Weight Loss–What Works?

Weight loss—what works? That’s the $20 billion question—literally.  ABC News reported in 2012 that this was the annual revenue of the U.S. diet industry, including diet books, diet drugs, and weight loss surgery.  Looking at rising U.S. obesity and type 2 diabetes rates, Americans did not spend their money wisely.  Many of you saw this disturbing “Obesity Trends” video clip when we posted it on Facebook recently (based on Centers for Disease control and Prevention data).

As women’s physicians, our commitment to your care includes helping you to reach and maintain the best possible level of wellness, including weight management and fitness. The honest truth is that a “fix it and forget it” approach to diet and exercise is doomed to fail.

For this reason we discourage weight-loss supplements, radical or trendy diets that eliminate entire food groups, and (in most cases) prescription weight-loss drugs. We don’t endorse commercial diet products or sell them in our office.  (There’s no Dr. Oz here!). What we do offer is information and referral, when appropriate, to resources that will help you make long-term healthy lifestyle changes. In some cases, we can discuss whether you would benefit from a referral to a bariatric surgeon. It’s not easy to accept that there’s no quick fix. But remember, the weight you’d like to lose did not come to you in a month or—in most cases—even a year.  Lasting weight loss is best accomplished the same way, moderately over a period of months or years depending on your goals.

Is it hormones?

Supporting your efforts includes helping you to understand why you’re struggling. You tell us in the office that you seem to gain weight much easier than when you were younger. You wonder whether the cause is hormone changes (birth control pills, childbirth, menopause, or thyroid gland problems).  We can test to be sure that you have normal levels of thyroid hormone and determine whether you are approaching menopause.  Research tells us that birth control pills and other hormonal methods are not the likely cause of significant weight gain. (Read more about this topic).

It’s hard to measure whether pregnancy affects weight gain (after the baby is born), because so many aspects of diet and lifestyle change once you have children.  And weight gain appears to be a part of aging whether or not a woman has had children.

Weight gain as you age is a statistical fact. The reasons are a complex mix of physiologic and lifestyle changes. We know that women lose bone mass as they age. They also lose muscle mass at the rate of between 3 and 10% per decade after age 30. The cells in muscle tissue produce much of the body’s metabolism.  So, no doubt, as you age your metabolism slows.

The specific effect of menopause on later-in-life weight gain is difficult to separate from other factors (like muscle loss, decreased activity, etc.).  But menopause definitely changes the areas where the body stores fat.  Women who typically gained weight in hips and thighs often notice that, in their fifties, they begin to gain in the abdomen.

Your plan

To slow the loss of muscle, try to include strength-training in your exercise plan at least a couple times a week. If you’ve never used weights, get some qualified instruction (the Y, church recreation center, a health club) and start slow. A good fitness instructor will teach you to exercise all muscle groups. Spot reducing is a fitness myth! Sit-ups will not target the layer of fat tissue that has found its way to your abdomen since childbirth or menopause. It will strengthen the muscles underneath, but where fat is stored or lost first depends on age and genetics.

Returning to our important question, what works? A better question is “What works for you?” What life changes can you keep up, month-in and month-out? Choose a well-balanced food plan. (Notice, I did not say “a diet”). We can refer you to a registered dietician if you need some help. Begin to increase your physical activity with the goal of reaching the CDC guidelines for physical activity. And finally, identify some specific tools that will keep you motivated and accountable. Look to an upcoming part two of this blog post for a discussion of food and exercise journals/apps, wearable fitness devices, support groups, and other motivation and accountability tips.

We want to encourage your commitment and congratulate your success!