The Top 4 Medical Reasons You Can't Lose Weight
Today's article is by Dr. Jen Pennock. She is an endocrinologist and obesity medicine specialist, and ebook author. In addition to treating people with obesity, she also used to be obese herself, so she understands and empathizes with her patients on a different level than most doctors.
You may have made healthy changes to your lifestyle, and yet you are not losing weight. I see many patients with this concern, and they often wonder if there is a medical reason why they are unable to lose weight.
There are some potential medical issues that can thwart weight loss, so part of my job is to do a medical evaluation to see if there is a treatable cause for the difficulty losing weight. If there is a medical condition slowing the patient’s weight loss, then sometimes I can diagnose and treat the condition so that they can lose weight more quickly and easily.
In this blog post, I’ll share with you the top 4 medical reasons that thwart weight loss. You can discuss these potential medical reasons with your healthcare professional if you think any of these conditions might be contributing to your slow or stalled weight loss.
Here are the Top 4 Medical Reasons That Can Slow Weight Loss:
A Medication That Can Cause Weight Gain
About half of people in the United States take at least one medicine, and about one in 4 people take at least 3 medications. Most medications do not affect weight, however, there are some medications that can cause weight gain.
If you’re taking a medication that can cause weight gain, you shouldn’t stop taking the medication. You can discuss the potential risks and benefits of the medication with your healthcare professional. Sometimes, after discussion, there is another medication that your healthcare professional could substitute, and still treat your medical condition without causing weight gain. Other times, however, there is no substitute for the medication that might be causing weight gain, and you will need to continue to take that medication.
If you have to take a medication that can cause weight gain, you will still be able to lose weight... it just might take longer for the weight to come off with the healthy lifestyle changes that you’ve made.
Here are some of the most common medications that cause weight gain:
Diabetes affects about 1 in 10 people in the United States and is more common in people who are overweight. Some of the most common medications used to treat diabetes can also cause weight gain. Some of the oral diabetes medications (pills to treat diabetes) that cause weight gain are pioglitazone, glipizide, glimepiride, glyburide. Also, insulin (an injectable medication for diabetes) often causes weight gain as well. There are some diabetes medications that are “weight neutral” (meaning that they don’t cause weight gain or weight loss) and there are some medications to treat diabetes that can cause weight loss.
If you are taking a medication for diabetes that causes weight gain, you can have a discussion with your health care professional to see if there are other options for your diabetes treatment. When I see patients with diabetes who are struggling with excess weight, often I can help them to make adjustments in their medications that can support their efforts to lose weight.
Medications for mood disorders like depression and anxiety:
Mood disorders such as anxiety and depression are very common. About one in 6 people in the United States take a medication for mood disorder. Some common medications prescribed for mood disorders can cause weight gain. Examples of the commonly prescribed medications that can cause weight gain are paroxetine (Paxil), sertraline (Zoloft) and amitriptyline. Other less commonly used medications that can cause weight gain are haldol, clozapine and lithium.
Medications for seizure disorder:
Some of the medications used for seizures can cause weight gain such as valproate and carbamazepine.
There are different types of steroids, but the most common steroids prescribed are called glucocorticoids, and these can cause weight gain. Glucocorticoids are steroids that decrease inflammation. These steroids are often prescribed to treat a variety of medical conditions that are caused by inflammation such as asthma attacks, severe sinus infections, severe lung diseases, rheumatoid arthritis, severe allergic reactions, lupus and many other diseases, Taking steroids for a short time generally doesn’t lead to a lot of weight gain. However, long term use of steroids often can lead to significant weight gain. Names of some common glucocorticoid steroids are prednisone, dexamethasone and solu-medrol.
Metoprolol and atenolol are medications called beta-blockers that are commonly used to treat high blood pressure and are sometimes used to prevent migraines. Beta blockers can cause weight gain.
2) Sleep Apnea
Sleep apnea is actually a quite common disorder and the most common form of sleep apnea is called obstructive sleep apnea (OSA). OSA is very common in people who have excess weight, and the heavier a person is...the higher the risk.
OSA is abnormal breathing during sleep, which causes repeated awakening and interrupts sound sleep. OSA occurs when the soft tissue that surrounds the airway relaxes as a person falls asleep. When the soft tissue relaxes, this can block air from flowing. People stop breathing for a few seconds or longer. The brain senses that there is not enough oxygen, and the person wakes up, takes a gasp of air, and falls right back to sleep. Most people do not even realize they have woken up. This cycle of air flow blockage, and then gasping awake, and falling back asleep can happen hundreds of times a night. When someone is waking up over and over again, sleep is shallow and not restorative.
Lack of restorative sleep impacts two hormones called ghrelin and leptin that affect your metabolism. When sleep apnea remains untreated, it is very difficult to lose weight. Once sleep apnea is diagnosed and treated, however, then the ghrelin and leptin levels return to normal and it becomes easier to lose weight.
3) An Eating Disorder (Binge Eating Disorder Or Night Eating Syndrome)
Anorexia nervosa and bulimia nervosa are probably the eating disorders that most people have heard about; however, these are not actually the most common eating disorders. The two most common eating disorders are binge eating disorder (BED) and night eating syndrome (NES); both are associated with obesity.
BED is characterized by eating large amounts of food in a short period of time (two hours) associated with feeling out of control. People with BED feel uncomfortably full and disgusted after binging. BED is different than just overeating; when people overeat, they generally feel relaxed or positive, and they are eating with others who are also overeating. In BED, people binge secretively and alone and usually experience negative emotions.
If you think that you might have BED, talk to your healthcare professional. The usual treatment for BED is called Cognitive Behavioral Therapy (CBT) which is a type of psychotherapy. There is also medication treatment that can help in some situations.
Another eating disorder is Night Eating Syndrome, or NES. NES is a less common than BED. NES is characterized by being very hungry at night and not hungry in the morning. People with NES generally consume 25-50% of their daily calories after their evening meal, and usually the food is high in carbohydrates. People with NES often have trouble falling asleep, and sometimes awaken in the night to eat as well. People with NES often suffer from depression, stress, and low self-esteem.
If you think you might have NES, you should discuss your symptoms with your healthcare professional. Generally behavioral treatment is used for NES, which teaches eating more regular meals that contain higher protein during the day.
If you have BED or NES, this may interfere with your ability to lose weight. Getting evaluation and treatment will be an important step in your ability to reach your weight and health goals.
Most people have heard of thyroid disease because it is very common. But, in case you are not familiar with thyroid disease, I will provide some background information. The thyroid is a little endocrine gland that sits in your neck and is shaped like a butterfly. The thyroid’s main job is to make thyroid hormone. The thyroid hormone released from the thyroid acts on specific receptors found in many places of the body, including the skin, the intestines and the brain.
If someone does not have enough thyroid hormone this is called hypothyroidism. The common symptoms of hypothyroidism are feeling tired, depressed, constipated and dry skin. They also may feel cold when other people feel comfortable. Other symptoms include low appetite and weight gain.
If you think that you might have a thyroid issue, you can discuss with your healthcare professional. The results of a simple blood test called the thyroid stimulating hormone (TSH) can usually diagnose a thyroid problem. If your thyroid is underactive, it is easy to treat with thyroid hormone replacement which comes in a daily pill.
If you are diagnosed with hypothyroidism, and you start thyroid hormone, you might feel better in many ways within a few weeks, including a little improvement in the amount of weight that you lose with your healthy lifestyle changes.
What if I don’t have any of these 4 medical problems, but I’m still having trouble losing weight?
There are some other rare medical conditions that can lead to difficulty losing weight that I didn’t review in this blog post. Your healthcare professional may do further evaluation. Often, however, your healthcare professional will not find a reason for your difficulty losing weight.
Scientists are researching excess weight and finding lots of other complex factors that affect people’s weight. The medical and science world may just have not yet found the reason for your difficulty losing weight.
As scientists learn more about the causes of excess weight, we can develop better strategies to help people lose weight, or even prevent excess weight to begin with!
If you want to learn more about the medical aspects of excess weight, you can check out my ebook, The Obesity Solution, a compassionate step-by-step guide to finally losing the weight and keeping it off.
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