This is a phrase we often hear from our patients. Usually, by the time they come to us, they have tried everything and are very frustrated. Maybe they were able to lose weight in the past but have gained it back and then some, or their weight has cycled their entire life. Sometimes they have tried and never been able to lose the weight or are rapidly gaining no matter what they do.
The advice to just ‘eat less, move more’ can leave these patient’s feeling defeated and sometimes wondering why they should even try. This is when we need to look deeper.
The first thing we look into is if there are any medical conditions contributing to weight. We do a thorough lab workup to find any additional factors. For example, hypothyroidism can slow your metabolism and lead to weight gain. Insulin resistance can also make it harder to lose weight. There are medications and dietary recommendations which can help to improve both of these conditions.
Next, we look for signs of impaired metabolism. Sometimes when a person’s weight has cycled significantly, or there has been dramatic weight loss, metabolism can be slowed. For example, an individual may have lost weight when consuming 1500 calories per day at one point in their lives, but now they may see no changes when consuming 1200 calories. On the other hand, a person may be consuming too few calories for their body needs, thus slowing their metabolism and causing them to hold onto excess fat.
Testing your metabolic rate can help us to determine if one of these scenarios may be affecting your weight loss. We have just purchased a new Resting Metabolic Rate machine and look forward to utilizing this more to help our patients.
When we find a patient’s metabolism is lower or higher than we would expect, certain dietary approaches can be helpful. Ketosis is one tool we use in the right patient to help them become more efficient at burning fat instead of using glucose for fuel. Sometimes an elimination diet can help to affect the microbiome and decrease inflammation, which can contribute to holding onto excess weight.
Hunger signals can be another reason it is hard to lose and keep the weight off. Unfortunately, our bodies can get used to being at a certain weight and when it starts to come off, our hunger signals can increase and become extremely difficult to ignore. Ghrelin is one such hormone that increases our appetite during weight loss. Weight loss medications can help to decrease appetite and are especially useful in this scenario. Bariatric surgery acts to decrease hunger signals. Certain dietary approaches can work as well.
These are just a few examples of potential reasons one might have a difficult time losing and/or maintaining weight loss. Other factors we look at include sleep, medications, stress, emotions, cravings, relationships, mood, work environment, allergies, inflammation, etc.
‘Calories in, calories out’ does not always work. We would love to help you figure out why you can’t seem to lose the weight.