The formula to lose weight is simple: eat less, move more, and watch the pounds disappear. For many people, it works. For some, the scales refuse to budge even after months or years of serious effort. This is not due to lack of willpower or not “trying hard enough”. There are physiological and medical reasons why standard approaches to weight loss may fail. Understanding the limitations of diet and exercise gives people the power to make the best decision for their specific situation.
The Metabolic Adaptation Problem
Most bodies energetically defend a stable weight, especially if that weight has been stable for a number of years. When someone diets and reduces their caloric intake, their body does not just passively allow the resulting weight loss to happen. Metabolism down-regulates to match the new energy input. This adaptive mechanism was useful for survival in our hunter-gatherer history but is now a barrier for people trying to lose weight.
Research shows that people who lose significant amounts of weight by diet alone have metabolic rates that are typically 20-25% lower than expected for their new weight. Their bodies burn less energy than someone of their new size. This means they have to eat even less in order just to maintain the weight loss. This is an understandably difficult struggle to sustain over the long term.
Hormonal Causes of Inability To Lose Weight
There are a number of hormonal conditions that make it virtually impossible to lose weight regardless of diet and exercise. Hypothyroidism lowers metabolic rate which makes it impossible to maintain a caloric deficit. Polycystic ovary syndrome alters insulin processing and fat storage locations which makes it almost impossible to lose weight, especially in the abdominal area.
These are far from uncommon conditions. Millions of people suffer from hormonal conditions that prevent successful weight loss. Someone with undiagnosed hypothyroidism could work out daily and eat a perfectly healthy diet but see no positive change on the scales. The problem in this case is not the quality or quantity of their efforts; it is a physical condition that needs to be diagnosed and treated before anything else will help.
When Interventions Are Appropriate
For individuals who suffer from obesity-related medical conditions or who have not responded to more conservative approaches, interventions like a gastric sleeve surgery offer a medical solution that addresses both the physical and metabolic reasons for their excess weight. These are not cosmetic or frivolous procedures – they are medical interventions for people at serious medical risk.
The criteria for eligibility for a surgical intervention usually include a BMI above certain levels as well as obesity-related medical risks such as type 2 diabetes, hypertension or obstructive sleep apnea. Patients also have to demonstrate that they have made reasonable attempts at other forms of weight loss interventions without achieving sustainable results.
Genetics
Genetics is important in determining metabolic rate, body fat distribution, and how efficiently an individual burns energy while exercising. Some people can eat a lot of food without gaining weight while others may have difficulty maintaining their weight even with a healthy caloric intake. Genetics predispose people to various bodyweights and there is not much anyone can do to change them.
Twin studies show that genetics account for 40-70% of differences in body weight between individuals. For someone with a genetic predisposition to obesity, the battle is therefore much harder than for someone with a natural tendency to weigh less than average. Nothing changes genetic predisposition but lifestyle factors may play a role in the well-being of someone who has a genetic tendency towards obesity, even if they can’t change their overall bodyweight.
Medication Side Effects
Many people take medications that have side effects that lead to significant weight gain. Antidepressants, antipsychotic medications, corticosteroids and diabetes medications are notorious for their weight gaining effects.
The dilemma that people face when on these medications is whether to prioritize their mental health or chronic illness over maintaining a certain bodyweight. For many people, the answer is likely yes, there is no other option under consideration.
Age-Related Causes
People’s metabolism slows down as they age and muscle mass decreases unless they regularly engage in resistance training. Eating and exercising habits that worked for someone when they were 25 years old no longer keep them at the same bodyweight once they hit 45+. Hormonal changes related to aging also create obstacles to losing weight.
Older adults have probably noticed that it is much harder to lose weight now than when they were younger. The struggle to lose every single pound becomes intimidating and defeating over time, especially if age-related physical conditions make regular exercise difficult or impossible.
Psychological Causes
Stress increases cortisol which leads to fat storage in the midsection. Sleep deprivation increases cravings for food and interferes with hormones that signal hunger. Certain psychological conditions can also affect the executive function required to stick to a dieting or exercise intervention.
All these factors create biochemical obstacles to losing weight that sheer willpower cannot overcome. It is not just that someone is not sticking to their diet or exercise routine; the conditions created by these factors actively work against them.
Knowing when diet and exercise stop working is not about giving up; it tells people when it may be time to seek medical help. Health should always be prioritized, if that means straying from standard approaches then so be it!
