How to Maintain a Healthy Weight When You Have Multiple Sclerosis

It can be challenging for anyone to follow a healthy lifestyle that supports a healthy body weight — eating nutritious foods, engaging in physical activity, and getting enough restorative sleep. For many people with multiple sclerosis (MS), these lifestyle measures can be even more difficult.

Still, it’s important to take whatever steps you can to maintain a healthy body weight when you have MS. Here’s what you should know about the steps you can take in that direction.

Maintaining a healthy body weight is especially important for people with MS, for a number of reasons.

“Maintaining a healthy weight is critical to reduce the risk of secondary progression or worsening of disability [in people with MS],” says Elena Grebenciucova, MD, a neurologist and MS specialist at Northwestern Medicine in Chicago.

If you have excess body weight, losing weight can also lead to improvements in function and quality of life. “Many of my patients note that when they lose weight, it is easier to move around, because their muscles don’t have to work as hard,” says Gloria Hou, MD, a rehabilitation medicine specialist and codirector of the UW Medicine Multiple Sclerosis Center in Seattle.

But Dr. Hou cautions against drastically reducing food consumption to lose weight if you have MS. “With inadequate caloric intake, the body tends to break down muscles for energy,” she says. “It is very important to take in sufficient nutrition to keep the muscles strong.”

While being underweight is a less common concern for people with MS than being overweight or having obesity, it can also be harmful. “If there’s insufficient muscle, people can become weaker much faster,” says Grebenciucova. With the widespread use of GLP-1s and other newer weight loss drugs, she says, there is also a risk that people with obesity who lose large amounts of weight could experience overall health benefits but also become weaker due to loss of muscle along with fatty tissue.

If you have any concerns about your body weight and how it may be affecting your MS, don’t hesitate to bring it up at your next regular doctor’s appointment — whether that appointment is with your primary care doctor or a neurologist.

“Not enough neurologists are bringing up weight as an issue,” says Grebenciucova. “I think there has been a reliance on primary care doctors to manage weight, but it’s our responsibility as neurologists to talk about weight as a risk factor for progression of multiple sclerosis.”

Depending on your needs and concerns, your doctor may be able to help you in several ways, Grebenciucova says, including:

• Referring you to a physical therapist for a personalized exercise plan
• Referring you to a physical medicine doctor to evaluate your physical limitations
• Offering advice on diet and exercise
• Discussing or prescribing weight loss strategies

Many medical centers offer weight management clinics that use a variety of strategies to help people lose weight in a healthy way — including access to structured exercise programs, dietitians, and weight loss drugs when appropriate, says Christopher Lock, MD, a neurologist and MS specialist at Stanford Health Care in Palo Alto, California.

While GLP-1 drugs were developed to treat diabetes and obesity, “These drugs are now being tested for neuroprotective and anti-inflammatory effects in MS and other neurologic conditions,” says Dr. Lock. Generally, he says, real-world experience shows that people with MS tend to tolerate these drugs well, with no increase in disease activity.

Hou notes that doctors and nutritionists can offer evidence-based dietary advice, helping you lose weight while maintaining a healthy, varied diet. Physical therapists can help with issues that could be making it more difficult for you to exercise, such as improving your strength, balance, flexibility, and gait.

“It has been shown that working with a physical therapist or coach is motivating, and people tend to make greater gains in fitness when working with a specialist,” says Hou, adding that rehabilitation psychologists can help with mental barriers that often affect people with fatigue or physical limitations.

Following a healthy diet can be a challenge for anyone, but having limited mobility or fatigue can make this even more of a challenge for people with MS. Rather than cooking for yourself or assembling a healthy array of foods, it can be much easier to rely on snacks or restaurant food.

“Eating at home is typically much healthier than eating out,” says Hou, even though it involves more work. But, she says, “There are also relatively easier ways to prepare meals, such as batch cooking food, cooking more on weekends, or splitting food prep up to help manage fatigue.”

The following tips may help with healthy eating at home, Hou says:

• Cook food in batches for multiple meals, such as roasting vegetables on a sheet pan or using a pressure cooker or slow cooker.
• Find an easy “go-to” healthy meal that you can make even when you’re low on energy.
• Replace refined grains and pasta with higher-fiber alternatives, like brown rice or pasta made from whole grains, beans, chickpeas, or lentils.
• Keep fruits or other fresh, healthy foods visible in your kitchen, so that you remember to reach for them instead of unhealthy snacks.

A number of food items or ingredients can be helpful for meal preparation or healthy snacking, including:

• Prechopped vegetables and prewashed greens, such as spinach and kale
• Fruits that take minimal preparation before eating, such as apples, pears, bananas, and berries
• Canned beans, fish, poultry, and meat
• Precooked rice and other grains
• Healthy snacks like hummus, baby carrots, unsweetened yogurt, whole-grain crackers, nuts and seeds, and string cheese

When it comes to following an overall healthy eating pattern, “We recommend the Mediterranean diet, which is well supported to help manage weight and vascular risk factors [and is fairly easy to follow],” says Andrew Wolf, MD, a neurologist at the Rocky Mountain MS Center at UCHealth University of Colorado Hospital in Aurora.

“It is important for patients to realize that they don’t have to be perfect about following a diet. Benefits are seen with long-term practices,” says Dr. Wolf. He notes that while there are different definitions of the Mediterranean diet, it generally means eating lots of whole fruits and vegetables, as well as plenty of whole grains, along with moderate amounts of lean meat and fish.

Staying active with MS can be especially challenging if you have physical limitations or often experience fatigue. It’s usually a good idea to start with a small increase in daily activity, then work up to a higher activity level over time.

Grebenciucova says that while it’s generally recommended that people get 150 minutes of weekly aerobic activity for overall health, “You can build up from 15 minutes each day” to reach “30 minutes, five times a week, or however you want to split it.” If you have mobility issues, she says, it’s a good idea to see a physical therapist to develop a safe exercise plan before getting started.

Taking physical limitations into account, Hou recommends finding activities that you find enjoyable or convenient, since you’ll be more likely to stick with them. “Bringing along a family member or friend may also be motivating,” she says. “In addition, if you can find a good recurring slot of time to make exercise into a routine, it is more likely to become a lifelong healthy habit.”

The following activities are worth considering for many people with MS, Hou says:

• Going for walks in your neighborhood or a park
• Yoga for balance, flexibility, and stress relief
• Pool exercises for strength and aerobic activity, especially if you have heat sensitivity
• Exercises adapted to mobility limitations, such as seated stationary cycling if you have difficulty with your balance or gait

As you try to become more active, “Setting small achievable goals can often lead to much more progress than setting an ambitious ‘reach’ goal,” says Hou. “It is important to celebrate all the small wins — this is motivating for long-term success.”