Why am I not losing weight?

Posted 8 years ago by Andreas Obermair

As doctors we commonly see and treat patients who struggle with weight issues. Commonly I hear: “Doctor I hardly eat anything and I still can’t lose weight. How can that be?”

We all would like to think that keeping the lid on food intake would automatically lead to the desired weight loss. Wouldn’t that be logical?

I was inspired to write this article by a patient I saw recently. She was genuinely interested to understand the physiological mechanisms that lead to weight loss and why she was not getting the results she wanted.

As a practicing gynaecological oncologist I am well aware that increased body weight is a sensitive issue. However, sometimes we have to have candid conversations with patients about weight because it may affect the quality of care that my team and I provide.

This article hopes to provide the background information for patients to understand how it is possible to eat minimal amounts and still not lose weight.

Firstly, all food we ingest counts. Some patients are unaware that all nutrients count as food. For example, for dinner I would have a couple of meatballs plus some vegetables. However, after dinner I would still be hungry and snack on a handful of nuts and dried fruit with the tiniest piece of chocolate imaginable.

What we perceive we have had for dinner (meatballs and vegetables) may sometimes differ from what we actually consumed. Don’t forget to account for snacks and beverages. Especially soft drinks, fruit juices, and alcoholic beverages which can be very high in sugar content and count. Try drinking more water throughout the day (women typically require 8 cups per day). Studies have found that drinking water may speed up your metabolism and discourage cravings for sugary drinks.

Reducing the hidden kilojoules / calories in our diet from snacking between meals and consuming sugary drinks can make a large difference to body weight in the long-term. Sometimes these smaller changes reap the biggest results and lead to more sustainable weight loss as opposed to yo-yo dieting.

Beware of food that is advertised as “low-fat”, these can sometimes contain more sugar than their “full fat” equivalents. The Australian Dietary Guidelines website have advice for the amount and kinds of food that we need to eat for our health and wellbeing.

Secondly, even if I hardly eat anything, it is almost impossible for me to lose weight if I don’t exercise. If I don’t move, my total daily energy expenditure would be very low. If we sit behind our desks for most of the day and our only “exercise” consists of getting in and out of the car we are not burning sufficient energy, which leads to increased body fat. The World Health Organisation and the National Heart Foundation of Australia recommend 10,000 steps (7.62 kilometres) per day to improve general health and reduce the risk of chronic disease. Care Australia released a study which found the average Aussie only walks about 4,000 steps per day.

Walking is a great way to improve or maintain your overall health, however the stimulus to the body can be rather low. To increase our energy expenditure, we need to exercise at a more moderate intensity – which means get puffing! Use the sing test, to measure intensity. As a rule of thumb: If you can talk and sing without puffing at all, you’re exercising at a low level. If you can comfortably talk, but not sing, you’re doing moderate intensity activity. If you can’t say more than a few words without gasping for breath, you’re exercising at a vigorous intensity. If you are unable to exercise at a moderate or vigorous intensity due to pain or other issues, then minimise prolonged sitting. Be as active as possible throughout the day and this can make a big difference to overall energy expenditure. Stand and stretch every hour, and this may help boost your metabolism.

Lastly, do you sleep too little? A study in The American Journal of Clinical Nutrition has found that women who slept fewer than four hours ate 300 more calories the next day. Make sure you are getting enough sleep each night.

Sustained change

It is most definitely the combination of diet, sleep and exercise that has the most long-term success. Diet and physical activity need to go together in order to produce a change.

What is most important however is sustained change. Making changes to your diet and physical activity levels for a few weeks won’t make any difference to body composition. Body composition is the proportion of fat and fat-free mass in the body.  Changes in body composition, general well-being and quality of life will only happen after months. Any change you make needs to be sustainable for you for the long term.

Need further information and motivation?

As an active surgeon I recognise the information needs of my patients. Finding the right balance to keep a healthy weight can be frustrating at times. In my new office in Spring Hill, I will have the opportunity to hold information sessions for my patients.

Our first session will be with Kelly Prosser, an exercise physiologist who is used to working with people who typically believe they cannot exercise because they are too big, or too unhealthy, or it just all seems too difficult.

The session will be held later in the year. If you are interested, please register to rooms@obermair.info to attend. The event is free and ample of parking is available nearby. 

If you wish to receive regular information, tips, resources, reassurance and inspiration for up-to-date care, that is safe and sound and in line with latest research please subscribe here to receive my blog, or like Dr Andreas Obermair on Facebook. Should you find this article interesting, please feel free to share it.