Mystery Diagnosis: Weight Gain

Find out the 5 most common medical conditions that can cause unintended weight gain – plus one that even stumped the House Call Doctor!

Sanaz Majd, MD,
Episode #105

The Exam

Upon examining Wendy, she appeared overweight but not out of the ordinary for someone who had just had a baby. She had an otherwise normal physical exam.

The Differential Diagnosis

Whether or not the patient’s diet and activity clearly reveal the potential cause of weight gain, I always think through this list of potential causes of weight gain for every single patient:

  1. Thyroid Disorder: A medical condition called “hypothyroidism” occurs when our thyroid gland, the gland that helps regulate our metabolism, pumps out too little thyroid hormone. When this occurs, our metabolism slows down, and besides hair loss, constipation, and fatigue, it can cause weight gain as well. A simple blood test ruled this out for Wendy, who had normal thyroid levels.

  2. Diabetes: Patients with Type 2 Diabetes tend to have more difficulty losing weight. They suffer from a phenomenon called “insulin resistance,” in which the body does not react the way it should to insulin. This slows down the metabolism and patients often gain weight in the mid-section. Diabetes is thought to be underestimated since many patients can be diabetic but experience no symptoms. Thankfully, Wendy’s test for diabetes was also normal.

  3. Medications: Certain medications can cause weight gain, including some antidepressants, antipsychotics, steroids, and diabetes medications. Wendy is a healthy young lady who is not taking any medications. 

  4. Stress: Certainly, those patients with elevated stress levels can cause weight gain indirectly.   When patients are stressed out, they may not pay attention to their nutritional intake, forgo exercise, or neglect to take care of themselves like they should. Many use food as a soother, and heavy comfort foods may be the first thing they reach for. Having a baby can certainly be stressful, and no one would fault Wendy for that. However, she is adamant about maintaining her diet and exercise regimen despite this stressful situation.

  5. Menopause: When estrogen levels decline, our metabolism tends to slow down. Some women nearing menopause tend to start gaining weight, especially in the mid-section. It can be caused by mood changes or lack of sleep that trigger high-carb snacking or the decline in estrogen itself, both of these cause a physiologic change in fat deposition. Wendy was only 38-years-old, and nowhere near menopause. The average age for starting menopause is 51 in the U.S.

So what could possibly be causing Wendy’s weight gain? She didn’t seem to fit the profile of any of my top causes of weight gain. She was eating right, exercising enough. She told me that she was not having intercourse, so she can’t be pregnant. 

But when I sent her to the lab for thyroid and diabetes tests, I added one more test – a pregnancy test – just to be on the safe side. And sure enough, she was pregnant! I called Wendy to tell her the news. Needless to say, she was totally surprised. “But I have had relations with my husband maybe once, at the most twice, since my baby was born!”

This was a good case to remind me of two lessons:

  1. All it takes is once to get pregnant.

  2. Pregnancy is possible even if your periods are irregular or not yet returned due to breastfeeding. Women may ovulate, even though they are not menstruating.

Wendy was quite shocked, but was truly happy once the news settled. She was also relieved to know that there was a reason for her unintended weight gain. She went on to deliver a healthy baby boy.

How did you deal with unintended weight gain? How did you shed those extra pounds? Share it with us on the House Call Doctor’s Facebook and Twitter pages!

Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.

Doctor and Patient image courtesy of Shutterstock


About the Author

Sanaz Majd, MD
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