One well‑recognised side‑effect is increased appetite leading to rapid weight gain. More than half of CYP receiving high‑dose steroids experience increased BMI and cushingoid features such as a round or puffy face. Steroids stimulate hunger by increasing ghrelin and reducing the body’s response to leptin, which normally signals satiety. They may also promote cravings for calorie‑dense foods high in sugar and fat. (Kuckuck et al., 2022, Kulkarni & Durham et al., 2022).
Recent studies confirm that weight gain can appear early during cancer treatment—particularly in acute lymphoblastic leukaemia (ALL). A 2023 cohort study found weight gain increased significantly during induction therapy and remained elevated at the end of treatment, with BMI at diagnosis being the strongest predictor of later weight gain. This underlines the importance of early nutritional monitoring and support. (Galati & Rocha et al., 2023)
Evidence on effective prevention strategies remains limited, with reviews showing a lack of high‑quality trials focused specifically on preventing steroid‑related weight gain in children (Conklin & Hong, 2019).
Practical advice for families
CYP can be supported to maintain a healthy weight by:
- Choosing low‑fat, high‑protein foods such as lean meats, fish, eggs, beans and lentils.
- Including starchy foods (bread, rice, pasta) at each meal to support satiety.
- Eating high‑fibre foods (whole grains, fruit, vegetables).
- Staying well hydrated with water or low‑calorie drinks.
- Using pre‑portioned snacks where helpful, while limiting foods high in sugar or fat.
- Steroid related weight gain during cancer treatment can be reversed after treatment completes. (Belle et al., 2018)
When receiving radiotherapy
For CYP with brain tumours, especially Diffuse Midline Glioma, steroid‑related weight gain can affect the fit of immobilisation masks and may require mask refitting, potentially delaying treatment. Maintaining weight stability helps ensure radiotherapy remains accurate and uninterrupted. (Beltran, Sharma, & Merchant, 2011)
CYP and families may feel guilt or distress about changes in appearance; psychosocial support is often needed.
How healthcare professionals can support CYP and families
- Offer dietetic input early for all patients.
- Encourage physical activity to help prevent excessive weight gain.
- Provide emotional support and refer to psychology or health play therapy where helpful.
Useful links
References
Belle, F.N., Kasteler, R., Schindera, C., Bochud, M., Ammann, R.A., von der Weid, N.X. and Kuehni, C.E. (2018). No evidence of overweight in long‐term survivors of childhood cancer after glucocorticoid treatment. Cancer, 124(17), pp.3576–3585. doi:https://doi.org/10.1002/cncr.31599.
Beltran, C., Sharma, S. and Merchant, T.E. (2011). Role of adaptive radiation therapy for pediatric patients with diffuse pontine glioma. Journal of Applied Clinical Medical Physics, 12(2), pp.96–101. doi:https://doi.org/10.1120/jacmp.v12i2.3421.
Conklin, A.I. and Hong, J. (2019). Obesity prevention in corticosteroid‐treated patients: Use and effectiveness of strategies for weight management. Clinical Obesity, 9(4). doi:https://doi.org/10.1111/cob.12312.
Galati, P., Roberta, P., Nádia Dias Gruezo and Angélica Amorim Amato (2023). Body mass trajectory from diagnosis to the end of treatment in a pediatric acute lymphoblastic leukemia cohort. Scientific Reports, 13(1). doi:https://doi.org/10.1038/s41598-023-39287-z.
Kuckuck, S., van der Valk, E.S., Scheurink, A.J.W., van der Voorn, B., Iyer, A.M., Visser, J.A., Delhanty, P.J.D., van den Berg, S.A.A. and van Rossum, E.F.C. (2022). Glucocorticoids, stress and eating: The mediating role of appetite‐regulating hormones. Obesity Reviews, 24(3). doi:https://doi.org/10.1111/obr.13539.
Kulkarni, S., Durham, H., Glover, L., Ather, O., Phillips, V., Nemes, S., Cousens, L.P., Parmis Blomgran and Ambery, P. (2022). Metabolic adverse events associated with systemic corticosteroid therapy—a systematic review and meta-analysis. BMJ Open, [online] 12(12), pp.e061476–e061476. doi:https://doi.org/10.1136/bmjopen-2022-061476.
Page last updated February 2026