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Nine medical reasons for putting on weight

Nine medical reasons for putting on weight

Most people put on weight because they eat and drink more calories than they burn through everyday movement and body functions.

But in some cases, your weight gain may be due to an underlying health condition. Here are nine medical reasons that can cause weight gain.

Underactive thyroid

An underactive thyroid (hypothyroidism) means that your thyroid gland is not producing enough thyroid hormones, which play a central role in regulating your metabolism. Although an underactive thyroid can occur at any age and in either sex, it is most common in older women. “Without enough thyroid hormone, the body’s metabolism slows down, which can lead to weight gain,” says dietitian Catherine Collins. The condition is usually treated with daily hormone-replacement tablets, called levothyroxine.

Diabetes treatment

Weight gain is a common side effect for people who take insulin to manage their diabetes. Insulin helps to control your blood sugar level. It’s not uncommon for people with longstanding diabetes to eat a diet that "matches" their insulin dose, which can mean they’re eating more than they need to in order to prevent low blood sugar – also known as hypoglycaemia or "hypo" – from developing.

“Excessive snacking to prevent a hypo contributes to an excessive calorie intake and overall weight gain,” says Collins, who recommends becoming an "expert patient" by attending a diabetes education course such as DESMOND for people with type 2 diabetes or DAFNE for type 1 diabetes, to help make your diabetes fit your lifestyle – not the other way round.

Ageing

People begin to lose modest amounts of muscle as they get older, largely because they become less active. Muscles are an efficient calorie burner, so a loss of muscle mass can mean you burn fewer calories. If you’re eating and drinking the same amount as you always have and are less physically active, this can lead to weight gain. “To reduce muscle loss, you should stay active and try to do regular muscle-strengthening exercises,” says Collins.

Steroid treatment

Steroids, also known as corticosteroids, are used to treat a variety of conditions, including asthma and arthritis. Long-term use of  corticosteroid tablets seems to increase appetite in some people, leading to weight gain. “The higher the dose and the longer you are on steroids, the more weight you are likely to put on,” says Collins. “This is because steroids make you feel hungry, affecting the areas in the brain that control feelings of hunger and satiety.”

She says that being extra careful about what you eat during your steroid course will help you not to eat more than you normally do. It’s not a good idea to reduce or stop your steroid treatment. If you’re worried about weight gain, chat to your GP about help to control your weight.

Cushing’s syndrome

Cushing's syndrome is very rare, affecting around one in 50,000 people, and is caused by high levels of the hormone cortisol. It can develop as a side effect of long-term steroid treatment (iatogenic Cushing's syndrome) or as a result of a tumour (endogenous Cushing’s syndrome). Weight gain is a common symptom, particularly on the chest, face and stomach. It occurs because cortisol causes fat to be redistributed to these areas. Depending on the cause, treatment typically involves either reducing or withdrawing the use of steroids, or surgery to remove the tumour.

Stress and low mood

People respond differently to stress, anxiety and depressed mood. Some people may lose weight, while others may gain weight. “People can turn to food as a coping mechanism,” says Collins. “It can lead to a vicious circle. Weight gain from depression can make you more depressed, which can lead to further weight gain. If you know you’re an emotional eater, you need to find other forms of distraction, such as exercise or a hobby, calling a friend, going for a walk or having a soothing bath.”

Tiredness

Some studies have shown that people who sleep less than seven hours a day may be more likely to be overweight than those who get nine hours of sleep or more. It’s not clear why, but one theory suggests that sleep-deprived people have reduced levels of leptin, the chemical that makes you feel full, and higher levels of ghrelin, the hunger-stimulating hormone. “If you’re always feeling tired, you are more likely to reach for high-calorie snacks to keep your energy levels up throughout the day and do less physical activity, which means you burn fewer calories,” says Collins.

Get tips on improving your sleep.

Fluid retention

Fluid retention (oedema) causes parts of the body to become swollen, which translates into weight gain. This gain is caused by fluid accumulating in the body. Some types of fluid retention are not uncommon – for example, if you're standing for long periods or are pre-menstrual. The swelling can occur in one particular part of the body, such as the ankles, or it can be more general.

“More severe fluid retention can also cause breathlessness,” says Collins. “If you notice that you have swollen ankles during the day, have to get up to pee overnight, and have to sleep on a few pillows to avoid breathlessness, you should see your GP, as these examples of fluid retention can indicate heart or kidney problems that need assessment.”

Polycystic ovary syndrome (PCOS) 

PCOS is a common condition that affects how a woman’s ovaries work. Symptoms can include irregular periods, trouble getting pregnant, excess hair and weight gain. The exact cause of PCOS is unknown, but it's thought to be hormone-related, including too much insulin and testosterone. “Women with PCOS typically put on weight around their waist,” says Collins. “The more weight you put on, the more insulin you produce, which causes further weight gain.” Weight loss through dietary changes and exercise, and in some cases medication such as orlistat, will help to break the cycle."

Spotting signs of child sexual abuse

Spotting signs of child sexual abuse

What is child sexual abuse?

Who commits child sexual abuse?

Which children are at risk of child sexual abuse?

What are the signs that a child is being abused?

What are the effects of child sexual abuse?

Will reporting the abuse make things worse?

How do I report child sexual abuse?

One in 20 children in the UK will experience child sexual abuse. Here are the signs to be aware of and what to do if you suspect a child is being sexually abused.

What is child sexual abuse?

Child sexual abuse is illegal in the UK and covers a range of sexual activities, including:

  • possessing images of child pornography
  • forcing a child to strip or masturbate
  • engaging in any kind of sexual activity in front of a child, including watching pornography
  • taking, downloading, viewing or distributing sexual images of children
  • encouraging a child to perform sexual acts in front of a webcam
  • not taking measures to protect a child from witnessing sexual activity or images
  • inappropriate sexual touching of a child, whether clothed or unclothed
  • penetrative sex

Both boys and girls can be victims of sexual abuse, but girls are six times more likely to be affected.

Who commits child sexual abuse?

People who sexually abuse children can be adult, adolescent or a child themselves. Most abusers are male but females sometimes abuse children too. Forty percent of child sexual abuse is carried out by other (usually older) children or young people.

Nine out of 10 children know or are related to their abuser. Eighty percent of child sex abuse happens either in the child’s home or the abuser’s. Boys are more likely to be abused outside the home, for example, at leisure and sports clubs.

“Child sex abusers often present as engaging, charming individuals,” says John Cameron, Head of Child Protection Operations at the National Society for the Prevention for Cruelty to Children (NSPCC).

“If someone wants to sexually abuse a child, they usually have to build up a relationship of trust before they go ahead. People often doubt their own eyes and ears because the abuser appears to be a decent person.”

You may notice that an abuser gives a child special treatment, offering them gifts, treats and outings. They may seek out opportunities to be alone with the child.

Which children are at risk of child sexual abuse?

Any child can be sexually abused, but there are some factors that increase the risk. Children are more vulnerable if they have already experienced abuse of some kind. Children who live in families where there is child neglect, for example, are more at risk.

Disabled children are three times more likely to be victims of sexual abuse, especially if they have difficulties with speech or language.

Children can also be at risk when using the internet. Social media, chat rooms and web forums are all used by child sex abusers to groom potential victims.

See how to protect your child from abuse.

What are the signs that a child is being abused?

Child sexual abuse can be difficult to identify. Research suggests that one in three children who are sexually abused don’t speak out about it at the time.

Children often don’t talk about the abuse because they think it is their fault or they have been convinced by their abuser that it is normal or a ‘special secret’. Children may also be bribed or threatened by their abuser, or told they won’t be believed.

A child who is being sexually abused may care for their abuser and worry about getting them into trouble.

Here are some of the signs you may notice:

Changes in behaviour – a child may start being aggressive, withdrawn, clingy, have difficulties sleeping or start wetting the bed.

Avoiding the abuser – the child may dislike or seem afraid of a particular person and try to avoid spending time alone with them.

Sexually inappropriate behaviour – children who have been abused may behave in sexually inappropriate ways or use sexually explicit language.

Physical problems – the child may develop health problems, including soreness in the genital and anal areas or sexually transmitted infections, or they may become pregnant.

Problems at school – an abused child may have difficulty concentrating and learning, and their grades may start to drop.

Giving clues – children may also drop hints and clues that the abuse is happening without revealing it outright.

What are the effects of child sexual abuse?

Sexual abuse can cause serious physical and emotional harm to children both in the short term and the long term.

In the short term children may suffer health issues, such as sexually transmitted infections, physical injuries and unwanted pregnancies.

In the long term people who have been sexually abused are more likely to suffer with depression, anxiety, eating disorders and post-traumatic stress disorder (PTSD). They are also more likely to self-harm, become involved in criminal behaviour, misuse drugs and alcohol and to commit suicide as young adults.

Children who have been sexually abused are also at risk of sexual exploitation, in which children are sometimes passed around a network of abusers for sexual purposes or are made to do sexual favours for others by their boyfriend.

See more about how to spot child sexual exploitation.

Will reporting the abuse make things worse?

Children are less likely to suffer long-term consequences from sexual abuse if they get the right help and support early. The only way this can happen is if they disclose the abuse themselves or if someone else reports it. If these things don't happen the abuse is likely to continue.

“Child sexual abuse is never a one-off,” says John Cameron. “It is often a highly addictive behaviour. Without intervention the likelihood of it stopping decreases over time.”

You may be worried that the child in question will be taken away from their parents and put into care. This could be a particular concern if you are the child’s parent.

“The last thing children’s services want to do is take children away,” says John Cameron. “What they are more likely to do is make sure the perpetrator is distanced from the child. If the father is the perpetrator, for example, he can be asked to leave the home and any further contact supervised.”

How do I report child sexual abuse?

It's best not to delay if you suspect a child is being sexually abused. “Don’t wait until you’re certain because you will be waiting forever and a day,” says John Cameron. “We all know that feeling when something isn’t quite right. If you have that sense of disquiet, trust your instincts and check it out with someone.”

You can talk directly to the police or your local children’s social services and this can be anonymous. You can also get advice or report your concerns anonymously to the NSPCC by phoning their free helpline on 0808 800 5000. Or you can report sexual abuse to the NSPCC via email or online.

If you are a health professional and suspect a child you are caring for is experiencing abuse or is at risk of abuse, you can seek advice on what to do from the ‘named nurse’ or ‘named doctor’ in your hospital or care setting.

You’ll find more information and advice about child sexual abuse on the NSPCC.

If you are concerned about your own thoughts or behaviour towards children, you can phone Stop It Now! in confidence on 0808 1000 900 or email help@stopitnow.org.uk.

If you are a child and someone is sexually abusing you, you can get help and advice from ChildLine – phone 0800 1111, calls are free and confidential.

Kellie Maloney: 'My 60-year secret'

Kellie Maloney: 'My 60-year secret'

Retired boxing promoter Kellie Maloney, formerly Frank, talks about her dreams, diaries and secret dress-ups, and why it took her 60 years to come out.

Las Vegas, November 1999. Lennox Lewis has just beaten Evander Holyfield to become Britain's first undisputed heavyweight champion of the world in more than 100 years.

After the ringside celebrations among 6,000 delirious British fans, Lewis' promoter Frank Maloney retires to his hotel room, where the darkness engulfs him.

He should be feeling on top of the world. He's just masterminded the greatest success story of British boxing in a century. It should be the crowning glory of his career.

But Frank has a secret. A secret so huge he has never been able to whisper a word of it to anyone for fear of losing everything.

It will be another 15 years before Frank reveals his lifelong secret to the world: that he is a woman trapped in a man's body.

By the time of the announcement in August 2014, Frank had been living as Kellie for a year and was preparing to have gender reassignment surgery.

One of the main reasons Kellie didn't come out earlier is because of her father, Tom, a former railway worker, who had been so proud of all his son had achieved after leaving school aged 15.

"I had his respect," she says. "He put me on a pedestal. I could never hurt him." Looking back, Kellie now believes her father's death from cancer aged 87 may have been a tipping point.

'Living with the burden any longer would have killed me'

Kellie Maloney

"I couldn't tell him, even on his death bed," she says. But his passing in 2009 meant Kellie no longer had to live up to her father's expectations. "I couldn't disappoint him anymore," she says.

Kellie had planned to complete her transformation in private, but was forced into going public after a national newspaper threatened to out her.

Buoyed by the public's positive reaction, Kellie has embraced her new-found status as Britain's most famous trans person to help raise awareness about transgender issues.

She followed a string of newspaper and TV interviews with a three-week appearance on Channel 5's Celebrity Big Brother.

'I always knew'

At 61, and after nearly 60 years of corrosive silence, she says: "Living with the burden any longer would have killed me. I always knew … from the age of three or four. I didn't know what it was, but I didn't associate with what I saw in the mirror."

But growing up in 1950s Peckham, south London, with working class Irish Catholic parents, being different was not an option.

"I just wanted to be a normal boy," she says. "In those days, you'd get called names just for having a speech impediment or having ginger hair."

So Kellie tried "extra hard to be accepted as one of the boys", dating pretty girls and getting into sports such as athletics, football and boxing.

But as hard as she tried to be a Jack the lad and fit in, deep down she still wanted to be a girl, to dress and act like them.

"I have a female brain," she says. "I knew I was different from the minute I could compare myself to other children. I wasn't in the right body. I was jealous of girls.

"If I saw a girl and she looked really nice, I'd wonder how I would look if I was wearing that. Then I'd try to distract myself and stop thinking about it."

The only place Kellie could be herself was in her dreams. "In every dream I've ever had I'm a girl," she says. "At first I used to think I was dreaming of someone else."

The childhood dreams never went away, and became more and more vivid as Kellie got older. "I was living as the real me in my dreams," she says.

She has always kept a diary, even at the height of her power and influence in the boxing world, where the suppressed Kellie could come out for some air.

"Everything you need to know about Kellie is on those pages," she says. "The diary helped me get things off my chest. It was like therapy."

Secret dress-ups

With nobody to share her secret with, Kellie found strength from reading about other people's experiences in transgender publications and websites.

She remembers reading the stories of Christine Jorgensen and April Ashley, who were among the first transsexuals to have gender reassignment surgery in the 1950s. "It just didn't seem a realistic possibility to me," she says.

To satisfy her desire to be Kellie, if only for a while, she attended private dressing up sessions in shops off high streets and down back roads in Dublin and Manchester.

"You could get a makeover for about £300 and stay there for three to four hours," she says. "For a few hours I was able to be the real me."

'Boxing was a great distraction'

Then it was back to the macho world of boxing, where Kellie had built a reputation as a hard-nosed Cockney geezer famous for wearing Union Flag suits in the ring.

"Boxing was a great way to distract myself from my thoughts," she says. "I was totally absorbed. I buried myself in my work, 24/7."

On fight nights, Kellie would sometimes leave her team in the locker room and enter the thronging arena to allow herself one little indulgence.

"I would try to imagine what it would be like to be one of those glamorous women in the audience," she says. "But I'd head back to the locker room and focus on the boxing."

Away from the boxing ring, Kellie tried to conform to what society expected. She says she genuinely found love, married twice, and has three daughters.

'I'm a woman, and my transition won't be complete until my body matches my mind'

Kellie Maloney

"I thought being in love and marrying would beat what was going on inside of my head, but the inner fight in me made it harder to keep going as the years went by," she says.

Marriage break-up

Kellie's secret was slowly tearing her apart. Struggling with depression, she began drinking heavily and tried to shut herself away from the world and her family.

"My life was spiralling out of control," she says. "I was very unhappy. My temper was getting worse."

She turned to counselling and says the help she received over the phone and in face-to-face sessions over the last 12 years "has helped me enormously to come to terms with myself".

She recalls having an angry exchange with one counsellor. "All I wanted was for him to tell me that I wasn't transgender, but he said I needed to accept myself if I want to live a normal life."

Kellie is still in touch with some of the organisations that helped her, including transgender support group TG Pals, and is keen to support their work.

Her father's death, the suicide of boxer Darren Sutherland, and her own health – she had a heart attack watching a boxing match – all weighed heavily on her decision to reveal all to her wife in 2009.

"Tracey was the first person I had told outside counsellors," she says. "She swore she would never tell anyone. She would've taken my secret to the grave to protect our girls."

The couple tried in vain to rekindle their relationship. Following the breakdown of their marriage, Kellie tried to take her own life on Christmas Day in 2012 – her second attempt in recent years.

"It got to a point where I just couldn't cope any longer," she says. "I couldn't go on, and I had to start living the life of the person I should've been born as."

She revealed all to the rest of her family before the story went public. After the shock and tears, they have mostly come out in support of her, although her daughters are unlikely to stop calling her "Dad".

"I can't say enough about my 81-year-old mother," she says. "She told me that she had always known I was different from my brothers and that at last she could see why.

"I think it stems from her that the family has accepted it, because she made the point of telling them. Their support has given me the confidence to go out in the world and be myself."

Gender surgery and identity

Over the past two years, Kellie has received hormone therapy, hair removal electrolysis, voice coaching and specialist counselling.

The final phase of her transformation will involve "the realignment of my male genitalia to become female genitalia", as well as having breast implants and facial surgery – all done privately.

She says her transition was about gender identity and not about sexual orientation.

Why the name Kellie? "It's always been Kellie," she says. "It's short and sweet. I'm dyslexic and Kellie is easy to pronounce and spell."

"Until I have the operation I feel like half a person," she says. "I'm a woman and my transition won't be complete until my body matches my mind," she says.

"I don't want to be labelled," she says. "I'm not a transsexual woman. I'm a human being. All that is being done is to correct a mistake at birth."

And where's Frank? "Frank is still a part of me, but the roles have been reversed," she says. "Kellie used to be a small part of Frank, but now Frank is a small part of Kellie."

Cannabis: the facts

Cannabis: the facts

Cannabis is the most widely used illegal drug in the UK, although its use in recent years has fallen.

The proportion of 11-15 year olds in England who had used cannabis in the last year fell from 13.3% in 2003 to 7% in 2013. The proportion of 16-59 year olds using cannabis in the last year has fallen from 10.6% in 2003-04 to 6.6% in 2013-14.

How cannabis makes you feel

The effects of cannabis vary from person to person:

  • some people may feel chilled out, relaxed and happy
  • others get the giggles or become more talkative
  • hunger pangs are common – this is sometimes known as "getting the munchies"
  • you may become more aware of your senses – colours may look more intense and music may sound better
  • it’s common to feel as though time is slowing down

Cannabis can have other effects too:

  • it makes some people feel faint and/or sick – this is sometimes known as a "whitey"
  • it can make you feel sleepy and lethargic
  • some people find it affects their memory, making it harder to remember things
  • it makes some people feel confused, anxious or paranoid, and some experience  panic attacks and hallucinations. These effects are particularly common with stronger forms of cannabis, such as skunk and sinsemilla

If you use cannabis regularly it can make you demotivated and uninterested in other things going on in your life, such as education or work. Long-term use can affect your ability to learn and to concentrate.

Can you get addicted to cannabis?

In the past cannabis wasn’t thought to be addictive. However, research has shown that it can be addictive, particularly if you have been using it regularly for quite a while. About 10% of regular cannabis users are thought to become dependent.

As with other addictive drugs such as cocaine and heroin, you can develop a tolerance to it. This means you have to have more and more to get the same effects. If you stop taking it, you can experience withdrawal symptoms, such as cravings, difficulty sleeping, mood swings, irritability and restlessness.

If you regularly smoke cannabis with tobacco, you’re likely to get addicted to nicotine and may develop tobacco-related illnesses, such as cancer and coronary heart disease. If you cut down or give up, you will experience withdrawal from nicotine as well as cannabis.

See tips for  stopping smoking.

Risks of smoking tobacco

Smoking cannabis with tobacco can raise your risk of tobacco-related illnesses, including:

See tips to stopping smoking.

Risks associated with cannabis

Recent research has helped us better understand the health risks from using cannabis. We know that:

  • Cannabis affects your ability to drive. This is one of the reasons why drug driving, like drink driving, is illegal. One French study found that drivers who had been using cannabis were more than twice as likely to cause a fatal car crash.
  • If you smoke it, cannabis can be harmful to your lungs. Like tobacco, it contains cancer-causing chemicals (carcinogens) that increase your risk of lung cancer. It can also make  asthma worse, and cause wheezing in people without asthma. If you mix cannabis with tobacco and smoke it, the risks to your lungs are higher.
  • Cannabis can harm your mental health. Regular use is associated with an increased risk of developing a psychotic illness, such as schizophrenia. A psychotic illness is one where you experience hallucinations (when you see things that aren’t really there) and delusions (when you believe things that aren’t really true). Your risk of developing a psychotic illness is higher if you start using cannabis in your teens and if you have a family history of mental illness. Cannabis use has also been shown to increase the risk of a relapse in people who have schizophrenia, and could make existing symptoms worse.
  • Cannabis may affect your fertility. Research done in animals suggests that cannabis can disrupt sperm production in males and ovulation in females.
  • If you are pregnant, cannabis may harm your unborn baby. Research suggests that using cannabis during pregnancy could affect your baby's brain development. Regularly smoking cannabis with tobacco is associated with an increased risk of your baby being born small or premature.

Does my age affect my risks?

The risks linked to using cannabis do seem to be higher for people who use it regularly from an early age, including the risk of developing a mental illness.

It’s not clear why the risks are higher for people who start using cannabis when young. It may be linked to the fact that, during the teenage years, the brain is still forming its connections and cannabis interferes with this process.

Does cannabis have medicinal benefits?

Herbal cannabis contains many different compounds, called cannabinoids, which have different effects. One of these cannabinoids – tetrahydrocannabinol, or THC for short – is the active ingredient of a prescribed drug called Sativex. Currently this is only licensed in the UK as a treatment to relieve the pain of muscle spasms in multiple sclerosis.

Further research is under way to test the effectiveness of cannabis-based drugs for a range of other conditions including the eye disease glaucoma, appetite loss in people with HIV or AIDS, epilepsy in children and pain associated with cancer. We won’t know whether or not these treatments are effective until trials have concluded.

See more on clinical trials involving cannabis

Does cannabis lead to other drugs?

While most people who use harder drugs like heroin have used cannabis, only a small proportion of people who use cannabis go on to use hard drugs. However, buying cannabis brings you into contact with the illegal drugs trade, making it more likely that you will be exposed to other drugs.

Where can I get more information about cannabis?

You’ll find more information about cannabis in the Frank website’s A-Z of drugs.

If you need support with giving up cannabis, you’ll find sources of help in Drugs: where to get help.

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