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Still Not Losing Weight

Posted on August 23, 2019 | No Comments on Still Not Losing Weight

Question: “I exercise 30 minutes a day and watch what I eat, why am I still not losing weight?”

Answer: Most people who have excess body fat leading to overweight or obesity have an imbalance between amount of food or calories taken each day (energy input) and amount of calories burned (energy output). The exact effects of the environment and genetics in the complex regulation of appetite and energy balance are still not fully understood and the consensus is that overweight and obesity result from multiple factors. However, there are certain diseases that lead to overweight and obesity that need to be worked up and treated—lest all forms of weight loss strategies be futile.

Hormonal or glandular diseases (endocrine disease) can lead to excess weight. One such endocrine disease is hypothyroidism or the lack of thyroid hormones coming from the thyroid gland. This condition leads to slow metabolism and water retention or edema. It is also associated with weakness, increased sleepiness, constipation, dryness of skin, slow movement and impaired thinking.

A neck mass or goiter may or may not be obvious. Another probable cause that endocrinologists consider
is the presence of too much glucocorticosteroids—or Cushing’s Syndrome. This may be due to excess production of the glucocorticosteroids by the adrenal glands or due to chronic intake of steroid drugs (prednisone, dexamethasone, etc.) for medical conditions or as a form of abuse. Associated signs and symptoms include muscle weakness, abnormal fat pads, skin changes/lesions, high blood sugar and high blood pressure.

A rare tumor—insulinoma—that secretes the hormone insulin in an unregulated manner causing low blood sugar—also leads to obesity because the person instinctively overeats to compensate for the low blood sugar. The increased calories and high insulin levels promote energy storage in fat.

Any disease that affects the appetite control center in the brain—the hypothalamus—can also damage the overall regulation of appetite. Tumors, infection, trauma or other subtle damages to the hypothalamus can also cause overweight/obesity. Unfortunately, the technology that we have today remain limited in detecting possible subtle damages. There are also some rare genetic syndromes that have obesity as a feature but these syndromes have other hallmarks like mental retardation or physical deformities that accompany the excess body fat.

It is not cost-effective to perform all tests for these diseases in all overweight and obese patients because these diseases are uncommon causes of obesity. The endocrinologists—specialists in hormone and metabolic diseases—review the medical history and physical examination findings very carefully before deciding whether or not further tests should be done; which ones are most appropriate; and finally how to correctly interpret the complex tests.

Even if these specific causes of overweight and obesity have been ruled out already, it should be pointed out that losing weight through exercise and counting calories do have a plateau in the pattern after a certain time. Counting calories and doing regular exercise are essential to weight loss. So much so that no medicine approved for weight loss can effectively reduce weight if it is not accompaniedby dietary restriction and increased burning of calories through exercise.

Certain characteristics also influence rate of weight loss: the heavier the person, the faster the weight loss for any given diet. Men lose more weight than women for a given weight and height because they tend to have leaner bodies and are able to use up more energy. Older people have slower metabolism so they lose weight at a slower rate.

It is important to determine one’s objectives: weight loss to reach a realistic target weight (i.e. five to 10 percent of baseline body weight over a six month period), maintenance of the body weight reached, and prevention of regaining the lost pounds. For each goal, the regimen also escalates requiring longer hours of exercise per week and lower daily calories. So 30 minutes of exercise and a rough estimate of daily calories instead of regulated calorie restriction may not be enough to lose and sustain weight depending on the objectives of weight loss, weight maintenance and prevention of regain.

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