Can’t Lose Weight?

When an overweight or obese patient comes to me, frustrated by his/her inability to lose weight, one of the first questions I ask is, “Do you feel full when you eat?” Many are surprised because no one has ever raised this question before—and their answer is often “No.”

Why most people can’t lose weight: When it comes to weight loss, biology often trumps willpower. If a person is obese, complicated metabolic issues almost always play a role, making it difficult—and in some cases impossible—for even the most diligent “dieter” to lose weight. (For those who are overweight but not obese, metabolic problems also may occur but are less common.)

Here’s what happens: When you consume a fattening food (usually a high-calorie combination of sugar and fat), it interrupts the body’s weight-regulating mechanisms, causing resistance to a hormone called leptin. When functioning properly, this hormone signals the brain, indicating how much fat is being stored and promoting a sense of satiety (fullness).

When your brain can’t tell how much fat is being stored, it’s like driving a car without a functioning gas gauge. Fearful of running out of gas, you fill up at every stop along the highway, even storing extra gas cans in the trunk.

If the situation is compounded by a lack of exercise, the body’s cells become increasingly resistant to leptin. The more the person eats, the hungrier he becomes, setting off a vicious cycle.

Simple but amazingly powerful solution: Enjoy filling, high-volume foods, including salad (such as mixed greens)…broth-based soup…and vegetables (such as steamed spinach, mushrooms and carrots) at the start of a meal to stimulate your body’s fullness mechanisms. When it’s time to eat the rest of the meal, which is likely to include more-fattening foods, you’ll be more satisfied and less inclined to overeat.

REAL-LIFE SUCCESS STORIES

The following case studies are based on real patients I’ve treated over the course of my 23-year career as a weight-loss specialist. Each of these patients reached his/her target of a 5% to 10% weight loss—and has maintained that loss. If you’re overweight and can relate to any of their stories, discuss these strategies with your doctor.

Lack of sleep was to blame. Jack, age 67, complained of weight gain, fatigue and constant hunger.* During the exam, I noted that his neck was bigger than normal, which made me suspect obstructive sleep apnea, a disorder that results from a blockage of the upper airway that causes sufferers to stop breathing during sleep multiple times a night. I asked if he snored or woke up in the middle of the night with a choking sensation (both signs of sleep apnea), and his positive reply confirmed my suspicions.

What is the sleep–weight gain connection? If you don’t sleep enough, your body produces lower levels of the satiating hormone leptin and higher levels of the appetite-stimulating hormone ghrelin.

My solution: I asked Jack to use a special mask that assists with breathing—a treatment known as continuous positive airway pressure (CPAP)—during sleep.

Result: Jack dropped from 220 to 202 pounds. His sleep dramatically improved, his hormones leveled out and his fatigue disappeared.

Not eating enough. For Stella, age 55, eating breakfast (typically toast or instant oatmeal) made her feel hungrier by midmorning, so she began skipping the first meal of the day. As a result, she was ravenous by lunch and dinner, and she even ate a late-night “snack” of chicken pot pie.

For optimal performance, our bodies require at least three daily meals. Since Stella skipped breakfast, her body viewed her lunch as breakfast and her dinner as lunch and wanted even more calories late at night. Stella then fell asleep with a full stomach, promoting weight gain and making it more difficult to remain asleep.

My solution: A high-protein, fiber-rich breakfast (such as an omelet and unlimited veggies—fresh or frozen)…for lunch and dinner, I recommended cooked vegetables, salad, plus chicken, turkey or fish for protein and one-half cup of a carbohydrate (such as rice or pasta) if needed…and a small nighttime snack, such as sugar-free gelatin or yogurt.

Result: Stella dropped from 165 to 153 pounds, had more energy during the day and slept better. But the key change was that Stella got her appetite under control and no longer felt famished by lunchtime.

Medication was the culprit. John, age 72, was obese and taking medications for elevated blood sugar (glucose) levels. Based in part on his primary care doctor’s advice, he was following a high-carbohydrate, low-fat diet—a typical breakfast was cereal with a banana and juice…lunch was turkey on rye with lettuce, tomato and mustard…and dinner was pasta with chicken and a salad.

But the scale was inching up and John was hungry all the time, so he snacked. Unbeknownst to John, the medications he was taking were causing higher-than-normal levels of insulin (a hormone necessary to move sugar from food into cells). Elevated insulin levels are associated with excessive hunger and the storage of calories as fat, potentially leading to weight gain and obesity.

My solution: Switch John to a combination of different diabetes drugs—metformin (Glucophage) and exenatide (Byetta)—both of which suppress production of glucose by the liver and often cause weight loss.

I also prescribed a higher-protein diet with more of his carbohydrates coming from vegetables rather than the cereal, toast, and bread that he had been eating.

Breakfast was now a big bowl of plain yogurt with berries…lunch was salad, lots of veggies, lean turkey and one-half cup of brown rice toward the end of the meal (so he would be consuming the high-calorie rice when he was nearly full)…and salmon, steamed asparagus and a green salad for dinner.

Result: John dropped from 210 to 180 pounds, and his blood sugar levels stabilized.

What many people don’t know: Certain medications can stimulate weight gain, including some sleep medications…antihistamines…heart drugs…migraine medication…and certain drugs prescribed for depression or bipolar disorder.

*Patients’ names and some identifying characteristics have been changed to protect their privacy.