Does Being Overweight Affect Asthma?

weight loss
Getty/Blend Images/John Fedele

Have you ever asked yourself or your doctor “does weight affect asthma?”

Do you remember what you weighed 20 years ago? I weighed about 40 pounds less than I weigh today. It really just slowly crept up on me- slowly but surely, a couple of pounds per year. While I and everyone else I talk to chalks it up to turning 40, 50, or whatever your latest age benchmark, maybe worsening asthma symptoms are really about those extra pounds?

Does Weight Affect Asthma?

While it might not seem like much, gaining 5 just pounds has been shown to worsen asthma control and quality of life. In one study published in the journal Respiratory Medicine gaining 5 pounds, compared to those who gained less or lost weight, was associated with a/an:

  • 22% poorer self-rated asthma control
  • 18% poorer self-reported quality of life
  • 31% increase in the odds of requiring a steroid burst

The authors concluded that “strategies to prevent weight gain could help patients achieve better asthma control and improve asthma-related quality of life. A clearer understanding of the mechanisms by which body weight/BMI influences asthma control and other asthma-related outcomes will enable treatment specialists to formulate treatment programs that include a weight-management component.” In fact, few studies have rigorously examined treatments in overweight/ obese asthmatics or the impact of weight loss in asthma.

Overweight Leads to Different Responses to Asthma Meds

In this scenario, weight has a direct impact asthma control. While there have not been studies specifically targeting overweight or obese asthmatics, obese patients do not appear to respond to controller medication in the same manner as non-overweight asthmatics. On the other hand, response to rescue medications is not altered. Not surprisingly, current research in asthma has not targeted obese patients specifically and this should be a target of future clinical research. Currently, there are no recommended treatment differences based on your weight.

Does Weight Loss Affect Asthma?

It may seem self-evident that if overweight is associated with poorer asthma control and decreased the quality of life that weight loss would reverse this. While most Americans will benefit from taking off a few pounds, I cannot guarantee it will improve your asthma.

Several studies have suggested that weight loss from bariatric surgery improves asthma control in obese patients. One study I have discussed previously stated that medication refills decreased by as much as 50% following bariatric surgery. More recent publications are have demonstrated improvements in asthma symptoms as well as pulmonary functions tests 5 years following surgery. One of the main limitations of all studies involving bariatric surgery and asthma is a small size, limiting the generalizability of the results.

While these reports are promising, bariatric surgery is a fairly radical step. The procedure has its own risks and complications. If lifestyle modifications targeting weight loss produce similar results, surgery may not be worth the risk.

A small randomized clinical trial (RCT) that involved diet and exercise demonstrated improved quality of life in 83% of participants and asthma control in 58% of participants following a 5–10% weight loss. In the dietary intervention, participants used 2 meal replacement shakes, one main meal, 2 snacks along with dietary counseling. In the physical activity, intervention patients received a gym membership and 1 hour per week of personal training with a tailored physical activity program. While this study and a few others are promising, to date no large, multi-center trials have been undertaken to see if these results could be replicated.

Implications for Me

So I think I can answer the question posed at the beginning of the article “does weight affect asthma” with a yes. While I cannot recommend weight loss for asthma specifically in overweight and obese patients, I can recommend weight loss for these patients in general. Patients in small studies have achieved meaningful improvements in asthma outcomes with weight loss. Any overweight or obese patient should attempt weight loss after appropriate medical consultation.

The methods utilized in the RCT above are certainly achievable in your own community if you have the resources to see a dietician and a personal trainer. However, with the right motivation and a little bit of knowledge, you can develop your own weight loss plan without a lot of expense.

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