Why can't I lose weight?
Midlife is not kind to your middle. Losing weight is difficult. It isn’t all about calories in versus calories out, and it isn’t about a lack of willpower or laziness. It is about your body working against you. Of course, you should eat healthy, unprocessed food, and take part in physical activity. But even this doesn’t always work for weight loss.
It doesn’t work because as we lose weight our hunger hormones kick in at full speed. We are evolutionarily designed to eat. When we were hunter/gatherers this was protective. But not today when food is plentiful (and super processed). When your body needs energy, ghrelin is released from your gut and goes to your brain and tells your brain you are hungry. When you restrict your calories and lose weight, the amount of ghrelin you make increases, pushing you to eat and making you feel like you don’t have willpower. Each time you lose weight and then regain it, the amount of ghrelin you make in response increases, driving you to eat even more. This is one way that yo-yo dieting ultimately leads to more weight gain than when you started.
Our understanding of obesity has changed over the last few decades. We used to think fat cells were just for storage. We now know that fat cells make oodles of hormones and other substances that affect our weight. Fat cells make a hormone called leptin. Leptin tells our brain we are full. But in people with obesity, leptin doesn’t work like it should. People may become “leptin resistant” and sometimes the parts of the brain that control fullness don’t respond to leptin anymore. We can’t blame it all on leptin and insulin resistance. Executive function in the brain plays a role too. We have control over things like eating when we are stressed or not hungry, and we certainly have control over how much physical activity we are getting.
At midlife/menopause a variety of changes take place. Hormone levels of estrogen and testosterone are plummeting. As estrogen decreases, excess fat starts to go right to your belly instead of hips and bust like it did premenopause. As we age, we naturally lose muscle and gain fat. It isn’t clear how much of this is due to decreasing hormones and how much is due to aging. Either way, as we become fatter and lose muscle, our metabolism slows down. This means it takes fewer calories to run our body. If we are eating the same number of calories and exercising the same as we used to, over time, weight gain will ensue. Fortunately, strength training increases your metabolic rate causing you to burn more calories. Even five minutes here and there makes a difference. If you can’t find time to get to the gym, get some home weights and lift when you can.
At midlife, women are more likely to become insulin resistant. This means that their bodies must produce more insulin to get the same amount of glucose into their cells to use for fuel. Insulin is an anabolic hormone, and it tells your body to deposit fat. Left untreated, insulin resistance can become prediabetes and ultimately diabetes.
Weight loss can restore normal insulin levels. There are a variety of safe and effective medicines that work very well for weight loss in all women, but also in women with insulin resistance. These are called GLP-1 agonists. GLP-1 stands for glucagon like peptide. GLP tells your brain that you are full. A GLP-1 “agonist” acts like GLP and makes you feel full, in other words it is an appetite suppressant. It is not an amphetamine, so it isn’t addicting. GLP-1s also slow the rate at which food leaves your stomach, making you feel fuller for longer. There are several GLP-1s on the market and studies show excellent amounts of weight loss. Some GLP-1s are also cardioprotective, meaning they may lower your risk of heart disease. GLP-1s are also used to treat diabetes, so for people with insulin resistance, they restore insulin to normal levels.
Obesity is a disease. Just like high blood pressure is a chronic condition, so is obesity. But we do have the power to overcome it. If you are having trouble losing weight, don’t fall for quick fixes that promise rapid weight loss. There is no magic supplement that is going to make you lose weight. Find a doctor who understands obesity. Go to the Obesity Medicine Association to find a practitioner. Even a small amount of weight loss leads to big improvements in your health, not to mention, you feel good about yourself. Start feeling like yourself again today!
Becky Lynn, MD is a gynecologist and weight loss specialist in St. Louis. She sees patients in Missouri, Illinois, and Tennessee. If you are having trouble losing weight, schedule a free 15-minute consult with Dr. Lynn to see if she is the right fit for you.
