How to lose weight if you have HIV

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Key points

  • Whether you have gained weight due to an imbalance of food and exercise, or having started HIV treatment, the steps to weight loss are the same.
  • Maintaining a healthy body mass index (BMI), between 18.5 and 25, through eating well and regular physical activity, is recommended.
  • There is no evidence that changing your HIV medication will you help you lose weight.

As for anyone, it’s important for people with HIV to maintain a healthy body weight. Being overweight or underweight can cause problems for your health.

Maintaining a healthy weight is about balancing the energy you take in and use up. If you consume more energy (calories) than you use, you’re likely to gain weight. On the other hand, if you burn more calories than you eat, the chances are you’ll lose weight.

After starting HIV treatment, you may gain some weight as your health improves. Some people gain quite a lot of weight after starting or changing treatment. (See Weight gain and HIV treatment research briefing for further details of what is known.) This weight gain may increase your risk of diabetes, heart disease or cancer. Maintaining a healthy weight limits your risk of developing these conditions, especially if you are older.

You may limit the amount of weight you gain by trying to eat a healthy balanced diet. Foods that are high in sugar, refined carbohydrates or fat will encourage weight gain. Instead, aim for half of each meal to be made from non-starchy vegetables such as greens, cauliflower, broccoli, tomatoes, onions, okra, and salad vegetables. To find out more about healthy eating, see the page on healthy eating for people living with HIV.

Finding the right balance over time allows you to achieve and maintain a healthy body weight. How and what you eat can help influence both your weight and the levels of fats and sugars in your blood.

Your GP or HIV dietitian can help you to work out if your current body weight is healthy. You can also use an online calculator. Body mass index  (BMI) is calculated to show whether you are underweight, normal weight, overweight or obese for someone of your height. A BMI between 25 and 29.9 is overweight. A BMI of 30 or above is obese and a body mass index above 40 is severely obese.

Your GP or HIV dietitian will also measure your waist line. Regardless of your BMI, you should try to lose weight if your waist is over 94cm (37 inches) for men or over 80cm (31.5 inches) for women. You're at very high risk of some serious health conditions if your waist is over 102cm (40 inches) for men or over 88cm (34.5 inches) for women. If this is the case, you definitely need to see a GP or dietitian.

This is because your risk of getting some health problems is affected by where you store your body fat, as well as by your weight.

People who carry more fat around the waist usually have increased fat deposits within the liver and pancreas. This leads to increased blood pressure and to increased levels of sugar and fats such as cholesterol in the blood. Losing weight around the middle results in reversal of excess fat deposits in the liver and pancreas and reduces your risk for stroke, heart attacks and diabetes. Losing just 5% of your body weight can reduce this health risk, although losing 10% will help significantly.

Basic steps towards weight loss

If you are overweight or obese there are some basic steps that you can follow to lose weight. These steps are the same for everyone, regardless of age or HIV status.

Glossary

body mass index (BMI)

Body mass index, or BMI, is a measure of body size. It combines a person's weight with their height. The BMI gives an idea of whether a person has the correct weight for their height. Below 18.5 is considered underweight; between 18.5 and 25 is normal; between 25 and 30 is overweight; and over 30 is obese. Many BMI calculators can be found on the internet.

diabetes

A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.

absorption

The process (or rate) of a drug or other substances, such as food, entering the blood.

antiretroviral (ARV)

A substance that acts against retroviruses such as HIV. There are several classes of antiretrovirals, which are defined by what step of viral replication they target: nucleoside reverse transcriptase inhibitors; non-nucleoside reverse transcriptase inhibitors; protease inhibitors; entry inhibitors; integrase (strand transfer) inhibitors.

drug interaction

A risky combination of drugs, when drug A interferes with the functioning of drug B. Blood levels of the drug may be lowered or raised, potentially interfering with effectiveness or making side-effects worse. Also known as a drug-drug interaction.

To get started, it will help you to know how much you are eating and how physically active you are in an average week. Keep a food and activity diary for a week.

You can download apps that can help track activity. Most smart phones come with activity monitors pre-loaded. Alternatively, you can wear an inexpensive pedometer to record how far you walk each day.

Get a weight loss plan. You can download a 12-week weight loss guide from the NHS website. The plan is designed to help you lose weight at a safe rate of 0.5kg to 1kg (1lb to 2lb) each week by sticking to a daily calorie allowance.

Limit your calorie intake. For most taller people, this means sticking to a calorie limit of no more than 1900kcal a day, and 1400kcal for most shorter people. As we are all different, ideally see your HIV dietitian to have your own target calculated. A very low calorie diet (less than 1200 calories a day) should only be attempted after consultation with an HIV dietitian. Remember that some antiretroviral drugs need to be taken with food. Check which drugs need to be taken with food here.

Do physical exercise. Exercise increases the number of calories you burn and helps weight loss. Set yourself exercise goals and aim to increase the amount you do each week.

Aim for 30 minutes of moderate intensity physical activity such as brisk walking, cycling, gardening, dancing or swimming, five times a week. Moderate intensity exercise raises your heart and breathing rate. Alternatively, aim for 75 minutes of high intensity exercise such as running or circuit training each week. High intensity exercise should make you breathe hard and your heart beat fast.

Some form of strength exercise twice a week will also help you lose weight. Lifting weights or carrying shopping bags for a distance count as strength exercise.

Your GP can refer you for exercise on prescription or to a local weight loss group.

Weight gain and pregnancy

It is normal to gain weight during pregnancy. Most women begin to lose some of this weight within a few months of having their baby. It is unclear if women who start HIV treatment during pregnancy gain more weight than other women. We don’t know if women already on HIV treatment when they become pregnant gain more weight than other women.

If you have a high body weight and you plan to have a baby, you will be encouraged to lose weight before becoming pregnant. Losing weight before becoming pregnant will benefit you and your baby, reducing the risk of complications during pregnancy and at the time of birth. Women who are obese are at higher risk of developing diabetes or high blood pressure during pregnancy.

Dieting during pregnancy or while you are breastfeeding is not recommended.

Medicine to help you lose weight

Your doctor may prescribe you a medicine called orlistat if diet and exercise don’t help you to lose weight and you have a BMI over 30 (or over 28 and diabetes or hypertension). A lower dose version of orlistat called Alli can be bought over the counter without a prescription.

Orlistat promotes weight loss by blocking fat absorption in the gut. It blocks absorption of about 30% of the fat you eat. Orlistat should be used with a balanced low-fat diet and exercise. Orlistat is not suitable for pregnant or breastfeeding women.

Orlistat is a short-term treatment and use for more than 12 months is rarely recommended.

It has not been studied as a weight loss aid in people living with HIV. There is a potential for a drug interaction that reduces levels of HIV drugs in the blood, leading to viral rebound. Orlistat should be taken 4-5 hours apart from antiretrovirals to avoid this risk.

Several other medicines to promote weight loss are not yet approved for prescription in the United Kingdom. Further evidence of effectiveness and value for money is needed before liraglutide (Saxenda) or naltrexone/bupoprion (Mysimba) could be offered by the NHS.

Changing HIV treatment

Some people put on weight after starting HIV treatment. However, there is no evidence that changing your HIV medication results in weight loss after weight gain. More research is needed to understand if specific antiretrovirals cause weight gain and if switching treatment has any effect on body weight. There’s more information on another page.

Weight loss surgery

If all other methods of weight loss have not worked and you are severely obese (BMI of at least 40, or 35 if you have a weight-related health condition, such as type 2 diabetes or high blood pressure), weight loss surgery may be an option. If weight loss surgery is suggested to you, it is because your weight places you at high risk of serious illness and shortened life.

Surgery to support weight loss is called bariatric surgery. Surgery may reduce the size of the stomach so that you feel full quicker or limit the absorption of calories from food. Bariatric surgery may lead to weight loss of 15 to 20% and weight loss is maintained when combined with exercise and a balanced diet.

Research suggests that people with HIV get the same benefits from bariatric surgery as everyone else and do not suffer a higher rate of complications. Bariatric surgery may lead to less absorption of antiretrovirals and more research is needed to understand its effects on drug absorption. You may need to take your antiretrovirals in a liquid formulation for a short time following surgery.

There’s more information on the NHS website.

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    Acknowledgements

    Thanks to Alastair Duncan for his advice.