January 5, 2024

From sleep to psychology, many factors contribute to success.

Weight loss can be challenging. Sometimes even a healthy diet and regular exercise do not lead to keeping extra weight off in the long run. 

This is because there are many other reasons for weight gain. Genetic predispositions, environmental causes, developmental changes, hormonal abnormalities, medications, cultural influences, insufficient sleep, eating disorders, depression, stress, trauma – all can contribute to weight gain (in addition to an unhealthy diet and getting too little exercise). 

Why is it so difficult to lose weight? 

The biology of weight is complex. Weight is regulated by a complicated system, led by the brain and hormones released by the gastrointestinal (digestive) system. When the system works correctly, energy is in a normal balance. The body responds to an increase in weight by decreasing appetite and increasing thermogenesis (producing heat) and spending more energy to shed weight.

When this system isn’t working properly, weight loss becomes difficult. When the brain recognizes a higher weight for a long period of time, it defends this level of fat mass, or “set point,” like a thermostat that maintains a higher temperature in a house. When weight decreases, there are mechanisms in the body that promote weight gain, such as an increase in appetite and a decrease in satiety, the feeling of being full. The brain learned by evolution that keeping a certain weight on the body helps survival.

Unfortunately it can be difficult to override the body’s responses with lifestyle changes alone. Weight loss medication, and in some cases bariatric surgery, can help lower your body’s weight set point and maintain weight loss over the long term. Medication and surgery can each help reduce appetite, increase a feeling of fullness and improve how your body spends energy.

The first step: What is your reason to lose weight?

Ask, “why do I want to lose weight?” Is it to improve your metabolic health? Is it due to not liking a certain part of your body? 

Understanding your motivation to lose weight is an important first step, to start this process with a healthy mindset. If you are mainly concerned about how your body looks, be aware that psychological issues can be an influence, and these should be addressed first. Furthermore, if you are struggling with an eating disorder, it is critical to speak with your doctor to decide whether professional structured treatment would be more appropriate than tackling a weight loss program on your own with no support.

Next, think about your habits 

Weight loss starts with caring for the body and mind in a compassionate way. This means paying attention to how much and what kind of food you eat, eating behaviors, physical activity, sleep habits and how you manage stress.

Instead of a short-term fad diet, focus on eating balanced meals. Plan and prepare healthy meals in advance and increase intake of high-quality foods. Choose foods that are not processed or minimally processed, whenever possible. These items are more nutritious.

Unprocessed and minimally processed foods are meats, vegetables and fruits that are in their natural state, such as fresh apples and precut vegetables. These foods contain less sugar and more fiber than processed food, so they help you feel full.

Processed foods are meats, vegetables and fruits that have been changed from their natural state (for example, fast-food chicken sandwiches or biscuits. Processed foods usually have more calories than unprocessed food and can lead to weight gain.

Try using the plate method to balance your diet. It is recommended by the American Diabetes Association to prevent insulin resistance, which is a cause of weight gain and diabetes. The plate method emphasizes eating a small amount of healthy carbohydrates and larger amounts of protein and vegetables. Protein can increase the feeling of fullness, maintain muscle mass and keep blood sugar stable. Research shows that consuming vegetables and protein before carbohydrates during a meal can lower your blood sugar level after the meal. Furthermore, eating food earlier in the day boosts metabolism (the rate at which your body burns energy) and encourages weight loss more than eating meals late at night.

Be aware of emotional eating 

It is normal to eat food for enjoyment and comfort. But eating can become problematic if food is a way to cope with unpleasant emotions. Think about why you are turning to food. Is it for pain relief, an escape or out of a sense of guilt? Think about the root cause of these feelings to help break the habit of emotional eating. Seek professional help from a therapist or a medical provider if it is difficult to change this habit on your own.  

Schedule physical activity

A busy work schedule and family obligations can make it hard to stay physically active. However, it is important to exercise to maintain muscle mass. Muscle tissue controls our metabolic rate (how much energy the body burns). The U.S. Preventive Services Task Force recommends at least 150 minutes of moderate to intense physical activity, plus two days of strength training, per week for adults. Taking time to exercise is an excellent form of stress relief and can help with anxiety and depression. Schedule time each week to make exercise a priority.  

Prioritize sleep  

Getting adequate sleep is critical for weight loss. Studies show individuals who sleep less than six hours per night have reduced levels of the hormone leptin. The lowered amount of leptin increases hunger the following day. A shortage of sleep also triggers cravings for sugar and an increase in the stress hormone cortisol, leading to more weight gain and an increased risk for Type 2 diabetes. It is important for adults to get six to eight hours of good quality sleep each night to help with weight loss and improve metabolism.

Manage stress in a healthy way 

Research has shown that people who have experienced more life trauma tend to gain more weight over time than those who did not suffer some kind of trauma or extreme stress. This could be due to chronic stress leading to an increase in cortisol, a hormone that encourages weight gain. Trauma may also contribute to depression, which in turn leads to poor eating patterns. 

When trying to lose weight, it is important to practice healthy coping mechanisms when stressed — such as exercise, meditation, yoga or deep breathing. Speaking to a therapist to work through any unresolved trauma can be very helpful.   

The right mindset: Building your confidence

Feeling confident in your ability to change can be hard, especially if you have tried to lose weight before without success. Remember that confidence builds with small accomplishments.

Set small goals that you can reach. Thinking that you need to lose a large amount of weight is daunting, so at first just work on losing 5 pounds. Then take note of small successes, such as being able to walk a certain distance without getting quite so tired, or noticing that your clothes are a bit looser, or that you can climb stairs with less joint pain and less shortness of breath. These are small victories. Notice them, congratulate yourself on them and remember why you decided to lose weight. 

Losing just 10% of body weight can have great health benefits, including an improvement in blood sugar, blood pressure, fatty liver disease, cholesterol, joint pain and overall energy level.  

Consider medication depending on your BMI

Weight-loss medication is appropriate for some people.

If you are overweight (with a body mass index BMI of 25-29.9), you may be able to shed weight by making lifestyle changes.

If you have obesity (a BMI of 30 or higher); or if your BMI is 27 or higher and you have a weight-related medical condition (for example, Type 2 diabetes, high blood pressure, fatty liver or others), combining weight loss medication with lifestyle changes may help. There are seven FDA-approved medications for patients meeting these criteria.

If you have a BMI of 30 or higher, without complicating conditions, medications may also benefit you.

This article was written by Dr. Nina Paddu, a clinical fellow in diabetes and endocrinology care with Vanderbilt Health.

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Help with weight loss

The Vanderbilt Weight Loss Center provides comprehensive, personalized care to help patients achieve and maintain their weight loss goals. Vanderbilt’s board-certified doctors are specially trained and experienced in all aspects of weight loss. They partner with a team of nurses, dietitians, exercise physiologists and psychologists to tailor treatment plans to meet each patient’s unique needs and health goals. To make an appointment, call 615-322-6000.

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