How to lose weight when meds pack on weight

December 16, 2009 10:58 AM

I want to lose weight, but the drugs I take to manage my bipolar disease actually add weight. Do you have ideas on how I can lose weight? Details inside.

I have been diagnosed with, Bipolar I, moderate to severe Dissociative Identity Disorder, Fibromyalgia, bursitis in both hips, and other lesser problems, and currently trying to lose weight. I weigh 336 pounds and am 40 years old and female.

Three of the drugs I take to manage the bipolarity, Lexapro, Seroquel and Zyprexa are extremely weight positive i.e. they really pack on the pounds. I was obviously overweight before starting these drugs, but now I'm on a down hill slide toward gaining weight and these drugs are pushing me down the hill.

I've been on slightly more weight neutral drugs for the bipolar, but they didn't help as well. It's to the point where my physical doctor is calling the shrink to ask for a different combination of drugs, but the shrink is unwilling to change them, because this particular cocktail works really good for the bipolar and allows treatment for the Dissociative Identity Disorder and all of its peripheral issues.

It's hard for me to walk or go to the gym due to pain, but the pool really works and I enjoy doing that. However, doing exercises in the pool doesn't seem to be enough to slow the psych drugs from throwing on pounds.

My eating is ok, could be better, I've tracked my eating habits, shared them with my doctor and he agrees they aren't a major problem. He did suggest a Lap-Band, which ties off the stomach, but in order to qualify for that, you need to be mentally sound, and being did doesn't qualify one as mentally sound.

1. Do you have any suggestion that would help me maintain weight. ANYTHING, I'm pretty much at a loss on how to do this and still literally remain sane.

2. I've heard that once the body gets over 300lbs, it's harder to lose weight, like the body reaches a plateau of sorts. Is that so?

posted by anonymous to Health & Fitness (23 answers total)

Sure, the drugs may alter your metabolism, but the basic equation still holds: You need to burn more calories than you eat in order to lose weight.

You're going to have to step up the exercise. Are you doing a half-hour per day? Then do an hour. Also begin really pushing yourself so that you're really working up a sweat, not just going through the motions.

The other half of the equation is your diet. Commit to tracking everything you eat for a week, using one of the many available websites that do that sort of thing. You may be surprised by how many calories are really in some things that you eat.

In general, it's *far* easier to take in less calories, because exercise burns so little. According to this chart, if you're 300 pounds and walk for one hour at 2 miles per hour, you've burned only 170 calories. To put that into perspective, that's about 1/3 of a Big Mac - yikes.

Also make an effort to be less sedentary in your daily life. Take the stairs instead of the elevator. Park in the back of the parking lot. Stand up while working on your computer - those little things really add up over time.

Best of luck.
posted by chrisamiller at 11:11 AM on December 16, 2009

See a doctor who specializes in metabolic and bariatric medicine.

No random person's suggestions are going to help you, because the medication is fucking up your metabolism and the only people who can lose weight easily are people with unimpaired metabolisms who have excess calories in their diets and don't exercise enough.

"Eat smarter, excercise more" is the only advice any lay person has, and though it's generally good advice, it's not relevant here. It's quite possible that you could follow an extreme calorie-cutting diet and increase your exercise and still gain weight; these drugs do that. A specialist should be able to help you.

Doing water aerobics with weights is one strategy for intensifying your water-based exercise program without straining your joints.
posted by Sidhedevil at 11:12 AM on December 16, 2009 [6 favorites]

Sure, the drugs may alter your metabolism, but the basic equation still holds: You need to burn more calories than you eat in order to lose weight.

No, see, this isn't helpful advice in this particular situation. Of course this poster needs to burn more calories than they eat in order to lose weight.

The thing is that some medications can fuck up the metabolism to the point where anything short of literal starvation (less than 1,000 calories per day) isn't going to be enough calorie-cutting in the absence of another intervention.

And starvation is riskier, health-wise, than obesity. Hence the need for a specialist.

Yes, yes, you don't see any obese people in famine zones. But you don't see any healthy people there, either. Health is more than just scale weight.
posted by Sidhedevil at 11:15 AM on December 16, 2009 [11 favorites]

This is an extremely common experience among people who take medications for Bipolar Disorders. It might be worth it to check out some bipolar forums/communities online, because there's undoubtedly some discussion about weight gain and management there. I did a quick google, and there seem to be quite a few sites out there.

I also agree with the above suggestion about a doctor specializing in metabolic issues. I'm really surprised that your physician has not suggested anything actually helpful. Time for a second opinion!
posted by so_gracefully at 11:15 AM on December 16, 2009 [1 favorite]

I would suggest looking into Health at Every Size. The idea there is that achieving the best physical health you can, rather than getting to a certain number on the scale, should be your primary goal. That means eating foods that are good for you and make you feel good, finding physical activity that is enjoyable and helps your body, and thinking about yourself and your body in a kind and loving way.

You may not be able to run marathons without hurting your hips, but you can swim or do yoga or ride a bicycle or whatever it is that you enjoy doing to move your body without hurting it. Going on a very low calorie diet that excludes the foods you really enjoy isn't going to enhance your well being as much as eating a variety of foods that satisfy both your nutritional needs and your body's hunger. And perhaps the most important thing is teaching yourself to love your body as it is. You may never be at the weight that fashion magazines and insurance charts say is "acceptable," but that doesn't mean that you have to think of yourself as unacceptable, and it certainly doesn't mean that you can't be happy and healthy.

If you're interested in learning more, there are tons of websites and books on these topics, and I'd be happy to point you towards some of the best ones if you'd like. I wish you all the best.
posted by decathecting at 11:35 AM on December 16, 2009 [1 favorite]

For all its worth, and I know nothing about bipolar disorder or the associated meds, but what has helped me lose weight more than any other single thing is dramatically increasing the amount of water I drink every day. As I understand it, when you take in more water it boosts your metabolism and helps your organs work more efficiently (that is purely a layman's understanding, and I invite anyone with medical expertise to correct me or offer a better explanation). I can't imagine that drinking more water can be anything but good for you. Personally, I am down nearly 40 lbs from where I started around Labor Day. Granted, I have also paid more attention to my diet and increased my exercise, but I have found that even in those periods were I slack off on the exercise and eat more than I should, keeping up with the water has kept my weight loss going.

Good luck.
posted by Lokheed at 11:42 AM on December 16, 2009

You have two issues. The first is your weight. The second is your medication.

Now it's true that your medication is affecting your ability to lose weight, but when you say things like 'the drugs...actually add weight', you're setting yourself up to fail, because blaming your situation on the drugs is an easy excuse to go back to bad eating habits.

So see a doctor about getting some help with this, but try to look at the drugs as an inconvenience to be worked around rather than something to blame for your lack of progress. And get some recommendations for a local weight loss group - having a support network of people with similar goals can be really helpful.
posted by le morte de bea arthur at 12:05 PM on December 16, 2009

I agree with Lokheed that the times I've been best able to keep weight off is when I drink a lot of water. I don't know if it has anything to do with metabolism, or it just makes me eat less becuase my mouth is busy and my stomach is full, but it seems to work!
posted by dpx.mfx at 12:06 PM on December 16, 2009

but when you say things like 'the drugs...actually add weight', you're setting yourself up to fail, because blaming your situation on the drugs is an easy excuse to go back to bad eating habits.

le morte de bea arthur, its clear you've never been on a drug that has weight gain as a side effect. A LOT of drugs have this as a side effect. I myself have taken a medication that made me gain almost 40 lbs in the first six months I was on it, despite all efforts to the contrary. To say that a drug has weight gain as a side effect isn't "an easy excuse" -- often its the literal truth.

In my situation, two things helped. First, I was able to talk with a doctor about changing the brand of meds I was on to something that did not have this particular side effect for me. I get that this may not be an option for you. Second, it may be a cause of changing what you eat -- in my case adding more protein to my diet helped a great deal, as did (and I know this sounds crazy, but it was recommended by a dietitian) widely varying the amount of calories I ate each day, but in a planned sort of way. So, in my case, my goal was to eat 10,000 calories per week, but not at a rate of 1428 per day. Instead, I would have what I called 'feast' or 'fast' days (although I wasn't fasting on the fast days - just limiting my intake to around 1000 calories or so). Apparently there is some science that says that unpredictable caloric intake can help your metabolism "get moving". *shrug* I'm still not thin by any means, but I'm at a stable weight.

So, yes, by all means talk to both your prescribing physician and also talk to a specialist. But also work on your aerobic exercise. Don't focus on weight loss or gain so much as set goals for yourself around heart rate and not being out of breath, etc.
posted by anastasiav at 12:30 PM on December 16, 2009 [2 favorites]

Now it's true that your medication is affecting your ability to lose weight, but when you say things like 'the drugs...actually add weight', you're setting yourself up to fail, because blaming your situation on the drugs is an easy excuse to go back to bad eating habits

Uh, I have watched people I know who were put on psych meds go from not overweight at all to CLINICALLY OBESE. (in that girl's case, the xypreza was the culprit.)Please do not make light of what is happening with these meds.

To the OP-can you get access to a pharmapsychiatrist? Yes, I know -boy howdy do I know-how hard it is to find a good cocktail of meds for what you have but there has to be something else out there that won't screw up your metabolism.

Meanwhile, do drink a lot of water, and do try to be as active as you can.
posted by St. Alia of the Bunnies at 12:34 PM on December 16, 2009 [1 favorite]

when you say things like 'the drugs...actually add weight', you're setting yourself up to fail, because blaming your situation on the drugs is an easy excuse to go back to bad eating habits.

STOP IT STOP IT STOP IT.

This is why I told the OP that the advice of random people wouldn't help them. You do not know what you're talking about. Nobody with an unimpaired metabolism, except a medical specialist, does (including me, but I know enough to know that people with impaired metabolisms will FUCK THEMSELVES UP A MILLION TIMES WORSE with starvation diets).

When your metabolism is impaired, you need completely different strategies from the ordinary "eat less/smarter and exercise more." You need professional help.

EVERYONE WHO IS SPOUTING THIS 'EAT LESS' NONSENSE NEEDS TO SHUT UP. You are endangering this poster's health by your uninformed advice. The poster needs to see a specialist who can really help, not to get off-the-cuff and inaccurate truisms.

I take this very personally because my late mother spent two of the last two-and-a-half years of her life on a 500-calorie-a-day diet at the advice of her primary care physician. She gained 25 pounds despite starving herself to the point of constant exhaustion, and it took him two years before he had the wit to figure out that something was fucked up with her body (it turned out to be Cushing's Disease) and sent her to a specialist. But it was probably too late to fix the damage that had been done to her heart by two years of starvation, and she died of a massive embolism. At the age of 42.

So seriously, anyone who is telling this poster that all they need to do is cut calories may be shortening the poster's life. It's reckless and irresponsible. The poster needs to see a specialist. The rest of us need to butt the fuck out.
posted by Sidhedevil at 12:40 PM on December 16, 2009 [15 favorites]

If I remember my pharmacology correctly, the effect of weight gain is probably due to antagonism of one particular type of serotonin receptor (although those drugs are also agonists of serotonin receptors too). Serotonin is not just a neurotransmitter. It is also a hormone. Serotonin mediates satiety - so blocking those receptors will negate satiety (and cause overeating). I do not discount the possibility that, even without overeating, the body finds a way to increase calorie retention.

Anyway, the main probable culprit is Zyprexa. I have seen people really put on the pounds with that drug.

Do you take lithium? Lithium, like Zyprexa, is an A+ rated drug for monotherpay of acute mania or mixed states. Have the lithium discussion with your doctor. Yes, there are a lot of side effects (scary side effects) with lithium, but you will not experience the same kind of weight gain. Also, it may be more efficacious.

Lithium side effects include: hair thinning, hypothyroidism, hyponatremia, neurotoxicity, and in high doses choreathetoid movements (snake-like), and hyperpyrexia. It is a drug with a narrow therapeutic range (meaning dosing is tricky).

That said, many people have taken lithium every day and done very well on it for long periods of time.

The only route of elimination is the kidneys - so you need to have good kidney function. If kidney function declines with time, your dose may also have to decline.

Whatever you do - just discuss this with your doctor and do not make changes to your therapy on your own. Keep taking your medicine as directed.
posted by verapamil at 12:45 PM on December 16, 2009

IANAD, but I have had my fair share of experience with med-related weight gain. The best advice I could give anybody dealing with this issue is to look into low carbing - not the stereotype of eating tons of butter and steak and bacon, but the health-conscious version. In short, eliminate all sugar and grains and processed food. Eat meat, veggies, nuts, eggs, and full-fat dairy (in moderation; the low fat junk has sugars as filler). Cook your own food. Avoid all fast food and chain restaurants when possible, because most of their food, even things like chicken breast, is full of starches or sugars as filler.

Re: difficulty in losing when over 300 lbs - from years of hanging out on the low carb message boards, I can tell you that on the contrary, when low carbing, the people who have the most to lose begin to do so at the fastest pace.

What's happening with some of these drugs is that they are causing or increasing insulin resistance. Some of them are even starting to say this on the patient labels; at any rate, after years of pooh-poohing the idea that SSRIs and other psych meds cause weight gain, the medical community is pretty much acknowledging this is a problem. However, conventional medicine still advocates the low-fat diet - pretty much the worst solution they could throw at this problem.
posted by chez shoes at 1:12 PM on December 16, 2009

According to this chart, if you're 300 pounds and walk for one hour at 2 miles per hour, you've burned only 170 calories. To put that into perspective, that's about 1/3 of a Big Mac - yikes.

Funny, I don't read it that way at all. Doesn't the chart show the calories burned PER MILE (caption above chart), rather than PER HOUR? So if you walk at 2 miles per hour (which is an extremely moderate rate, too), at 300 pounds you would burn, according to that chart, 340 calories.

The assumption is that if you are walking that slowly, you are burning more calories because you are stopping and starting and your momentum is not helping to carry you along. Not saying that's right, as it seems high to me, but that's what your chart appears to indicate.
posted by misha at 1:13 PM on December 16, 2009

When your metabolism is impaired, you need completely different strategies from the ordinary "eat less/smarter and exercise more." You need professional help.

Absolutely. Sidhedevil is right--get the doctor to refer you to a specialist, like an endocrinologist. Get that figured out FIRST.

Also, I can see your shrink not wanting to take away from the cocktail that is working for you. However, maybe he could add to it? Wellbutrin might not be a bad suggestion for you, or Pristiq. But IANYD, and though I have taken similar drugs IANBi-polar, so, again, get to a specialist first, find out all of your metabolic issues, then work on the weight-loss plan.
posted by misha at 1:19 PM on December 16, 2009

You may want to consider trying Topamax for the bipolar. It is a horrible drug that will screw with your recall and cognitive abilities BUT it will make you lose weight like you wouldn't believe.
posted by amro at 2:14 PM on December 16, 2009

le morte de bea arthur, its clear you've never been on a drug that has weight gain as a side effect.

No, that's incorrect. I have, and I know how certain drugs make it bloody hard not to pile the weight on, especially if (like a previous version of me), you already have a tendency to eat badly. Nevertheless, the battle can be won, one way or another.

This is why I told the OP that the advice of random people wouldn't help them. You do not know what you're talking about. Nobody with an unimpaired metabolism, except a medical specialist, does (including me, but I know enough to know that people with impaired metabolisms will FUCK THEMSELVES UP A MILLION TIMES WORSE with starvation diets).

When your metabolism is impaired, you need completely different strategies from the ordinary "eat less/smarter and exercise more." You need professional help.

Which is precisely why I said 'see a doctor', and didn't suggest that the OP go on any kind of diet.

In fact, I don't disagree with anything you're saying. My point was that, impaired metabolism or not, using anything as an excuse for your weight makes it very easy to just let the problem get worse. Twenty years of weight issues, with and without medication, have taught me that much. What I'm saying that persistence in trying to sort things out, whether it's by finding a better drug regime, getting more exercise, eating more appropriately or whatever, is key.
posted by le morte de bea arthur at 2:19 PM on December 16, 2009 [2 favorites]

My boyfriend gained 80lbs in a month due to Zyprexa. He switched to Depakote and the weight came off after four months. If there is any way you can do this - or even better, Lamictal - do it.
posted by herbaliser at 3:25 PM on December 16, 2009 [1 favorite]

It sounds to me as though you might want to consider switching psychiatrists. If your weight is a major area of concern for you and your physical doctor, your psychiatrist should be working with both of you to come up with a combination of meds that addresses your mental health concerns and has side effects you can live with.
posted by epj at 5:13 PM on December 16, 2009

Topamax doesn't make everyone lose weight, altho it clearly does for some people. It makes food taste different, and you need to drink a LOT of water on it because it makes one prone to kidney stones. And yes, the side effects are multitudinous and a pain in the butt, so honestly I don't recommend it.
posted by St. Alia of the Bunnies at 6:29 PM on December 16, 2009

It makes food taste different

Not for me. Just obliterated my appetite.
posted by amro at 7:10 PM on December 16, 2009

OP, please do not listen to other people's suggestions of what medication you "should" be taking. They don't realize that you have likely tried plenty of combinations already, and that being as stable on the meds as you can get is the most important thing (it won't matter how much you weigh if you commit suicide during a depressive episode).
posted by so_gracefully at 8:46 PM on December 16, 2009

Unfortunately all three medications you are taking are known for weight gain, but the worst is the zyprexa. There are newer medications in that same class that cause much less weight gain. I really hope you can switch. As for the "eat less, move more" people- they just don't get how very complicated these drugs are for our metabolism.
posted by elizfield at 2:23 PM on December 17, 2009