The Truth: Do Steroid Injections Cause Weight Gain?

October 6, 2025 •

5 min read

While long-term oral steroid use is known to cause weight gain in a significant number of patients, it is a common misconception that localized steroid injections have the same systemic effect. Understanding the key differences in how these two forms of medication are administered and processed by the body provides the answer to the question: 'Do steroid injections cause weight gain?'.

Quick Summary

Steroid injections for localized inflammation typically do not cause significant systemic weight gain. This side effect is primarily associated with long-term, high-dose oral corticosteroids, which have a broader impact on metabolism and body-wide fat distribution.

Key Points

Injections are Localized: Steroid injections are targeted treatments that affect a specific area, meaning they have a minimal impact on overall body metabolism and weight.
Oral Steroids Cause Systemic Effects: Significant weight gain is a known side effect of long-term, high-dose oral steroid therapy due to their systemic (body-wide) action.
Weight Gain Mechanisms Differ: Oral steroids can increase appetite, cause fluid retention, and redistribute fat, effects that are generally not seen with localized injections.
Temporary Effects Are Possible: In rare cases, a small amount of systemic absorption from an injection may cause temporary, minor effects like fluid retention, but it is not a major contributor to weight gain.
Duration and Dosage Matter: The risk of steroid-related side effects, including weight gain, increases with higher doses and longer durations of medication.
Local Injections Have Their Own Risks: Side effects of injections are typically localized and include potential pain at the site, skin discoloration, or fat atrophy.
Consult a Physician: Always discuss the potential side effects and benefits of any steroid treatment with your healthcare provider for personalized advice.

Corticosteroids are powerful anti-inflammatory medications used to treat a variety of conditions, including arthritis, autoimmune disorders, and allergic reactions. While they are highly effective, they also come with a reputation for causing significant side effects, including weight gain. However, the type of steroid and method of delivery—injection versus oral pill—play a crucial role in determining this risk. For most patients receiving targeted, intermittent injections, weight gain is not a significant concern.

Steroid Injections vs. Oral Steroids: A Matter of Delivery

The fundamental difference between steroid injections and oral steroids is their route of administration and systemic effect. This distinction is critical for understanding the likelihood of weight gain.

Localized Steroid Injections

When a steroid is injected directly into a joint, tendon, or bursa, it is a localized treatment. The goal is to deliver a high concentration of the medication precisely where inflammation is occurring. The amount of medication that is absorbed into the wider bloodstream is minimal. As a result, the systemic side effects commonly associated with steroids are rare. This localized delivery is why most single or intermittent steroid injections, such as a cortisone shot for a knee or shoulder, do not cause significant weight gain.

Systemic Oral Steroids

Oral corticosteroids, such as prednisone, are taken as a pill and absorbed into the bloodstream, where they circulate throughout the entire body to address systemic inflammation. This systemic approach requires higher doses over longer periods, increasing the risk of widespread side effects. It is this long-term, high-dose use of oral steroids that is most strongly linked to steroid-induced weight gain.

Why Oral Steroids Can Cause Weight Gain

The weight gain associated with long-term oral steroid use is the result of several physiological changes. These mechanisms explain why patients on systemic treatment often experience a noticeable increase in body mass.

Increased Appetite: Oral steroids can stimulate the appetite center in the brain, leading to increased food cravings and calorie intake.
Fluid Retention: Corticosteroids can alter the body's electrolyte balance, causing it to retain extra salt and water, which presents as temporary 'water weight' and swelling.
Fat Redistribution: Systemic steroid use can cause a characteristic redistribution of body fat to certain areas. This can result in a rounded, puffy face, often called 'moon face,' and increased fat deposits in the abdomen and the back of the neck, known as a 'buffalo hump'.
Metabolic Changes: Steroids can disrupt metabolism and lead to insulin resistance, making it harder for cells to properly use sugar and promoting fat storage.

Examining the Risk of Weight Gain from Injections

While the systemic absorption from a localized injection is low, some temporary effects are possible, but they are not typically significant enough to cause lasting weight gain. Any minor water retention is temporary, and metabolic changes are usually short-lived. For instance, people with diabetes may experience a temporary elevation in blood sugar for a few days following an injection. This underscores that while a small amount of the drug enters the system, the effects are not the same as with long-term oral therapy.

Common Side Effects of Localized Injections

Even though significant systemic weight gain is unlikely, steroid injections do carry other potential, mostly localized, side effects.

Injection Flare: Some patients experience a temporary increase in pain and inflammation at the injection site for a day or two before the steroid begins to provide relief. This can be managed with rest and ice.
Skin Changes: The injection site may experience a localized dimpling (fat atrophy) or lightening of the skin (hypopigmentation) due to the steroid's effect on fat and melanin in the area.
Tendon Rupture: Injections directly into or near a tendon can weaken it over time, increasing the risk of rupture. For this reason, physicians limit the frequency of injections into the same area.
Infection: As with any injection, there is a small risk of infection at the injection site.

Oral Steroids vs. Steroid Injections: A Comparison


Feature	Oral Steroids	Steroid Injections
Administration	Taken by mouth (pills).	Injected directly into the affected area (joint, tendon, etc.).
Systemic Absorption	Full systemic absorption throughout the body.	Very minimal systemic absorption.
Dosage	Often higher doses for longer periods of time.	Low, concentrated dose delivered locally.
Weight Gain Risk	High risk with long-term, high-dose use due to systemic effects.	Very low risk of significant systemic weight gain.
Metabolic Effects	Significant impact on appetite, fluid balance, and fat metabolism.	Temporary, minor systemic effects possible (e.g., blood sugar).
Fat Redistribution	Common, leading to 'moon face' and 'buffalo hump'.	Localized fat atrophy at injection site is possible.
Duration of Effect	Can be long-term, dependent on medication course.	Effects typically last from a few weeks to several months.

Conclusion: Context is Key for Weight Gain Concerns

The concern that all corticosteroids lead to weight gain is a simplification that ignores the vital context of medication delivery. For the vast majority of patients receiving a localized steroid injection, the risk of significant, systemic weight gain is extremely low. This side effect is primarily a concern for those undergoing long-term, high-dose oral steroid therapy. While injections carry their own set of potential, typically localized, side effects, they offer a powerful and targeted treatment with a much more favorable profile regarding body weight. As always, it is crucial to discuss any medication concerns with a healthcare provider to ensure you have a complete understanding of the benefits and risks for your specific situation. [https://my.clevelandclinic.org/health/treatments/cortisone-shots-steroid-injections]

Key Takeaways

Localized vs. Systemic: The primary reason steroid injections rarely cause weight gain is their localized delivery, unlike oral steroids which affect the entire body.
Oral Steroids Increase Appetite: Weight gain from oral steroids often stems from increased appetite and fluid retention, not typically seen with injections.
Fat Redistribution Is Oral-Related: The characteristic redistribution of fat to the face and trunk ('moon face' and 'buffalo hump') is a side effect of systemic oral steroid use.
Injections Have Local Side Effects: While not causing weight gain, injections can lead to localized issues like skin discoloration, fat atrophy, or an injection flare.
Risk Depends on Dose and Duration: The risk of significant weight gain from steroids is directly correlated with higher doses and longer durations of use, especially with oral administration.

Frequently Asked Questions

No, a single cortisone shot is highly unlikely to cause significant systemic weight gain. The medication is delivered locally and only a minimal amount enters the rest of your body, meaning it does not trigger the metabolic changes that lead to weight gain with long-term oral steroid use.

Any temporary weight gain following an injection is most often due to minor and short-lived fluid retention. This is not the same as the sustained fat gain seen with long-term oral steroid use and typically resolves quickly.

Yes, there is a major difference. Steroid injections are localized and have minimal systemic side effects, while steroid pills (oral steroids) are systemic and can cause widespread side effects like weight gain, fat redistribution, and osteoporosis with long-term use.

While frequent, repeated injections could theoretically increase systemic exposure over time, the risk of significant weight gain remains very low compared to oral steroids. Physicians typically limit the number of injections in a specific area to reduce localized risks like tendon damage.

Managing weight gain from oral steroids involves a healthy, balanced diet low in salt and sugar, regular exercise, and staying well-hydrated. Discuss strategies with your doctor or a dietitian, but never stop taking oral steroids abruptly without medical supervision.

No, these are characteristic side effects of long-term, high-dose oral corticosteroid use, which cause a systemic redistribution of fat. Localized injections do not carry this risk.

No, studies have shown that epidural steroid injections for conditions like back pain do not typically induce weight gain. Similar to other localized injections, the risk is minimal.