5 Reasons You're Not Losing Weight
In my practice, I see a lot of women who complain of difficulty losing weight, despite their best efforts. Especially as women approach their 40’s and 50’s, weight loss can become even more challenging and frustrating. Many tell me they have tried strict diets and exercise programs while working with personal trainers, dietitians, nutritionists, or psychiatrists, and yet the needle doesn’t budge. So, what gives?
Weight loss is not simply about calories in, calories out, and exercising more. A more significant piece has to do with underlying systems becoming imbalanced. When your digestive and hormonal systems are not working up to snuff, the downstream problem becomes weight loss resistance. When these systems are balanced, weight loss is the natural result. I have outlined the top 5 reasons why you may be unable to lose weight and some simple strategies to help break the cycle. One caveat, though: because everyone comes to the table with different genetic makeups and medical, behavioral, and psychosocial histories, you may have the most success working with a qualified professional who can dig deep into your story and develop a program that’s specific to you.
1. Excess sugar gets stored as fat and sets you up for pre-diabetes.
Many people do not realize how eating too many carbohydrates and not eating them in the right way—with additional fat, fiber, and protein—can cause blood sugar swings, hormone imbalance, and weight gain. Carbohydrates are found in all processed foods (cookies, crackers, cakes, breads, pastas), plant-based foods including fruits and vegetables, as well as alcohol, juices, and drinks other than water. All carbohydrates break down into glucose (sugar) our bodies’ energy source. Glucose that is not used for energy will be stored in the liver and the muscles in the form of glycogen. Storage capacity in these areas is very limited, however, so excess glucose will be stored as fat.
In addition, when eating meals or foods consisting of simple carbohydrates like fruit or processed foods without sufficient fiber, fat, and protein, the pancreas secretes greater amounts of insulin. Insulin is the hormone that helps take glucose out of the blood stream and into the cells for energy. A big hit of sugar causes a sharp rise in insulin. If insulin levels stay high enough for long enough, due to high blood sugar, then the cells that usually respond to insulin by taking glucose into the cells, become unresponsive. As the pancreas tries to pump out more and more insulin to get sugar into the cells, the cells become “deaf” to its signal. This is what we call insulin resistance. The cells are unable to take glucose in, so more glucose stays in the blood, leading eventually to pre-diabetes and Type 2 Diabetes. This surge in insulin to restore blood sugar balance keeps the body in fat storage mode and sets us up for chronic disease.
Best strategies-
· Eliminate all added sugar, processed foods, and alcohol from your diet. Watch out for high sugar coffee drinks, juices, and even “green” drinks, which can be packed with sugar. Read labels, look for foods or drinks with 5 grams of sugar or less. If you are struggling with eliminating that glass (or two) of wine at night, consider how alcohol is serving you right now. Are there other things you could substitute for a stress release? Try eliminating alcohol for a period of time (3 weeks) or until you reach your desired goal. Then make a decision on how much you want to re-introduce it, if at all. Alcohol raises blood sugar as well as the hormone estrogen, adding to weight loss resistance.
· Include a healthy protein, fat, and carbohydrate together with each and every meal and snack. For example, fruit with nuts is better than fruit alone. This will minimize the insulin/cortisol response and keep your blood sugar lower, steadier, and out of fat storage mode.
· Space meals apart. If you are always snacking or continually eating, you will keep insulin high and stay in fat storage mode. Aim for at least 3-4 hours between meals and snacks. Are you famished 2 hours after eating? Look at what you ate the meal before. Did it include enough healthy carb, protein, and fat? Keep making adjustments until you find the right food combinations and amounts to sustain you for a longer period of time. This will also allow you to start burning fat as energy instead of just glucose.
· Know your levels, measure your blood sugar. Ask your physician to run some tests to see what your glucose and insulin levels are and determine if you are becoming pre-diabetic. These tests include: fasting insulin, hemoglobin A1C, and fasting blood glucose. There are also some home kits that you can use to monitor your blood sugar levels on a daily basis to help you maintain better blood sugar balance.
2. Stress increases fat storage, especially in your stomach, and makes you hungrier.
When we are stressed, the brain sends a signal to the adrenal glands to increase the levels of cortisol, our stress hormone, to create energy the body needs to get through the crisis. With chronic stress, the signal to create more cortisol doesn’t turn off, which results in chronically high cortisol levels. Cortisol’s main function is to create more glucose, mobilizing it from storage sites in the liver and muscles so it can be used for energy. Under stress, and especially chronic stress, high cortisol levels result in higher blood sugar, and more storage of that sugar as fat, especially abdominal fat (1). When we are unable to manage our stress levels, it is equivalent to dumping a candy bar into the blood stream. Talk about sabotaging your diet and workout efforts— yikes!
Stress also causes an increase in the hormone ghrelin, which is secreted by the stomach (2). Ghrelin is the hormone that signals the body to eat more. Stress causes us to produce more ghrelin, which causes more cravings and the desire to keep eating (3). “Psychological stress can trigger the consumption of high fat and sweet food, leading to overall weight gain” (1). So, stress makes us hungrier, crave the wrong foods, and increases stomach fat, not a good combination.
Best Strategies:
· Practice Meditation. Any type of meditation, practiced consistently, will make a difference in your response to stress by helping to lower cortisol levels and minimize emotional eating. Mindfulness meditation was shown to reduce stress and emotional eating (1). Other types of meditation, like focused attention, transcendental, or a movement meditation like yoga or tai chi would be beneficial as well. There are numerous apps, like Calm, Headspace, or Mindfulness App, that can lead you through guided meditations in just minutes a day. The key here is to do it consistently, every day, for best results. Start with a really small goal, like 5 minutes a day, commit to it every day for a month, and see how you feel.
· Breathe Deeply. Take frequent times during the day to check in and see if you are breathing deeply. When I sit with a patient, I often notice that they are breathing up in their shoulders or, worse, holding their breath. When we don’t breath deeply, really expanding the diaphragm down when inhaling, we remain in fight or flight response, which raises cortisol levels, creating more glucose in the blood. Practice 5 deep, belly breaths often throughout the day to a count of 5 on the inhale and 5 on the exhale. Deep breathing slowly activates the parasympathetic nervous system, which helps to calm you down. An easy way to remember to do this is every time you use the bathroom take 5 long breaths. Stuck in traffic or just encountered a difficult conversation? Use your breath during or immediately afterward to bring down your levels and stop the stress response from taking over.
· Book a massage or bodywork session. We all know this feels good and we should do it more often, so why not do it? This could include massage, Reiki, Cranio-sacral therapy, acupuncture, acupressure, or reflexology. A study from Brazil showed positive reduction in anxiety with combined massage and Reiki (4). No time for a full massage? Ask your hairdresser to do a 10-15 minute scalp massage. A study showed scalp massage as having positive effects on decreasing stress hormones, blood pressure and heart rate (5). Yes, please!
· Exercise regularly, move more, sit less. Exercise is one of the best ways to lower stress levels, improve mood, deepen sleep, improve insulin sensitivity, and decrease cardiac risk factors. How’s that for benefits? At least 4-5 days a week exercise for 30-45 minutes in a way that gets you sweaty and elevates your heart rate. Exercise reduces your stress hormones and increases endorphins, your feel good hormones. Do you manage to get in this amount of exercise but then sit most of the day at a desk or in a car? Turns out being an “exercising couch potato” does not lower your risk of heart disease. According to Dr. Peter Katzmarzyk, from Pennington, the nation’s leading obesity research center, “regularly exercising is not the same as being active” (6). In 2009 Dr. Katzmarzyk studied the lifestyles of 17,000 men and women. He found that the people who sat for the entire day were 54% more likely to be clutching their chests. His research showed that it didn’t matter how much the people that sat all day exercised or weighed. Sitting is an independent risk factor that increases the likelihood of heart disease (6). In addition to getting in some weekly exercise, get out of your chair and move at least once an hour. Some ideas for moving are: walking while talking on the phone, going up and downstairs 10 times, squatting 15 times, push ups 10 times, or high knee walking. My work now involves a lot of sitting and computer time, so as I write this I am walking slowly on my treadmill using Surf Shelf, a platform attachment I found on Amazon.
· Journal. Can’t meditate just yet? Try journaling. Journaling can help reduce stress, improve focus, and bring clarity to your day as you clear clutter from the brain. In the book, The Artist’s Way Julia Cameron writes of doing the “morning pages” as a form of meditation and connecting to one’s higher purpose (7). Each morning when you wake up, complete three, longhand, stream-of-consciousness pages of writing. Do not re-read these pages. I can personally vouch for this; it will truly create a sense of calm and a positive shift in your thinking.
· Connect with positive people. Sometimes connecting with a friend as a sounding board can help dissipate stress. Or, get some professional counseling to develop better strategies to deal with your stress or a particular situation that is creating havoc in your life. As the saying goes, “Insanity is doing the same thing over and over again but expecting different results.” Figure out what causes you the most stress and get pro-active in developing ways to combat it.
3. Sleep Loss causes a shift in the hormones that make you hungry.
Americans are chronically sleep deprived. We’re busy, over-caffeinated and stressed, which makes it difficult to get a continuous 7-8 hours of sleep every night. We have fallen away from our natural inner circadian rhythm, which tells us to get up in the morning with the sun and go to sleep shortly after the sun goes down. Sleep is further disrupted by exposure to blue light at night in the form of computers, TV, or artificial lighting. When we get away from our natural inner circadian rhythm, our hormones get out of whack. It becomes difficult, if not impossible, to get a good night’s sleep.
You are hungrier when you sleep less. If you sleep five hours a night or less you will have more of the hormone ghrelin, which tells you to eat more, and less of the hormone leptin, which tells you to eat less (8). In addition, not getting enough sleep makes you too tired to do the things you know will help with weight loss, like choosing and cooking healthy foods or exercising. When you stay awake watching TV, or stay on your computer, phone, or other device, the blue light suppresses your body’s production of melatonin, your sleep hormone. It also keeps cortisol levels high when they should be low. Remember that cortisol’s main function is to create more glucose in the blood, so when we do these things our hormones are now working against us to store fat as well as disrupt our sleep.
Best Strategies:
· Avoid caffeine, alcohol, nicotine, or other chemicals that interfere with sleep. Some people, depending on their genetic make-up, are poor metabolizers of caffeine and may need to limit themselves to only 1 cup in the morning or eliminate it completely. Alcohol, because of its sugar content, acts as a stimulant and will increase night awakenings.
· The ideal time for sleep is 10:00 P.M. – 6 A.M. Consistent sleep each day between these hours helps to match with our natural circadian rhythm. Physical repair and regeneration takes place during this time. Try to get as close to this as possible; the quality of sleep from 2 A.M.- 10:00 A.M. is not the same. Set fixed times for sleep, even on the weekends, resisting the urge to sleep in. Instead, take a short 20 min nap earlier during the day if you are tired.
· Change your sleeping environment to induce sleep. Keep your bedroom dark, cover all lights, use blackout shades or
an eye mask. Light (particularly blue light) will inhibit melatonin
hormones from rising to allow restful sleep. Put on amber colored
glasses shortly after dinner to read or watch TV, which allows
Melatonin levels to rise and make you more tired. I’ve found Uvex
Blue Light blocking glasses on Amazon to be inexpensive and work really well. Use amber colored nightlights for bedroom and
bathroom light if you routinely get up to use the bathroom at night.
Keep room cool, 65-68 degrees. Use the bedroom as a sleep place
only—eliminate electronics.
· Allow for complete digestion. Stop eating 3 hours before going to sleep, so your body can rest instead of digest.
· Check for nutrient deficiencies. Low serum vitamin D may make it more difficult to fall asleep (9). Low Vitamin D has also been associated with restless leg syndrome, which can impair sleep as well. Ideally D levels should be in the 60-80 ng/mL range, so ask your doctor to test for this or send away for a home test from a company like directlab.com.
· Expose yourself to 20-30 minutes of sunlight upon waking. This helps to set your awakening response and lower your melatonin levels in the morning and raise them at night.
· Eat fat before bedtime. Take a TBL of nut butter or coconut butter before going to bed at night to avoid blood sugar dips and nighttime awakenings.
4. Hormone Imbalance causes weight gain and fat accumulation.
Hormone imbalance can take center stage for women over 40 as we navigate peri-menopause with increased stress, possibly due to older children, aging parents, financial strain, and sleep disturbances. These imbalances may be even more pronounced if there were pre-existing menstrual problems in our 20’s and 30’s, so this advice is for younger women as well. We have already discussed how stress and lack of sleep throw off our cortisol, insulin, leptin, and ghrelin hormones, but now we can add the female hormones, progesterone and estrogen, into the mix. In her book The Hormone Reset Diet, Dr. Sara Gottfried states that “estrogen dominance is the main reason women have a harder time losing weight regardless of age when compared with men” (10). As we get older, estrogen and progesterone decline. Estrogen is the hormone that gives us femininity, affects almost every organ in the body, and makes us feel sane and emotionally stable. Progesterone balances estrogen and helps us burn fat, sleep, and gives us a sense of wellbeing. When estrogen becomes more dominant than progesterone, we can have weight loss resistance. Estrogen can be dominant even if levels are low if progesterone has dropped significantly in relationship to it. There are many reasons why estrogen could still be higher than progesterone, but some may include high sugar diets, alcohol, and eating conventional red meat. On the flip side, if estrogen is too low, the body will store fat, especially in the abdomen, to produce estrogen from the fat cells. So our fat can make estrogen, perpetuating the cycle. It’s the balance of just enough but not too much. In addition, if the thyroid is sluggish or there is an undiagnosed thyroid condition, your metabolism will be further compromised.
Best Strategies:
· Get tested, know your hormone levels. Ask your physician to test your female hormones, ideally 6-7 days after ovulation, so you can get an optimal ratio of progesterone to estrogen. Another way to measure female hormones is with a test called the D.U.T.C.H, which stands for Dried Urine Test for Comprehensive Hormones. This test gives you your female hormones and their metabolites as well as cortisol and daily cortisol rhythm. The D.U.T.C.H. doesn’t directly measure your thyroid levels, but there are markers that can be suggestive of thyroid issues, in which case you may need to investigate further with blood work.
· Minimize meat consumption and switch to grass fed meats, pasture raised poultry and eggs, which are less inflammatory. Conventionally raised livestock are subjected to steroid hormones, anti-biotics, and are usually fed genetically modified corn and grains. Grass fed meat, unlike conventional meat, is higher in Omega 3’s, which has anti-inflammatory benefits.
· Increase fiber, at least 35-45 grams/day in the form of veggies, especially cruciferous veggies. The more fiber you have the more you will get rid of excess estrogen in your stool, so it doesn’t recirculate in the body.
· Exercise regularly. In addition to the stress benefits stated above, exercise helps lower estrogen levels as well as your risk of breast cancer.
· Consider food/herbal/supplement support to balance low or high hormone levels. For high estrogen levels, eliminate alcohol and caffeine, increase cruciferous veggies, and eat foods high in resveratrol, like berries and grapes as well as Vitamin C like citrus, berries, and tomatoes. Ask your health care provider about DIM (Di-indolemethane) to supplement, if necessary. To boost and balance estrogen, add ground flaxseed to a protein shake or sprinkle on a salad. Maca, an adaptogen, helps balance hormones and can improve symptoms of PMS and menopause. You can easily add this to a morning shake. For low progesterone, eat foods high in magnesium like nuts and seeds, dark leafy greens, and dark chocolate. Chaste berry has been shown to help with PMS and improve progesterone levels (11). However, you should avoid chaste berry if taking any kind of hormonal birth control, are pregnant, or taking medications to get pregnant.
· Acupuncture. Acupuncture has been shown to balance female hormones and improve sleep (12).
· Consider bio-identical hormones if you are unable to balance hormone levels with diet and lifestyle changes first.
5. Food Sensitivities Lead to Weight Gain
Food sensitivities have been shown to cause a leaky gut, which triggers a system-wide immune response and inflammation. Inflammation creates insulin resistance, resulting in fat storage and weight gain. Gluten is one of the major triggers for leaky gut and inflammation even in non-celiac patients (13). Eliminating the most common food allergens from your diet helps reduce inflammation and subsequent weight gain. In addition, when we have dysbiosis, an imbalance of bad bacteria to good, we develop inflammation along with insulin resistance. Dysbiosis may “adversely impact metabolism and immune responses favoring obesity and obesity-related disorders such as insulin/diabetes mellitus and non alcoholic fatty liver disease” (14). So, the wrong type or amounts of gut bacteria can not only make us fat but can also lead to chronic illnesses.
Best Strategies
· Eliminate common food allergens for at least 3 weeks such as gluten, dairy, soy, corn, peanuts (tree nuts), and eggs.
· Eat a whole food, plant based diet to help increase the amount of good bacteria in the gut.
· Take probiotics to help balance gut bacteria. Add fermented foods, if you tolerate them, like sauerkraut, Kim chi, kombucha, or coconut yogurt to your diet each day.
To summarize, sugar, stress, lack of sleep, food sensitivities, and hormone and gut imbalance can all sabotage our best efforts to lose weight. When we can correct these imbalanced areas, we not only improve our health, but also, as a result, lose weight. Implementing some of these strategies may help to move the needle in the other direction. Consider working with a functional medicine practitioner, nutritionist, or a health care provider who will help you get to the root of your imbalance and provide you with the best guidance and support to achieve your health goals.
This is not intended to be medical advice, and is not a substitute for being under the care of a physician. Check with your physician before stopping or starting a new program.
1. Daubenmier, J., et al. “Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study.” Journal of Obesity 2011;2011:651936. doi: 10.1155/2011/651936.
2. Chuang, J.C., et al. “Ghrelin's Roles in Stress, Mood, and Anxiety Regulation.” International Journal of Peptides Volume 2010 (2010), Article ID 460549, 5 pages http://dx.doi.org/10.1155/2010/460549
3.Chao, A.M., et al. “Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight.”
Obesity (Silver Spring). 2017 Apr;25(4):713-720. doi: 10.1002/oby.2179
4. Kurebavashi, L.F., et al. “Massage and Reiki used to reduce stress and anxiety: Randomized Clinical Trial.” Revista Latin America de Enfermagem. 2016 Nov 28;(24):e2834. doi: 10.1590/1518-8345.1614.2834.
(Article in English, Portuguese, Spanish)
5. Kim, H., et al. “The effect of a scalp massage on stress hormone, blood pressure, and heart rate of healthy female.” Journal of Physical Therapy Science. 2016 Oct;28(10):2703-2707. Epub 2016 Oct 28.
6. Katzmarzyk, P.T., et al. “Sitting time and mortality from all causes, cardiovascular disease, and cancer.” Medicine Science Sports and Exercise. 2009 May;41(5):998-1005. doi: 10.1249/MSS.0b013e3181930355.
7. Cameron, Julia. “The Artist’s Way” New York: Penguin Putnam, 1992.
8. Spiegel, K., et al. “ Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, and increased hunger and appetite.” Annals of Internal Medicine 141, no. 11 (2004): 846-50.
9. Shiue, I. “Low vitamin D levels in adults with longer time to fall asleep: US
NHANES, 2005-2006.” International Journal of Cardiology 41 (2013):20-21.
10. Gottfried, Sara. “The Hormone Reset Diet” New York: Harper Collins, 2015.
11. Westphal, L.M., et al. “Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women.” Clinical and Experimental Obstetrics and Gynecology 33 (4) (2006):205-8.
12. Chiu, H.Y., et al. “Acupuncture to Reduce Sleep Disturbance in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-analysis.” Obstetrics and Gynecology 127 (3) (2016): 507-15.
13. Uhde, M., et al. “Intestinal cell damage and systemic immune activation in
individuals reporting sensitivity to wheat in the absence of coeliac disease.”
Gut Dec;65(12) (2016):1930-1937. doi: 10.1136/gutjnl-2016-311964. Epub 2016 Jul 25.
14. Machado, M.V., et al. “Diet, Microbiota, Obesity, and NAFLD: A Dangerous Quartet.” International Journal of Molecular Science. 17(4) (2016 Apr): 481.
Published online 2016 Apr 1. doi: 10.3390/ijms17040481