So you’ve been trying to lose weight.  You’ve read lots of great advice on the internet and joined a weight loss organisation or maybe signed up for a short-term programme.  You’re doing all of the right things – eating less, trying to make healthy food choices, exercising more, but nothing’s working.  Why???

Weight loss is way more than energy in vs. energy out.  As a nutritionist and personal trainer, when I see a client for weight loss I’m looking at more than food consumption and how many times they manage to exercise in a week.  Here are some of the factors I look for in my weight loss clients:

Hormone Imbalances

Hormone imbalances are a major factor in weight gain.   Our hormones and our fat cells are part of a complex and comprehensive network responsible for metabolism, appetite, digestion, heat regulation, and detoxification.  Any breakdown in communication between hormones will result in a myriad of symptoms including weight gain.  Hormones such as leptin, insulin, oestrogen, progesterone, testosterone, thyroid, cortisol and growth hormone play a major role in how and where you gain weight.  I like to describe our hormones as part of a spiders web – if one side of the web gets pulled at too much then the whole web gets pulled out of shape.  For example, if you are eating a high sugar/refined carbohydrate diet you’ll produce too much insulin, or if you are constantly stressed your cortisol will remain high leading to imbalances in all of the other hormones.  As hormones have a major role in so many body functions so the symptoms of dysfunction are far reaching, but some examples of hormone imbalances include PMS, irregular periods, mid-afternoon dips, fatigue, depression, feeling constantly overwhelmed, poor memory, unexplained constant hunger, fuzzy brain, acne, hair appearing in places it shouldn’t or hair loss, and last but not least, weight gain that stubbornly won’t go away!

Stress

Stress plays a huge part in weight gain (or weight loss).  If you are a comfort-eater a stressful day will have you heading for the sugary/fatty foods to help you feel better.  This is partly due to a fight-or-flight response which has your brain reaching for the extra calories it needs to get you through your perceived crisis.  Long-term stress may lead to steadily higher cortisol levels, which ensures that blood sugar stays at optimal levels to deal with the stressor.  This triggers the release of insulin which takes the required blood glucose to the body cells and, then stores the rest in your fat stores (predominantly abdominally), which may leave you with lower blood glucose than you need and subsequent sugar cravings.  Once you satisfy your sugar cravings with some cookies or chips, the whole rollercoaster starts again leaving you somewhat overweight and overwhelmed.

Emotional Baggage

People can hold onto extra weight for many reasons.  Sometimes it provides a barrier to hide behind and gives them an excuse not to face the world head on.  This may be due to a lack of self confidence, self esteem issues or they may harbouring a traumatic experience of previous abuse.  Self belief and self worth both play major parts in weight loss and maintenance.

Thyroid Disorder

The thyroid’s main function is energy metabolism and protein metabolism.  There are quite a few nutrients required for thyroid function including iodine, selenium and tyrosine, and during pregnancy these nutrients can be captured by the growing foetus leaving the mother somewhat depleted.  This can lead to transient hypothyroidism shortly after birth, but can also lead to long-term thyroid dysfunction, especially after multiple children (I find quite often that the third child takes the thyroid with it!).   Hypothyroidism (too low thyroid) can also be caused by an autoimmune disease (Hashimoto’s thyroiditis), which is denoted by the occurrence of thyroid antibodies in a blood test.  If you are hypothyroid , you may have a real struggle getting back to normal weight due to a decreased metabolic rate.  Symptoms of hypothyroidism include weak nails and/or hair, constipation, fatigue, depression, cold intolerance, dry skin and inability to lose weight.  This may be preceded by hyperthyroidism (too high thyroid), the symptoms of which include rapid heartbeat, trouble sleeping, anxiety, weight loss, hand tremors, mood swings, fatigue and muscle weakness.

Liver Overload

A healthy liver is an important factor in good health and achieving a healthy weight.  The liver is an amazing organ responsible for breaking down fats, aiding in digestion, the absorption of nutrients, cleansing our blood and detoxifying our body.  However,  it can become easily overloaded with excess toxin exposure (both environmental and food), alcohol, drugs and a high sugar diet.  If the liver becomes sluggish then it has a profound effect on the whole body including the digestive system, and can make weight loss a challenge.  Have you ever stopped drinking alcohol for a month and noticed the kgs drop off?  This is partly due to less calories consumed but is also due to the liver having the time and ability to deal with excess fat instead of trying to detox your body from the constant assault of alcohol.  Symptoms of a stressed liver include joint inflammation, autoimmune conditions, frequent colds and infections, chemical sensitivities, allergies, hormone imbalances, bad breath, skin rashes, digestive symptoms etc.

Perimenopause/Menopause

If the hormone rollercoaster hadn’t started before, it starts here!  From perimenopause through into menopause, women find their bodies changing in quite dramatic ways and one of those ways is weight gain which refuses to go away when addressed.  After the age of 40 our muscle mass declines much faster than it did previously leading to sagging of body parts, but more importantly for weight loss, a decrease in metabolic rate.  Also, as estrogens naturally drop, the body changes from storing weight around the hips, to storing around the abdominal area leading to the dreaded muffin top.  This is also coupled with the changes the falling oestrogen levels have on the other hormones included in our spiders web leading to a very tumultuous time in hormonal health.  Muscle plays a major part in producing oestrogen as  women age so maintaining (or gaining) muscle mass is an important factor for ageing adults.  Unfortunately, strength training is an area that is so often neglected in favour of activities such as swimming, walking and cycling.  These activities are also important and great for heart health but building muscle should be a major part of an individual’s fitness routine at any age.

Yo-Yo Dieting

If you have been dieting for years on and off this may have had serious consequences for the way you store and metabolise fat and your overall energy metabolism.  When a person substantially reduces their calorie intake they initially lose weight but reset their metabolic rate to a point where weight loss no longer occurs even though calorie restriction continues.  This is due to changes in those all important hormones!  To add insult to injury, the body remembers the fast weight loss, and interprets it as starvation and makes any future weight loss even more difficult.  Many of the popular diet companies report the amazing results they achieve in the first few months, but fail to report the weight gain+ that many of their customers suffer after a year or two.  It is near impossible (unless you have masochistic tendencies) to eat less than you need on a long term  basis.  Hunger is a signal that cannot be permanently ignored!  Yo-yo dieting also comes with a psychological cost due to the depression and disappointment the dieter feels when dieting doesn’t work or weight loss cannot be sustained.

Sleep

Inadequate sleep decreases the satiety hormone, leptin and increases the hunger hormone, ghrelin, in other words you get hungrier and your body is less likely to signal to you that you are full – double whammy!  Lack of sleep also seems to stimulate the areas of the brain related to hedonistic behaviour leading to you reaching for a fatty/sugary food when tired rather than a bunch of kale, and sleep deprivation has been shown to increase appetite substantially, especially in the latter part of the day.  Therefore, if you find yourself reaching for snacks late afternoon it may be a reaction to inadequate rest the night before, and going to bed an hour or two earlier may solve the problem of cravings.  It has been found that short sleep duration will result in a person burning more calories during the day than a person experiencing an adequate nights sleep, but the increased calorie intake offsets this effect leading to weight gain.

Everyday Toxin Exposure

Environmental toxins such as BPA have the ability to alter our DNA to a type which is more susceptible to obesity (especially when we are still in the womb due to maternal exposure or when we are infants).  This process is known as epigenetics as the DNA sequence itself isn’t altered but signaling to the DNA can be changed.  These toxins are also endocrine disruptors, in other words they act like estrogen and can stimulate estrogenic effects in the body, which leads to a knock on effect on all of our other hormones.   We’re back to hormone balance again!  They also interfere with brain synapses that regulate energy metabolism.  The environmental burden of toxin exposure has increased linearly with the rise in global obesity – a coincidence?

Gut Microbiota

Did you know that the bacteria that normally dwells in our gut equals more cells and DNA than we have in our entire body.  Scientists are now only starting to realise the importance of our gut bacteria in our overall health.  Gut microbiota is all about the mix – if you have a good mix you will remain in good health but if you have a bad mix then you may suffer from a myriad of possible diseases.  The same goes for weight loss.  If you have a mix of the wrong type of bacteria in your gut then this will make you more susceptible to weight gain.  This is due to pro inflammatory cells released from non-beneficial types of bacteria when they die leading to the accumulation of fat tissue.  Factors which may sway your gut bacteria towards a non-beneficial mix – high sugar diet, antibiotics, high red meat consumption, alcohol – all the good stuff!  Symptoms of a bad mix of gut bacteria – gastro intestinal issues (bloating, IBS symptoms, excess wind, diarrhoea, constipation, pain etc), multiple allergies and food intolerances, immune dysfunction, candida, autoimmune disorders etc.

Infections

Ten different infectious microbes have been identified as causing obesity in laboratory experiments.  Fat cells and immune cells have very similar characteristics and immature fat cells can actually change into immune cells if required to fight infection.  In turn, fat stores can expand in response to an infection.  Gut infections such as helicobacter pylori, which is extremely common, have been shown to increase fat tissue.  Therefore, if there is evidence that your gut is not working well (pain gas, bloating, diarrhoea, constipation etc), there may be infection, which may be leading to obesity.

Obesogenic Environment

Have you ever been out shopping and decided to have a healthy lunch mid-way through.  It is nearly impossible!  Our city centres are full of fast food chains, pub grub and coffee shop chains.  It really is no surprise that our populations are becoming more and more obese as the range of whole, healthy foods on offer is non-existent.  It makes me so sad to see the food halls in local malls full to the rafters with people eating junk.  The car culture in Australia and most Western countries doesn’t help the obesity epidemic either.  Our lives are so automated that we barely do any physical work at all and instead of walking to the local shop and home with some groceries we drive to the local supermarket, load up and drive home.  I have a rule that if I’m going somewhere in my local suburb, then I’m not allowed to take the car.  Walking everywhere is great for keeping the weight off!

Medications

Many medications lead to weight gain (something your doctor may have forgotten to mention) for many different reasons including increasing appetite, slowing metabolism or causing you to hold on to more fluid.  Medications which can lead to weight gain include anti-depressants, mood stabilisers, diabetic drugs, corticosteroids (anti-inflammatories), anti-seizure and migraine medications, beta-blockers and anti-allergy medications.  That is quite a list!  If you have concerns that your medications may be causing you to gain weight then talk to your doctor about changing to another type of drug or weaning off them altogether.

Case Taking

So a client comes to see me for weigh loss.  The first thing I do is sit with them for an hour and find out what is going on in their life.  Here are some of the things I look for?

  1. What is the client eating on a day to day basis and what is their exercise programme?
  2. How is their hormonal health?  Any signs of hormonal dysfunction? Do they have evidence of thyroid disease or dysfunction?  Do they need some blood tests to assess for imbalances?
  3. How are the client’s stress levels?  Do they handle stress well or have mechanisms in place to help them handle their stress?  Are they emotionally ready for long-term weight loss?  Do they need counselling?  Can I provide ways to help them feel calmer and more in control?
  4. How is my client sleeping?  Are they aiming for adequate sleep every night?  How is their sleep hygiene?  Are they spending too much time on social media just before bed?  Are they drinking caffeinated drinks just before bed?
  5. Is my client peri-menopausal or menopausal?  Do I need tests to confirm their current hormonal status?
  6. Has my client lost and gained weight before?  Is there any evidence of yo-yo dieting?  Why was it unsustainable?
  7. How is my clients toxin exposure – at work and at home?  Do they have evidence of liver dysfunction?  Would they benefit from a detox programme?
  8. Is there any evidence of gut dysfunction or a non beneficial mix of gut bacteria?  Do they have signs and symptoms of a possible gut infection?
  9. What medications are they on?  Would any of these drugs have a profound effect on my client’s weight loss goal?

Recommendations

Only after exploring all of these areas (and more – everyone has their own very special issues), would I sit down and make some dietary and lifestyle recommendations.

When I look at diet, I think about gradual changes I can make to help the client reach their goal.  If there are hormone imbalances, I recommend foods and food combining (more important) to help bring about that all important hormonal homeostasis.  If they are menopausal I recommend foods and exercise that are going to help them maintain adequate oestrogen in their bodies.  I’ll make dietary and lifestyle recommendations to help them sleep better.  I’ll recommend detox programmes or nutrients required to help their liver do its job.  I’ll recommend gut healing programmes and foods and supplements to help get the gut bacteria at an optimal mix.  The list is endless and done on a very individualistic basis, but all of the recommendations are focussed upon making the client feel amazing and reaching their optimal and sustainable weight loss goal.

And that is why you should see a holistic nutritionist for weight loss.