Do Proton Pump Inhibitors Like Omeprazole Cause Weight Gain? Here’s What You Should Know
Key takeaways:
Proton pump inhibitors (PPIs) are medications used to treat gastroesophageal reflux disease (GERD). They work by lowering the amount of acid your stomach makes.
Although rare, PPIs have been reported to cause weight gain. This may be more likely to happen with long-term use. But it hasn’t been clearly proven.
Avoiding food right before bedtime and exercising often can help you maintain a healthy weight. These lifestyle changes can also lessen GERD symptoms.
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If you experience chronic acid reflux, you may reach for a proton pump inhibitor (PPI) to manage your symptoms.
PPIs are among the top 10 most prescribed medications in the U.S. They’re often the first-choice medications for gastroesophageal reflux disease (GERD). PPIs work by lowering the amount of acid your stomach makes.
Like all medications, PPIs can cause side effects. You may have heard about one in particular — weight gain. Read on to find out if you should be concerned about weight gain if you’re taking a PPI, and what you can do to prevent it.
What medications are PPIs?
You’ve likely come across PPIs while browsing the aisles of your local pharmacy. Some PPIs are available over the counter (OTC), while others are prescription only.
Here’s a chart of the currently available OTC and prescription PPIs.
| Prescription | OTC |
|---|---|
| Omeprazole (Prilosec) | Omeprazole (Prilosec OTC) |
| Esomeprazole (Nexium) | Esomeprazole (Nexium 24HR) |
| Lansoprazole (Prevacid) | Lansoprazole (Prevacid 24HR) |
| Dexlansoprazole (Dexilant) | Omeprazole/sodium bicarbonate (Zegerid) |
| Rabeprazole (Aciphex) | |
| Pantoprazole (Protonix) | |
| Omeprazole/sodium bicarbonate (Zegerid) |
Do PPIs cause weight gain?
They might. PPIs have been reported to cause weight gain. That being said, weight gain isn’t a common side effect. It also seems to be more likely when you take PPIs long term.
One study found that long-term use of omeprazole, rabeprazole, or lansoprazole was associated with weight gain.
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Study participants were divided into two groups: people with GERD treated with PPIs and people without GERD. Those taking PPIs used them for an average of 2 years. Both body weight and body mass index (BMI) went up in the group taking PPIs.
In fact, over one-third of the people taking PPIs experienced a more than 5% increase in baseline body weight — an average of about 7.5 lbs (3.5 kg). Only 4% of the people without GERD had an increase in body weight.
Another study of over 3,000 people found that men taking PPIs experienced more weight gain (about 3 lbs more) compared to men who weren’t taking PPIs. But women taking PPIs didn’t gain more weight than women not taking PPIs.
Food intake and physical activities levels were similar among all study participants. But it’s important to note that body weights were self-reported in this study and weren’t confirmed by researchers.
While these studies may make it seem likely that PPIs cause weight gain, there are some important points to consider:
GERD itself is associated with greater body weight. Neither of these studies compared people with GERD taking PPIs to people with GERD not taking PPIs. So, it’s unclear whether the weight gain in the PPI group is actually due to the PPI or the disease it’s treating.
Not all studies show weight gain from PPIs. A study from 2016 found that taking PPIs had no significant effect on weight in people taking them for at least 1 year.
Why might PPIs make you gain weight?
Although the exact cause is unknown, there are a couple of theories about why PPIs could make you gain weight:
PPIs may change the bacteria in your gut. One study reported that people who had gastric bypass surgery (weight loss surgery) seemed to have a harder time losing weight if they were taking a PPI. The main type of gut bacteria in PPI users was different than in non-users. This was the main difference between the two groups of people. It was also thought to be the reason that people taking PPIs had a harder time losing weight. But this theory has yet to be proven.
PPIs may make it easier to eat more. People who experience heartburn and GERD may have trouble finishing large meals or certain foods. Doing so may make their symptoms worse. However, once a PPI relieves these symptoms, people may be able to eat a larger amount and variety of food. This may lead to weight gain. Again, this is only a theory and hasn’t been proven to be true. But it’s good to be mindful of this possibility if you’re taking a PPI and concerned about weight gain.
How can you manage weight gain from PPIs?
You shouldn’t use any OTC PPIs for longer than 2 weeks without talking to a healthcare provider.
With prescription PPIs, try to limit use to 8 weeks or less when possible. This may help prevent weight gain and other possible side effects. But if you’ve been taking a PPI for 8 weeks and don’t feel any better, talk to your healthcare provider.
Many of the tips for relieving GERD symptoms can also be helpful for managing your weight:
Avoid meals 2 to 3 hours before bedtime.
Avoid smoking or other tobacco products.
Avoid high-fat and spicy foods.
Drink water instead of coffee, tea, or soda.
It might also be a good idea to maintain a regular exercise routine and follow a healthy diet if you aren’t already.
In fact, a study showed that a drop of 5% to 10% of body weight in women and 10% of body weight in men may help lessen GERD symptoms. Lowering your body weight may also help you lower your dose of your PPI or stop taking it altogether.
Always reach out to your healthcare provider before you stop taking your PPI. They may want to help you slowly lower your dose before stopping it to prevent an “acid rebound” effect (a return of GERD symptoms due to a rapid rise in stomach acid levels).
Are there alternatives to PPIs that don’t cause weight gain?
Histamine-2 antagonists (H2 blockers) are another class of acid-reducing medications that can help manage conditions like GERD. Examples of H2 blockers include famotidine (Pepcid AC, Zantac 360) and nizatidine. They haven’t been reported to cause weight gain.
But keep in mind that H2 blockers aren’t usually as effective as PPIs for managing conditions like GERD. Talk to your healthcare provider or pharmacist about the best option for your needs.
The bottom line
PPIs are effective medications for managing conditions like GERD. There are reports of PPIs causing weight gain, especially with long-term use. But this is still considered a rare side effect.
Following a healthy diet and exercise routine can help manage weight gain as well as lessen the symptoms of GERD. And don’t take a PPI longer than recommended without your healthcare provider’s OK. Long-term use of PPIs may be more likely to cause side effects like weight gain.
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References
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