@christopherc

That gets complicated and I don't know the answer to that question. The way my endocrinologist explains it was hard for me to understand. I think obesity contributes to inflammation and prednisone caused me to be obese.

While Prednisone is effective at lowering inflammation, it is strongly associated with causing weight gain that leads to obesity. Prednisone exacerbates obesity-related metabolic issues. The relationship between these factors is complicated. Obesity often requires higher doses of anti-inflammatory steroids, which in turn can lead to further weight gain and metabolic syndrome. My endocrinologist says all of this is hormone driven. He has consistently said "preventative measures" should have been taken if I was going to be on Prednisone for a long time. I did have preventive measures after having other side effects from prednisone but nobody cared too much about my hormones.

It sounds better when my endocrinologist says I have Prednisone induced metabolic syndrome.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9772659/
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I struggle with being called obese. It depends on what angle you see me from. I just have a large belly and everything else is skinny. I'm starting to get some muscle tone back and that might help my metabolism. On my medical problem list it now says "obesity-non specified" whatever that means but I blamed prednisone. Now that I have been off Prednisone for 5 years, I take personal responsibility. However, my endocrinologist says it still isn't my fault and some of it might be irreversible.

Don't ever believe anyone who says prednisone side effects are easy to manage when you know how. The truth of the matter is --- nobody knows how.