I want to lose weight but can’t medical reasons

The essentials in brief

I want to lose weight but can’t – what could be the reason?

“I want to lose weight but can’t”: many patients say this sentence in the initial consultation, often after years of diets, fitness programmes and good intentions. It is rarely due to a lack of discipline. Body weight is controlled by a finely tuned system of hormones, nerve signals and metabolic processes. If this system is thrown off balance, the body works against any weight loss.

Part of this is perfectly normal biology. After every diet, hunger increases and the basal metabolic rate drops. Why diets therefore so often end in the yo-yo effect is explained in the article Losing weight for good after unsuccessful diets. This article is about something else: conditions and influences that can be diagnosed by a doctor – and that you should know about before you start your next attempt.

Predisposition also plays a role. Twin and family studies show that body weight is to a considerable extent influenced by heredity. That does not mean that losing weight is impossible. But it explains why two people with the same diet can gain weight very differently.

Insulin resistance: when blood sugar slows down weight loss

Insulin is the hormone that moves sugar from the blood into the body’s cells. With insulin resistance, the cells respond less well to it. The pancreas compensates by releasing more insulin. A permanently high insulin level promotes fat storage, especially around the abdomen, and can encourage cravings. Over the years, this can develop into type 2 diabetes.

Insulin resistance causes no symptoms for a long time. Signs include a large waist circumference, raised blood sugar or blood lipid levels and high blood pressure. When several of these factors occur together, this is called metabolic syndrome. You can assess your waist circumference in relation to your height with the WHtR calculator.

Hormones that influence weight

Medication as a weight brake

Some medications can increase weight or make losing weight more difficult. These include certain drugs for depression and psychosis and some drugs for epilepsy or migraine. Often the medication increases appetite; sometimes it changes the metabolism.

Important: never stop taking a medication on your own. Raise the weight gain with your doctor. There are often alternatives or a different dosage.

Sleep, stress and eating behaviour

Sleep is an underestimated factor in weight loss. People who regularly get too little sleep often have a bigger appetite: studies show lower levels of the satiety hormone leptin and higher levels of the hunger hormone ghrelin with short sleep duration. Loud snoring with pauses in breathing can indicate sleep apnoea. It robs you of restful sleep, puts a strain on the heart and circulation and should be investigated by a doctor.

Eating behaviour itself can also be a treatable cause. Recurring episodes of binge eating with the feeling of losing control can indicate binge eating disorder. It is a recognised condition and can be treated well with psychotherapy. There is no need for shame here – doctors are familiar with this situation.

It doesn’t “click”? When hunger is stronger than your resolve

Many people wait for the one moment when it “clicks” and losing weight finally becomes easy. If it doesn’t come, they look for the fault in themselves. Yet hunger is not a character trait but a biological signal. The hunger hormone ghrelin is produced mainly in the stomach and rises after weight loss; the satiety hormone leptin falls. In this way the body defends its previous weight – sometimes for months. How ghrelin works and how it can be influenced is explained in the article Lowering the hunger hormone ghrelin.

Motivation alone is often not enough to counter this counter-regulation. A more realistic approach is a plan that takes biology into account: fixed meals instead of deprivation, support in everyday life and, if needed, a medical treatment that targets hunger and satiety.

Put into honest perspective: what tests can do – and what they can’t

Not everyone has a single abnormal value. More often, several influences work together: predisposition, hormones, sleep, stress, medication and the consequences of previous diets. An examination is still worthwhile, because treatable causes such as an underactive thyroid or undiagnosed diabetes should not be overlooked. And related conditions help determine which treatment is an option.

If you gain weight rapidly for no apparent reason, if your legs or abdomen swell or if you quickly become short of breath on exertion, have this checked by a doctor promptly. In the event of breathlessness, chest pain or sudden deterioration, call the emergency number 112 immediately.

Consultation

If you would like to know why losing weight is not working, a conversation with experts is a good first step. At Weight Doctors®, specialists look at your medical history, your values and your goals and show you which options are possible – from nutrition coaching to medically supervised therapy. Between appointments, Weight Doctors® Mira answers questions about nutrition, exercise and motivation in the app around the clock. The consultation is available in person, by phone or by video and is 100% no obligation: Book a consultation