Dr Araz Rawshani

Why is it difficult to lose weight and why is gaining weight so easy?

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Why is it so difficult to lose weight?

Overweight and obesity have become so common that most of us stopped remarks on it. Overweight and obesity have simply become so common that we are now at risk of considering these conditions as normal. However, this is not the case; overweight and obesity are harmful and lead to diseases and complications. Fortunately, most people know that obesity can lead to type 2 diabetes. The best treatment for obesity and excess weight is to lose weight. Decades of research show that it really does not matter how to lose weight, as long as you lose weight. There is a wide range of different methods that all work for those who want to lose weight. A wide range of diets, medications, exercise programs, surgical procedures etc are available to achieve weight loss. However, the fact is that one can lose weight almost regardless of the method chosen.

The big concern is to maintain a weight loss. The vast majority of people are gaining weight again and for some this may mean that they actually weigh more after an attempt to lose weight. The following picture clearly shows how fast you can lose weight with different methods, but also that the weight subsequently rises for everyone. In this article we will discuss why it is difficult to lose weight, and also maintain their weight loss.

This picture shows a large compilation of many studies. Here you can see how much you lose weight with different methods. Calorie restriction means that you are instructed to eat less calories (also called low-calorie diet). As you can see, severe calorie restriction means losing weight very quickly, but then gaining weight again. This is due to the fact that such a diet is difficult to maintain. Source: Franz et al: Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-up. J Am Diet Assoc. 2007; 107:1755 -1767.
This picture shows a large compilation of many studies. Here you can see how much you lose weight with different methods. Calorie restriction means that you are instructed to eat less calories (also called low-calorie diet). As you can see, severe calorie restriction means losing weight very quickly, but then gaining weight again. This is due to the fact that such a diet is difficult to maintain. Source: Franz et al: Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-up. J Am Diet Assoc. 2007; 107:1755 -1767.Meta-Analysis of Weight-Loss Clinical Trials with
a Minimum 1-Year Follow-Up. J Am Diet Assoc. 2007;107:1755-1767.

Why we gain weight

Our environment is unhealthy

In the 20th century, human existence changed dramatically. New knowledge, new drugs and technological developments helped us survive infectious diseases and instead learned to manufacture cigarettes, machinery and food in large quantities. Food culture changed so that we started producing more food than we needed and the energy content of the food was very high (the food contained more calories than we need). In addition, portions became larger during the 20th century. We even learned to use flavor enhancers, which increased our appetite even more. At the same time, we moved less and less because cars, buses, TV viewing, machines etc resulted in us becoming more and more sedentary.

In addition, life and everyday life have become more stressful during the 20th century and people sleep less; stress and lack of sleep lead to even worse eating habits. In other words, we eat too much food and we move less and less.

Our inheritance (genes) affects body weight

You might know someone who eats a lot of food but is still very slim. The explanation for this is, at least in part, that the person has genes that prevent it from gaining weight. So there are genes that affect our body weight. These genes affect our weight by influencing how well the body takes up nutrition, how well the body stores nutrition and how effectively the body burns energy. All these things affect our weight.

Today it is considered that overweight and obesity are hereditary. This means that if your mother or father is overweight/fat, it increases your risk of overweight and obesity. People who are overweight, obese and/or have diabetes can often tell that there are more people in the family who have the disease. However, this does not mean that the genes are the only reason why several people in the family have obesity/diabetes. We can also inherit lifestyle and unhealthy habits.

Today we certainly know that there are many genes that affect our weight, but this effect is very small. The fact is that only up to 5% of body weight depends on our genes! The most powerful gene associated with body weight is called the FTO gene and if you have “bad” FTO genes, you weigh 1.2 kg to 3 kg more than other people. 3

Energy balance: calories in and out

Energy balance is incredibly important. Energy balance is the balance between the amount of energy we waste and the amount of energy we get through our food. The energy is measured in the unit calories. The energy content of food is measured in calories. The body’s burning is also measured in calories. Neutral energy balance means that we get as many calories as we consume. Positive energy balance means that we get more calories than we lose and then you gain weight. Negative energy balance means eating fewer calories than consuming and losing weight.

It is genes, behavior and environment that regulate our energy balance and thus weight

The interaction between genes, behavior and the environment is very complicated. In the brain (that part called the hypothalamus) there is an area that regulates our hunger. This area can sense if we have the need to eat. If you are fasting, certain substances are released from the gastrointestinal tract and these substances affect the area of the hypothalamus so that it creates a feeling of hunger. When you have just eaten food, that area instead creates a feeling of being full.

So it is the brain that controls our hunger and our appetite. The brain listens to the following signals:

Substances and hormones released from the pancreas (pancreas), stomach, intestines and adipose tissue.Signals for other parts of the brain trying to regulate behavior. For example, you can stop yourself from eating if you really try to refrain from eating. The feeling of hunger can therefore be overcome by a higher will.

The body tries to counter a weight loss

When you eat less food or increase your physical activity, you cause a negative energy balance and then you lose weight. This starts several processes in the body and the purpose is to prevent a weight loss. Namely, the body believes that weight loss is unfavorable and tries to prevent it. The body has the following methods to do this:

Reduced energy consumption at rest. The body actually burns energy constantly, even at rest. But in case of negative energy balance, the body can reduce energy consumption at rest, as a result of which one does not lose weight equally fast. Increased hunger and increased appetite. This is done through the hypothalamus of the brain. It can be very difficult to overcome these impulses.

This makes it more difficult to lose weight. In fact, even when you have lost weight and managed to maintain weight, these processes can take a very long time. 4

This means that you who manage to lose weight will have an abnormal metabolism for some time after weight loss. This will make it harder for you to maintain your weight loss and it is important to know this. Very many people who lose weight do not manage to maintain their new weight, but actually gain weight again. This applies to every method that exists for weight loss. Weight loss requires a very long-term plan and motivation to maintain the results!

Read more about the Harmful effects of overweight and obesity.

How the body reacts to weight loss

Most people trying to lose weight do so by eating less food and moving more. This gives a negative energy balance which means that the body burns more energy than it gets through the food. Then you lose weight. The vast majority of people trying to lose weight succeed, more or less. The maximum weight loss is usually achieved within a few months and after that the vast majority of people gain weight again (picture above). The reasons for gaining weight again are as follows:

One, as a rule, gets worse at following the diet or exercise routines.The body tries to counteract weight loss.

  • Increased hunger and appetite.
  • Reduced energy consumption at rest.

Losing 5% to 10% of your body weight results in clear improvements in blood counts, better function of beta cells, better insulin sensitivity in muscles, fat and liver, etc. The more you lose weight, the greater the health benefits. The important thing is to lose weight. It is less important how to do to lose weight.

How much do you usually manage to lose weight? This depends entirely on what method you use and how motivated you are. Generally, dietary changes tend to lead to greater weight loss than physical activity. Several drugs cause a clear weight loss (see photo below). The most severe weight loss is obtained with gastric bypass (obesity surgery).

In the large Look Ahead study, which studied people with type 2 diabetes, almost 9% weight loss was achieved after 12 months and this resulted in clear improvements in blood counts, etc. In the DPP study, participants managed to lose 5.6 kg after almost 3 years and this reduced their risk of type 2 diabetes by closer to 60%. Thus, there are huge gains from losing weight. This protective effect of weight loss actually persisted even 10 years after the study was completed.

More severe weight loss (about 15 to 30% of body weight) can be achieved by obesity surgery (gastric bypass). This method is so effective that one can cure type 2 diabetes. Gastric bypass is also associated with reduced mortality and reduced risk of cardiovascular disease. Blood sugar, blood pressure and blood lipids are significantly improved. The following picture shows how people with obesity who underwent gastric bypass manage to lose more than 30% of their body weight within 12 months. After that, they actually increase slightly in weight, but after 10 years they have maintained a weight loss of about 25%.

What is not improved by weight loss?

Weight loss is good for most risk factors and diseases (related to overweight and obesity) but there are exceptions. Sleep apnea is usually not cured with weight loss, although it usually gets better. It should also be mentioned that in the Look Ahead study participants achieved a weight loss of almost 9% with intensive lifestyle change, but this did not result in a lower risk of cardiovascular disease. Even today, the learned disputes about why Look Ahead failed to prove that the risk of cardiovascular disease decreased, but it is still unclear why. At diabeteson.com, we are of the opinion that intensive lifestyle change (better diet, more exercise) entails a lower risk of cardiovascular disease.

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