‘Why is it that I gain the weight back every time I successfully lose weight?’

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“Why is it that I gain the weight back every time I successfully lose weight?”

 My patient, Mrs. Taylor, was so frustrated as she asked me this question during her recent visit. The conversation was initiated after we evaluated the status of her gaining back the 15 pounds she had previously lost, resulting in a great deal of disappointment for my patient. Mrs. Taylor explained that she tried to continue the same diet and exercise routine but did not gain the same success. In further discussion, she admitted that she wasn’t as successful in the dietary regimen due to finding herself significantly hungrier. Almost to the point of tears, my patient looked me in the eyes with a great deal of frustration and said, “I give up!”

“It’s not your fault,” was my first statement to my discouraged patient. She then asked me why I felt this way. Mrs. Taylor shared that she was the one who ate the extra food and failed to stick to her diet. She also admitted that she found herself stopping at fast food restaurants on the journey home from work at least three nights a week after maintaining no fast food during the initial period when she successfully lost weight. She also shared that she lost energy and motivation after losing weight resulting in less exercise. I stopped my patient from continuing to share her failures and restated, “It’s not your fault.”

I explained that weight loss and weight loss maintenance is a complex, multi-level system involving many internal and external factors. Two of these complex internal factors include gut and adipose (fat cell) tissue hormones. These hormones provide input to the brain that affect hunger, sensory perception, cognition, emotion, and behavior. These are two of the functions that affect a person’s weight, including increased or decreased appetite and energy expenditure. I explained to my patient that this means these hormones impact how hungry you are and how fast your body burns calories. 

I told Mrs. Taylor that I wanted to share information about two hormones –Ghrelin and Leptin – that have a great impact on this regulatory system. I further explained that these two hormones are regulated by our body’s natural survival mechanisms. Mrs. Taylor smiled as I reminded her that our bodies have natural coping mechanisms to help us survive. When asked why she was smiling, she told me that she studied this as a pre-med student. She told me that it was the same as a person’s skin becoming darker in pigmentation due to exposed sunlight to help protect that person from cancer. She explained that this is why we get darker in the summer months when we spend more time outside in the sun. 

I explained that Ghrelin is a hormone released from the stomach that makes us hungrier before, during, and after meals. I further explained that we have higher levels of this hormone when we lose weight. This is due to our body’s natural survival mechanism resulting from the evolution of our primitive state (i.e. caveman days). I further explained that a person, during this primitive time, who was losing weight most likely had less of a food supply. This increased hunger, due to these elevated hormones, would cause the person to become more aggressive in hunting and gathering to better obtain food. Lastly, I informed her that losing weight had the exact opposite effect with the hormone Leptin. 

With this new knowledge, Mrs. Taylor shared that she understood that the weight regain was not her fault. I encouraged her to continue her efforts and explained that there are additional techniques that she can employ to increase her success. I suggested that she consider structured weight loss programs with support, specific instruction, and accountability. I also informed her that FDA-approved weight loss medications are available and are very effective at counteracting the effects of the changes in the hormones previously mentioned.  This could result in losing weight and also maintaining the weight loss. Mrs. Taylor expressed excitement due to this new information. My patient left our office with encouragement and a new understanding!

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‘Why is it that I gain the weight back every time I successfully lose weight?’

By Timothy and Melissa Quinn
December 16, 2021