Losing Weight with RA and Chronic Painby Lene Andersen, MSW Patient Advocate
How do you lose weight with RA?
That's a good question one that I've been stuck on for a while. These days, there's more of me than there used to be and it's getting harder to ignore. That's especially true at this time of year, when the promise of warmer temperatures has me thinking about spring jackets and T-shirts instead of being buried in sweaters. On the heels of these thoughts came the realization that perhaps over the winter I had added a few extra pounds (for insulation, y'know).
The formula for losing weight is a deceptively simple one: Take in fewer calories than you use. This is often translated into the maxim "eat less, move more." That's difficult enough for healthy, able-bodied people, but when you have RA, you have extra challenges to take into account.
How do you make the formula work with a chronic illness?
The role of medication
One of the frequent side effects to many medications is weight change. RA meds are no different. For many of us, prednisone can be a vital tool in managing our disease, but it's an appetite stimulant and often leads to weight gain. For me, Humira has encouraged the Middle-Aged Spread Fairy to gift me with some extra weight. It's hard to say whether it's the medication itself or the fact that I'm feeling good and therefore have an appetite for the first time in my 40-plus years with RA.
It's important to have perspective when you look at medication-induced weight gain. If the medication is effective in controlling your disease, gaining a bit of extra weight may be an acceptable side effect. Active RA can damage your joints, causing permanent deformities and potential disability. A healthy body that carries five or 10 extra pounds is probably preferable. If you have a lot of weight gain or the medication is not controlling your RA, talk to your doctor about alternatives.
Do you know how large a portion is? Both dinner plates and portion sizes have increased in the last few decades, which means we eat much more than we need. We also consume more salt and sugar than we should. The World Health Organization (WHO) is urging people to reduce their sugar intake to five percent of their daily caloric intake. That may not seem like much of a challenge until you start looking at labels and realize how many hidden sugars have been added to our food.
Cooking your food from scratch is the best way to control what goes into your body. This can help you reduce unhealthy fats and sugar and focus on healthy ingredients. Don't get too ambitious, though spending a lot of time in the kitchen can be hard on your RA. Make sure you get lots of fresh vegetables and fruit, limit starchy foods, unhealthy fats and sugar, and when you get the urge to snack, pick something that's good for you.
Think about portions and the size of your plate. If you have large dinner plates, consider finding something smaller. Follow the rule that half your plate should be vegetables, a quarter starch and a quarter protein. Eating several smaller meals throughout your day can help keep your stomach busy and keep you feeling less like you're hungry. If your medication makes you feel hungry all the time, make sure you carry healthy snacks so you're not tempted to binge on doughnuts and chocolate. But do let yourself have a treat every now and again to avoid feeling deprived and cranky. Just use moderation if eaten slowly, a spoonful of ice cream or a quarter doughnut can be enough to satisfy your sweet tooth. Drinking lots of water can also keep you hydrated and feeling full.
Moving more can be very challenging if you have chronic pain. For people with RA, the adage "no pain, no gain" couldn't be further from the truth. Pushing through until you hurt can land you on the couch with a flare that lasts for days.
How much and what kind of physical activity you do depends on your RA. If you have severe or uncontrolled RA, getting through the day can count as physical activity. Moving around in your home, taking care of yourself, your family and pets keeps you active. If your RA is moderate, swimming, tai chi and yoga may be the answer. For those who live with mild or uncontrolled RA, more strenuous exercises such as cardio, weightlifting and running may be part of your routine. Get a referral from your doctor for a physical therapist who can help you put together an exercise routine that protects your joints. Take a look at our exercise and RA video for examples of physical activity for different levels of RA.
To determine your limits are, start slowly. Take a small walk, swim a length in the pool, do some gentle yoga. If your joints hurt, stop. Once you find a level that is comfortable, keep doing it for a week or so, then increase slightly. Repeat gradually and slowly. If you get frustrated, remember the story about the turtle and the hare. For people with RA, slow and steady wins the race.
Increasing your strength will help support your joints and reduce pain. Increasing your fitness will help your heart be healthy. Keep in mind that losing just one pound will take four pounds of stress off your knees. Breaking down your goal into smaller units can make it much more attainable. Focus on just one pound at a time and you'll get there.
Losing weight and getting stronger is possible, even when you live with chronic pain. Writing this article has helped me get motivated. Do you want to be my weight loss buddy? I can't stand up to weigh myself, so I'll have to measure my success in pants size. I'll start with one, going from a 16 to a 14 by my birthday in late August.
What's your goal?