Losing Weight with Asthma

Many people struggle with their weight. And many people have a hard time losing weight. The U.S. Centers for Disease Control and Prevention (CDC) says 73.6% of adults are overweight and nearly 42% are considered obese. Among adolescents and teens, 22.2% are considered obese.

For people with asthma, the problem of obesity is extra hard because it can impact lung function, making breathing difficult. Obesity is associated with the development of asthma. It can cause worsened asthma symptoms and poor asthma control. People with a BMI (Body Mass Index) of 30 or higher are at higher risk of developing asthma.

Weight loss can help people improve their asthma control and reduce the need for medication. But for many, losing weight is easier said than done. Overweight and obese adults and children may have genetic factors that hinder their weight loss efforts.

In addition, diseases that often occur with obesity can worsen asthma. These include diabetes, gastroesophageal reflux disease (GERD) and hypertension.

Is there a link between weight gain and asthma?

Yes, weight gain and obesity are risk factors for developing asthma. Whether you have had asthma since childhood or you developed adult-onset asthma, losing weight can make a difference in your asthma management.

Obesity can increase inflammation in the body. This can worsen asthma symptoms. Extra weight puts pressure on the airways and lungs, making it harder to breathe.

Being overweight is associated with reduced physical activity. This can make it harder to lose weight and increase metabolism. Obesity and lack of exercise can also weaken the respiratory muscles. If you have asthma, this puts you at risk of a severe asthma attack.

People with asthma who are obese or overweight may not respond as well to controller medications. If asthma is uncontrolled for long periods of time, they may be at risk for severe asthma. They may also be at risk for COPD (chronic obstructive pulmonary disease).

Maintaining a healthy weight can also help reduce the risk of developing adult-onset asthma.

Can losing weight improve asthma?

Losing weight can improve your asthma, but it is not a cure. There is no cure for asthma. Weight loss can:

• improve lung function
• improve asthma control
• decrease medication use
• reduce asthma symptoms

Losing even 5-10 pounds can make a big difference in reducing asthma symptoms. In addition, weight loss can help people with asthma to exercise more. Regular exercise has been shown to improve not only asthma symptoms but also asthma-related health outcomes.

In one study, people with asthma were encouraged to reduce their calories, walk regularly and keep daily food diaries. A modest 5% body weight loss resulted in improved asthma control. Participants reported improvement in their overall health-related quality of life.

Remember, asthma is a chronic respiratory condition. It requires ongoing medical treatment. Weight loss is not a replacement for proper asthma treatment.

Overweight adults with asthma sometimes have other medical conditions that can affect asthma. These include depression, anxiety, obstructive sleep apnea and gastroesophageal reflux disease (GERD), among others.

Work with a healthcare provider to develop a comprehensive asthma management plan.

Can asthma medications cause weight gain?

Some asthma medications can cause weight gain. It depends on the medication and the person’s response to it.

Oral corticosteroids (OCS) used to treat acute asthma flares and severe asthma can cause weight gain in some people. This is a common side effect. OCS may cause weight gain due to an increased appetite and changes in metabolism. The dose of OCS is higher than inhaled corticosteroids. It is absorbed throughout your body, which increases the side effects.

In rare cases, inhaled corticosteroids (ICS) can cause weight gain. But this is not a common side effect. ICS is used to control airway inflammation. The medication is inhaled directly into the lungs. There is very little absorption of the medication throughout the rest of the body.

Talk with a healthcare provider to learn the potential side effects of specific asthma medications. Monitor weight changes during treatment.

Overweight children and asthma

Research shows that being overweight or obese in childhood increases the risk of developing asthma. Asthma symptoms in children can also worsen with excess weight.

As with adults, overweight children with asthma are more likely to have uncontrolled symptoms. They are more at risk for asthma attacks, and more likely to have severe asthma. A recent Duke University study focused on children with asthma ages 2-5. The study found overweight children had more frequent asthma flares than children who were not overweight.

Children who don’t feel well due to asthma may be unable to exercise. Inactivity can lead to weight gain. Disrupted sleep is another sign of uncontrolled asthma and is also a risk factor for obesity.

Weight management in children with asthma is important. It may include:

• promoting healthier eating habits;
• increasing physical activity levels;
• working with a healthcare provider to develop a personalized treatment plan.

Is it asthma or am I short of breath from being overweight?

Many health conditions can cause respiratory symptoms. It is important to get a proper diagnosis if you are having trouble breathing. Obesity and asthma can worsen your respiratory symptoms, but so can just being a little overweight.

It may be difficult for some people to know if their symptoms are asthma. They may wonder if it’s their weight, being “out of shape,” or another medical condition.

Make an appointment with a healthcare professional to discuss your symptoms. Ask for a pulmonary function evaluation. You can also ask for an evaluation of your BMI. Many people that lose weight see an improvement of their asthma symptoms.

Work together with your doctor in developing an asthma management plan. This should include appropriate medication use and strategies for avoiding triggers.

Are there weight loss interventions for asthma?

Yes, there are weight loss interventions that can benefit people with asthma. Remember, weight loss is often a gradual process that requires patience and discipline. With the right strategies in place, it is possible to achieve a healthy weight and better asthma control.

Any weight loss program should be done under the guidance of a healthcare professional. Weight loss programs may involve:

• Dietary Modifications: Following a healthy, balanced diet can help with weight loss. To lose weight, make dietary changes. Reduce your calorie intake. A well-balanced diet rich in fruit and vegetables and no processed foods can help.
• Exercise: Regular physical activity helps in losing weight. It can improve lung function in people with asthma. Low-impact activities like walking, cycling, yoga or swimming are often best for people with asthma.
• Medications: Prescription weight loss medication can be an option for some people with asthma who are struggling to lose weight.
• Behavioral Therapy: Behavioral therapy can help people understand their eating patterns. It can also help identify strategies to change eating behavior.
• Bariatric surgery/weight loss devices: For some obese adults with asthma, these may be an option.

Crafting a plan to lose weight and improve your asthma

People with asthma who are able to lose weight develop better asthma control. Here are some ways to achieve weight loss:

Nonsurgical weight loss and asthma control

A healthy weight can improve your asthma control. Nonsurgical options for weight loss include:

• healthy eating
• regular exercise
• behavioral therapy
• medications for weight loss

Studies show people who report consistently well-controlled asthma are more likely to maintain control.

What are diet recommendations for people with asthma?

There is no specific diet that can improve your asthma. However, foods you put in your body are an important factor in asthma management. There’s a pro-inflammatory diet that includes sugary, starchy foods. These foods can cause your body to release inflammatory hormones, such as leptin, that can increase inflammation in the lungs. This can lead to asthma symptoms.

Diet alone cannot replace medical treatment for asthma. But it may help alleviate some symptoms.

A good way to start is to eat a healthy, balanced diet that includes more fruit and vegetables and less sugary, starchy foods. Regular exercise is important, but make sure you warm up properly and stay hydrated. Keep your quick-relief inhaler with you if exercise causes asthma symptoms. Ask your healthcare provider or asthma specialist for a referral to a nutritionist or dietitian.

Healthy eating tips:

• Eat a well-balanced diet, learn how to eat right to maintain a healthy weight. Consult a registered dietitian or nutritionist for guidance. They can help you create a healthy diet plan.
• Cut down on foods that are high in saturated and trans fats, added sugars, and salt. Include foods that are rich in fiber, protein, and healthy fats.
• Follow an anti-inflammatory diet. Some foods may help decrease inflammation in your body. Check out the Anti-Inflammatory Diet Pyramid.
• Include foods that are high in antioxidants. These include berries, leafy greens, and citrus fruits.
• Avoid processed foods and foods that contain additives and preservatives. Sulfites are a preservative that can be an asthma trigger for some people. They are often found in wine, beer, shrimp, pickled foods, processed meats and dried fruits/vegetables.
• Consume foods that are rich in omega-3 fatty acids such as fatty fish, flaxseeds, and chia seed.
• Stay hydrated by drinking plenty of water throughout the day.
• Eat slow, it takes time for you to feel full.
• Portion control – we often can eat less if we take more time to eat and chew our food slowly.
• Plan and prep your meals ahead of time. This makes it easier to choose healthy options and portions.

Do not make significant changes to your diet by yourself. Consult with a healthcare professional or asthma specialist first.

Can people with asthma exercise to lose weight?

Yes, exercise can help people with asthma lose weight. Work with your healthcare provider to develop an asthma management plan that includes strategies for avoiding triggers during exercise and appropriate medication use.

About one in 10 people have asthma-related symptoms with physical activity. These symptoms may include coughing, wheezing, chest tightness or shortness of breath. Symptoms may begin during or shortly after physical activity. Many people don’t recognize the problem is asthma. Instead, they avoid exercise.

Exercise has many benefits for people with asthma:

• Improved lung function – can build endurance and stamina.
• A healthy weight – reduces the risk of asthma flares, asthma symptoms and improves asthma control.
• Improved immune system function – reduces the risk of getting respiratory infections.
• Improved sense of well–being and quality of life.
• Stress reduction – stress is a common asthma trigger
• Reduced airway inflammation
• Stronger muscles – good for all parts of your body, promotes blood flow to the lungs and heart.

How do you start an exercise program to lose weight with asthma?

• Choose low-impact activities that are less likely to trigger asthma symptoms. These include walking, swimming, yoga or cycling.
• Start slowly and gradually, increasing the intensity and duration of exercise over time.
• Incorporate strength training exercises to build muscle and boost metabolism. Use light weights or resistance bands.
• Monitor your symptoms closely. Adjust your exercise routine as needed to avoid worsening asthma.
• Monitor your exercise environment for your asthma triggers. Avoid situations or environments with known asthma triggers.
• Warm up and cool down before and after exercise. This is important and can decrease exercise-related symptoms.
• Stay hydrated: drink water BEFORE you become dehydrated. Keep water with you when exercising.

Behavioral therapy and weight loss

Behavioral therapy can be a very effective tool to help you lose weight and improve asthma control. It focuses on improving your eating and exercise habits. It also involves nutrition education and self-monitoring.

Behavioral therapy addresses the psychological components that may be making it hard to lose weight. You learn problem-solving skills and ways to prevent relapses.

Behavioral therapy is guided by a behavioral therapists, psychologists, registered dietitians, doctors, exercise physiologists and/or lifestyle coaches. Some app-based programs may offer behavioral therapy components as well.

Here’s what to expect:

• Food tracking. Use an app or a journal.
• Portion control. Learn ways to avoid eating too much.
• Goals. Make realistic goals with rewards.
• Nutrition. Get education and guidance.
• Physical activity. Create physical activity and exercise goals.
• Support. Get individual and/or group motivational support.
• Psychological issues. Work on mental health issues that may be slowing your progress.

Weight loss medications

Some people are not able to lose weight despite their best efforts. When diet, exercise and other lifestyle changes are not effective, weight loss medications may be an option for overweight and obese adults.

Not every weight loss medication is appropriate for every person. One size does not fit all. Before prescribing a weight-loss medication, your healthcare provider will:

• take your complete medical history;
• determine your body mass index;
• perform a physical exam.

Ask questions about the safety of the medication if you have asthma. Find out about side effects, how long you may have to take the medication, and how well it has worked in other people.

Current FDA-approved weight loss medications include:

• Bupropion-naltrexone (Contrave): a combination (two medications in one) pill taken daily.
• Liraglutide (Saxenda): an injection given daily.
• Orlistat (Xenical, Alli): a capsule taken before or during a meal containing fat.
• Phentermine-topiramate (Qsymia): a capsule taken daily.
• Semaglutide (Wegovy): an injection given once a week.
• Setmelanotide (Imcivree): an injection given daily.

Weight loss and weight management devices

Weight loss and weight management devices may be helpful options. They can help asthma patients obtain a healthy weight. The devices are FDA-regulated medical devices. The FDA categorizes the devices based on the amount of weight a person is expected to lose.

Weight loss devices

The following are types of weight loss devices that may help:

• Gastric bands. The top portion of the stomach has a band placed around it to decrease the size of the stomach.
• Gastric balloon systems. Balloons are placed in the stomach, taking up space in the stomach, making you feel fuller sooner.
• Endoscopic suturing devices. These alter your gastric anatomy. Suture materials travel down the throat and into the stomach where stitches are placed to reduce the volume of the stomach. This makes you feel fuller sooner by limiting the amount of food that can enter the stomach.
• Gastric emptying device. A tube is inserted into the stomach and connects with the outside of the abdomen via a port. This allows for some of the food that has entered your stomach to be drained after you eat.

Weight management devices

The following are types of weight reduction devices that may help:

• Oral removable palatal space occupying device. This device is placed in the mouth to decrease bite size. This reduces how much food is eaten.
• Ingested, transient, space occupying device. This device is swallowed and takes up space in the stomach. It makes you feel fuller sooner.

What options are available for weight loss surgery for obese patients?

When other means of weight loss have failed or are not an option, surgically induced weight loss may be a consideration. Bariatric surgery is a more invasive option for weight loss and to improve asthma outcomes.

Bariatric surgery options

The following are different types of weight loss or bariatric surgeries to treat obesity:

• Gastric sleeve. This involves part of the stomach removed by a surgeon. It limits how much food will fit in the stomach.
• Gastric bypass. A surgeon decreases the stomach size and alters the small intestine to limit how many calories your body absorbs.
• Adjustable gastric band. A surgeon puts a ring around the stomach with an adjustable inflatable band. The stomach size is decreased and can be changed with the adjustable band.
• Biliopancreatic diversion with duodenal switch. This surgery is similar to the gastric sleeve. The surgery alters the small intestine to limit the number of calories and nutrients that are absorbed. This bariatric surgery may cause more surgery-related complications.

---

Reviewed by…

Jacqueline Eghrari-Sabet, MD, FACAAI, is board-certified in allergy, immunology and pediatrics. She is the Medical Director of Telehealth for Allergy & Asthma Network. Dr. Eghrari-Sabet is the founder of Family Allergy & Asthma Care and the FAAR Institute in the Washington, DC area, where she has been in private practice since 1994. Dr. Eghrari-Sabet is Assistant Clinical Professor at George Washington University School of Medicine and Health Sciences where she mentors the next generation of doctors. She is also President of White Coat Resources, a health education consulting service.

Vickram Tejwani, MD, is an assistant professor at the Cleveland Clinic Lerner College of Medicine. He joined Cleveland Clinic Lerner College of Medicine as a physician in the asthma and COPD centers after completion of a pulmonary and critical care fellowship at Johns Hopkins University. Dr. Tejwani is an active scientific investigator in both asthma and COPD.