Modern Metabolic Health with Dr. Lindsay Ogle, MD

Why is it so hard to lose weight?

• Lindsay Ogle, MD • Episode 2

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We unpack why weight loss is hard, how set point and hunger hormones push back, and what tools make maintenance possible. We move from biology and environment to medications, mindset, and practical support so you can protect your metabolic health for the long term.

• evolutionary biology driving energy conservation
• modern food environment increasing calorie density and reward
• weight set point and metabolic adaptation mechanisms
• evidence from The Biggest Loser metabolic study
• ghrelin and hunger increases after weight loss
• role of anti-obesity medications for chronic management
• mindset shift from motivation to dedication in maintenance
• value of coaching, groups, and medical support

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Speaker:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatment. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. Today I'm going to talk about why it is so hard to lose weight. The struggles with weight management is something that I talk about every single day in my primary care practice. Many patients feel defeated. They've been told that it's their fault that they can't reach their goal weight or they can't maintain weight once they've lost it. And doctors have even told them that it's easy, just eat less and move more. We hear this all the time. But the truth is it's not that simple. Our bodies are way more complex than simple input and output. So with all of my patients who are wanting help to lose weight, I talk about why it's hard to be to lose weight to begin with. And it's really, it can feel like our body is working against us, and that can be really frustrating. But the truth is, our body is trying to help us, it's coming from a good place. So many, many years ago, hundreds, thousands of years ago, food was much harder to come by. And so the way that we survived was that our bodies became really efficient at managing the calories and the nutrition that it was able to obtain, and so it got really good at holding on to calories over time and helping the our ancestors maintain that weight so that they could survive. So the people that survived were the ones that were able to maintain that weight during periods of food scarcity, during starvation periods, during famines, when we weren't able to get to get that nutrition. So that's how our biology is set up. It's set up to conserve energy and to reserve those fat stores for a time when we may need them. Fast forward to the modern day, we still have those bodies and that genetic code, but we're in an environment, we're in a society where food is readily accessible for most people, and it comes in higher caloric density, meaning there are more calories and smaller portions of food. The food industry has made food taste much better. It combines salt and fat and sugar and into a perfect combination that feels good on the mouth when you're eating it, it triggers the brain, it tells it makes us feel like we're really helping ourselves. It sets us up to be where we are now, where we have this what we call an epidemic of overweight and obesity that's leading to significant health outcomes and metabolic disease. So it's not so much that you know we as especially as doctors that we care about the size of our patients, it's about their health and the impact on their health. And so, of course, that's always the lens that I'm coming by when I talk about weight management. So, how does the biology and the genetics actually work? And what happens is we develop what we call a weight set point. There are hundreds of thousands of functions and hormones and chemical reactions that are happening in the body all of the time, and the body is does an excellent job at maintaining what we call homeostasis. And so your body is constantly adjusting to the environment and what you're taking in, uh, your food, uh, your physical activity, how warm or how cold it is outside, um, how hydrated or dehydrated you are, your body is constantly tweaking so that it maintains a steady state so that you can survive. And it does the same thing with weight, and so it your body wants to stay the same, and so it has this weight set point that once you start to lose weight, then your body kind of freaks out, it thinks that something really bad is happening, it's worried about you, and the way that it's trying to protect you and itself is that it lowers its metabolism and it increases hunger. And this is what makes it so hard to lose weight and especially maintain weight, and this has been proven. One of the most popular studies is the with the biggest loser. And I think we're all familiar with that show many years ago. And if you're not, it was a competition where they had patients who were living with obesity get on kind of this like reality game show where they exercise a lot and were put on a strict diet, and they would weigh themselves throughout that competition, and these contestants would lose lots and lots of weight. And what the study did over time, over the next several years, I think it was six years that they looked at these patients, they checked their metabolism afterwards, and their metabolism was actually 500 calories less than what they would expect in a person of that size, and that was consistent whether or not they maintained their weight loss. And so this really highlights the fact that even to maintain the weight loss, that person is going to have to eat less and less over time, and this is why those medications that we use for weight management are so powerful because they can help offset these biologic changes, and I will definitely talk more about those medications at a future video. Another adaptation that your body goes under is hunger increases, and the main hunger hormone is called ghrelin, and this has been measured also in humans who have undergone weight loss, they get the baseline ghrelin levels before the weight loss, and then they check those levels after weight loss, and they're higher. And so, people who when you lose weight, your hunger goes up. We all know what it feels like to be hungry, it's uncomfortable. Lots of people get hangry, and you really you can't keep that at bay for an extended period of time. It's just it's not feasible. Those are the two main reasons that it is very difficult to maintain weight loss, and where the anti-obesity medications really play a big role in the weight loss and weight management. This also highlights the importance of continuing these medications long term. Obesity is a chronic medical condition and should be treated as such. There also is a component of mindset, and this is really interesting because when you're losing weight, there is a lot of positive reinforcement that you get. You get it internally every time you step on the scale and you see that number go down. That's exciting. You have coworkers, friends, family, and your doctor who are congratulating you on your weight loss and they notice the improvements. Your clothes fit better, you're able to get new clothes that you're excited about, you're able to do things that you weren't able to do before. You may see your blood pressure go down or your blood sugar go down, you may even be able to get off of medications. And this is all really, again, fun, exciting, great, and wonderful. But once you hit your new weight set point and you're focusing on weight maintenance, you're not really seeing those changes. You're the weight on the scale is staying the same, or it goes up and down a couple of pounds. Your blood pressure, blood sugar, those are staying pretty steady, and you're continuing on your current uh medications, you're not getting those same compliments that you were getting before. People around you have have kind of accepted this new version of you, and that's what they come to expect. And so it can be really disinheartening when when this happens because it was really exciting during that weight loss phase, and the weight maintenance phase just is honestly pretty mundane, and but it's really important because that's what you're wanting to do for your health long term, and you're going to have to switch from motivation to dedication and commitment, and you're going to have to just tell yourself that this is your new normal, this is what you do on a regular basis now. You have to work just as hard, if not harder, for weight maintenance than you did for weight loss, and that can be really hard to hear, but it is it's the truth. If you are able to get a coach or be a part of a group, it can be really helpful to have that additional support. Work with an obesity medicine physician. I'm going to have another video talking more about weight management next week. So hope to see you there. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.