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The science behind weight loss and regain
Learn how changes in the body make it difficult to keep weight off over time.
Why is it so hard to keep the pounds off? Well, there’s more to weight management than meets the eye. People may see results when they limit calories, by reducing the size of meals, for example. And find ways to increase physical activity, like taking regular walks around the block. Science has shown the body responds in surprising ways when a person loses weight. It reacts to weight loss by trying to regain weight, making weight management a constant tug-of-war. Metabolism slows down and gets more efficient, requiring fewer calories to do its job. Hormonal signals can also change. The body increases a hunger hormone, called ghrelin, which tries to get you to eat more calories. And the hormones that tell the brain it's time to stop eating, the “feeling full” signals, decrease. These are just some of the factors that make weight regain so common.
Dr. Holly Lofton, MD, explains how losing weight can cause changes in the body that lead to weight regain.*
I really believe that willpower is not a factor in weight management and it's a construct that we as humans can understand. But what we have to really delve into is the body's natural desire to regain weight. So when you eat less and move more, the body is fighting back by slowing your metabolism, increasing your hunger hormones, and lowering your fullness, or satiety hormones. And this is what drives weight regain. It's very important to understand that if you try to lose weight and you're not successful, that it's not your fault and that your body is really trying to preserve you as a human being. And this is how our civilization has persisted over time. And if you need extra help that there are safe effective modalities that can be offered by the medical setting, and I implore you to use those.
Dr. Robert Kushner explains factors that make it hard to keep off weight.
You know, one of the most common misbeliefs about obesity is that it's a problem of willpower and moral failure, and indeed, that is the farthest from the truth. It turns out that obesity is considered a chronic disease with multiple determinants, such as genetics, biology, heritage, behaviors, such as what you eat and how you move your body around and your culture. It's also a tug of war between what you eat and what you burn and changes in metabolism as you lose weight. People could lose weight short term by changing their behavior, but the problems of obesity is that there's a change in metabolism, people tend to get hungrier and burn less calories. That's why we think of it as a chronic, long-term disease. I hope that perspective and understanding helps you realize that you would benefit from additional support and resources to help manage your weight.
Talking to a health care provider
Dr. Scott Isaacs, MD, explains how people living with obesity can benefit from the help of a health care provider.*
If you've been working really hard at losing weight and not being successful, then that's a perfect situation for seeing a weight-loss specialist, seeing a physician, and talking to them about a medication for weight loss. You don't have to do it on your own. And we have a lot of professionals that are out there that are there to help people. That's what we're here for. And we're very fortunate now that we have a number of medications that are available to help people when they have difficulty losing weight with diet and exercise alone.
Dr. Dawn Smiley-Byrd, MD, offers tips for talking to a health care provider about weight-management options.*
So for people at home, I think that one of the things that you can do is get in front of the mirror and practice. Practice those things that you really wanna ask. You know, "Hey Doc, I would like to lose weight. What can I do for this?" Also, again, mention what you've done in the past, what's worked for you, what hasn't worked for you, and then be sure to talk about the risk and the benefits of the medications, particularly the side effect profile, so it will help you better determine what would be a good fit for you.
Dr. Robert Kushner discusses partnering with a health care provider on weight management.
If you are comfortable and trust your healthcare provider tell him or her how you feel. Tell him or her that it is not as simple as eating less and moving more. That there are multiple determinants when it comes to weight control and that partnering with someone to get support is vital. I will tell you, there's zero tolerance, however, for any shame or prejudice that goes in during the encounter. Most healthcare providers are sensitive, but may not know how to bring up weight or be trained enough about your weight, that interaction should be positive. That partnering will lead to increased weight loss, long-term weight control and an improved therapeutic encounter with your healthcare provider. The bottom line is, however, if you're uncomfortable with your healthcare provider, find someone else who you trust and is supportive and remember, good communication is a two-way street and if you're prepared to have this conversation with your healthcare provider remain positive, things are likely to go well.
Dr. Robert Kushner has tips for starting a conversation with a health care provider.
If your healthcare provider does not bring up the topic of weight, I would encourage you to be assertive and bring it up yourself. Tell the healthcare provider that you are looking for additional support and ask them are they able to do so. Tell them why you're concerned about your weight and, if you can, what kind of help you're looking for. For example, do you need more guidance on diet or physical activity or behavior change or emotional eating? Then, of course, it's up to the healthcare provider how they would respond. If they respond, "Yes, I can help you," then you may want to have some of the questions ready to ask as appropriate as follows. Which of my medical problems are related to my weight? Do any of my medications cause weight gain? Will any of my medications need to be adjusted if I lose weight? Will I need any lab tests repeated as I lose weight? Do you have any additional weight management tips that you can help me with? Can I begin an increased physical activity program? Are there any precautions that I should take? If I need additional help with my food intake, increase physical activity, or health behaviors, will you be able to refer me to the If I would benefit from medication to treat my weight, can you prescribe that for me or refer me to an obesity medicine specialist?
*This video was created by My Weight - What to Know with support from Novo Nordisk. My Weight - What to Know provides education and support for people living with obesity through engaging videos, articles, live-streaming events, and a podcast. Their goal is to help people with obesity access perspectives from medical professionals based on the latest science.
Hear from people like you
After learning how appetite hormones change following weight loss, Reneé made a plan for weight management.
When I went to the doctor and I learned that obesity was a disease and I couldn't believe it. I thought that having obesity was my fault. When I heard that the hormones played a big part of our appetite. the way our body just reacts and and hold on to weight that was a big game changer for me. I think people need to change their views around obesity knowing that it is a disease. What I was suggest others to ask of their health care provider, first of all be honest with yourself. Knowing that you're struggling, you have to let them know, I'm struggling with this, what can I do? It's a journey. I have to make that journey work for me tomorrow and keep going and going until I'm able to just be okay with who I am. And I think that's what it is, having confidence in who I am and what I do. The advice I would give to someone who's struggling with their weight even to this day is to advocate for yourself. There's a big chest of tools that you can choose from and choose one that's best for you.
Patty explains how learning about the science behind weight loss changed her outlook.
I've had obesity since I was a child, but what really hurt was the bias and the stigma I faced, all the teasing and bullying. It's very hard to speak out when you have been the subject of such ridicule and stigma and blame. I eventually got tired of living that way, so I started looking for an obesity medicine specialist. He helped me learn more about what I don't control in my body, and how your body fights back against weight loss. Understanding the disease of obesity changed my life. I stopped blaming myself. An obesity diagnosis and its treatment if diagnosed has to be individualized. Some of it was little changes, some of them were bigger, but they added up to a successful plan for me. Be kind to yourself. Start appreciating where, who you are, where you're at now, and take positive steps to improve your health, which may include treatment for obesity.
Lisa explains what motivated her to form a weight-management plan.
My mother passed away at 47. And the contributing factors was diabetes, obesity. Over the years, I had looked for a physician that would understand and not just dismiss or diminish my concerns. After going through 4 to 5 physicians, and just getting the same information of just exercise and eat right, that wasn't enough for me, because I was doing those things. That's when I started my journey to find the right physician. She said, well, one thing is that you are obese. I can help you, if you're willing to do the work. Today, my approach to manage my weight is that I'm still currently on medication. I exercise every day. If my mother was here, she would be so proud, 'cause she would say, you did it and you didn't let no one stop you. If you love life, you love your life, you wanna live your life, and you have medical conditions, now I'm talking anything, ask questions.
Once Donna discovered obesity is a disease, she was able to make changes that worked for her.
For as long as I can remember, I have always been hungry. Weight has been an issue for me all of my life. I didn't look for jobs because I was sure I was gonna be judged based on my weight, and I just put myself out of the running before I got rejected by somebody else. I went to a medical conference in 2016 and for the first time, I learned that obesity was actually a disease. I had never heard that before. It was a huge relief for me to learn that this wasn't something that I had to handle on my own, and that if it became a problem for me again, that there were other options available for me that could help me to manage it. I think that any change that you make that allows you to become more active and more fit is gonna be positive. And being healthy doesn't necessarily mean that you have to look a certain way. It's really just about making the changes that are gonna allow you to live the kind of life that you wanna live. This is a personal decision, and you're going to have to make it on your own, but you need to be educated and know that this is something that you can take control of, and that it is a disease and it's not your fault.
