The Difficulties Behind Succesful Weight Loss

In the February 2015 issue of Lancet, a very prominent British medical journal, an interesting article was published about obesity and its effects on the body.  This article speaks against the simple reasoning that once someone is obese, treatment to lose the weight is as simple as “eating less and exercising more”.

There are many physiological changes that happen in the body once someone becomes overweight or obese.  The article mentions the following examples:

  • The body’s ability to store fat increases
  • The body’s method of stimulating appetite and hunger sends stronger-than-usual signals for the person eat calorie-rich foods (via neural dopamine signaling)
  • The body’s ability to use energy becomes more efficient, and it becomes harder to lose weight or even maintain it compared to someone with normal body weight.

These adaptations tend to occur once the body has been dealing with increased weight for a good deal of time – though how exactly long a time is still not certain.  Therefore there should be a sense of urgency in reversing the trend of weight gain before the body becomes “used to it”.

The four authors of this article –  one pediatrician, two internal medicine doctors, and one psychiatrist, make recommendations for weight loss, including the following:

  • First and foremost it is important to acknowledge and address the obesity. Even today, not everyone in the entire medical community is on the same page in regards to how bad obesity is for one’s health.   It is important to start addressing the problem as early as possible, as the longer the problem goes on the harder it will be to address in the future.
  • Lifestyle changes (diet and exercise), though essential, may not be enough to reverse the weight gain. Either additional therapies with either medications or surgery may be necessary.
  • It is good to know that to lose the weight and keep it off will require more work than someone who has never had obesity. For example, a formerly obese patient of normal weight may have to consume 300 calories less than someone of the same weight who never had obesity, just to maintain that weight.

I would also like to mention that in the article this panel of non-surgical physicians do state that “bariatric surgery is the only available treatment to show long-term effectiveness”.   The reason for this is the correction of “appetite-related hormone profiles and neural responsivity”, which cannot be achieved with diet and exercise changes or any current medications.

So if you are dealing with obesity, and you can lose the weight with just diet and exercise, that’s great!  But if you’re trying your best to eat and exercise right, and you’re still not losing the weight (or even gaining more), you shouldn’t feel like you’re a failure or it’s your fault.  Your body may have adapted to the extra weight enough to where it is actually fighting against your attempts to lose the weight.

So if you feel like you’re getting nowhere with weight loss despite your best efforts, don’t hesitate to ask your primary doctor about the possibility of bariatric surgery.  It is safe and in some cases the only effective treatment for obesity.  Your health and future may depend on it.

Finally, if you’re out there struggling with obesity and have people around you who blame your lack of effort for not being able to lose the weight, I leave you lastly with this quote from the article:

“…the mere recommendation to avoid calorically dense foods might be no more effective for the typical patient seeking weight reduction than would be a recommendation to avoid sharp objects for someone bleeding profusely.”



Ochner CN, Tsai AG, Kushner RF, Wadden TA.  Treating obesity seriously: when recommendations for lifestyle change confront biological adaptations.  Lancet Diabetes Endocrinol 2015 Feb 11

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