Why is it so hard to lose weight and keep it off?

If you find it hard to keep weight off once you’ve lost it, you’re not alone.  You may have been made to feel that it’s all your fault. You almost certainly have been told ‘it’s simple: energy in versus energy out’.

Growing scientific evidence says otherwise. Changes occur in the human body in response to weight loss that make weight regain likely for many people. Learning more about these mechanisms may help us find ways to overcome them.

Keeping weight off can feel like a losing battle

Losing weight is not as simple as ‘energy in versus energy out.’ It is unhelpful, unnecessary and unkind to shame people because of their size.

For some people, trying to lose weight and keep it off is like swimming upstream against a strong current.

Sustained lifestyle changes and forming new healthy habits may lead to better long term results than repetitive crash dieting.

With rates of obesity rising, more people are trying to lose weight. Losing weight comes down to a lot more than willpower. Humans have evolved to store energy, some of us more than others.

As well as genes and a convenience-food environment, there are hormonal, behavioural and brain mechanisms at play as our bodies fight against weight loss.

Many people who have reduced their weight will, despite their best efforts, regain some or all of the weight they lost^(1,2). Society tends to blame the individual for weight regain, calling them lazy, or claiming they lack willpower. These misconceptions are being corrected by scientific evidence^(1-4).

So, why is weight regain so common?

These are some of the many changes that can happen in our bodies when we have lost weight:

• Our resting energy output (or ‘basal metabolic rate’) drops. This is called ‘adaptive thermogenesis’. The lower metabolic rate promotes weight gain. Some studies suggests a low carb or a lowGI diet can help people counteract this change⁽¹⁾.
• Levels of leptin (a fullness hormone) drop. This reduction in leptin seems to reduce the basal metabolic rate while increasing appetite and how much food we eat⁽³⁾.
• Other fullness hormones are reduced, while ghrelin (a hunger hormone) increases in people whose weight has dropped⁽³⁾. Thus, weight loss may trigger a decrease in fullness and an increase in hunger.
• Cortisol levels go up after losing excess weight. The weight-gain effect of cortisol is well known⁽¹⁾.
• The ‘reward’ signals our brain gets from food may increase, making some high-energy foods seem more appealing⁽⁴⁾. Combined with strong hunger signals, the drive to eat can be overwhelming.

Rather than being discouraged by these factors, we should not lose hope. Finding the truth will bring us closer to the answers. It can help to know that there are real physiological reasons why weight loss is hard.

Up to 20% of individuals who lose excess weight are able to keep some of it, if not all of it, off. Scientific studies are looking into what might help the other 80%. There are promising results for ongoing monitoring (such as weighing yourself regularly⁽²⁾), structured eating plans and plenty of exercise.

Careful persistence and sustainable dietary and lifestyle modifications can minimise weight regain. This requires more effort at first, but some evidence suggests that after a couple of years of avoiding weight regain, it may get easier^(5,6).

For some people whose health is threatened by excess weight and who are unable to sustain weight loss, bariatric surgery is an option.

However, it isn’t a quick fix. It still requires major lifestyle and behavioural changes. As surgery carries significant risks, it should be very carefully considered.

If you are looking at having a weight loss operation, whether it be a gastric band, sleeve gastrectomy or a gastric bypass, make sure you are fully informed about the risks, likely benefits, what life will be like afterwards and what follow up commitments are needed.

It is not the right choice for everyone, but for some people, it is the best chance they have at fixing or improving weight-related health issues.

Surgical options

Some people find they can break free of the dieting, weight loss and weight regain cycle and achieve better health.

Dr Amanda Salis (PhD) is a research scientist who suggests learning to read your body’s hunger and fullness signals is one good strategy, working with your body rather than against it, while gradually losing weight.

She outlines her scientific findings in her book, ‘The Don’t-Go-Hungry Diet’.

The ‘Health At Every Size^(R)’ movement advocates making good health the goal, rather than struggling to achieve a certain weight or size.

Practitioners aim to help people accept and love their bodies as they are and to try improving their health in ways that aren’t so punishing.

The underlying concept is that some people can be large and still be metabolically healthy. Some scientists counter that while occasionally people who have obesity may be metabolically healthy, this state is probably only temporary; over time, health is likely to decline⁽⁷⁾.

Helpful tips to minimise weight regain   

Want to lose weight, keep it off, or just improve your health? These tips may help.

Eat mainly whole, unprocessed foods

Eat plenty of different vegies, adequate protein, enough (but not excessive) fats and adequate fibre. According to the new Australian food pyramid, vegies should make up most of what we eat.

Smaller serving sizes

Serving onto a smaller plate can help with portion sizes.

Throw out leftovers

Throwing out or saving leftovers is preferable than to eat the leftovers despite being full already.

Minimise recreational eating

Try to minimise or recreational (or ‘non-hungry’) eating, especially when you’re bored, in a social setting or just because food is around.

Pause after eating

After eating a meal, sit for a while before getting up for more. Allow your body time to realise if you are full or not. Learn to respond to your hunger and fullness cues.

Hydration

Staying hydrated, getting adequate sleep and managing stress can help us maintain healthier habits.

Excercise

Exercise can help prevent weight regain⁽⁶⁾. Pick a form of exercise you enjoy. Perhaps make a commitment to yourself to do some form of exercise every day, even if it’s just a brisk walk.

If you work at a desk, take frequent breaks so that you’re not sitting all day.

Ban junk food in the house

Not keeping ‘junk’ food in the house is the best strategy for some people (of any size) who may feel powerless to avoid overindulging if these foods are available.

Get help for emotional eating

If you are prone to emotional eating, eating past the point of fullness, or bingeing, don’t ignore it. You may have some deeper issues that need addressing. Psychological support can help.

Set goals

If you have lost weight and want to keep it off, keep on track with goals, regular weighs (perhaps weekly), self-review and reflection. Extra support could come from friends, an organised group, an accredited practicing dietitian or your doctor⁽²⁾.

If, despite your best efforts you have regained weight, treat yourself kindly. You are only human. Set new goals or try a different approach, making use of the supports around you.

One of the most important steps when commencing any new diet is to consult with your doctor. They will assess your general health and can advise on the safety and suitability of any diet you might be considering. If you are about to start a new diet regime, HealthEngine can help you find and book an appointment with your doctor today.

References

1. E. Blomain, D. Drihan, M. Valentino, G. Kim and S. Waldman; ‘Mechanisms of Weight Regain following Weight Loss‘; Obesity 2013 Review Article.
2. Claire D Madigan, Kate Jolly, Andrea Roalfe, Amanda L Lewis, Laura Webber, Paul Aveyard and Amanda J Daley; ‘Study protocol: the effectiveness and cost effectiveness of a brief behavioural intervention to promote regular self-weighing to prevent weight regain after weight loss: randomised controlled trial (The LIMIT Study)‘, BMC Public Health (2015) 15:530.
3. Christopher N. Ochner, Dulce M. Barrios, Clement D. Lee, and F. Xavier Pi-Sunyer; ‘Biological Mechanisms that Promote Weight Regain Following Weight Loss in Obese Humans‘; NIH Public Access Version (Author manuscript) of Physiol Behav. 2013 August 15; 106–113.
4. M. Cornier; ‘Is Your Brain to Blame for Weight Regain?‘; Physiol Behav. 2011 September 26; 104(4): 608–612.
5. Christina Garcia Ulen; Mary Margaret Huizinga, MD, MPH; Bettina Beech, DrPH; and Tom A. Elasy, MD, MPH; ‘Weight Regain Prevention‘; Volume 26, Number 3, 2008 • Clinical Diabetes.
6. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK; American College of Sports Medicine Position Stand- ‘Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults‘; Medicine and Science in Sports and Exercise [2009, 41(2):459-471].
7. P. Skerrett; Overweight and Healthy- the concept of metabolically healthy obesity; Harvard Health; 24/9/13.

This article is for informational purposes only and should not be taken as medical advice. If in doubt, HealthEngine recommends consulting with a registered health practitioner.