Authors
Paula Hardeman , Physician Assistant & Katy Burgess , MPAS, PA-C
Caring for Aging Parents While Managing MS
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3 Nov 2025 | ~08:01 Engagement Time
The simple answer is no, but there are several challenges that people with multiple sclerosis (MS) could face that could increase their risk of gaining or losing weight. Weight gain occurs when a person consumes more calories than their body needs, or due to a decrease in activity. As we all age, our bodies’ needs and metabolism change, leading to weight gain or loss. In addition to aging, people with MS face additional challenges that could lead to weight issues, such as fatigue, sleep disturbances, depression/anxiety, pain/spasticity, gait challenges, and medications. Maintaining a healthy weight can help improve the overall management of MS symptoms (walking, fatigue, bladder control) and prevent the development of other health conditions (heart disease, diabetes, bone loss).
Fatigue is a common symptom in people with MS. Most people with MS will report fatigue at some point during their disease course, and for many, it is their most debilitating symptom. Multiple sclerosis associated fatigue is not a feeling of tiredness or sleepiness. It is defined as a significant lack of physical and/or mental energy that interferes with daily activities, including work. It is often described as a “pervasive exhaustion.” To conserve energy, people with MS will skip exercise or choose not to cook healthy meals which could lead to weight gain over time. Currently, no FDA approved therapies exist for MS-associated fatigue. However, your healthcare provider may be able to provide different strategies to manage fatigue.
In addition, people with MS can have sleep disturbances which can lead to poor sleep quality and worsen fatigue. Poor sleep quality and disturbances have both been associated with weight gain independent of fatigue. Pain, spasticity, urinary frequency, and mood disorders can also lead to poor sleep quality. People with MS associated fatigue may take naps during the day which could also contribute to poor sleep quality at bedtime. Practicing good sleep hygiene habits (avoiding caffeine or alcohol at bedtime, limiting daytime napping, avoiding screens before bed, etc) and treating MS symptoms that interfere with sleep can help optimize sleep quality.
Another contributing factor for weight gain in MS is mood disorders such as depression and anxiety. Depression can have a wide range of emotions or feelings from sadness, lack of motivation, or hopelessness. Whereas anxiety can cause feelings of stress, uncertainty, or overwhelm. People with MS commonly experience depression and anxiety which can impact how one functions and their overall quality of life. When left untreated, depression and anxiety can impact sleep, cognitive function, fatigue, and pain as well as other MS symptoms. As a result, it can be very difficult to incorporate exercise and physical activity into one’s routine leading to a sedentary lifestyle, which is often associated with weight gain. Additionally, many people cope with difficult emotions by overeating. Several treatment options are available for depression and anxiety that you can discuss with your healthcare provider.
In addition, people with MS experience pain and studies report that 2/3 of people with MS may experience some type of pain. Musculoskeletal or joint pain can occur in people with MS secondary to muscle weakness, gait challenges, balance problems, spasticity or muscle tightness. Neuropathic pain, or the feeling of burning or tingling, is another common type of pain people with MS can experience. People with MS can also experience spasticity pain which can be described as muscle tightness/spasms or abnormal jerky movements. Regardless of the type of pain, people with MS could have difficulty exercising or remaining active, leading to weight gain over time.
Those with gait challenges may have difficulty remaining active or exercising and may be at increased risk of gaining weight as a result. Gait challenges can be secondary to lower leg weakness and cause one to either drag their foot or difficulty lifting the legs. Muscle tightness or spasms can also cause abnormal posture and problems with bending the leg correctly which could lead to gait challenges. Physical therapy can improve gait challenges and pain associated with MS. Physical therapist can also provide an individualized exercise program tailored to an individual’s needs and goals. Routine exercise and movement throughout the day increases one’s calorie expenditure and improves one’s metabolism along with other healthy lifestyle changes.
Finally, some of the medications used to treat MS can cause weight gain. For instance, steroids which are used to treat acute flares of MS are notorious for causing weight gain, especially if used for long periods of time. Most of the newer disease modifying therapies used to treat MS do not cause weight gain. However, some of the medications used to treat symptoms associated with MS could contribute to weight gain. If you are concerned about weight gain, speak to your provider to see if any of your medications could be contributing.
There are a variety of lifestyle interventions that can help people with MS maintain a healthy weight. There is no specific diet for MS, but following a healthy eating pattern can help manage daily symptoms and reduce weight gain. Focus on limiting processed foods that are high in sugar and sodium and prioritize eating a wide variety of whole foods like fruits, vegetables, whole grains, legumes, and lean proteins. Eating food high in fiber and protein can help make you feel fuller longer.
Also, practice mindful eating, when you listen to your body’s hunger cues, you are less likely to overeat or eat when you are not actually hungry. Exercise can also improve symptoms like fatigue and cognitive function in addition to helping maintain a healthy weight. A combination of aerobic exercise and strength training is most ideal. Aerobic activities like walking, biking, and swimming burns calories, and weight training builds muscles. Increasing muscle mass improves one’s basil metabolic rate, meaning they burn more calories throughout the day even at rest. Aim for 150 minutes of moderate activity each week. Even small increments of 5-10 minutes at a time can have a meaningful impact.
Managing stress is also critical in achieving and maintaining a healthy weight. When the body is under stress, it releases a hormone called cortisol, which can impact one’s weight in a variety of ways. Cortisol can increase appetite, promote fat storage, slow down one’s metabolism, and disrupt sleep. Deep breathing, medication, and exercise are all great ways to help manage stress. For those who have been unsuccessful in losing weight with lifestyle changes alone, there are a variety of medications available to aid with weight loss.
Maintaining a healthy weight can be difficult for some individuals due to unintentional weight loss. Being underweight contributes to physical frailty and malnutrition if not addressed. Those who are malnourished are at risk for other health conditions like osteoporosis and anemia as well as having increased risk of infection, slow wound healing, fatigue, and muscle weakness.
As with weight gain, a variety of MS symptoms can contribute to undesired weight loss. As previously mentioned, many people with MS struggle with depression and anxiety. Loss of motivation is common for those who suffer from mood disorders, which can make it very challenging to take care of basic needs like meal planning, grocery shopping, preparing food, as well as eating. Mood changes may also suppress one’s appetite leading to reduced caloric intake.
In addition, those with limited mobility and other physical disabilities may not be able to independently go to the supermarket or prepare their own meals. While those with cognitive impairment often have trouble maintaining a routine schedule with regular meals. People with significant fatigue may not have the energy to prepare healthy meals and snacks, or they may have to prioritize rest over cooking and grocery shopping.
Many people with MS also have limitations in the foods they can eat because of swallowing difficulties or trouble chewing. Those with tremors may have a hard time feeding themselves and must rely on someone else for assistance. Medications can also be a contributing factor. Medications used to manage fatigue, and some antidepressants can suppress one’s appetite making it difficult to get enough nutrients.
These factors highlight the need for all individuals with MS to follow a nutritious pattern of eating. If you are having a difficult time maintaining a healthy weight talk to your neurologist or primary care provider. They may recommend you meet with a dietician, who can work with you to tailor an eating plan to your specific needs. If you feel full easily, focus on eating smaller, more frequent meals and snacks. Make an effort to increase healthy fats with foods like avocados and nut butters and keep nutrient dense foods like cheese and nuts readily available to snack on throughout the day. Supplementing meals with protein shakes can also be a great way to consume extra calories. For those who have trouble with grocery shopping and preparing meals, consider grocery and meal delivery services. Charitable organizations like Meals on Wheels for seniors can also be a great way to access nutritious meals. Check what resources are available in your area.
Maintaining a healthy weight is challenging, especially for those with a chronic health condition like MS. Focus on a well-balanced diet that fuels your body and makes movement throughout the day a priority. Prioritize high quality sleep and incorporate mindfulness strategies to manage stress. Set yourself up for success by gradually adopting new habits by making one or two small changes at a time. Even small changes make a meaningful impact over time.
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