Some beta blockers can cause an average weight gain of 2 lbs to 3 lbs in the first few months of treatment. Some people may also find it harder to lose weight while taking a beta blocker.
Metoprolol (Lopressor, Toprol XL), atenolol (Tenormin), and propranolol are more likely to cause weight gain than other beta blockers.
In previous studies [9–11], beta blockers have been associated with long-term weight gain, but little is known about the effect of beta blockers on weight loss in response to a precise hypocaloric regimen. The obesity-promoting impact of beta blockers is not currently well understood. Resting energy expenditure and thermogenesis induced by external factors [12], such as meals and cold exposure, but also stress and anxiety, have a facultative component mediated by the sympathetic-adrenal system through catecholamines working on beta adrenoceptors. Treatment with beta blockers reduces the facultative thermogenesis by 50–100 kcal/day, which corresponds to the weight gain of 2–5 kg/year reported in clinical trials [12]. It can also result in insulin resistance, which may aggravate existing diabetes and elicit diabetes in predisposed patients. Overweight and obesity are frequently complicated with hypertension, which is often treated by beta blockers. Obesity is associated with a defective sympathetic activity, and treatment with beta blockers may further reduce facultative thermogenesis and promote weight gain. The consequence may be aggravation of hypertension, insulin resistance, and other metabolic disturbances. β-Adrenoceptor antagonists have historically been considered an effective and safe option for first-line treatment of hypertension, but very recently, it has been proposed that β-blockers should no longer be considered suitable for first-line therapy in the patient with uncomplicated hypertension because of unfavorable metabolic effects [12].
https://www.medicalnewstoday.com/articles/bisoprolol-oral-tablet#other-warnings
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