The biggest frustration I hear from patients who work hard on their diet, eat healthy, and exercise is that they still have trouble losing weight no matter how hard they try. Or the weight comes off and it’s just as hard to maintain. The truth is, you’re not crazy. It is difficult to drop the weight and keep it off due to two biological factors- human evolution and the body’s ability to ensure its survival. But, it is not impossible.
Most people with obesity are able to lose weight, but research shows that only 20 percent manage to maintain the new, lower weight.
The first factor comes into play because the body wants to stay where it’s comfortable and resists dieting. As a result, the hunger hormone ghrelin increases when we lose weight, the stomach releases greater amounts of this hormone which makes us feel hungry. Everyone has this hormone, but if you’ve been overweight and then lose weight, the hormone level increases. The disappointing news about ghrelin is that the level does not appear to adjust over time. A 2 year study in the American Journal of Physiology, Endocrinology and Metabolism found that the level of ghrelin in the study participants remained high throughout the two years. They all lost weight, but everyone was hungrier in the end. The feelings of satiety after a meal also increased, but the feeling of hunger increased more.
The other mechanism working against maintaining weight loss is the body’s ability to conserve. A person who’s been obese has needed more energy just to breathe, sleep, digest food or walk. When the body loses weight, less energy is needed for these basic functions, simply because the body is lighter. Some people also go into saving mode. Someone who has weighed 180 lbs their whole life can eat more than a person who is 180 pounds after losing weight. The difference in the amount of food is about 400 calories – the amount of a good breakfast. In other words, people who have lost weight need less energy to maintain their new lighter bodies. Yet they feel hungrier because the body is trying to get that weight back, just to be safe. Blame it on the the hunger hormone ghrelin, which spikes when you suddenly lower your food intake. It’s a phenomenon that harkens back to when early humans had to survive bouts of famine.
According to the study, most people with obesity are able to lose weight, but research shows that only 20 percent manage to maintain the new, lower weight.
The United States maintains a large register of people who have lost weight through lifestyle change, where weight loss was at least 14 kilos (30.86 lbs) and was maintained for at least one year. On average, people lost 32 kilos (70.55 lbs) and maintained their weight loss for six years.
People who managed to maintain their weight loss did so by:
• Eating fewer calories and little fat
• Weighed themselves weekly
• Ate breakfast every day
• Did an hour of exercise daily, even just going for a walk
• Realized their lower-weight bodies needed significantly fewer calories than their pre-weight-loss bodies.
Sometimes just knowing, and understanding what’s happening is enough to conquer it. But like any long term process, it takes a lot of support. That’s why I believe the weight loss programs that not only help with caloric intake but also with exercise and emotional support see better results in the long run.
This is no different than patients with diabetes, cardio vascular disease, or chronic pain. We need to stop looking at obesity as a loss of willpower and realize there are a multitude of forces at work that, all combined, make it difficult for anyone to succeed. Obesity is a daily struggle just like any other chronic process. We have to stop treating it as a short-term issue by giving patients some intermittent support and help, and then letting them fend for themselves.
I know this news can be frustrating and difficult to hear. I’ve been there. Not with weight, but pain. Accepting I’d have to live with it everyday of my life was overwhelming and frightening. For years I demanded and sought out quick fixes until I realized – I was the fix. I needed to stop seeking external solutions and turn to the one thing that could help- me. Once I made this pivot, accepted my new reality, I could move forward. I fall a lot (figuratively!) but I always get back up.
We are in this together. Families, friends, co- workers and especially healthcare workers need to join the battle. No one should feel alone, alienated, or isolated.
In the next post I’ll talk about strategies to deal with the hunger pangs that come with weight loss, by decreasing appetite.
Main image provided courtesy of: myfooddiary.com