If You Have Crohn’s Why Are You Fat?

CN: Discussions of Weight and Medical Conditions

Every once in a while, someone will stray far enough from the trail of courtesy to ask me why I am overweight. Crohn’s is known to cause extreme weight loss, so my weight must be a sign that I’m not actually as sick as I say I am. This is part of the danger that exists when people who have no experience with medicine, laymen, pretend to be medical practitioners or to have knowledge of health. Their understanding of various illnesses is superficial at best.

It is true that Crohn’s causes weight loss. It does so in large part because the patient loses the ability to digest food. This happens because the intestines, which are responsible for a significant portion of human digestion, are so inflamed and ulcerated that nutrients are unable to pass through into the bloodstream.

As a result, the body starts to digest its own fat reserves and proteins resulting in the rapid weight loss associated with Crohn’s disease. At my worst flare, before being diagnosed, I lost 60 lbs in the span of two months.

If that’s the case, then how come right now I am at my fattest ever?

Because the weight loss created by crohn’s is not sustainable to life. When a Crohn’s patient is losing weight it is because they are literally wasting away, starving to death no matter how much they eat. The point of treatment, regardless of whether one goes into remission or not, is to stop the patient in question from flushing their lives down the toilet.

Many of the drugs used to treat flares in particular, like prednisone, or crohn’s in general like Remicade, include weight gain as a side effect. Prednisone in particular is so famous for causing weight gain that one of the side effects is called moon face: literally it causes weight to accumulate around your face making it circular as a full moon. It can also cause buffalo humps: fatty deposits on your back below the neck that create a temporary hump.

Prednisone is a steroid, and part of its purpose is to promote weight gain. What’s more, prednisone also impedes your ability to exercise effectively since it causes much of your muscle to be additionally converted into fat all the while draining your bones of calcium.

The tendency of crohn’s flares to cause rapid weight loss also leads to weight gain the same way dieting does. When you lose weight too quickly or as a result of a temporary loss of calories, your body enters starvation mode. Its goal becomes in preventing future death by storing extra fat in preparation for the next period of starvation as soon as it begins digesting food again. In many ways Crohn’s is like the ultimate yo-yo diet: while you are flaring you lose weight, and as soon as you can digest again, you start storing fat for the next flare.

In addition to the medication and physical impacts on weight, crohn’s has a significant co-morbidity with depression. Depression in turn has been known to cause weight gain, as have anti-depressants. Moreover, the exhaustion caused by crohn’s can make it difficult to exercise effectively. When just going about your daily routine can be too much for your ravaged body, trying to find the energy to go for a walk or to go to the gym can be impossible. When you barely have the physical strength to handle a trip to the grocery store, how are you supposed to handle anything more intense?

In addition to all that, the response to even low level flaring is often to employ a low residue diet. This consists of high levels of carbs and protein, foods that are easy to digest or those that may digest in earlier sections of the digestive tract. When I’m flaring, a hamburger can be healthier for me than a salad. In fact having a salad counts as cheating on my diet (and requires me to medicate significantly if I don’t want to spend the whole night crying).

I’m self-conscious about my weight, because I know the world judges me because of it. I’ve heard too often from family that my weight determines my value as a person: a message reinforced by our society. Ultimately however, for all that I might wince when I look in the mirror, I have more important things to worry about. When at any moment my body might decide to start digesting itself again, having some belly fat may well be a life saver. My survival is worth me being fat.

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If You Have Crohn’s Why Are You Fat?
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2 thoughts on “If You Have Crohn’s Why Are You Fat?

  1. 1

    Yes to all of this. I have a similar-but-different combination of chronic illnesses, and I laugh bitterly in the face of ‘healthy eating’ recommendations that would make it impossible for me to leave the house. And I found it very hard to listen to the ‘compliments’ I received after a bad flare-up led to significant weight loss. My increased weight is a sign of a period of good health now, but I still have to work at making myself feel positively about it.

  2. 2

    One thing that I’ve learned over the years that I wish would be said more often: Unless you’re an expert on ALL the aspects of a particular disease or condition (and no, having a friend with the disease isn’t enough), you have to be very careful, sensitive, and respectful when asking about something that seems weird to you. Diseases are complex, and human physiology even more so.

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