Underlying cause of weight gain & what to do about it

Updated: Feb 24, 2021

Weight loss is at the top of the list of why people come to our practice these days—also high on that list of primary care visits is depression, anxiety, stomach pain, ADD, and headaches.

Folks often want to know what we can offer them for weight loss---but sometimes they come to their appointment already with an idea of what they want—maybe to get their hormones checked or to start weight loss medications.

While I do offer weight loss medications, all medications come with potential side effects and adverse effects—and often, they are just a Band-Aid—they may offer temporary weight loss, and sometimes can be a helpful adjunct in “getting the ball rolling” for weight loss, but they won’t fix the underlying contributors to weight.

I love to support patients in weight loss. I usually ask them to keep a journal of what they are eating, drinking, how many hours they are sleeping (and when), what kind of exercise they are doing (and how much and how often), and what medications/supplements they are already on.

If I ask 20 patients to do this for me so we can review/analyze their patterns and habits together, maybe one person will actually do this.

Most folks want a quick fix—they don’t have the time or make the time to reflect on the small, daily things they are doing (or not doing) that led to their current weight.

There are a few things I like to “rule out” or address/explore as contributors to weight gain when I first see a patient for weight loss.

1. Underlying sleep disorders—this can certainly cause weight gain and can be checked with a sleep study or helped with certain meds or supplements if needed; sometimes a CPAP machine is also needed. Conversely, too much weight can contribute to poor sleep or sleep apnea, which then messes up the hormones responsible for maintaining a healthy weight, so it becomes a vicious circle of weight gain and poor sleep (and often depression and ADD accompany this)

2. Hormones—I like to check certain hormones to see how these may be playing a role in weight gain/appetite—estrogen, testosterone, cortisol, thyroid, for example.

3. Nutrient levels—Sometimes those with excessive weight are actually nutrient deficient and can increase their metabolism with the right nutrients. For example, low iron can cause odd food cravings as well as profound fatigue, which can make exercise and weight loss difficult. Low B12 can also cause fatigue. I like to check nutrients in bloodwork and by analyzing one’s diet with them. Insufficient fiber and poor gut bacteria can likewise make weight loss harder.

4. Food /drink intake—I’m not a fan of the “low fat” diet, and I’m also not a fan of the strict keto diet—I’m a fan of a “lower carb, complex carb, healthy fat, healthy protein” balanced diet. We NEED fats to burn fats and make healthy hormones (yes, many hormones are built from FAT molecules). We need some carbs—like complex carbs, for specific nutrients. Also, too much protein is really hard on the kidneys. I ask patients to keep a lifestyle journal so we can analyze together which foods are contributing to insulin spikes, which then contributes to weight gain. Alcohol and “sugar free” foods and drinks are also big culprits. I do a lot of education of insulin and glycemic index of foods and how insulin causes weight gain.

5. Mental health—I frequently check-in with patients on anxiety and depression and disordered eating. Binge eating is often a coping mechanism for anxiety or depression—as is often bulimia. Having lived through a severe eating disorder as well as depression and anxiety, I am passionate about creating a safe and judgment-free provider-patient relationship to explore these connections and address the underlying mental health component in weight. Sometimes, addressing the mental health piece with therapy, supplements or medications results in weight loss because food as a coping mechanism is replaced with balanced brain hormones, such as serotonin.

6. Chronic pain and underlying conditions—I have many patients who struggle with both weight and chronic pain. Many tell me that their pain was never “taken seriously by previous providers” because they were “just treated like a fat person.” In practicing mind-body-spirit “whole body medicine”, I believe everything is intricately related. Chronic pain makes it very hard to exercise. Joint diseases like Ehlers Danlos and rheumatoid arthritis may make it very difficult to exercise; some of the medications used in conventional medicine to treat joint pain may cause weight gain, such as steroids. Some mental health medications used for depression or mood disorders contribute to weight. Some blood pressure meds make it harder to exercise, such as beta blockers. Medical conditions that can make exercise difficult include chronic headaches, dizziness, stomach issues, heart problems, asthma and more—we may have to treat and control these issues to make exercise more tolerable. Often, by getting someone exercising, their systemic problems improve.

7. Exercise—the ability or inability to get moving plays a big role in weight. I see many folks try all sorts of fancy diets and meal plan services, but often, if we cut right to the chase, they report to me that they only get sweat-producing, heart-rate raising exercise once or twice a week at best. Our bodies were never meant to be sedentary, and weight is a natural consequence of not moving. My motto with movement has become “some, not none.” If I don’t have time to go to the gym or for a 2 hour bike ride with a friend, I can still go for a walk between patients, even if just 20 min. I can park at the end of the parking lot instead of the front. I can take the stairs instead of the elevator. I can sit in front of my TV at the end of the day and do some crunches and squats—some, not none. Any movement is better than no movement when it comes to weight loss.