You're On a Diet....So Why Aren't You Losing Weight?

So many diets and so little weight loss! The majority of us who undertake a diet find it difficult and ultimately unrewarding. There's so much info out there about how to get weight off. Why, then, should dieting be a frustrating exercise that often ends in failure? Here is a full posting devoted to a question I hear with great frequency: Why is my weight loss diet not causing me to lose weight?

New patients to my practice often say that they can't lose weight no matter what they do. They chalk this up to a bad metabolism or to something that must be extremely dysfunctional about them. Over the years, however, I'm hard pressed to remember anyone who was not able to lose weight once they began an effective diet. No matter how impossible weight loss once seemed, it became possible once the diet was properly adjusted. Naturally, this result depends on the dieter following the diet exactly as prescribed. 

Why then the frustration? And why do many diets seem to fail? Here is what I've come to believe (followed by some suggestions that may help):

1. Diets Fail Because We Fail to Understand What They Are

I like to think of dieting as an unnatural act. (Strange that I would make my living by encouraging unnatural behavior, isn't it?) But seriously, if you could revisit ancient times, you would not find any humans forcing themselves to lose weight. Having a bit of extra fat would have conveyed a survival advantage, so why would anyone have wanted to get rid of extra pounds? Our twenty-first century bodies still behave this way. In fact, they seem to completely ignore weight as we gain it.

Knowing the body's propensity to defend itself against harm, one would think that storing a lot of dangerous fat would cause the appetite to shut down, or perhaps prompt the release of a cascade of hormones to dissipate the excess. But that doesn't happen. We can carry even hundreds of pounds of extra fat without the body paying any attention. Perhaps the reason is this: our ancient genes (the ones we still harbor) never thought we could gain a dangerous amount of weight. Since it used to be a good thing to store some extra fat, our genes never developed a program for aborting weight gain.

Since the body ignores our fat, how do we create weight loss? We do it by recreating an ancient situation...one that forced the body to notice its own fat. That situation was a significant food shortage. In actuality, a modern weight loss diet is simply the process of tricking the body into believing that there is a famine in the outside world. Once the body gets the idea that there is very little food coming in, it suddenly wakes up to the presence of stored fat and starts to use it up.  This state of awakening was doubtlessly designed as a survival response hundreds of thousands of years ago. Let's call this bodily state: "The Ancient Famine Response".

This response consists of two parts, one of which makes dieters happy and the other frustrated. First, the body starts looking for energy to sustain itself in the face of famine. It turns its attention to its own fat, recognizes it, and starts burning it. Second, the body wisely decides to burn this fat as slowly as possible in order to outlast any extended food shortage. It does this by slowing down its bodily processes, heating itself less, and using other tricks to conserve energy. This is annoying to dieters, but is a built-in and unavoidable feature of the Famine Response.

Having discussed the reason we lose weight, let's next think about what would have constituted normal eating for the same ancient ancestors. Since they hunted and gathered, they probably had days of ample food one day and days when food was scarce. To adjust to this, human bodies likely developed a very flexible system for using food. If food is temporarily in short supply, the body can slow down , burn fewer calories, and be more efficient. If we eat more, the body can speed up.  These mechanisms allowed our ancestors to stay at stable weight even when food intake fluctuated. Let's call that the "Normal Ancient State".

Most of us start a diet with all intentions of following the rules exactly. That works! We lose weight because we are consistently telling the body that there is very little food coming. We've mimicked the"Ancient Famine Response" or, as I sometimes tell patients, "we've turned on an emergency light in the brain".  But we soon start to get creative. We eat things which seem to be minor but which aren't on plan Or, we don't eat on some days and we eat more on others. All of these behaviors put us back into the "Normal Ancient State". We can't figure it out, because when we look at the intake for a whole week, we ate very little...certainly many fewer calories than we used to eat before dieting. Why aren't we losing??? It's because food intake is intermittent and not sufficiently restrictive.  The body adjusts to intermittent eating, lowers its burn, and keeps weight stable, just as it's programmed to do.

Suggestion: Pick a diet that you can follow to the letter. Stay as compliant as you possibly can. Resist the temptation to go off the diet on some days and resume on others.

2. Diets Fail Because We Don't Have a Way to Get Calories Low Enough

In our practice, we create weight loss with a diet that has approximately 1200 calories. Larger women and/or men may use 1500 calories or so. This sounds simple, but it isn't.  Calorie counting is complete guesswork in the modern world. Using packaged foods which have known caloric content can help. Once you start eating out in restaurants, as most of us do, counting becomes impossible.  Although I do not like processed foods over the long run, dieting may be a good time to use them. If you can construct a diet from bars, supplements, frozen diet entrees, low fat dairy products and other foods which have calories already listed, you can be pretty sure of the number of calories you are getting. 

In our program, we use three diet shakes or bars (each 160 cals) per day and have patients eat a dinner which is composed of about 1/4 of a dinner plate of lean animal protein (chicken, fish, meat), a large mixed vegetable salad, a big portion of cooked green vegetables, a piece of fruit, and a 100 cal fat free pudding. You can work out your own plan, but knowing that you are getting the right calorie count is important. 

Suggestion: If you aren't losing, check your calories.  Make more use of foods which have calorie labels. Try to avoid eating out if it is scuttling your weight loss. And of course, remembering the information above, remain consistent each day.

3. Diets Fail Because We Don't Get Our Insulin Low Enough 

Insulin is a mega-important hormone for dieters because it stores fat. It not only puts fat away into the fat cells, but it also stands guard outside the cells to make sure the fat stays put. Only by lowering your insulin levels can you break down fat. Imagine insulin as a jailer that keeps fatty prisoners trapped on your body. Put him to sleep and they can escape. 

Insulin is made whenever we eat starch or sugar because those two things turn into blood sugar once they are absorbed. (Insulin's other job is to control the levels of blood sugar). Dieters have already intuited the role of insulin. What is the first thing they do when they start a diet? They begin with salad and chicken breast. They eliminate bread, pasta, crackers, rice and dessert. Insulin goes to sleep and weight loss follows. But before long, their carb addiction begins to howl. That piece of pita doesn't have that many calories. That rice cake is a diet thing, right? Wrong. This part isn't about calories. Wake up your insulin enough and you won't lose weight.

Suggestion: Keep starch and sugar to a bare minimum when dieting. (BTW, this works for maintenance too!).

4. Diets Fail Because We Rely Too Much on Exercise as a Weight Loss Tool

Exercise is great. I love it! But alone, it will not cause weight loss (unless you are running the ultra-marathon or something).  Remember the Ancient Famine Response: unless you create a consistent state of calorie reduction, you won't lose.  In my practice I have many skilled tennis players, marathon runners, volley ball enthusiasts, and other athletes. If exercise caused weight loss, they would not be visiting me to get off the 30 extra pounds they've accumulated.  Be especially careful with the temptation to over-exercise. This can create hunger and entitlement (as in, "I earned that bag of M and M's"). Exercise by all means, but during weight loss, put most of your faith in calorie reduction that is consistent and calculable. 

Suggestion: During weight loss, think of exercise as secondary to caloric reduction. 

Remember this: magazine covers would lead you to believe that weight loss is simple and that pretty much everyone in America is having their pounds "melt off". This is the big lie. Weight loss is tough and takes a tough effort. What remains true is that the rewards for this effort are great; the endpoint incredibly worthwhile. So keep at it and always congratulate yourself for taking on such an important and challenging task.

Dr. Barbara Berkeley is Medical Director of Weight Management for LakeHealth and has a private practice in the Cleveland suburbs. She blogs at www.refusetoregain.com.