How to Safely Lose Weight on HIV Treatment

Antiretroviral therapy (ART) can keep you healthy. And weight gain can be a sign your treatment is working. But it’s possible for people to pack on too many pounds when they’re in treatment for HIV. That could lead to excess weight, obesity, or other health problems. That might leave you wondering about the safest way to lose weight.

John Koethe, MD, assistant professor in the division of infectious diseases at Vanderbilt University, says there’s ongoing research into this kind of treatment-related weight gain. He says researchers are trying to figure out the best drug regimens to counter the effects. But we don’t have answers yet.

For now, Koethe says the weight loss guidelines for people with HIV and treatment-related weight gain are the same as those for anyone else. “The mainstay being high fiber, low fat, and portion control, along with adequate exercise,” he says. 

Studies show that a balanced diet, along with physical activity, can be good for people with HIV. So talk to your doctor about your weight gain. They can set you up with a registered dietitian who works with people living with HIV.

Here are some tips they might give you.

Change Your Diet

There isn’t a specific food that’ll help you lose weight. But a healthy diet pattern can boost your odds of success. And good nutrition isn’t just important for your waistline. It’ll support your immune system and help your ART work better, says Lauri Wright PhD, chair of the University of North Florida Department of nutrition and dietetics.

Kristen Matthews, a registered dietitian who works with people who have HIV at the Vanderbilt Comprehensive Care Clinic, agrees that a balanced diet will put you on the right track. But you don’t have to make big changes all at once. “Pick one goal that’s doable,” she says. “Even the smallest thing can make a big impact.”

Here are some of their tips:

Eat a variety of fruits and vegetables. Fiber, vitamins, and minerals can support both weight loss and your immune system. Aim for at least 4-5 servings a day. But that’s just a minimum. “The more plants, the better,” Matthews says.

It’s OK to stock up on canned or frozen fruits and veggies. They’re just as nutritious as the fresh stuff, Matthews says, and they won’t go bad as fast. Plus, they might be cheaper. Just look for the kind without added sodium or sugar.

Add healthy protein to each meal. You need this nutrient for cell function and muscle growth. But it’s best to avoid high-fat animal-based choices, such as full-fat dairy and red or processed meat. Instead, add more of the following:

• Skinless poultry and fish
• Low-fat dairy
• Lean meats
• Nuts or beans
• Soy-based foods, such as tofu or tempeh

Eat certain foods together. Carbs trigger the release of glucose, or sugar. If you don’t use it all, your body can store extra glucose as belly fat. But you can lessen this blood sugar spike if you pair carbs with protein, healthy fats, or fiber.

This kind of “food pairing” can help you turn glucose into energy “a little bit better, and prevent fat gain in the central region,” Matthews says.

Here are some examples:

• Apple and peanut butter or low-fat cheese
• Berries and a handful of nuts, such as almonds or walnuts
• Granola bar and a hard-boiled egg

Control your portion sizes. It can be easy to indulge in too much of even a good thing. This is especially true when you eat out. Restaurants and food companies often give you way more food than you need. That makes it really easy to take in too many calories by accident. Visit ChooseMyPlate.gov for more info on how to get the right portions.

Tell your doctor if you can’t afford healthy foods. They can point you toward local or national groups that offer financial aid. Visit USA.gov/food-help for more information on food assistance.

Skip Sugary Drinks

One of the first changes Matthews asks people to make is to give up soda. She knows that this can be hard. But it “doesn’t require too much spending or a major lifestyle change, but it can make one of the biggest impacts on weight,” she says.

Other drinks to limit or avoid include the following:

• Fruit juices
• Sweetened waters
• Coffee or tea with added sugar
• Energy or sports drinks

Try to drink more water. Add berries or slices of lemon, lime, or cucumber for flavor. Mix in some unsweetened sparkling water to get back some of that fizz. 

Get Enough Exercise

Studies show physical activity alone isn’t the key to weight loss. But it can help prevent weight gain and strengthen your muscles. That can go a long way to lessen unhealthy body fat. “You’re going to see the most body composition changes with exercise,” Matthews says.

Aim for 150 to 300 minutes of moderate to vigorous physical activity a week. That’s about 30 to 60 minutes a day.

Add in a couple of days of strength training each week. And don’t worry if you don’t have dumbbells at home. Matthews suggest 20 minutes of bodyweight exercises, such as:

• Push-ups
• Wall sits
• Squats

Want some added resistance? Find some things around your house to lift. Matthews says she got creative when she couldn’t go to the gym during the COVID-19 pandemic. “I filled up an empty detergent bottle with water and just used that to curl.”

Take Notes

You might lose weight faster if you keep track of your progress. Jot down your physical activity and all the foods you eat. Take this info to your doctor or dietitian. They can help you tweak your goals along the way.

Manage Stomach Symptoms

You might get nausea, diarrhea, or other digestive issues from time to time during your treatment. It can be hard to eat healthy when you don’t feel well. Don’t reach for junk food. Here are some of Wright’s tips to stay on track:

• Eat small meals more often to ease nausea and bloating.
• Eat nutrient-dense foods, such as avocados, nuts, or eggs.
• Keep notes on which foods make you sick.
• Avoid sugary or fatty foods.

Manage Stress and Sleep

Ongoing stress can raise your cortisol levels. That’s a hormone linked to increased hunger, belly fat, and obesity. A lack of sleep — less than 7 to 9 hours a night — can do a similar thing. Tell your health care team if you have trouble sleeping or managing your stress. You can make some behavioral changes to improve both. They’ll set you up with a specialist who can teach you how.

 “Life is crazy, and it’s not always going to be stress-free with perfect sleep,” Matthews says. “But it’s important to prioritize those things if weight loss is your goal.”

Talk to Your Doctor

If lifestyle changes aren’t enough, your doctor might switch you to a different drug. They’ll look at your overall health before they make the change. Be honest about your diet and exercise habits. Your health care team will need the right info to make the best choice for your health.