Why is it so hard to lose weight?

We unpack why weight loss is hard, how set point and hunger hormones push back, and what tools make maintenance possible. We move from biology and environment to medications, mindset, and practical support so you can protect your metabolic health for the long term.

• evolutionary biology driving energy conservation
• modern food environment increasing calorie density and reward
• weight set point and metabolic adaptation mechanisms
• evidence from The Biggest Loser metabolic study
• ghrelin and hunger increases after weight loss
• role of anti-obesity medications for chronic management
• mindset shift from motivation to dedication in maintenance
• value of coaching, groups, and medical support

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Episode Transcript

Speaker (00:00):
Welcome to the Modern Metabolic Health Podcast with
your host, Dr.
Lindsay Ogle, Board CertifiedFamily Medicine and Obesity
Medicine Physician.
Here we learn how we can treatand prevent modern metabolic
conditions such as diabetes,PCOS, fatty liver disease,
metabolic syndrome, sleep apnea,and more.

(00:21):
We focus on optimizinglifestyle while utilizing safe
and effective medical treatment.
Please remember that while I ama physician, I am not your
physician.
Everything discussed here isprovided as general medical
knowledge and not direct medicaladvice.
Please talk to your doctorabout what is best for you.
Today I'm going to talk aboutwhy it is so hard to lose

(00:49):
weight.
The struggles with weightmanagement is something that I
talk about every single day inmy primary care practice.
Many patients feel defeated.
They've been told that it'stheir fault that they can't
reach their goal weight or theycan't maintain weight once
they've lost it.

(01:10):
And doctors have even told themthat it's easy, just eat less
and move more.
We hear this all the time.
But the truth is it's not thatsimple.
Our bodies are way more complexthan simple input and output.
So with all of my patients whoare wanting help to lose weight,

(01:32):
I talk about why it's hard tobe to lose weight to begin with.
And it's really, it can feellike our body is working against
us, and that can be reallyfrustrating.
But the truth is, our body istrying to help us, it's coming
from a good place.
So many, many years ago,hundreds, thousands of years

(01:52):
ago, food was much harder tocome by.
And so the way that we survivedwas that our bodies became
really efficient at managing thecalories and the nutrition that
it was able to obtain, and soit got really good at holding on
to calories over time andhelping the our ancestors

(02:16):
maintain that weight so thatthey could survive.
So the people that survivedwere the ones that were able to
maintain that weight duringperiods of food scarcity, during
starvation periods, duringfamines, when we weren't able to
get to get that nutrition.
So that's how our biology isset up.

(02:38):
It's set up to conserve energyand to reserve those fat stores
for a time when we may needthem.
Fast forward to the modern day,we still have those bodies and
that genetic code, but we're inan environment, we're in a
society where food is readilyaccessible for most people, and

(03:01):
it comes in higher caloricdensity, meaning there are more
calories and smaller portions offood.
The food industry has made foodtaste much better.
It combines salt and fat andsugar and into a perfect
combination that feels good onthe mouth when you're eating it,

(03:23):
it triggers the brain, it tellsit makes us feel like we're
really helping ourselves.
It sets us up to be where weare now, where we have this what

(03:57):
we call an epidemic ofoverweight and obesity that's
leading to significant healthoutcomes and metabolic disease.
So it's not so much that youknow we as especially as doctors
that we care about the size ofour patients, it's about their
health and the impact on theirhealth.
And so, of course, that'salways the lens that I'm coming

(04:19):
by when I talk about weightmanagement.
So, how does the biology andthe genetics actually work?
And what happens is we developwhat we call a weight set point.
There are hundreds of thousandsof functions and hormones and
chemical reactions that arehappening in the body all of the

(04:42):
time, and the body is does anexcellent job at maintaining
what we call homeostasis.
And so your body is constantlyadjusting to the environment and
what you're taking in, uh, yourfood, uh, your physical
activity, how warm or how coldit is outside, um, how hydrated

(05:05):
or dehydrated you are, your bodyis constantly tweaking so that
it maintains a steady state sothat you can survive.
And it does the same thing withweight, and so it your body
wants to stay the same, and soit has this weight set point
that once you start to loseweight, then your body kind of

(05:27):
freaks out, it thinks thatsomething really bad is
happening, it's worried aboutyou, and the way that it's
trying to protect you and itselfis that it lowers its
metabolism and it increaseshunger.
And this is what makes it sohard to lose weight and
especially maintain weight, andthis has been proven.

(05:51):
One of the most popular studiesis the with the biggest loser.
And I think we're all familiarwith that show many years ago.
And if you're not, it was acompetition where they had
patients who were living withobesity get on kind of this like
reality game show where theyexercise a lot and were put on a

(06:13):
strict diet, and they wouldweigh themselves throughout that
competition, and thesecontestants would lose lots and
lots of weight.
And what the study did overtime, over the next several
years, I think it was six yearsthat they looked at these
patients, they checked theirmetabolism afterwards, and their

(06:37):
metabolism was actually 500calories less than what they
would expect in a person of thatsize, and that was consistent
whether or not they maintainedtheir weight loss.
And so this really highlightsthe fact that even to maintain
the weight loss, that person isgoing to have to eat less and

(06:59):
less over time, and this is whythose medications that we use
for weight management are sopowerful because they can help
offset these biologic changes,and I will definitely talk more
about those medications at afuture video.
Another adaptation that yourbody goes under is hunger

(07:19):
increases, and the main hungerhormone is called ghrelin, and
this has been measured also inhumans who have undergone weight
loss, they get the baselineghrelin levels before the weight
loss, and then they check thoselevels after weight loss, and
they're higher.
And so, people who when youlose weight, your hunger goes

(07:42):
up.
We all know what it feels liketo be hungry, it's
uncomfortable.
Lots of people get hangry, andyou really you can't keep that
at bay for an extended period oftime.
It's just it's not feasible.
Those are the two main reasonsthat it is very difficult to

(08:02):
maintain weight loss, and wherethe anti-obesity medications
really play a big role in theweight loss and weight
management.
This also highlights theimportance of continuing these
medications long term.
Obesity is a chronic medicalcondition and should be treated
as such.
There also is a component ofmindset, and this is really

(08:27):
interesting because when you'relosing weight, there is a lot of
positive reinforcement that youget.
You get it internally everytime you step on the scale and
you see that number go down.
That's exciting.
You have coworkers, friends,family, and your doctor who are
congratulating you on yourweight loss and they notice the

(08:48):
improvements.
Your clothes fit better, you'reable to get new clothes that
you're excited about, you'reable to do things that you
weren't able to do before.
You may see your blood pressurego down or your blood sugar go
down, you may even be able toget off of medications.
And this is all really, again,fun, exciting, great, and

(09:09):
wonderful.
But once you hit your newweight set point and you're
focusing on weight maintenance,you're not really seeing those
changes.
You're the weight on the scaleis staying the same, or it goes
up and down a couple of pounds.
Your blood pressure, bloodsugar, those are staying pretty
steady, and you're continuing onyour current uh medications,

(09:33):
you're not getting those samecompliments that you were
getting before.
People around you have havekind of accepted this new
version of you, and that's whatthey come to expect.
And so it can be reallydisinheartening when when this
happens because it was reallyexciting during that weight loss
phase, and the weightmaintenance phase just is

(09:55):
honestly pretty mundane, and butit's really important because
that's what you're wanting to dofor your health long term, and
you're going to have to switchfrom motivation to dedication
and commitment, and you're goingto have to just tell yourself

(10:18):
that this is your new normal,this is what you do on a regular
basis now.
You have to work just as hard,if not harder, for weight
maintenance than you did forweight loss, and that can be
really hard to hear, but it isit's the truth.
If you are able to get a coachor be a part of a group, it can

(10:41):
be really helpful to have thatadditional support.
Work with an obesity medicinephysician.
I'm going to have another videotalking more about weight
management next week.
So hope to see you there.
Thank you for listening andlearning how you can improve
your metabolic health in thismodern world.

(11:02):
If you found this informationhelpful, please share with a
friend, family member, orcolleague.
We need to do all we can tocombat the dangerous
misinformation that is outthere.
Please subscribe and write areview.
This will help others find thepodcast so they may also improve
their metabolic health.
I look forward to ourconversation next week.