It’s an age old question that has long fascinated and frustrated researchers and dieters alike – why do so many people regain weight when they have worked so hard to lose it?²
The statistics are disheartening – by some estimates, 80% of people who successfully lose at least 10% of their body weight will gradually regain it to end up as heavy or even heavier than they were before they lost the weight².
Results of a landmark study published in the November 2016 issue of the journal Obesity, states that appetite is the reason for weight gain. Simply put, people who successfully lose weight get very hungry².
This, together with a drop in metabolism which takes place when people lose weight, are some of the physical reasons for weight gain².
Dr Grant Fourie, a General Practitioner from Bellville in Cape Town, believes that we have been sold a myth that weight gain is simply a negative consequence of overeating and under-exercising, and that the actual reasons for weight gain are extremely complex¹.
He cites a variety of reasons for weight gain which include genetic disorders, inflammation in the body, toxic exposure, changes in the quality of food, poor nutrition advice given since the 1950’s, depression and anxiety, overuse of antibiotics and antacids and anti-inflammatories; the rise of the auto-immune pandemic as well as lifestyle diseases (metabolic diseases) like hypertension and diabetes to name a few¹.
Dr Rosetta Guidozzi, a General Practitioner from Johannesburg with a special interest in weight management, says that we are fighting media, cultures, food industries, lifestyle and stress4. “Maybe we should be dealing with the food industries, media promoting thinness and emphasis on being thin. Dieting is a huge multi billion industry and people think that dieting is different to eating properly for life,” she says(4).
Dr Guidozzi agrees that there are a number of factors at play, but still believes that appetite is more often than not at the core of weight gain, and not necessarily only genes, inflammation and chronic lifestyle disease(4).
She cites the success of bariatric surgery as an example. “Essentially bariatric surgery curbs people’s appetite and makes them eat less! There is no effect on their metabolism,” she says(4).
Dr Fourie, who is also a certified Functional Medicine Practitioner and certified Diabetes Educator, says that it goes much deeper than just eating less and doing more.
He says that the initial result when dieting can often be so promising that it is virtually impossible to convince people that this is not the case¹.
“The consequences of continuing with this very precarious belief are obvious and often catastrophic – not only do most regain the weight, but they unwittingly also increase the level of difficulty of re-achieving this result even when they go on a more “strict” protocol when they do eventually get over the initial despondency of this (often repeated) cycle of failure,” he says¹.
Dr Fourie says that it seems our metabolism is duty bound to return to a ‘set-point’¹.
“On a metabolic level it seems our bodies act more like the elastic on a catapult than we would prefer. So the harder you try, the more you change, the hungrier you get – the closer you come to that pivotal point at which no more strain can be taken, and every cell in your body acts in a way not dissimilar from the panic one would encounter in the last few minutes before you drown or suffocate,” he explains¹.
Basically, this is because as you lose weight, your metabolism declines, causing you to burn fewer calories than you did at your heavier weight. In turn, your slower metabolism will slow your weight loss, even if you eat the same number of calories that helped you lose weight³.
In fact, Dr Fourie says that this slowing of the metabolism, whilst frustrating for people trying to lose weight, is actually our body’s way of preventing starvation¹.
“It is the very ability of the body to pack on cellulite and adipose that keeps us alive as the body weaves its way through the chemical gauntlet we have made it run!” he says¹.
Dr Guidozzi says that it is important to remember that fast weight loss at first attempt will also cause a loss in muscle bulk and this in the long term will further slowdown the metabolism, so it is important not to lose weight too fast or to lose too much muscle bulk. She adds that that exercise needs to be introduced gradually as the weight begins to shift to compensate for the slowing of metabolism(4).
Age is also a factor. “With each attempt at losing weight, the person is getting older and age is also associated with a slowing of metabolism. So, people who are older need to lose weight much more slowly and need to incorporate sufficient protein in their diets,” she says(4).
While Dr Fourie believes that most people eat more due to many reasons other than the commonly blamed ‘gluttony’ or ‘poor self-control’, he says that there may be a place for a prescription medication for very short periods of time and only as an aid to change, and not as a quick fix option, in patients who really have gained weight because of eating too much(5).
Dr Guidozzi agrees that pharmacotherapy can play a part. “Pharmacotherapy is used as an induction to initiate weight loss as well to maintain weight loss in a supervised situation. With the advent of some of the newer formulations as well as some of the older trusted products, the results seen in a medical setting can be very good,” she says and reiterates that the public need to understand that obesity can be treated and managed by the medical profession.
“Weight loss must no longer be seen as a cosmetic problem and left to be treated by the industries at large, but rather be managed and dealt with by the medical profession. Obesity is a diseased state and should be treated correctly,” she says(6).
Dr Guidozzi stresses, however, that not everyone is made to be thin. “There can be a variation of 10 kgs-12kgs between one person and another of same height, gender, age and shape, but anything greater is probably due to overeating and being sedentary. The increase in the obesity epidemic has been too quick or fast for it to be purely genetic,” she explains.
“There are certain normal parameters that we all fit into as human beings and we are guided by these normal boundaries- anything below or in excess is out of range of the normal and will therefore have been induced by the environment or by the personality of that individual” (4).
Dr Fourie believes that we should be spending more time and effort on health and restoration, and in so doing, fat loss would be a welcome consequence, and not the “monstrous curse” we make it out to be¹.
Remember also that even modest weight loss can improve chronic health conditions³.
Dr Guidozzi agrees that the emphasis should be on health and health strategies and that being healthy and following a healthy lifestyle is a template for life(4).
Dr Fourie’s advice is to recognise underlying problems and pay attention to the small clues found in our daily behaviour. “Look for addictions, obsessions, compulsions and repetitive patterns and activities that don’t promote health,” he says¹.
“Changing your weight is changing the way you live forever,” Dr Guidozzi concludes(4).
Speak to your doctor about why you may be gaining weight, and about options for weight management or go to www.ilivelite.co.za for more information.
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- Q&A with Dr Grant Fourie – 17 March 2019 (unpaid).
- Web MD – How your appetite can sabotage your weight loss (2016) at https://www.webmd.com/diet/news/20161014/how-your-appetite-can-sabotage-weight-loss#1
- Mayo Clinic – Getting past a weight loss plateau (2018) at https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-plateau/art-20044615
- Q&A with Dr Rosetta Guidozzi – 2 May 2019 (unpaid)
- Q&A with Dr Grant Fourie – 11 April 2019 (unpaid)
- Q&A with Dr Rosetta Guidozzi – 9 May 2019 (unpaid)