Obesity, Weight Issues, & Lupus Symptoms

Between medication side effects and the challenges of life with lupus, it can be difficult to maintain a healthy weight.

Battling a lupus flare? The steroids often used to battle lupus can cause people to gain weight. And, even when not flaring, symptoms such as arthritic joints, fatigue, and pain can make it hard to exercise.

Despite these challenges, it is important to be aware of the added health risks associated with obesity. A couple of new research studies have explored the challenges that being obese can add for a person living with lupus. The results show that obesity impacts patient reported outcomes, disease activity, and symptoms.

What is obesity?

The terms ‘obese’ and ‘overweight’ both mean that a person’s weight is not healthy given a person’s height. However, obesity is specifically having too much body fat (as opposed to muscle, body water, or bone).

One of the ways body fat is analyzed is by using the body mass index (BMI). A person’s BMI is calculated by dividing body mass by the square of a person’s height. Or, to make it easier, there are online BMI calculators.

There are 4 common classifications of BMI. They are:

1. Underweight (under 18.5 kg/m^2)
2. Normal weight (18.5 – 25 kg/m^2)
3. Overweight (25 – 30 kg/m^2)
4. Obese (Over 30 kg/m^2)

By itself, obesity has negative impacts on health, including increasing a person’s risk of type 2 diabetes, stroke, cardiovascular diseases, hypertension, and arthritis.

Obesity, BMI, & Lupus

Obesity is becoming more common in the United States, with 1 in 3 American adults reaching the BMI range. A study published in 2011 looked into the role of obesity on women with lupus.

The researchers conducted interviews with 716 women with systemic lupus erythematosus. Data were gathered from interviews and surveys of functioning.

For this study, two BMI thresholds were considered:

• 27.8% of participants were over 30 kg/m^2
• 40.6% of participants were over 26.8 kg/m^2

For both groups, baseline function was far worse for the obese cohorts than for the non-obese cohorts. Depending on the measure, the obese cohort experienced a 20-33% drop off in functioning.

After 4 years, follow-up interviews and surveys were conducted with the participants. Again, both obese cohorts had decreased functioning and had declined statistically.

These results show that even being overweight, but not quite obese, adds challenges and decreases function for women with lupus. This study suggests that different thresholds may be necessary for evaluating BMI for people with lupus.

Other measures of obesity and the impact on lupus

New research presented at the September 2017 annual meeting of the American College of Rheumatology looked into specific patient reported outcomes (PROs) effected by being obese.

The BMI threshold was >= 30 mg/kg^2. Fat Mass Index (FMI) was also used at a threshold of >= 13 mg/kg^2.

Four PROs were used:

1. Disease activity
   • Systemic Lupus Activity Questionnaires (SLAQ)
2. Depressive symptoms
   • Center for Epidemiologic Studies Depression Scale (CES-D)
3. Pain
   • Short Form 36 Health Survey (SF-36) Pain Subscale
4. Fatigue
   • SF-36 Vitality Subscale

In total, there were 148 participants. Average age was 48 years old (+/- 12 years). 65% of participants were white; 14% Asian; 13% African-American.

32% of participants met the threshold for obesity via FMI, and 30% of participants were obese as measured by BMI.

The researchers found that all 4 patient reported outcomes were negatively impacted by being obese. Obesity was associated with increased patient reports of disease activity. And, being obese was associated with increased depression, fatigue, and pain.

The authors of the research noted that battling weight may be a “modifiable target for improving patient outcomes” for people battling lupus.

One strategy is to work to stay active while staying safe. The National Institutes of Health have shared strategies for working out if you are overweight or obese.

Also, it is important to bring up any changes in your activity with your lupus treatment team and make sure you are healthy enough for exercise.

Clearly, weight is an important factor in health. And Lupus Warriors need to pay extra attention to changes in weight to minimize risks.