Losing weight can be difficult. But keeping the weight off is another challenge. There are many factors that go into weight management. Some are in your control and some aren’t.
In the WebMD webinar “Why Is It So Hard to Lose Weight and Keep it Off?” Amanda Velazquez, MD, an obesity medicine and nutrition specialist who serves as director of obesity medicine at Cedars-Sinai Medical Center, explained why obesity is a chronic disease and what goes into losing weight without gaining it back.
“Obesity is very complex,” she said. “It's too simple to say that it's just due to diet and exercise -- it's been oversimplified for so many decades. It’s a disease just like any other medical condition we talk about.”
Poll Questions
More than 2,300 webinar viewers were asked about their strategies to lose weight. More than half said they tried dieting, while over a third reported using exercise to lose weight.
A whopping 92% reported trying weight loss medications.
What Affects Weight Loss?
Many things affect your weight. Among them are:
- Your genetics
- Prenatal and postnatal health
- Endocrine disrupting chemicals (EDCs)
- Your environment
- A history of trauma
- Being a victim of weight bias or stigma
- Your diet
- Your eating patterns
- How much exercise you do
- Your quality of sleep
- Whether you have a sedentary lifestyle
- Pregnancy
- Your age
- Menopause
- Life-changing events
- Taking "weight-promoting" medications
- Your medical conditions
- Your stress level
- How much alcohol you drink
- Whether you smoke
- Your mental health
“I want you to appreciate that some things impacting your weight today start even before you're out of the womb,” said Velazquez. “And there are so many things here that aren’t in our control.”
While this can be discouraging, Velazquez said working with your health care team can put power back in your hands. Understanding your relationship to weight is the first step to taking action.
Obesity Treatments and Weight Loss
There are so many avenues to take when it comes to losing weight:
Lifestyle. This includes making changes to your diet, exercise routine, sleep, and stress management habits. You can push through barriers to reach your goals.
Medications. Along with lifestyle changes, you might use medications for the long term to help with weight loss.
Endoscopic bariatric procedures. This includes endoscopic sleeve gastroplasty or intragastric balloon.
Weight loss surgery. There are different types, like gastric sleeve or gastric bypass (Roux-en-Y).
“There are lots of treatments on the horizon, which is really exciting,” said Velazquez. “But lifestyle is always going to be the foundation. We need to build upon that.”
Viewer Questions
What do people over 70 need to do differently than younger people to lose weight?
Do some weight loss plans work better (or not as well) for different ethnicities?
Why is the American diet less healthy than ever?
We know people over 65, especially those who’ve gone through menopause, have changes in body composition. Your body is more likely to lose muscle mass.
In this age group, it’s important to include resistance training in your exercise routine. This helps your body increase your metabolic rate and muscle composition. Resistance training means doing anything against gravity, so that includes things like resistance bands or Pilates and yoga.
We need more research to understand how your ethnicity affects weight loss. But we know what risk factors and diseases are more common in certain communities. Therefore, we may recommend certain diets.
For example, in the Latinx community, there's a high prevalence of diabetes. Because of this, we may lean towards a diet plan that's lower in carbohydrates. But ultimately, it’s going to be a very individualized approach for each person.
In America, industrialization that's occurred over the past decades affects the preparation for food, fast food, and other things. There are many variables at play: endocrine disruptor chemicals, food being more processed, and more chemicals influencing your metabolism. It’s very different from how they regulate food in Europe.
What's the best plan for reducing belly fat?
What about intermittent fasting?
Can you change your gut microbiota to change your metabolism?
Belly fat is a certain type of fat tissue called visceral adiposity. It helps to be mindful of your carbohydrate intake, avoid processed foods, and keep your alcohol consumption low. That’s because all of those can contribute to belly fat.
It’s difficult because our bodies may put on more belly weight as we get older. Especially for women, with changes in estrogen levels from menopause.
There’s research to support intermittent fasting. Especially when you have insulin resistance. If you have pre-diabetes or diabetes, you might benefit from intermittent fasting. It may also help you lose weight.
The tricky part is how sustainable it is. Can you do it long term? I recommend a personalized plan.
If you have prediabetes and you eat within an 8-hour window per day, and it works for you, then that's a good fit. But if you need to eat three to five meals a day or you don’t have a history of insulin resistance, maybe intermittent fasting isn’t the right fit.
We aren't sure yet if there’s an effective way to change your gut microbiota. I can't say that taking a certain probiotic or starting a new diet plan is going to automatically convert your microbiota to help you lose weight. More research needs to be done.
For now, the important part is finding a healthy eating plan that has your gut working well and allows you to stick with it. You need to have regular bowel movements, not feel bloated pain in your stomach, and feel full and satisfied after you eat.
Do some prescription meds make it harder to lose weight?
What type of doctor is best to see for weight loss issues? How can I find one in my area?
Is losing weight enough to stop prediabetes from becoming diabetes?
One of the uncontrollable variables in weight are weight-promoting medications. For example, someone may have asthma and take prednisone, which can cause weight gain. You need to talk with your health care provider to weigh the pros and cons.
If a medication is helping you significantly, we have to weigh the pro of that compared to the gain of 5 pounds. But in other cases, like with birth control, we know that a Depo-Provera injection can cause weight gain. Maybe that’s an easy switch for you. You might swap to a weight-neutral birth control method, like an IUD.
There are specialists that have training in obesity medicine, which is what I do. You can check the website ABOM.org to search for providers in your area. Another way is to talk with your primary care doctor. Our hope is that more primary care doctors are addressing obesity.
In terms of prediabetes, losing even 5%-10% of your total body weight can help improve your blood sugars and prevent diabetes. Ideally, aim for 15% total body weight loss. Weight loss, generally, can prevent prediabetes from becoming diabetes.
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