By Lindsey Getz
When clients and patients begin eating a gluten-free diet because of a celiac disease or gluten-sensitivity diagnosis, chances are they’ll begin to gain weight.
According to research by Daniel Leffler, MD, MS, an international authority on celiac disease and assistant professor of medicine at Harvard Medical School, the closer people adhere to a gluten-free diet, the more likely they are to gain weight. This can put added stress on a recent gluten-free foods convert, which is a good reason to begin counseling celiac and gluten-sensitive patients about weight management immediately after their diagnosis and for the long term.
There are several reasons why people who begin eating gluten-free foods gain weight. Better absorption of nutrients and calories is a key reason, says Amy Jones, MS, RD, LD, chief clinical dietitian and celiac support group facilitator at Mary Rutan Hospital in Bellefontaine, Ohio. “Though in the past they haven’t been able to absorb well, now they’re absorbing more calories,” she says. “Plus, if they had diarrhea or decreased intake for so long, it’s no doubt that they’re going to start eating more when they start feeling better.”
Certain gluten-free products are another contributing factor to weight gain, as the growing variety of prepackaged, processed foods isn’t always the best choice. “Now that we have an ample supply of gluten-free foods on the market, we’re seeing extended weight gain,” says Rachel Begun, MS, RDN, a gluten-free lifestyle expert and spokesperson for the Academy of Nutrition and Dietetics. “Many gluten-free products are high in calories, fat, and sugar while also being low in nutrients. When people go gluten free and eat too much of these highly processed, low-nutrient foods they’re likely to gain weight. There’s also a ‘health halo’ surrounding gluten-free right now. It’s important that consumers understand that just because something is gluten free doesn’t necessarily mean it’s healthful or is a good option for weight loss.”
Because patients may have been able to eat whatever they wanted because of poor calorie or nutrient absorption before their diagnosis, it’s common for them to experience what’s called portion distortion once they go gluten free. “As one of the patients in my support group put it, she was renting her food instead of absorbing it,” Jones says. “The attitude of portion size is automatically distorted because the individual is used to eating whatever they want in any amount.”
Given these facts, it’s important for patients’ success to teach them how to maintain a healthful weight after switching to a gluten-free diet. Discouragement as a result of gaining weight is a common reason many patients stop following the diet. “It’s so important to prepare the patient for that almost-inevitable weight gain,” Jones says. “I make sure patients know it’s not that they’re doing something wrong and point out that it’s a measure of healing. While weight gain can be uncomfortable for most people, it means they’re doing pretty well on the new diet. I try to put it in a positive light.”
In addition, Jones discusses weight management techniques with her patients. “I’m a big believer in mindful eating,” she says. “Simple things like not having food out and available, using small plates, and not eating while watching TV all work.”
Begun adds that a diet rich in highly processed gluten-free foods isn’t ideal for either healing the body or achieving a healthful weight. She encourages patients to eat whole, nutrient-rich foods. “Nutrient deficiencies also are common with a celiac diagnosis, so patients need to work with a dietitian to tailor a diet rich in the nutrients their body is lacking,” she says.
Since most people snack, suggest good choices such as Greek yogurt and fruit, dried fruit and nuts, 100% corn tortilla chips and salsa, peanut or almond butter on apple slices, or hummus and veggie sticks, Begun says.
Of course, physical activity also is critical to weight maintenance. “Finding something you love and enjoy such as walking is incredibly helpful,” Jones adds. “I like pedometers because they remind you to be more active. It’s important to be active throughout the day. I’m a big proponent of six 5-minute walks throughout the day compared to one 30-minute walk.”
Helping clients set realistic expectations is important as RDs counsel patients, Jones continues. “It’s not uncommon for patients to get frustrated if they’re not losing weight fast enough, so they definitely need encouragement—particularly so that they stick with the diet.”
— Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.
