip meals. While skipping meals may seem like a reasonable way to avoid weight gain, it can backfire, LeRitz warns. After several hours of not eating, blood sugar levels drop and hunger hormones surge in response, leading to overeating later.

  [8]

   “This is because by the time you eat, hunger cues will be elevated, making portion control difficult,” he says, noting that skipping meals can also increase cravings, especially for junk food.

  [9]

• Don’t fill up on liquid calories. Birnbaum suggests staying away from sugary drinks and alcohol, which can increase your daily caloric intake quickly without increasing fullness.

Fluid retention can make weight gain feel more dramatic, but there are ways to reduce its impact.

“A good place to start is making sure that you are adequately hydrated,” says LeRitz. While it may seem counterintuitive, drinking enough fluids supports kidney function and helps to regulate fluid balance.

When you’re dealing with the stiffness and pain of PMR, intense workouts may not be realistic. But gentle, consistent movement can still support weight management, mood and stress levels — and overall health, says Nilanjana Bose, MD, a rheumatologist based in Houston.

Low-impact activities like walking, swimming, cycling, or yoga are often the most appropriate options, according to LeRitz.

Pay attention to your symptoms and pare down activity when pain and stiffness are heightened, Dr. Bose says. “As patients start feeling better, they’re able to exercise more and have more energy,” she says.

The key is consistency, not intensity. You could take up seated stretches, getting on a stationary bike, or doing your favorite hobby like gardening or cooking. “Everybody has things that they prefer. It’s not what you do, it’s that you do something,” Birnbaum says.

Steroids can interfere with sleep, especially if they’re taken later in the day. At the same time, poor sleep can increase hunger and make weight management more difficult, Bose says.

“Impaired sleep can not only cause fatigue but weight gain and a lot of downstream effects like cravings and not reaching for healthy food,” she warns.

To improve sleep, Bose recommends taking steroids earlier in the day. If you’re having chronic sleep issues, talk to your rheumatologist before adjusting your medication timing.

• Sticking to a consistent sleep schedule
• Limiting caffeine later in the day
• Creating a cool, dark, quiet sleep environment
• Turning off devices at least one hour before bedtime

• Corticosteroids are the first-line treatment for polymyalgia rheumatica, providing rapid symptom relief from pain and joint stiffness, but they can lead to side effects like increased appetite, fluid retention, and potential weight gain in some patients.
• Managing weight gain starts with diet, including eating protein- and fiber-rich, high-volume foods to stay full, avoiding liquid calories, and reducing sodium intake to help limit fluid retention.
• Other factors like incorporating regular low impact exercise (like walking, swimming, or yoga) and prioritizing good sleep habits can also support weight management by regulating appetite and improving overall health and well-being.