That may seem like a harsh title, but I am asked that question almost daily in my medical practice. People that struggle with their weight are desperate for answers.
As most people would guess, diet and exercise play a huge role in your ability to lose weight, but there are multiple other things also going on that are making it difficult for you to drop the pounds.
In this article, I will discuss 9 commonly ignored reasons that anyone should consider if they are failing in their weight loss attempts.
These include thyroid issues, stress, poor sleep habits, insulin resistance, and many others...
Most Americans need to lose weight. The latest statistics show that 7 out of 10 people are overweight or obese. Interestingly, only 36% of people think they need to lose weight.
If you are reading this article, I suspect that you need to lose weight but you don't know how.
I'm going to discuss 9 reasons that may be a hurdle in your weight loss journey. All of them may not apply to you and your specific situation, but chances are most of them do.
Let's start with the obvious. What we are eating in America is slowly killing us.
If you don't get your diet under control, nothing else that I discuss in this article will be enough to help you lose weight. What you eat is the cornerstone for everything else.
As the percentage of Americans that are considered obese continues to skyrocket, so are conditions such as heart disease, cancer, and Type 2 diabetes.
A big reason why is obviously our diets. Many people have chosen convenience over health. Eating out has replaced cooking at home for a large portion of Americans. This includes fast-food restaurants.
Even if you choose "healthy" options from a good restaurant, you have no input on the quality of food that is served (for instance, grass-fed beef vs corn-fed), what kinds of oils are used, how much sodium and other chemicals are added, etc.
Our priorities are totally out of whack.
According to the USDA, almost 1000 calories per day in the Standard American Diet (SAD) come from saturated fats and sweeteners. Fruits and vegetables account for only about 200 calories!
The biggest source of calories comes from grains, which is a 45% increase from 50 years ago. Not only that, the quality of the grains consumed has changed. Read "Wheat Belly" by Dr. William Davis if you want to learn more.
Even more concerning is the fact that sugar consumption has gone from about 40 pounds per person per year in 1900 to over 100 pounds per person per year today!
Last but not least, about 2/3 of the calories in the standard American diet (SAD) come from food-like substances and processed food. It's not even real food!
Note that the typical SAD diet consists of about 2500 calories per day.
Depending on your metabolic rate, most people burn about 1800-2000 calories per day.
While I don't prescribe to or recommend the "calorie in, calorie out" model of weight loss, it only makes sense that if you continue to consume more calories than you burn each day, you aren't going to lose weight.
This is especially true if you have some of the other issues going on that I will discuss in this article.
You should immediately change to a nutrient-dense, high quality, real whole food diet.
As a general rule, I recommend the ratio of the macromolecules in your diet to be in these ranges:
A good starting point would be to start with one of these diets. There is a ton of online information and recipes for each:
- Whole 30 Diet -
- Ketogenic Diet -
- Paleo Diet -
Another tool that can be extremely helpful with weight loss is intermittent fasting. Learning when NOT to eat is just as important as learning WHAT to eat.
When used appropriately, intermittent fasting can actually INCREASE your resting energy expenditure.
I typically recommend 2 types of fasting:
- 14-16 hour fast - Eat an early dinner, then don't eat again until lunch the next day.
- 2 consecutive 24 hour fasts - For example, eat a good dinner on Friday night, then don't eat again until Saturday night. You have 30 minutes to eat at that time. Then don't eat again until Sunday night.
Fasting is so effective that you need to be careful if you have severe adrenal fatigue or if you are diabetic and are on certain medications that increase insulin. In these situations it can cause your blood sugar to drop to dangerous levels. Talk to your doctor first and monitor your blood glucose closely.
If you want to learn more about intermittent fasting, read my article here.
You may ultimately need the help of a knowledgeable nutritionist if you are having difficulty.
While there is no amount of exercise that by itself will get you to your goal weight, it can be an invaluable tool to help with your journey.
Exercise not only helps with weight loss, it has been shown to increase cognitive function and overall quality of life. It also reduces symptoms of anxiety and depression.
It is important to know what KIND of exercise and how MUCH of it to do. Too little of it will not have enough of an effect while too much exercise can actually be harmful.
If you have adrenal issues, even light exercise may exhaust you. Get your adrenals functioning well first.
If you are currently not exercising at all, then start doing SOMETHING. A brisk walk for 15-30 minutes 4-5 days per week is a great start. Let your fatigue level guide you on how much you can progress.
HIIT consists of doing all-out, maximum bursts of exercise followed by 30-60 seconds of recovery time then repeating the cycle 5-6 times.
This can be done with any equipment you have (elliptical, treadmill, bike, rowing machine, etc), or even by jogging/walking or using a jump rope.
HIIT training only needs to be done 1-3 times per week for 10-15 minutes. Yes, you have time for that!
If you want to lose weight, get started with an exercise program TODAY!.
If you have ever read any of my other articles, you know that I mention stress as a factor in almost all medical conditions.
The fact is, stress undermines our health on multiple levels. You will never reach your maximum health potential if you don't learn how to better manage your stress.
When I say stress, I am talking about physical, emotional and mental stress. This could include an injury or illness, work stress, relationship stress, death of a loved one, and many others.
Stress causes our adrenal glands to secrete cortisol, which signals the mitochondria in our cells to increase energy production to get us through that stressful time.
This is great for acute stresses, but bad when the stresses are chronic and continuous.
Remove any stressors in your life that you can. That may include changing jobs, getting rid of toxic relationships, or getting marriage counseling.
If there are major stressors that can't be removed such as an illness in a family member, kid troubles, etc., you will need to work on improving your coping mechanisms.
Ways of reducing your stress includes:
If you feel you need more help on this subject, read my article on adrenal fatigue.
Lack of sleep has been directly linked to obesity. It increases inflammation in the body and causes weight gain.
Your quality of sleep directly impacts your melatonin level which increases your cortisol. Your sleep quality also impacts your metabolism which affects your body weight.
You should be getting at least 7 hours of quality sleep per night. When you wake up, you should feel refreshed and energized.
If that doesn't describe you, consider making the following changes:
If you are still having sleep issues, you should consider talking to your doctor about testing you for obstructive sleep apnea. In this condition, the muscles in your throat and neck collapse as you fall asleep which in effect chokes you, sometimes dozens of times per hour.
Your brain has to wake you in order to overcome the muscle relaxation so that you can breathe. As a result, you never get into the restful stages 3 and 4 of sleep which are required for you to be refreshed.
This may require you to undergo a sleep study, which will consist of sleeping in a sleep lab while you are monitored.
If you have obstructive sleep apnea, you may need to sleep with a nasal CPAP machine which will keep the air pressure in your airway high enough to prevent your airway from collapsing while you sleep.
If you can lose the weight you need to lose, there is a high likelihood that your sleep apnea will resolve and you will no longer need a CPAP machine.
If obstructive sleep apnea has been ruled out but you are still struggling with sleep, supplements may be necessary. My favorites are below:
Why I Like It
May help improve energy levels
May help to decrease levels of inflammation
May help reduce brain fog and mental slowness
Requires lifestyle change for best results
How to Tell if You Need It
How to Use
My Recommended Brand and Product
For minor sleep issues start with supplements containing 5-HTP which may promote proper melatonin production and induce sleep naturally (take 100mg 30 minutes before your scheduled bed time):
For more difficult cases consider the addition of melatonin + 5-HTP, start with 1-3mg of melatonin and don't be afraid to use melatonin if you need it.
For more the most difficult cases consider using serotonin and GABA potentiators. These supplements help enhance GABA and serotonin neurotransmitters in the brain and help induce deep sleep.
The statistics show that over 12% of the population is hypothyroid. Some experts suggest that it could actually be closer to 40%.
About 2/3 of people with thyroid issues don't even know they have it!
Since the thyroid is the "metabolism factory" of the body, it only makes sense that people who are struggling with their weight may have an issue with their thyroid.
In my practice, I see people with undiagnosed and untreated or undertreated thyroid conditions several times a day.
The vast majority fit into the following 3 categories:
The thyroid should always be one of the first things assessed in someone who is overweight.
That is especially true if the person also has many of the other common symptoms seen in hypothyroidism - fatigue, constipation, cold intolerance, hair loss, brittle nails, etc.
Only checking the TSH blood test may miss a large percentage of hypothyroid patients.
That is why you need to ask for a complete thyroid panel:
If your doctor is unwilling to run all of these tests, I would STRONGLY suggest you find a doctor who will. Your thyroid status cannot be fully evaluated without them.
Read more about how to interpret your results in my article here.
Hashimoto's is the common name given for autoimmune thyroiditis.
It is estimated that up to 10% of the population has Hashimoto's. It is 7 times more common in women than in men.
Some experts estimate that Hashimoto's is the cause of up to 90% of hypothyrodism.
That's why it is important to have your thyroid antibody levels checked if you are hypothyroid. If either the TPO antibody level or the thyroglobulin antibody level is >35, the diagnosis of Hashimoto's can be made.
Hashimoto's can cause the same symptoms that you see in hypothyroidism (including weight gain), but it may have some additional symtoms as well. These include joint pain, muscle aches, throat swelling, and even low grade fever.
Click here to learn more about how to treat Hashimoto's thyroiditis.
Reverse T3 is an inert hormone that is made normally by the body in small amounts.
It binds to the thyroid receptors on the cells of the body, but it does it has no function. In effect, it serves as a "brake" for our metabolism.
It is another way that the body can regulate its own metabolism.
In acute situations (such as an infection or injury), it helps the body to reserve its energy stores by lowering the metabolism.
However, many people have chronic inflammation in their body due to things such as obesity, insulin resistance, leptin resistance, poor diet, etc. All of these conditions cause the reverse T3 level to be chronically elevated, which is called reverse T3 dominance.
When this occurs, the TSH and T4 levels may be normal, but the elevated reverse T3 blocks the action of the active T3 on the cells of the body. Hypothyroidism at the cellular level results.
The above labs are from one of my recent patients. If you just looked at the TSH, it would show that she has normal thyroid function. The free T3 and reverse T3 tell the true story.
If your reverse T3 level is >15 or if your free T3 to reverse T3 ratio is < 0.2, you have reverse T3 dominance (also called thyroid resistance) that needs to be addressed.
Read my article on Reverse T3 Dominance to learn more.
Most people that I know who struggle with their weight have tried tons of different diets. Some have worked, some haven't.
Many of these diets such as the HCG diet require severe calorie restriction (as low as 500-600 calories per day).
This severe calorie restriction can damage your metabolism for many years and make it impossible to lose weight and keep it off.
The typical story goes like this - the first time they went on the diet they lost 40 pounds, the next time 25 pounds, then next time 10 pounds, then next time none at all.
These diets cause this by re-setting your basal metabolic rate. Instead of burning the usual 1800-2000 calories per day, after severe calorie restriction, your body may only burn about 800 calories per day.
That's why you eat less than anyone else you know but still gain weight.
Never go on a severe calorie-restricted diet or recommend any friends or family to do it. It can be devastating to your body.
Correcting this can be very difficult and will require the help of a knowledgeable doctor and/or nutritionist. It will most likely take a long time to fix.
Insulin is a hormone made by the pancreas.
Its function is to bind to glucose (sugar) in the bloodstream and carry it into the cells where it can be used for energy production. It also carries the glucose into the fat cells and liver cells where it is stored to be used later.
With insulin resistance, the process doesn't work like it should.
When people eat a diet too high in sugar (as in the standard American diet), the cells in the body become so bombarded with the sugar that it can become toxic to the cells.
As a protective measure, the cells down-regulate the insulin receptors, meaning it reduces the number of insulin receptors that are available for the insulin to attach. As a result, the insulin level in the bloodstream increases (as does the sugar levels).
Eventually, the sugar level increases to the point that it measures high on a blood test. Pre-diabetes or diabetes is then diagnosed.
In other words, diabetes is really just advanced insulin resistance.
Having high levels of insulin is bad in many ways.
Insulin causes us to gain weight by increasing the size of our fat cells.
Insulin is one of the most inflammatory substances in our body. That inflammation increases our cancer risk. Insulin resistance has been shown to be directly linked to thyroid disorders which also results in more weight gain.
A hemoglobin A1c level > 5.3 is suggestive of insulin resistance. A total fasting insulin level >5 also indicates insulin resistance.
Anyone who has the diagnosis of pre-diabetes or type 2 diabetes by definition also has insulin resistance.
To learn more about how to diagnose and treat insulin resistance, read my article here.
What in the world is leptin resistance?
In order to understand leptin resistance, you need to understand the function of leptin.
Leptin is a hormone made by fat cells. Yes, they do more than just make our clothes to not fit!
Leptin is our "satiety" hormone. It's primary function is to signal to our brain that we have plenty of fat stored in our body and we don't need anymore.
The brain then increases our metabolism and reduces our hunger until the leptin levels drop.
In leptin resistance, something happens that is similar to what happens in insulin resistance. Our brain becomes desensitized to the high leptin levels and basically ignores the signal.
As a result, our metabolism becomes locked in the "low" setting and our hunger sensation stays locked in the "high" setting, a perfect storm that results in weight gain and obesity.
The weight gain results in more fat cells which results in more leptin production, and the cycle feeds itself (literally!).
Leptin resistance typically occurs simultaneously with insulin resistance.
Leptin resistance also triggers an increase in reverse T3 production (reverse T3 dominance) that also results in weight gain.
Leptin resistance is diagnosed by checking a serum leptin level. If it is >12, the diagnosis can be made.
Long term successful weight loss will not be possible until the leptin resistance is treated and eradicated.
Click here to learn more about leptin resistance and its treatment.
If you have ever watched a show where they follow people on their weight loss journey, a common theme emerges.
They lose a little weight, then the weight loss stops. They don't begin losing weight again until they have a "breakthrough" regarding a trauma from their past.
Many of these traumas may have been locked away in your brain. You may not recall them, but they may be subconsciously sabotaging your life in many ways.
This may or may not be playing a role in your particular situation, but you owe it to yourself to deal with any past trauma if you have any.
I strongly recommend that anyone struggling with their weight should see a licensed professional counselor to assess if they have any past issues that need to be addressed.
Seeing a counselor is a sign of strength, NOT weakness. It means you love yourself enough to deal with any issues that are impacting your quality of life.
50% of the US population is either overweight or obese.
Many reasons are to blame. While diet and exercise play a major role, hormonal and metabolic issues are most likely involved as well.
If you can't lose weight, it is important for you to consider and address your diet, exercise, stress level and your sleep quality.
You should also be tested for any thyroid issues, insulin resistance, and leptin resistance.
If you have a history of severe low calorie dieting, your metabolism may be damaged which will require long term, intensive treatment.
Finally, you need to address any past trauma in your life to finally release its grip on you.
Now it's your turn...
Have you ever asked the question in this article title?
If so, what has helped you with your weight loss?
What have you tried that didn't work?
Leave your comments below...
Dr. Whelchel is a family physician who specializes in functional medicine, especially hormone optimization. He has over 20 years experience in private practice managing patients with various medical issues. His passion is helping patients reach their full potential of wellness and quality of life. He grew up in the Texas Panhandle where he currently lives. He is married and has 3 awesome children.