My 21 year old daughter has been trying to lose weight. She eats healthy, consulted a dietitian, has been exercising/running every single day for over five months. She is frustrated because she has not even lost five pounds. She is taking quinapril and Lipitor and her cholesterol has been excellent for the past year. Would either of these medications cause weight gain or water retention?

She is also on an insulin pump and did experience weight gain initially (that was almost that years ago when she went on it). She has been able to lower her insulin doses recently due to her high activity level. I know she’s sticking to her diet and is putting in the work exercising. Neither of us wants her frustration to continue any longer and I’m concerned she’ll stop the healthy lifestyle out of pure discouragement.

I have patients who have experienced similar frustrations, as it relates to weight and intensive glucose control. First, the Lipitor and quinapril do not cause weight gain or water retention. It is the insulin that is the culprit. Most patients in intensive insulin therapy gain weight initially. This was an average of 12 pounds in the Diabetes Control and Complications Trial. There is more going on here. Remember that the intensive exercise will help increase muscle mass. The muscle tissue is more dense than fat. Therefore, there is some tradeoff with regard to body composition that may favor some weight gain. As you stated, exercise will decrease insulin requirements. Make sure she is not having to eat excessively to avoid hypoglycemia. If this occurs, she may be able to cut her insulin dose further. Another possibility might be for her to seek the opinion of a trained exercise physiologist. Someone in the personal trainer mode may be able to individualize an exercise regimen that allows her to optimize her exercise and minimize some of the grind. For instance, purely aerobic exercise, such as running, is not as efficient for her diabetes and fat loss as a combination of aerobic and resistance (weight lifting) exercise. Unfortunately, the payoff is at the far end of the time spectrum.

Healthy living will allow her to potentially avoid long-term complications. It will make her healthier when it comes time for her to start her family and consider pregnancy. She also needs support. Finding an exercise buddy is also helpful to keep her going. There are no easy answers here.

JTL