Colitis refers to inflammation of the colon, or large intestine. The two main types of colitis are ulcerative colitis and Crohn’s disease. Both are chronic inflammatory conditions that can cause abdominal pain, diarrhea, fatigue and weight loss. However, once the inflammation is under control, some people with colitis find they start to put on excess weight. This article examines the complex relationship between colitis and weight gain.
What causes weight changes with colitis?
There are several reasons why colitis can initially lead to weight loss:
- Loss of appetite and nausea make it difficult to eat enough
- Diarrhea results in poor absorption of nutrients from food
- Inflammation increases calorie and protein needs
- Medications like steroids increase metabolism
During a colitis flare-up, it’s common for patients to lose weight rapidly. Once the inflammation starts to resolve, appetite usually improves and diarrhea becomes less frequent. This can lead to weight gain for the following reasons:
- Increased calorie intake as appetite recovers
- Improved nutrient absorption as diarrhea stops
- Reduced calorie needs as inflammation resolves
- Fluid retention from inflammatory processes
- Slower metabolism when tapering off steroids
These factors can tip the energy balance towards weight gain. The compulsion to eat more to recover lost weight can also drive overeating.
Medications that contribute to weight gain
Corticosteroids like prednisone are commonly used to induce remission in ulcerative colitis and Crohn’s disease. These medications have well-known metabolic side effects that promote weight gain, including:
- Increased appetite
- Redistribution of body fat to the face, neck and abdomen
- Fluid retention
- Muscle wasting
- Insulin resistance
Prednisone taper is usually associated with increased calorie intake which can lead to rapid weight gain. Other drugs used in colitis treatment can also impact weight:
- Antidepressants like imipramine and SSRIs may increase appetite and calorie intake
- Immunosuppressants like 6-mercaptopurine can cause fluid retention
- Biologics like infliximab may be linked to new onset obesity
Consult a doctor regarding strategies to minimize negative effects of medications on body weight. Gradual tapers, dosage adjustments or alternative drugs may help.
Dietary considerations
Diet is a crucial part of managing colitis and preventing excessive weight gain. Some strategies include:
- Eat small, frequent meals to prevent overeating
- Choose whole grains, fruits, vegetables, lean proteins and healthy fats
- Limit sugar, salt, alcohol and deep-fried or processed foods
- Stay hydrated with water and other unsweetened beverages
- Take care with dairy and high-fiber foods if intolerant
- Consider keeping a food journal to identify problematic items
A personalized, anti-inflammatory diet supervised by a registered dietitian can help optimize nutrition status while avoiding foods that trigger symptoms.
Physical activity
Regular exercise provides many benefits for managing colitis:
- Helps restore muscle mass lost during flares
- Increases daily calorie burn to prevent excessive weight gain
- Reduces inflammation and relieves stress
- Improves mood, energy and quality of life
Aim for 150 minutes of moderate activity per week, like brisk walking. Start slow and increase intensity gradually. Listen to your body and take rest as needed. Avoid high-impact exercise during flares. Yoga, pilates and swimming are great low-impact options.
Get support
Managing the difficult balance between underweight during flares and overweight when inflammation resolves can be frustrating. Work closely with your healthcare team and get support from other patients. Consider joining a local Crohn’s and Colitis group for shared understanding.
Medical and surgical options
If diet, exercise and anti-inflammatory medications aren’t enough to prevent unhealthy weight gain, other options to explore include:
- Switching to lower risk immunosuppressive drugs
- Trying gut-directed hypnotherapy
- Using orlistat or metformin for weight loss
- Considering bariatric surgery if obesity is severe
Discuss benefits and risks of these interventions with your doctor. Controlling inflammatory disease activity is key for long-term weight management.
Does body composition matter more than weight?
The number on the scale may be less important than body composition for colitis patients. Increase in body fat, especially visceral fat around the abdomen, drives chronic inflammation and disease progression.
On the other hand, increased skeletal muscle mass helps regulate metabolism and reduces cardiovascular risk. Evaluating changes in fat mass versus muscle mass over time using DEXA scans can guide appropriate treatment.
Take-home messages
To summarize key points:
- Weight changes are common in colitis due to shifts in inflammation, medications and eating patterns
- Diet and exercise are vital for managing weight long-term
- Focus on achieving remission and optimize body composition
- Work with your healthcare team to make appropriate medication and lifestyle adjustments
- Get support from other patients dealing with weight issues
With the right strategies, it’s possible to achieve your optimal weight and body composition, despite the metabolic challenges of living with colitis.
Frequently asked questions
Why do I lose weight with colitis flares?
Inflammation increases calorie and protein requirements. Meanwhile, symptoms like loss of appetite, nausea and diarrhea reduce nutrient intake and absorption. Medications also increase metabolism. The combined effect is rapid weight loss.
Why do I gain weight in remission?
As inflammation resolves, appetite recovers and diarrhea stops. This allows increased calorie intake and better nutrient absorption. Steroids slow metabolism and cause fluid retention, further driving weight gain.
How can I prevent excessive weight gain?
Eat a healthy anti-inflammatory diet with fruits, vegetables and lean proteins. Avoid processed foods. Exercise regularly, starting slow and increasing intensity over time. Work on tapering steroid medications. Try gut-directed hypnotherapy for regulating appetite.
Could my colitis medications be contributing to weight gain?
Yes. Corticosteroids are notorious for causing weight gain via increased appetite, changes in fat distribution and fluid retention. Other drugs used in colitis like SSRIs, TCAs and immunosuppressants can also impact weight. Discuss options with your doctor.
Is weight or body composition more important in colitis?
Body composition is more important, as increased adipose tissue drives inflammation, while improved muscle mass has metabolic benefits. Evaluating changes in fat mass versus muscle over time with DEXA scans helps guide appropriate interventions.
Conclusion
Managing weight fluctuations alongside an inflammatory bowel disease like colitis can be challenging. Sticking to a healthy anti-inflammatory diet, exercising regularly, optimizing medications with your doctor and getting support are effective strategies to achieve your best body composition. Keep the focus on improving inflammatory control and digestive health. That will pave the way for long-term weight management success.
