Weight Gain

What is Weight Gain?

Weight gain is an increase in body weight, which can come from body fat, fluid, or muscle. When it is mainly excess body fat, it can progress to overweight and obesity. Obesity is a chronic, complex condition that affects about 42% of US adults and raises the risk of type 2 diabetes, high blood pressure, heart disease, sleep disorders and osteoarthritis.^{[1, 2]}

Common symptoms

Weight gain often shows up as a higher number on the scale, a larger waist or clothes that fit more tightly. Other signs depend on the cause.

• Tiredness, cold intolerance or constipation, which can go with an underactive thyroid^[3]
• Swelling of the legs, face or abdomen when fluid is involved
• Easy bruising, purple stretch marks, high blood pressure or high blood sugar, which can go with excess cortisol^[4]
• Snoring, joint strain and reduced stamina

Causes and risk factors

Most weight gain comes from a long-term mismatch between energy taken in and energy used, shaped by genetics, food environment, activity and many other factors. The body also defends a weight range, so regaining lost weight is common.^[5] Some medicines cause weight gain, including certain antidepressants and diabetes drugs such as insulin and glyburide, so medicine lists should be reviewed.^[1]

Medical causes include an underactive thyroid, which commonly brings weight gain along with fatigue,^[3] and excess cortisol, in Cushing syndrome.^[4] Short or mistimed sleep also promotes weight gain by altering appetite hormones, food intake and energy use.^[6]

How it is diagnosed and treated conventionally

Evaluation looks for medical causes and medicine effects, and measures body mass index and waist size, although BMI alone is not recommended to judge individual risk.^[1] Blood tests, such as thyroid function, are used when symptoms point to a hormone cause.^[3]

Evidence-based treatment combines behavioral support, nutrition, physical activity, medicines and, for some people, metabolic or bariatric surgery.^[1] Behavioral programs often produce 5% to 10% weight loss, though weight regain is common, and modern obesity medicines and surgery can produce larger losses.^{[1, 2]}

Why Weight Gain calls for a whole-person approach

Weight is the result of several systems at once: appetite hormones, sleep, stress, thyroid and other hormones, medicines, activity and food. Treating only one tends to leave the others unchanged. That is one reason lifestyle programs alone give lasting results in only a minority of people.^[2]

Supportive care can help with the day-to-day factors, such as stress, sleep and cravings, that make habit change hard. It works best alongside medical evaluation and a nutrition and activity plan.

Sleep and circadian rhythm

Insufficient sleep and eating at times when the body clock favors sleep are linked to changes in appetite hormones (ghrelin, leptin and peptide YY), energy expenditure and food intake, and to a greater risk of obesity.^[6]

Hormones

An underactive thyroid and excess cortisol are the main hormone causes that clinicians look for.^{[3, 4]} Both need medical diagnosis, and treating them is a medical task.

Stress, mood and appetite

Obesity is shaped by appetite regulation as well as by willpower. The body responds to weight loss with increased hunger and lower energy use, which explains much of the regain.^[5] Stress and low mood can add to eating for comfort, and these are areas where supportive care may help.

Medicines

Some commonly prescribed medicines raise body weight, so any concern should be raised with the prescriber, who may consider alternatives.^[1]

Acupuncture for Weight Gain

What the research shows

Research suggests acupuncture may produce a small average reduction in weight in people with overweight or obesity, although the reviewers call for longer and more rigorous trials. A meta-analysis of 8 sham-controlled trials with 403 patients found acupuncture reduced body mass index by about 1 point and body weight by about 1.85 kg more than sham.^[7]

A meta-analysis of 13 trials with 779 participants found electroacupuncture lowered BMI, weight and waist size compared with sham, standard care or no treatment.^[8] A meta-analysis of 12 trials in Asian populations reached a similar conclusion, but acupuncture added to exercise gave no further benefit over exercise alone in the short term, and the authors called for long-term studies.^[9] A meta-analysis of 23 studies reported greater BMI reduction with acupuncture, alone or with lifestyle change, with mild adverse events.^[10]

Acupuncture is not a substitute for dietary and activity changes, and the effects seen in these trials were small.

How acupuncture may work

The mechanisms by which acupuncture might affect weight are not established. These meta-analyses did not test how it works, and we do not make claims about appetite hormones or metabolism from them.

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the body, usually left in place for about 20 to 40 minutes. Some practitioners use electroacupuncture, in which a small current is passed between needles. A course is typically several visits, with reassessment to see whether appetite, sleep, stress and weight are changing.

In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Weight Gain

The Ayurvedic view

Ayurveda describes weight gain and excess body fat as sthaulya, and links it to Kapha imbalance and weak digestive fire (agni) that builds up residue (ama) and excess fat tissue (meda). This is a traditional framework used to choose supportive measures, not a biomedical diagnosis.

Therapies that may be used

Care is individual and traditionally combines:

• Diet and daily routine: regular, warm, lighter meals, less sugary and heavy food, and steady meal and sleep times
• Daily physical activity and stress-reducing practices such as breathing exercises and yoga
• Dry-powder (udvartana) or oil massage
• Individually chosen herbs, such as triphala, guggul or garcinia (vrikshamla), only after review of your medicines
• Panchakarma only where traditionally appropriate and medically sensible

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and it is not a weight-loss treatment.

What the research shows

The research on Ayurveda for weight gain is very limited. We found no systematic review of Ayurvedic treatment as a whole for obesity. One small placebo-controlled crossover trial of 19 overweight people with impaired glucose tolerance tested a traditional Ayurvedic mixture of 20 herbs for four weeks. It found no benefit for glucose or blood fats, and a non-significant trend toward higher insulin.^[12]

Some herbs used in Ayurveda have been studied on their own. A meta-analysis found that Garcinia cambogia supplements lowered weight slightly compared with placebo,^[13] while a larger review of herbal medicines found no effect for it.^[14] Curcumin from turmeric was linked to a small weight reduction, with moderate-certainty evidence, in a network meta-analysis of 111 trials of supplements.^[15] Another review of eight trials found its effects were seen mainly with more absorbable forms or longer use.^[16]

Herbal medicine for Weight Gain

Herbs and formulas that have been studied

Many herbs and supplements have been tested for weight loss, including green tea, white kidney bean (Phaseolus vulgaris), Nigella sativa, Garcinia, Caralluma fimbriata, curcumin and others.^{[14, 15, 17]} Chinese herbal and combination formulas are also used, but we found no strong summary of them for weight gain.

What the research shows

The overall evidence is limited and the effects are small. A review of 54 placebo-controlled trials found that, among herbs with at least four trials, only Phaseolus vulgaris produced a statistically significant weight loss as a single agent, and this was not clinically important. The authors concluded there is insufficient evidence to recommend any of the herbal medicines reviewed.^[14]

Other reviews are more positive but stress quality problems. One review of 279 trials reported benefit with green tea, Phaseolus vulgaris, Garcinia cambogia, Nigella sativa and some other plants and called for high-quality trials.^[17] A network meta-analysis of 111 trials found small weight losses of roughly 1 to 4 kg with several supplements, including curcumin and Nigella sativa.^[15]

Safety and herb-drug interactions

Herbal and dietary supplements, including green tea extract and multi-ingredient products, are a recognized cause of liver injury.^[18] Herbs can also interact with medicines, including blood thinners and diabetes drugs, so every herb needs review against your full medicine list.^[19]

About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, thyroid disease or heart disease, or take thyroid medicine.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes weight gain with patterns of spleen weakness, dampness and phlegm, and Ayurveda describes a Kapha excess with weak agni. Researchers studying these ideas look at appetite regulation, energy expenditure, sleep and hormones, and the way the body defends a weight set point.^{[5, 6]}

No study has shown that a traditional pattern or dosha corresponds to a specific metabolic abnormality, and these frameworks are not used here to diagnose a cause of weight gain.

How this care fits with your medical care

Integrative care for weight gain is complementary. Keep your physician involved, especially for unexplained or rapid gain, and follow any plan for nutrition, activity, medicines or surgery. Do not stop or change prescribed medicines, including diabetes medicines, thyroid medicine or obesity medicines, without your prescriber. We do not diagnose the cause of weight gain.

Please bring your recent blood tests, a full list of medicines and supplements, and any diagnoses such as thyroid disease, PCOS or diabetes.

When to seek urgent medical care

Rapid or unexplained weight gain can be a sign of a medical problem, and some symptoms need urgent care.^{[3, 4]}

• Rapid weight gain over days with swelling of the legs or abdomen, or shortness of breath when lying flat
• Chest pain, severe shortness of breath or a fast, irregular heartbeat
• Sudden swelling of the face or throat, or trouble breathing
• Weight gain with severe fatigue, confusion, extreme cold intolerance or a very slow heartbeat

If any of these occur, call 911 or go to the nearest emergency department.