Weight Gain

WHEN TO SEE YOUR DOCTOR

* Your weight gain is sudden or starts after you begin taking a new medication.

* You also have insomnia or feel weak and depressed.

* You also urinate more at night or have a history of heart problems or chest pain.

What Your Symptom Is Telling You

You probably haven't gone from Twiggy to Roseanne overnight, but you have noticed a new snugness in your favorite jeans and a tug around the tummy in that tee shirt.

While fluctuations of a pound or two from day to day are normal, a steady increase in weight (actually, in fat) is not.

The most common cause of weight gain is excess fat intake and too little exercise. "It's difficult to gain weight except by eating fat," says Donald S. Robertson, M.D., medical director of Southwest Bariatric Nutrition Center in Scottsdale, Arizona, and coauthor of The Snowbird Diet.

A small percentage of overweight people appear to have a genetic knack for gaining weight. "We're not talking about everybody," says Richard L. Atkinson, M.D., associate chief of staff for research and development at the Veterans Affairs Hospital in Hampton, Virginia, and professor of medicine at Eastern Virginia Medical School in Norfolk. "Those who are seriously obese by say 50 or 100 pounds over their ideal body weight may have a metabolic alteration predisposing them to store calories as fat."

As you age, your metabolism gradually slows, making it easier for pounds to stick, says Dr. Atkinson. To complicate the problem, many older people are less active than when they were younger, yet continue to eat the same amount of food.

People who quit smoking often gain some weight because nicotine is no longer artificially stimulating their metabolism and because they tend to eat instead of smoke, says G. Michael Steelman, M.D., vice president of the American Society of Bariatric Physicians, who is in private practice in Oklahoma City.

And strict dieting can also make you gain weight. When you restrict calories too much, your body thinks it's starving and slows down your metabolism. When you begin eating again, it doesn't shift completely back into normal, and you put on the pounds more easily, explains Dr. Steelman.

Some medical problems can trigger weight gain. An underactive thyroid, although not a cause of significant weight gain, slows the metabolism, allowing calories to be stored more easily as fat. People with diabetes who begin taking insulin may notice an increase in weight. And, in rare instances, hormonal disturbances that cause an overproduction of insulin or cortisol in the body also cause weight gain.

As a side effect, some medications can stimulate the appetite, slow the metabolism or allow calories to be stored more easily as fat. Women taking birth control pills or estrogen replacement therapy probably will notice a weight gain of about five pounds or so, says Dr. Robertson. Any glucocorticoids, such as prednisone for arthritis, can also be a problem. And Elavil, an antidepressant, is "a nasty one for inducing weight gain," says Dr. Atkinson. "Antiseizure drugs, anxiety drugs, schizophrenia drugs?many that affect mood and emotion?can also cause weight gain," he adds.

In fact, mental health itself influences body weight. While many people with depression curb eating and lose weight, some people eat and gain weight, according to Dr. Atkinson.

Not all weight gain can be attributed to the body storing away extra fat. Extra pounds could also be the result of fluid retention from kidney, liver or heart disease. Even before your ankles begin to swell, Dr. Atkinson says, you easily could gain five or ten pounds from retaining fluid.

Symptom Relief

Some of the causes of weight gain?like fluid retention and drug side effects?are medical problems and need the attention of your doctor. As for the everyday problem of overweight, there's a lot more to be said about it than we can give you in a few tips. But the basics are, well, basic. The body doesn't want to be fat anymore than it wants to be sick. Weight loss will happen if you stick to these few principles.

Cut fat. While a little fat is necessary to metabolize some nutrients and to manufacture hormones, it should comprise no more than between 20 and 30 percent of your total daily calories, Dr. Robertson says. "Learn where the fat is and eliminate it." Current nutritional guidelines recommend that most of your diet consist of whole grains, fruits and vegetables. Cut back on the amounts of meat and dairy products that you eat, and use butter, margarine, oils and oily salad dressings sparingly.

Get moving. To burn calories that have already been stored as fat and to ensure that your body won't become a fat silo, you must work out regularly. "It doesn't have to be extremely vigorous," Dr. Robertson says. "You can walk two to three miles a day at a pace of one mile in 15 minutes, or you could do 15 minutes of aerobics followed by 15 minutes of light weight lifting." If 15-minute miles are too vigorous for you, start slowly. Take a half-hour to walk around the block if you have to. The idea is to get yourself moving and do it on a regular basis.

Exercise, by the way, will also help you deal with depression, which could be contributing to overeating. (For other ways to deal with depression, see page 119.)

Make more muscle. Don't shun lifting weights for fear of developing too much muscle or because you're too old, Dr. Robertson says. "The more muscle mass you have, the higher your metabolic rate and the more calories you'll burn at rest," he says. "That's true even into your eighties and nineties." If the idea of lifting weights intimidates you, talk to your doctor about getting some resistance exercise that's appropriate for your level of fitness. He might be able to recommend a local program that can get you started safely.

Commit to the change. Preventing fat formation requires a lifelong lifestyle change in favor of physical activity and healthy eating, Dr. Atkinson says. Don't think of exercise and watching what you eat as a temporary measure to help you lose weight. Realize from the start that these are activities for the rest of your life.

See also Water Retention