The Connection Between Obesity and Asthma

Navigating through the effects of asthma is difficult enough—add in obesity and it can be come that much more difficult to manage. “Obesity has the potential to both cause and exacerbate asthma,” notes Denise Pate, M.D., an internal medicine physician and medical director with Medical Offices of Manhattan in New York City.

The connection may work in the other direction as well, research suggests: Having asthma could put you at higher risk of developing obesity, particularly if the respiratory condition limits physical activity and has weight gain as a side effect of certain medications.

For more on how asthma and obesity may be linked, we asked the experts to break down the science, plus share potential treatment options and lifestyle strategies that can help ease the symptoms of both conditions.

How Obesity Raises Asthma Risks

Research in the Journal of Allergy and Clinical Immunology notes that both children and adults who have obesity and asthma tend to have more severe forms of the respiratory disorder and poorer disease control than those without obesity. The researchers report that 250,000 new asthma cases per year in the US are related to obesity.

According to the Centers for Disease Control and Prevention (CDC), obesity is associated with worsening asthma symptoms and control of the condition, which can increase the risk of asthma-related hospitalizations, as well as increased medication use. The CDC also notes that women with obesity have significantly higher rates of asthma than women who are in the normal weight or overweight categories.

“Patients with asthma who have obesity often have more symptoms, more frequent and severe exacerbations, less response to asthma therapies, and a lower quality of life,” says Leah Nuss, M.D., a pediatric pulmonologist at Children's Hospital New Orleans in Louisiana. "Also, those with obesity may be more at risk of developing asthma."

Although that link isn't fully yet understood, it’s likely the major contributors are inflammatory changes, insulin resistance, and alterations in lipid metabolism—which is how your body stores and breaks down fats, says Dr. Nuss.

Carrying more weight also strains the lungs and chest wall, making it more challenging to breathe and limiting lung expansion, adds Dr. Pate. Over time, this can lead to chronic, low-grade inflammation in the airways, which may worsen asthma for those who already have it, or prompt its development in the first place.

How Asthma May Drive Obesity

Although it’s more common for obesity to be a factor for developing or exacerbating asthma, Dr. Pate says the connection may sometimes work in the other direction, with asthma increasing the risk of weight gain. In fact, studies show that nearly 60% of adults with severe asthma in the U.S. have obesity.

For starters, patients with asthma may feel they are unable to exercise or do regular physical activity, which can make them more sedentary. That not only raises the chances of becoming overweight or having obesity, it can also increase inflammation, research in Sports Medicine and Health Science reports. Researchers noted that the type of persistent, systemic low-grade inflammation associated with physical inactivity tends to cause weight gain largely in the abdominal region—which can set up a variety of other health risks, including an increased risk of heart disease.

Use of inhaled corticosteroids—a common treatment for asthma—can be another factor in terms of weight gain as a side effect, according to research published in the Journal of Asthma. That study found a more than 60% increase in BMI trajectory among pediatric patients on a high-dose steroid compared to those on a low dose of the medication.

Ripple Effects of Both Asthma and Obesity

Having both asthma and obesity can do more than increase the chances of asthma attacks—the combination can lead to significant issues with quality of life, since they both come with a higher risk of difficulties in terms of sleep, digestion, and mood disorders. These are a few ways the two conditions can set off a chain of related health complications:

• Anxiety and depression can play a major role in asthma and obesity, worsening the effects of each while strengthening the connection between the two conditions. A study in Psychiatry Investigation reported that the relationship between obesity and depression is well established, and research in Brain, Behavior & Immunity found that people with asthma are three times more likely to develop anxiety and depression than those without the condition.

• Gastroesophageal reflux disease (GERD) is common among those with asthma. One estimate shows that over half of patients with asthma also have GERD; other estimates suggest the number might be as high as 75%. At the same time, obesity can also raise the risk of developing GERD, according to a study in the American Journal of Physiology, which notes that increased inflammation from fat tissue can be one of the biggest factors in triggering the digestive disorder.

• Obstructive sleep apnea is another condition that affects those with asthma and obesity. According to a research review in Frontiers in Medicine, people with asthma are at higher risk for poor sleep quality overall, including sleep apnea. The connection between sleep apnea and obesity is well known, too, according to research in the Journal of Sleep Medicine and Disorders, which notes that obesity is one of the main components contributing to the development of sleep apnea.

Having to cope with asthma or obesity by itself can make these risks challenging, but dealing with both conditions at once can worsen the effects of issues like sleep apnea, anxiety, or heartburn, notes to Michelle Ogunwole, M.D., specialist in internal medicine and assistant professor of medicine at The Johns Hopkins University School of Medicine in Baltimore, MD.

“Dealing with more than one chronic condition and its effects can feel overwhelming,” she says. “Especially if you’re seeing some serious symptoms like sleep disturbance or mood disorders, it can be difficult to know where to start, but that’s where your health team and some meaningful lifestyle changes can come in.”

Role of Weight Loss in Managing Asthma

Focusing on decreasing your weight if you have obesity may help reduce frequency of asthma attacks and lead to better symptom management overall, says Dr. Pate.

“Losing weight lowers the pressure on the lungs and chest wall, which helps the lungs work more efficiently,” she says. “Losing weight can also lessen asthma symptoms by reducing inflammation throughout the body, particularly the airways.”

Each person's degree of improvement may be different, she adds, but getting advice from your health team for this effort can be a good first step.

Set Goals for Lifestyle Changes

Lifestyle changes that can have an effect not just on physical health but also on emotional wellbeing are also crucial, adds Dr. Ogunwole. These changes can include:

• Eating healthy foods

• Exercising regularly

• Getting enough social interaction

• Lowering stress

• Moderating alcohol consumption

• Not smoking

If all these suggestions feel kind of vague and lofty to you, it can help to set specific, meaningful goals to give yourself a hard target to aim at, Dr. Ogunwole says. For example, instead of just pledging to exercise more and eating healthier to lose weight—which feels vague—give yourself short-term goals, like switching to water instead of a high-calorie drink with meals, eating at least five vegetables each day, or walking for a few minutes around the block.

In addition, reframe these actions so they feel more positive: Instead of worrying about what you may not get to eat, think about the many benefits you may experience with weight loss, such as being able to breathe easier and having more energy to play with your kids.

“Maybe you simply want to feel less tired during the day, and that’s your goal,” adds Dr. Ogunwole. “Whatever it is, think of working toward it in an incremental way, with healthy habits allowing you to get there.”

Finally, let your health provider know your specific goals. They may be able to help you put together a treatment plan and provide milestones to reach toward—all of which can provide a sense of progress when it comes to managing both obesity and asthma.