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Obesity and Weight Management

20 mg of prednisone

12/18/2006

Question:

I am 28 and on 20 mg of prednisone a day for my asthma. I have gained about 60 or 70lbs and badly need to loose weight. Currently 5`3 220lbs. I am now told that I may have a hairline fracture in my pelive because of weakened bones. I have recently joined weight watchers but have a hard time because of the hunger and cravings. I asked my pulmonologist what can I do to loose weight and was told not much because of the steroids. But there has got to be a way. Please, please tell me what might work for me.

Can I take some type of diet pill that will help me control my eating while doing the WW program. I don`t think I can exercise just yet but will try after the result come back about my pelvis.

Answer:

There are several things that need to be considered when taking prednisone daily. Prednisone will increase weight not only by holding water in the body tissues, but also by stimulating appetite. Many patients crave high calorie, high carbohydrate, salty foods. The salt adds to water retention; the calories to body fat. If the chronic disease limits daily activity, this can be a recipe for rapid weight gain. The clinician's first objective is to eliminate the steroids altogether.

If that isn't feasible, then using alternate day or pulse therapy may help lessen steroid side effects. In asthma, optimal use of inhaled steroids in combination with other asthma medications often helps to avoid the need for oral prednisone. Newer, even experimental, drugs or drug combinations may be available through asthma research centers, such as National Jewish Hospital in Denver. To combat the weight gain from prednisone, see a registered dietitian. By reviewing your diet, the RD can offer suggestions to cut calories and salt and minimize weight gain.

For activity, an occupational therapist or physician in rehabilitation or sports medicine may be helpful in designing an exercise program that minimizes stress on the bones. Non-weight bearing exercise, such as swimming, may be best initially until the fracture heals. Weight bearing exercise is best to help strengthen bone, however. So you will have both a short-term and longer-term exercise plan.

The osteoporosis from steroid use can be addressed by using some of the newer medications that slow bone turnover and lessen fracture risk (such as, alendronate or alphacalcidol) when used in conjunction with calcium and vitamin D. This is an important component of therapy when faced with using oral steroids at high dose over a long period of time.

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Response by:

Robert D Murray, MD Robert D Murray, MD
Clinical Professor of Health Behaviors & Health Promotion
Retired Professor of Human Nutrition
College of Medicine
The Ohio State University