When patients first enter my office, one of the most common goals they have is to shed pounds. They soon find out, however, that it's easier said than done; there are so many factors that go into a person’s weight-loss journey, and these can be both deeply personal and highly varied.
It’s easy to assume that your excess weight stems from poor lifestyle choices like too much junk food and a lack of physical activity, and that all you need to do is find the right diet and workout routine. But what happens when you've already tried all that without seeing any results? Often, the inability to lose weight is a symptom of a bigger underlying health problem or seemingly unrelated issue. Here are some key questions I always ask my patients who are struggling to lose weight:
1. What's your sleep like?
Irregular sleep cycles can lead to messed up circadian rhythms, which contribute to leptin resistance. Leptin is a hormone produced in your body’s fat cells, and its job is to tell your brain to use your fat for energy. With leptin resistance the hypothalamic cells of your brain don’t recognize this hormone and end up storing the fat instead of burning it off for energy, leaving you in constant hibernation mode, storing all your fat for a winter that will never end.
I often see patients who struggle with fatigue, many of whom experience a second wind in the afternoon. It’s easy to brush this off and attribute it to a busy lifestyle, but I consider it a major red flag for adrenal fatigue. This hormonal imbalance happens when your stress hormone cortisol is high when it should be low, or low when it should be high, and makes losing weight nearly impossible.
2. What does your current diet look like?
What you eat can either feed your microbiome or destroy it. If you're eating a diet full of processed, inflammatory foods, you can be perpetuating chronic microbiome problems such as leaky-gut syndrome. This increased intestinal permeability can increase fat around your organs and contribute to metabolic syndrome. Not to mention that the chronic inflammation that goes along with leaky gut can also lead to hormone imbalance and leptin resistance. Studies have shown that people who typically eat a wider variety of fermented foods like sauerkraut and kefir generally have greater bacterial diversity, which has been correlated with lower weight.
3. How stressed are you, really?
Our culture tells us that weight has everything to do with diet and exercise, but your mental health plays a huge role in healthy weight management. Chronic stress has been implicated in health issues ranging from adrenal fatigue, autoimmune conditions, and digestive issues—all of which can impact your weight. Stress alone can actually slow down your metabolism and increase food cravings! Typically I start by helping patients adopt some mindfulness tools to jump-start the healing and weight-loss process.
4. Are you exposed to toxins on a regular basis?
We all come in contact with toxins on a daily basis. And over the years the amount of chemicals in our world has grown while our bodies and genes struggle to keep up. This leads to a slew of autoimmune, digestive, and hormonal problems that can contribute to weight-loss resistance. It’s important to note that certain people (hair stylists, for example) are constantly exposed to chemicals in their everyday lives. So it's important to evaluate the level of your daily exposure.
5. Have you had lab tests done?
Lab results are the last piece of the puzzle when it comes to weight-loss resistance. Underlying hormonal imbalances and gut issues are typically playing a major role:
Cortisol: Your adrenal glands release cortisol, your body's main stress hormone. When there is too much or too little it can also lead to adrenal fatigue.
Testosterone: When this hormone is too low for men and too high for women, it leads to weight gain.
Estrogen: Men and women can have estrogen imbalance. There are three types of estrogen in your body, estrone (E1), estradiol (E2), and estriol (E3), and you need the proper ratio between each. Too much can lead to rapid weight gain.
Progesterone: This is needed to balance the effects of too much estrogen; when this is out of whack our estrogen will be, too.
Thyroid: Every cell in your body needs thyroid hormones to function. Autoimmune thyroid problems, thyroid resistance, and thyroid conversion problems are all possible thyroid issues.
Microbiome: Gut issues can also contribute to your weight gain. I always like to run gut labs to see what we are up against since needn't be experiencing gut symptoms to have an gut problem. It has been shown that people who are overweight have less microbiome diversity and that people who have leaky-gut syndrome tend to be more overweight. This can lead to metabolic syndrome and can further perpetuate inflammation and hormone imbalance.
Looking at these labs will help determine your level of gut permeability:
- Zonulin and occludin antibodies: These are the proteins that govern gut permeability. Antibodies could mean there has been damage to the intestinal tight junctions.
- Actomyosin antibodies: The presence of these could mean there was a destruction of healthy gut lining.
- Lipopolysaccharides (LPS) antibodies: These are bacterial endotoxins located in your gut. If these are found it could indicate leaky-gut syndrome
Finally, I always remind my patients, if they want to get healthy, losing weight is only part of the journey. If you have an underlying issue and are restricting calories and exercising like mad you could just exacerbate the problem. But when you think about the process as getting healthy to lose weight, weight loss will come much more easily and naturally as you start to heal your body from within.