Maintaining a healthy weight can be difficult if you’re living with rheumatoid arthritis (RA). Some medications for RA can cause weight gain, and the pain of RA can make it hard to exercise and prepare meals. At the same time, RA sometimes leads to too much weight loss.
Members of myRAteam have discussed experiencing weight problems. A member shared, “I’m trying so hard to lose weight, but I don’t stand a chance with all of these meds.” Another member said that they had trouble gaining weight. “Has anyone experienced weight loss after an RA diagnosis?” they asked.
To learn more about the role of weight in RA, myRAteam talked with Dr. Iris Navarro-Millán, a rheumatologist at Weill Cornell Medicine and the Hospital for Special Surgery in New York City. She is also a member of the American College of Rheumatology. She provided tips for managing weight with RA and explained connections between RA, weight gain, and weight loss.
Dr. Navarro-Millán had several suggestions for regulating weight while also managing RA.
Don’t try to make major changes too soon. “Start small and work your way towards healthier change,” Dr. Navarro-Millán said. “I tell my patients to start with cutting out hamburgers and french fries.”
Once you’ve eliminated unhealthier foods, you can begin to introduce healthier choices. “There is strong evidence coming from Spain regarding the benefits of the Mediterranean diet,” Dr. Navarro-Millán said. “This diet is low in red meat. It has almost no processed meat, bacon, sausages, or hamburgers.”
According to Dr. Navarro-Millán, studies have found that people with RA who ate at least two portions of about 3.5 ounces of fish per week — predominantly salmon — had lower disease activity than those who didn’t consume that amount. These fish contain “good fats” — monounsaturated and polyunsaturated fats — which are generally linked to positive health benefits.
Dr. Navarro-Millán also suggested introducing other foods high in good fats into your diet. “Olive oil is frequently used in the meals of the Mediterranean diet. Remember, these oils should not be heated because heating them can lead to the production of unhealthy cholesterol,” she said.
She also recommended legumes: “Legumes include beans and chickpeas. Nuts also contain a lot of healthy fat, and avocado is fantastic in terms of decreasing bad cholesterol and also is good for decreasing belly fat.”
Compared with the general population, people with RA have a higher risk of cardiovascular problems, such as heart disease, heart attack, and stroke. “The strongest data about the Mediterranean diet is that it reduces your risk for heart attack and stroke,” Dr. Navarro-Millán said. “The data is more limited for the diet’s direct effect on RA, but people who follow it tend to have better function, less pain, and less inflammation.”
Physical activity provides another great way to manage weight. “I would say it’s the same for exercise as for diet — start small,” Dr. Navarro-Millán said. “This could mean water therapy, because water therapy is low-impact on your joints. If water therapy is available to you, it’s a good start. You can walk yourself from the pool back to the ground, because you’re getting cardiovascular fitness that will also help you with exercises done out of the pool.”
Dr. Navarro-Millán also recommended using a stationary bicycle. “You don’t want to use the stationary bike without some level of resistance, because not using resistance can be stressful on the knees,” she said.
Once you’ve practiced with water therapy or stationary cycling, you can proceed to walking. Dr. Navarro-Millán does not recommend running.
Dr. Navarro-Millán also suggested doing resistance exercises to build your muscles. “Everybody is different. Some people can exercise with resistance bands, and some people with RA can still lift weights. Listen to your body,” she said.
If you’re wondering where to start with an exercise program that’s right for you and your level of RA, Dr. Navarro-Millán suggests asking your rheumatologist for a referral to physical therapy. “With a physical therapist, you can get an exercise program that you can do at home,” she said. “You can even do some of these exercises during commercials while you’re watching TV. These exercises are simple and can help with your arthritis without necessarily causing a flare-up.”
Dr. Navarro-Millán noted that some studies have shown that with the right programs, many people with RA do not experience flare-ups from exercising: “The worst exercise is the one that is not done.”
Extra weight can aggravate existing rheumatoid arthritis symptoms. In a study of more than 23,000 people with RA, those who had severe obesity — a body mass index (BMI) of 35 or above — were at greater risk of becoming progressively disabled than those who had overweight (a BMI of 25 to 29).
Dr. Navarro-Millán pointed out that excess weight increases pressure on the joints and worsens joint pain. Previously inflamed and painful joints must deal with extra work. In addition, if you have RA, your immune system produces chemicals called cytokines, which cause inflammation and joint damage. Excess fat also produces cytokines, so the more extra weight you have, the more inflammation you might experience on top of what RA already causes.
Maintaining a healthy weight — or even just dropping some extra pounds — can help ease RA symptoms. A study of 174 people with RA found that those who had overweight or obesity at the beginning of the study but lost at least 11 pounds showed improvement in their RA symptoms.
Some myRAteam members have found that intentionally losing weight helped their RA symptoms. “I wasn’t terribly overweight, but my hips felt like they were giving out on me. I thought losing weight might help,” one member said. “It wasn’t easy, especially at my age (67) with RA. However, I persevered with going to the gym and a diet high in vegetables and lean protein. I have lost 25 pounds and I do believe this has helped, especially in my hips and feet.”
Dr. Navarro-Millán noted that some treatments for RA can also lead to weight loss. For example, weight loss is a common side effect in people taking the disease-modifying antirheumatic drug (DMARD) leflunomide (Arava). The reasons for this are not fully understood, she said.
Weight loss doesn’t necessarily lead only to positive outcomes for people with RA. In fact, several studies have shown that people with RA who have a BMI of 30 or above actually have a lower risk of death than those with a BMI under 30. In other words, people with RA who have obesity seem to live longer than those who don’t. This puzzling finding is called the obesity paradox.
An explanation of the obesity paradox may be found in the progression of RA — specifically, the development of a condition called rheumatoid sarcopenia. In rheumatoid sarcopenia, chronic inflammation leads to metabolic hyperactivity, which causes the body to shed muscle mass and may cause visible signs of muscle wasting. Meanwhile, fat might replace the remaining muscle.
Some people in this situation don’t see any weight changes because the fat they’ve gained balances out the lost muscle. However, weight loss can also be a sign of metabolic hyperactivity, according to Dr. Navarro-Millán: “Some people with RA are not doing any intentional weight loss program but find that they’re losing weight.”
Therefore, the obesity paradox may actually result from people with RA and a high BMI suddenly losing weight due to other factors — which may also trigger severe health events.
It’s important to remember that gradual, intentional weight loss is not the same as sudden weight loss caused by rheumatoid sarcopenia and cachexia (loss of muscle mass and strength). Sudden weight loss and other symptoms of rheumatoid cachexia can be eased through the use of tumor necrosis factor (TNF) inhibitors — which reduce inflammation — and high-intensity strength training, which improves muscle strength and physical functioning.
On myRAteam, the social network and online support group for those living with rheumatoid arthritis, more than 197,000 members talk about a range of personal experiences and struggles. Weight management is one of the most discussed topics.
Have you explored diet or exercise as a way to balance your weight with RA? Do you have any suggestions for other members on ways to manage weight changes with RA? Go to myRAteam today and start the conversation. You’ll be surprised just how many others may share similar stories.