Some people can't lose weight no matter what they do. What's going on?
Most of us who counsel people on weight management eventually run into overweight people who seem to be unable to lose weight, even when they do everything right. They monitor their caloric intake (or their WW points) diligently. They are exercising every day. According to all the formulas, they should be losing weight. And yet they don't. Are some people simply resistant to weight loss?
My guest today is Dr. Yoni Freedhoff, someone you have heard me reference and quote numerous times over the past years. Dr. Freedhoff is the founder the Bariatric Medical Institute in Ottowa, Canada, a non-surgical, evidence-based nutrition and weight management center. He's also the author of a terrific book called The Diet Fix, which aims to help people stop dieting and start on a path to sustainable weight loss. and he blogs at weightymatters.ca. If you don't already follow Dr. Freedhoff's blog or social media feeds, I highly recommend them.
Below are highlights from our conversation. To hear the entire interview, please click on the audio player.
ND: You're a physician who specialized in weight loss. Do you see people in your practice who can't lose weight even when they are doing everything right?
YF: Most people don't lose as much or as quickly as they hope or expect to. And, certainly, I see people struggle to lose weight despite reporting that they’re doing everything by the book.
ND: How often does it turn out that they are simply eating more (or moving less) than they realize or are admitting?
YF: This is by far the most common scenario. We live in a hypercaloric food environment where super palatable, energy-dense food is thrust at us wherever we go, There's also the fact that 0ur eyes are terrible measuring tools. And most of us, despite our best intentions, are poor food historians.
ND. There's a related phenomenon that I've talked about before. People who overestimate the number of calories that they burn through exercise and physical activity (abetted by their fit bits and treadmill readouts) and as a result allow themselves an unrealistic number of extra calories.
YF: For sure!
ND: So, in those cases where "weight loss resistance" is really more of a record keeping issue, what do you suggest people do?
YF: A "science experiment" where they use measuring tools, a real-time food diary, and complete avoidance of restaurants for a minimum of two weeks to determine to the best of a person’s ability, exactly what they’re consuming.
ND: I've worked with people who literally weigh every thing that goes into their mouths for months at a time. Given their current weight and their reported calorie intake, they should be losing weight.
YF: To be sure, people lose weight at different rates. But they aren't magical creatures. If you create a deficit, I expect to see weight loss. BUT there are those who burn fewer calories than would be predicted. We measure the REE [resting energy expenditure] of every patient, using indirect calorimetry. On rare occasions, we see people who are burning 25% fewer calories than would be predicted. These are people who might be considered weight loss resistant but the truth is they just need fewer calories than you might expect.
ND: Any idea what might cause someone to have a dramatically lower metabolic rate?
YF: Genetics, yoyo dieting, body composition, microbiome. Who knows?
ND: Is there anything we can do to help people in this situation boost their metabolism?
YF: Not a great amount of hope in my experience. That said, sustained regular exercise does burn calories, but people are rarely consistent. People often bite off more than they can chew and burn out. Adopting a consistent pattern of exercise can buffer some of the unfairness of slow metabolism.
ND: And certainly for people with a low resting metabolism, who have a lot fewer calories to "spend" every day, it becomes even more important to select foods that fill you up for fewer calories. I think I'm a bit more optimistic than you are about the chances of recovering a more normal metabolism. But I know that we both agree that dieting is the worst way to go about losing weight! If you have a slow metabolism, you may lose weight more slowly than others, but slow weight loss is more likely to be sustainable weight loss.
For more of Dr. Freedhoff's advice on sustainable weight loss, check out his book The Diet Fix and his blog at weightymatters.ca.