Why Losing Weight Is Hard: The Barriers That Get Overlooked

Plenty of people arrive at the clinic having tried a lot of things, wondering why losing weight is so hard when they have already cut back on food and added exercise. In most cases the problem is not effort. The problem is one or two weight loss barriers that were never checked, and for as long as they go unchecked the same effort will keep producing the same result.

The weight loss barriers that rarely get checked

This list is not theory. These are the things that come up in the consultation room every week.

• Low thyroid function that has never been tested
• Insulin resistance that has never been measured, because fasting glucose alone can look normal
• Other medication causing weight gain, including some blood pressure drugs, psychiatric medication and steroids
• Undiagnosed sleep apnoea, disrupting sleep every night without the person knowing
• Ongoing chronic inflammation, which changes how the body uses energy
• Years of repeated dieting cycles, which leave muscle mass lower than it should be

Why this list matters

Every item on it can be detected with the right test or the right question, and every one changes the treatment plan. If thyroid is low, cutting calories further will not fix anything. If sleep apnoea is the cause, more exercise only adds fatigue. This is why we start with assessment and testing rather than with a prescription. See metabolic assessment.

The barrier that comes from dieting history

Someone who has been through five or six rounds of strict dieting across twenty years usually sits at lower muscle mass than a person who never dieted, even at the same body weight. That muscle is what determines how much energy gets used each day. So the people who have tried hardest sometimes start from the hardest position. That is not a punishment. It just means the first step should be rebuilding muscle, not cutting further.

The barriers that are not medical

There are also barriers with nothing to do with blood tests. Shift work that moves mealtimes every week. Caring for small children or elderly parents, which takes both time and energy. A commute long enough that there is no time to cook. These are real and they change what is practical. A plan that ignores somebody’s actual circumstances will not survive three weeks, however correct it looks on paper.

The order we work in

Check first, then plan. Full history and a list of current medication, then basic tests, then the results read together. Only after that does a plan get written, and it starts with the biggest barrier rather than the easiest one. If sleep is the largest problem, sleep gets handled first. If muscle is too low, resistance training and protein come first.

Next step

If you have been trying for a long time and the result does not match the effort, there is a good chance something has not been measured. Book a consultation for an assessment, or read why weight stops dropping and exercise for weight loss.

The health-risk background for body weight sits in the WHO fact sheet.

Every iLIV guide is written and reviewed under our editorial standards, and each one carries the name of the reviewing doctor together with their MMC registration number.

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