x
When Susan O'Rourke was diagnosed with Parkinson's disease in 2015, her doctor prescribed pramipexole (Mirapex), a drug that not only gave her insomnia but left her ravenously hungry. “I ate the refrigerator,” says O'Rourke, 71, of Newark, NJ. “I've never been a thin person, but I became obese.”
When she topped 220 pounds and could no longer walk more than a block without tiring, O'Rourke got serious. She found a new doctor who switched her to a medication that didn't increase appetite, signed up for an online weight-management program, pushed herself to walk for exercise, and took up yoga. Over the next 14 months she lost 60 pounds. She also improved her gait and lowered her blood pressure.
“I felt way better,” says O'Rourke. And when she underwent successful deep brain stimulation to treat the tremor in her left hand in 2020, “her improved health made her recovery more robust,” says her neurologist, Elana N. Clar, MD, of the New Jersey Brain and Spine Center in Oradell.
Research has indicated that losing weight can make various neurologic disorders more manageable. A study published in Surgery for Obesity and Related Diseases in February 2021 showed that it could improve quality of life in patients with multiple sclerosis (MS), and a 2020 review in Obesity Surgery found that it reduced the frequency and intensity of migraine headaches. And many studies have demonstrated that it may help reduce the severity of obstructive sleep apnea.
Having too much body fat can threaten brain health in multiple ways: It can increase the odds of developing high blood pressure, type 2 diabetes, and unhealthy blood fats—three conditions that are risk factors for ischemic stroke, which is caused by blockages in the brain's arteries, explains Seemant Chaturvedi, MD, FAAN, professor of neurology at the University of Maryland School of Medicine in Baltimore.
A body mass index (BMI) of 30 or higher—which is an indicator of obesity—increases the risk for ischemic strokes by 50 to 100 percent, according to a 2021 guideline from the American Stroke Association.
Women between ages 20 and 49 who are overweight (with a BMI of 25 to 29) are 1.8 times more likely than people of normal weight to develop dementia later in life, according to a 2021 study in Alzheimer's & Dementia. For obese young women, the odds are 2.45 times higher. A 2019 study in Annals of Clinical and Translational Neurology found that obesity may contribute to the development of MS.
Moreover, scientists have learned that belly flab, especially in the midsection, can promote inflammation, says Eva Feldman, MD, PhD, FAAN, endowed professor of neurology at the University of Michigan Medical School in Ann Arbor. The release of inflammatory chemicals from abdominal fat may damage brain tissue, says Dr. Feldman.
Animal studies done by Dr. Feldman and her colleagues have shown that neurons can develop insulin resistance, which appears to play a role in cognitive decline, Alzheimer's, Parkinson's, and other neurologic disorders, she says. When neurons develop insulin resistance (the main cause of type 2 diabetes), they use glucose less efficiently.
It's clear that maintaining a healthy weight is good for body and mind. But losing weight can be challenging. These strategies may help.
Many drugs prescribed for neurologic conditions cause weight gain; they include valproic acid, commonly used to manage epilepsy, as well as pregabalin, gabapentin, carbamazepine, and vigabatrin, all of which treat seizures or nerve-related pain. Patients should notify their doctors if they gain more than five pounds after starting a new medication, advises Lawrence Cheskin, MD, chair of the department of nutrition and food studies at George Mason University's College of Health and Human Services in Fairfax, VA. “Your doctor may be able to prescribe something that doesn't cause weight gain,” he says. You can also ask your doctor about weight-management or appetite-suppressant medication. In June, the US Food and Drug Administration approved the injected drug semaglutide (Wegovy) for adults with a BMI of 30 or higher, or a minimum BMI of 27 if they have weight-related conditions. In a study published in the New England Journal of Medicine in March 2021, overweight people treated with semaglutide lost 15 percent of their body weight on average, versus 2.4 percent for those given a placebo.
Physical activity is essential, even for those with limited mobility, says Aliza Ben-Zacharia, PhD, DNP, assistant professor at the Hunter College School of Nursing in New York City. She recommends chair pedal exercisers, hand weights, swimming, or water workouts for her patients in wheelchairs or with leg weakness. Patients who experience pain and fatigue can ask their doctors for a physical assessment and assistance in tailoring an appropriate plan. “Finding a degree of exertion that matches your abilities can help you stick with an exercise plan,” says Dr. Ben-Zacharia.
No specific diet has been shown to be more effective than any others for weight loss. Still, Dr. Feldman's research suggests that cutting back on saturated fat—the kind found in red meat, whole milk, and butter—is good for brain cells. In a 2016 study published in PLoS One, she and her colleagues found that when mice were fed diets high in saturated fat, they quickly became obese and their memory worsened; when returned to a normal diet, they lost girth and regained their memory. Moreover, a study by Dr. Feldman's team published in the Journal of Neuroscience in May 2021 linked saturated fat and obesity to peripheral neuropathy. She encourages patients to eat more produce, nuts, whole grains, fish, poultry, and healthy fats such as olive oil. Dr. Cheskin advises his patients to avoid buying cookies, candy, and other high-calorie snacks.
Sharing your plan to lose weight with friends and family may keep you accountable. You might even suggest that the whole family adopt healthier eating habits, says Dr. Cheskin. Joining a commercial weight-loss program also may be helpful. Programs such as WW (formerly Weight Watchers) help people change their eating behavior, which can increase weight loss and prevent regaining lost pounds, according to a 2018 report by the US Preventive Services Task Force. O'Rourke used the Noom app, which focuses on changing the way you think about food and offers personal coaching for weight management. One small 2016 study published in BMJ Open Diabetes Research & Care found that 36 adults with prediabetes who used Noom lost 7.5 percent of their body weight on average.
