Last month, pop star and actor Selena Gomez posted a video where she explained that the medication she takes for lupus causes her weight to fluctuate.
Speaking on TikTok live, the 30-year-old responded to those bodyshaming her online by saying: “When I’m taking it, I tend to hold a lot of water weight, and that happens very normally. When I’m off of it, I tend to kind of lose weight.” The “Only Murders in the Building” star added that she’s “not a model” and “never will be.”
Gomez didn’t specify what medication she takes in her TikTok video, but Mithu Maheswaranathan, a rheumatologist at Duke University School of Medicine, says Gomez could be talking about the steroid prednisone.
“Prednisone is a common medication used to treat internal organ complications of lupus, but has side effects of weight gain and water retention, or retaining extra fluid,” he told HuffPost.
In a podcast interview in 2019, Gomez talked generally about her medication and how disarming it can be to have people commenting about her face swelling or changes to her body.
“It’s the medication I have to take for the rest of my life — it depends on even the month, to be honest,” she said. “So for me, I really noticed when people started attacking me for that. And in reality, that’s just my truth. I fluctuate. It depends what’s happening in my life.”
For those who’ve experienced weight fluctuation as a side effect of a medication, it’s been painful to watch Gomez not only endure criticism for her weight gain but also feel as though she has to answer for it.
“Looking at it as someone whose body has changed in similar ways, the comments I see about Selena are echoing negative thoughts I’ve already had about my own condition,” said Gabriela, a 23-year-old who’s currently on prednisolone oral steroid tablets for an autoimmune skin condition she has. (Gabriela, like many in this story, asked to use only her first name for privacy while talking about her medical condition.)
When online commenters asked, “What happened to her face?” after Gomez appeared on the red carpet of the 2023 Golden Globes in January, Gabriela instinctually thought of her own face.
“My face is currently a very similar, ‘moon face’ shape, and it’s the part I’ve struggled with the most, as it’s the first thing people recognize you by,” she said.
“With my body, I went from a size small to finding large-sized clothes a squeeze; it’s a known side effect of the medication, but I was surprised by how sudden it was,” said Gabriela, who’s been on steroids since September.
“Struggling with chronic illnesses and mental health issues is hard enough, but it feels like an additional curse to have to choose between the medication and their self-image.”
What makes things worse is how superficial she feels complaining about a medication that’s ultimately keeping her healthy.
“It’s difficult because I was keen to get on this medication in the first place, as the condition that it’s treating was seriously impacting my quality of life and had the potential to be fatal if left untreated,” she said. “I felt ungrateful to now be cursing it for making me gain weight.”
The bind Gabriela found herself in ― appreciating that her medication is stabilizing her condition while also feeling perturbed by her weight fluctuation ― is a common experience.
Many medications used for chronic illnesses― steroids, antidepressants, epilepsy medications ― are linked with weight gain. (Plus, with many chronic health issues, you might not have the energy to be as active as you’d like to be.)
For women especially, it can feel like an impossible uphill battle to follow society’s rigid beauty standards. The mental math of comparing the risks and benefits of a new medication can be exhausting, said Tracey Marks, a psychiatrist and the founder of the Mental Wellness Space.
“Some patients will get on and off medications, like yo-yo dieting, to get some benefit from the medications even if it’s only for a short time,” she told HuffPost. “Others will feel resigned not to take anything and feel ill because they don’t want to hate looking at themselves,” she said.
Sometimes, clients are just so relieved to receive a clear diagnosis after years of symptoms that the changes to their bodies are less bothersome, said Tanya B. Freirich, a registered dietitian nutritionist who specializes in helping people manage their lupus symptoms.
In a viral HuffPost essay last year, writer Olivia Campbell wrote of her own antidepressant-induced weight gain. The way she looked at it, she was trading thinness for fulfillment. “Being fat and happy is so much better than being thin and miserable,” she wrote.
That’s an admirable, worthy way of looking at it, but getting to that place mentally can take time, Marks said. “Struggling with chronic illnesses and mental health issues is hard enough, but it feels like an additional curse to have to choose between the medication and their self-image.”
Kendra, 22, started Lexapro, a SSRI prescribed for depression and anxiety, back in 2019. She stayed on it for roughly two years. In that time, she gained 15 to 20 pounds ― something that took her aback since her doctor never informed her of the potential side effect.
“I later found out that Lexapro in particular had the potential for weight gain. I was also prescribed Remeron as needed, which caused weight gain, as well,” she told HuffPost.
Given Kendra’s long history with body image issues, dealing with that particular side effect wasn’t easy. “It was a conflicting feeling because the meds did really help with my depression and anxiety, but I wanted to go back to my ‘normal’ weight more than I wanted to be ‘cured,’ almost,” she said.
Having an unsympathetic psychiatrist made everything worse. “It felt like she was gaslighting me by saying it was ‘hardly any weight gain,’ or that the ’benefits were more significant,” Kendra said. “She basically minimized my experience.”
Freirch said it’s not uncommon for doctors to underestimate body image concerns. “Side effects of medications that interfere with one’s daily life or mental health for any reason should all be taken seriously,” she said. “In the case of lupus, if someone is suffering from stress or anxiety related to their body image, it could be enough to trigger an autoimmune flare on its own.”
Doctors should be willing to have those open and empathetic conversations with their patients. But it also may take a little inside work for people to come to terms with weight fluctuation. Below, Freirich and other experts share how to come to terms with those changes and get closer to body neutrality.
Focus on the positive of the medications.
As much as possible, reflect on the positives of the medication: Maybe your autoimmune disease symptoms are improving or your depression or anxiety feel less heavy.
And recognize that repairing your relationship with your body takes time and patience. “It will not happen overnight. It takes hard work to unravel and unlearn a lifetime’s worth of conditioning and toxic beauty ideals,” said Jessica Sprengle, a licensed professional therapist who specializes in treating eating disorders.
Don’t feel guilty if you feel conflicted about your medication.
These changes to your body often have big emotions attached: frustration, grief, sadness or anger that the reflection in the mirror no longer looks like who you remember. You also may be stressed to have such a visible reminder of your illness, Freirich said.
“It can worsen further when someone’s appearance changes enough that they have to field questions from family, friends or acquaintances,” she said.
Given all that, you’re not overreacting or being petty to feel concern about this. Allow yourself to feel these emotions.
Don’t go off the medication cold turkey.
It’s your decision how you treat your disorder. Doctors are there to guide you, but it’s still your decision how many side effects you’re willing to tolerate. That said, as demoralized as you may get, if you’re stopping your medication, it’s important to plan for your withdrawal.
“Get your doctor to help you wean off because some medication can have rebound withdrawal effects if you suddenly discontinue,” Marks said.
Ask your doctor if there are any alternatives to the medication you’re taking.
You should feel comfortable talking to them about any side effects, including how your medication is impacting your body, Maheswaranathan said.
“In the case of taking steroids, your doctor may be able to work with you on finding ‘steroid-sparing’ medications that can treat the underlying problem with much less side effects,” he said.
Some cases may require long-term use of steroids like prednisone, but working with your doctor will help ensure you’re getting the best treatment in combination with the best quality of life.
In the case of treating depression, figuring out the right treatment for your mental health can take time and patience, but there’s quite a few options on the market. “Keep shopping around until you find one that best suits you,” Kendra, who started taking Wellbutrin and duloxetine for her own depression.
If you’ve advocated for yourself and feel that your doctor is continuing to dismiss your concerns, it may be time to find a new doctor who is willing to listen, Freirich said.
Connect with a therapist or mental health provider who is body-inclusive.
Learning to love your body is an inside job, but it doesn’t hurt to have the support of someone keyed into the body neutrality movement.
“If you have access, try to connect with a body inclusive, eating disorder-informed, Health at Every Size (HAES)-informed therapist who can help you navigate the process of becoming body neutral,” Sprengle said.
Unfortunately, the mental health field is ripe with wellness and diet culture, so be careful and look for someone who’s informed and won’t cause more harm, Sprengle said.
Don’t cling to your old wardrobe.
In the spirit of accepting your new image, make sure your closet has options you feel comfortable and confident in. “Holding on to tight, ill-fitting clothes is a painful reminder of the body you used to have,” Marks said. “Also continue to nurture other aspects of your appearance that you can control, like your hair, makeup and skin care.”
Looking to add some new additions to your wardrobe without breaking the bank? We wrote a guide for that.
Think of your body as a useful instrument, not an ornament.
The toxic messaging that’s sent when someone as high-profile as Gomez gets bullied and feels obligated to explain her weight gain is clear: Our worth is tethered to our appearance.
Remind yourself that bodies are meant to be functional, allowing us to do so many wonderful things, said Holly Willis, a nurse practitioner at the eating disorder treatment center Renfrew Center in Atlanta.
“I find it helpful to really ask yourself where the messages about what your body ‘should’ look like are coming from and if the source of these messages aligns with your values,” Willis told HuffPost. “All too often, gender roles based in a patriarchal world dictate the ideal male and female form in a very stereotypical way.”
Marks added that self-loathing often happens when you take your hatred of your body and generalize it to your entire being. “But if you spend time doing things that give you pleasure or exploit your strengths, you can appreciate your worth on a different level,” she said.
Lastly, a reminder for everyone: If you’re thinking of commenting about somebody’s weight, save it.
Weight gain happens for myriad reasons: Chronic illness, medication changes, lifestyle changes like pregnancy and aging. (What’s more, someone’s BMI is not a very accurate measurement for determining whether they’re healthy.)
Ultimately, the reasons someone has gained weight are none of your business.
“When you compliment weight loss, you might be complimenting someone’s eating disorder, or a recent health diagnosis that has compromised the person’s quality of life,” Sprengle said. “When you shame someone for weight gain, you may be shaming a body they’ve fought hard to take good care of. ... Keep it to yourself!”