Why Can’t I Lose Weight?!? p2

Science by Landon Deru, MS, MBA, ATC

Welcome back! Our discussion last week helped us understand several components that impact our weight including the food we eat, hydration, exercise, sleep, and medications. If you missed last week’s article, catch up HERE. I hope this gave you some insights to help you make small course corrections in your health journey. Today, I’d like to continue our discussion of things that influence our weight with a focus on things that are less commonly discussed, but are equally influential. This includes factors such as basal metabolic rate, genetics, endocrine profile, and gut microbiome.

Basal Metabolic Rate (BMR)
BMR is the energy it takes to maintain our basic body functions at rest. These functions include the production of energy and heat as well as maintaining the function of various organs. If we have a higher BMR, it means we are burning more calories just to maintain a steady baseline. Many people blame their excess body weight on a “slow metabolism” (or a low BMR) when in reality, larger people have a higher/faster metabolic rate because it takes more energy to maintain more tissue. However, adipose only requires about 4.5 calories/kg/day to maintain where muscle requires about 13 calories/kg/day to maintain.[1] Thus, increasing your muscle mass can really increase your BMR. In fact, you might step on the scale before and after a period regular exercise and not see much change in weight, but your BMR might be increasing if you are replacing adipose with muscle. The best way to tell if you are losing fat and gaining muscle is to get a body composition test. The gold standard body composition test is a dual x-ray absorptiometry (DXA) scan which measures your bone density, body fat percentage, and muscle percentage. The “Bod Pod” and bioelectrical impedance tests can also give you a good idea of your body fat percentage.

One explanation for hitting a plateau in weight loss might be because your BMR slows down as you lose weight. Less tissue to maintain = lower BMR. Your BMR can reduce by up to 15% as you lose weight, so it literally becomes harder for your body to lose weight as you lose weight.[2] But don’t let this discourage you. Remember, it’s far better to be healthy than it is to have a “perfect weight”.

Genetics
Genetics are commonly blamed for our weight struggles. Many people say, “Obesity just runs in my family.” But do genetics really have an impact on our body type and our risk for obesity? The answer is, ”Yes!” In fact, researchers have identified more that 300 areas in our genome that impact our body weight.[3] However, a sharp spike in the world-wide obesity rate has only been an issue for the past 4 or 5 decades and our genetics have not changed in this timeframe, so what’s causing the increase in obesity? If you guessed “lifestyle”, you’re right!

If you think about modern advances in science and technology, they have largely made our lives easier and more sedentary. Our “obesogenic environment” might be amplifying genetic risk for obesity. This means that even if your ancestors did not struggle with weight loss, they may have been genetically set up to be overweight but because they were chopping down trees every day, actively hunting for food, and had limited access to refined sugars, these genes were not expressed. In our day, however, genes that lead to weight gain can be more expressed when stimulated by their environment. So you might say that our genes load the gun and our environment pulls the trigger. One example of this is insulin, which enhances gene expression of various fat-specific transcription factors leading to adipose growth.[4]

There is no doubt that some must work harder than others to avoid weight gain because of their genetics, but we have the power to express our genetics differently based on the environment we provide to them. Even those at highest genetic risk could mitigate their risk by increasing physical activity, hydrating properly, improving their sleep hygiene, and by “filling with fat, prioritizing protein and controlling carbohydrates”.

Endocrine Profile
The endocrine system is a system of glands that make hormones in our bodies. These hormones are chemical messengers that circulate through our body and regulate how cells and organs do their work. Many of these hormones play a role in weight regulation and metabolism. Here are a few examples:

    • Thyroid hormones affect every cell in the body and regulate the rate at which calories are burned. Hypothyroidism slows down metabolism in the cells, reducing BMR and resulting in weight gain.[5]
    • Human Growth Hormone helps build bone and muscle and is markedly reduced in the presence of obesity. [6]
    • Testosterone contributes to the building of muscle and bone and regulates fat distribution. When it is low, glucose control, fat distribution, insulin sensitivity and muscle mass are all negatively affected.[7]
    • Estrogen contributes to cognitive health, bone health, the function of the cardiovascular system, and weight regulation. Low estrogen levels are common as we age and can result in loss of bone mass (increasing risk for osteoporosis) and weight gain.[8]
    • Cortisol helps our bodies respond to inflammation, stress, or danger and can increase our body’s metabolism of glucose. Individuals who produce excessive cortisol are more prone to obesity.[9]

I recently helped someone very close to me understand the importance of hormones in weight regulation and overall health. They are getting help with regulating these levels and they are finally seeing a light at the end of what has been a very long tunnel of poor health. It may be worth seeing a hormone specialist if you think your levels might need some adjusting.

Gut Microbiome
Often ignored in the realm of health is the importance of a healthy gut. There are literally trillions of bacteria lining your intestines that both protect you from infections and help you digest and metabolize food. This layer of bacteria is known broadly as the microbiome. Without a healthy microbiome you are unable to make certain vitamins, digestion of certain complex sugars is impossible, gut mobility is impaired, immunity suffers, metabolism is impaired, and even your eyesight can be diminished.[10] As you can imagine, an unhealthy gut can have an enormous impact on your overall health – including your weight. There are several things that are particularly damaging to your gut microbiome including high stress levels, lack of sleep, eating processed and high-sugar foods, and taking antibiotics. So, you can promote a healthy microbiome by reducing stress (yeah right), getting adequate sleep, controlling, and regularly consuming healthy gut enzymes and probiotics (as found in HLTH Code).

Concluding Thoughts
As you can see, weight regulation is a complex issue. There is a lot to digest here (pun intended), but as you remember that basal metabolic rate, genetics, endocrine profile, and gut microbiome all play factors into your health, you can assess where you are with each one and make small changes to optimize them. Again, your weight relies largely on the lifestyle behaviors you adopt over time. As you focus more on improving health and less on improving the number on the scale, the weight will naturally follow. Making good lifestyle choices consistently will pay off in the long run.

References

1. Xiao G, Xie Q, He Y, et al. Comparing the measured basal metabolic rates in patients with chronic disorders of consciousness to the estimated basal metabolic rate calculated from common predictive equations. Clin Nutr. 2017;36(5):1397-1402.
2. Doros RD, Alina; Mardare, Liliana; Petcu, Laura. Basal Metabolic Rate in Metabolic Disorders. Proceedings of the Romanian Academy, Series B. 2015;17(2):137-143.
3. Goodarzi MO. Genetics of obesity: what genetic association studies have taught us about the biology of obesity and its complications. Lancet Diabetes Endo. 2018;6(3):223-236.
4. Cignarelli A, Genchi VA, Perrini S, Natalicchio A, Laviola L, Giorgino F. Insulin and Insulin Receptors in Adipose Tissue Development. International Journal of Molecular Sciences. 2019;20(3).
5. Reinehr T, Isa A, de Sousa G, Dieffenbach R, Andler W. Thyroid hormones and their relation to weight status. Horm Res. 2008;70(1):51-57.
6. Scacchi M, Pincelli AL, Cavagnini F. Growth hormone in obesity. Int J Obesity. 1999;23(3):260-271.
7. Kelly DM, Jones TH. Testosterone and obesity. Obesity Reviews. 2015;16(7):581-606.
8. Grantham JP, Henneberg M. The Estrogen Hypothesis of Obesity. Plos One. 2014;9(6).
9. Hewagalamulage SD, Lee TK, Clarke IJ, Henry BA. Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domest Anim Endocrin. 2016;56:S112-S120.
10. Okeke F, Roland BC, Mullin GE. The role of the gut microbiome in the pathogenesis and treatment of obesity. Glob Adv Health Med. 2014;3(3):44-57.

This article is for informational and educational purposes only. It is not, nor is it intended to be substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.