Why is it so difficult to lose weight?

I am asked this question at least a dozen times a week. This is invariably followed by - I must have a hormonal problem, doctor, can you not find it and fix it?
My stock answer is always - "If I knew why it is so difficult to lose weight, and if I could fix it, I would be richer than Bill Gates". I was asked to give a talk on this topic sometime ago, so these are a few very interesting points I got while researching this question. Please note, I AM NOT OFFERING QUICK FIXES FOR WEIGHT LOSS. If that is what you are looking for, read no further. 
There are are some reasons why the body is reluctant to let go of the fat (or adipose tissue) that it has gained. On top of this, there are reasons why some people lose weight easily, and others struggle. Some reasons are:
1. Men lose weight more easily than women. There is a wonderful, small study done that followed men and women who exercised similar amounts. 90% of the men lost weight. Among the women, a third lost weight, a third remained the same, and a third actually GAINED WEIGHT! Granted, this is only one small study, but it bears out what we have seen in real life. Wives get very frustrated when their husbands lose weight easily, while they struggle. This may have to do with the muscle mass, and testosterone levels. This is why, it is good for women to build up muscle mass, which helps them burn more calories. 
2. Our metabolic rate tends to go down as we get older. At the age of 50, we have to work at double the intensity of when we were 35 to lose the same weight, or even to maintain the weight and prevent it from going up. 
3. Brown fat is a wonderful fat that each one of us has in varying amounts. It is called "good fat", as it helps increase the metabolic rate and burn more calories up. All of us are born with varying amounts of brown fat. In some people, more of the brown fat remains, and this helps them remain thin, no matter what. When people say "she has a good metabolism", it really is true if she has a lot of good brown fat. These people either do not gain weight, or lose weight faster with diet and exercise. 
4. There are some genetic differences in people that make them respond in differing ways to even weight loss medicines. Certain variations of genes have been noted to help lose weight and respond to medicines better than other types of gene. If your family is tending towards the overweight, so will you.
5. Studies have shown that we tend to underestimate what we eat, and overestimate our exercise. Net result - we are eating more than we should, and exercising less.
6. Consistency is key. If we lose weight at the rate of 1/2 kg per month, we are doing well. Slow and steady does win the race in this situation.
Finally, most important, weight does not matter. I have decided to stop measuring peoples' weights in the clinic, unless they tell me they feel they have lost or gained a lot of weight. What is most important is - are you following a healthy life style. Are you eating well? Are you exercising your mind, body and soul? THE WEIGHT ALONE DOES NOT MATTER. Throw away those accursed scales!
The reason I say this, is people get hung up on the number on the scales, and forget about what is important - which is living a healthy lifestyle. 

How can I make healthy eating choices?

Healthy eating

Following a healthy eating pattern is not difficult, and the same simple food choices will help whether you are trying to control your blood sugars, cholesterol, blood pressure or to lose weight. Some individual variations may be needed, but overall the healthy options are the same. Remember to eat small frequent meals and be guided by your hunger, not by the clock.

1. Less sugar – limit the amount of sugary things. Avoid sugar in your tea and coffee. Avoid sweets, chocolates, ice creams, cool and fizzy drinks, jam cakes, pastries, biscuits. An occasional sweet is okay – say once in 10 days.

2. Less fat – avoid oily and deep fried items like samosas, bondas and chips. A rough guide is one can use 2-3 tablespoon of oil per person per day. Our traditional oils, particularly sesame oil is very healthy. Use a mixture of different oils.

3. High fiber: Increase intake of fruits and vegetables. Have at least 1-2 fruits and 3-4 cups of vegetables daily. Fruits like apple, orange (and musambi), guava, papaya, pomegranate are low in sugar and can be had daily. Fruits like mango, banana, jackfruit, watermelon tend to push blood sugars up more, and should be had less frequently if you have high blood sugars.

4. Have 1-2 glasses of milk and 1 cup curd (plain yoghurt) daily.

5. Do include some nuts daily - they are good for the heart. Badam (almonds), pista (pistachios), akrut (walnuts) can be had daily (up to 8-10 pieces in total). Peanuts are a good healthy snack.

6. Avoid dried fruits like dates and figs if you have very high blood sugars. Prunes and apricots have less sugar and may be had even when blood sugars are raised.

7. Include cereals and millets in your diet. Millets like ragi, bajra (kambu), jowar, thinai are good sources of fiber, do not increase blood sugars significantly, and also are a good source of other minerals like calcium and magnesium. When using rice, try to include unpolished rice or red rice.

8. An egg may be had daily. Eggs are low in calories, and the yellow yolk contains precious vitamin D and other nutrients.

9. Non-vegetarian food can be healthy if not deep fried. Fish, chicken and lean cuts of meat are mainly protein and help some people with better blood sugar control and weight loss.

10. Use less salt. If you have high blood pressure or heart problems, one easy way to do this is to cook without salt. Keep 1-2 teaspoon of salt in a cup, and sprinkle this over your food when you sit to eat.

For further information, please go to http://jayashreegopalendocrinology.webs.com

Twitter: @JayashreeGopal, Blog: whatcanieatdoc.blogspot.in

Time/Meal	Options	Alternatives/comments
7 AM	A glass of milk/tea or coffee, without sugar.	You can also have a glass of wheat grass juice, or green tea.
8-9 AM - Breakfast	Idlis – 3-4 Dosais – 2-3 Adai – 2-3 Wheat uppuma – 1-2 cups Oats porridge or uppuma – 4 tbsp total dry oats	Wheat dosai, ragi dosai, chappatis, 2- egg white omelette, 3-4 slices of whole grain bread.
11 AM – Mid day snack	1 glass soup/ tender coconut water	Peanuts – ½ cup, a fruit
1 PM -Lunch	1-2 cups of rice, with plenty of vegetables, dal, curd	You can try alternative cereals like wheat rice, red rice, quinoa, oats
4-5 PM	1 cup of tea or coffee with 1-2 biscuits if hungry. Try and have low sugar biscuits like Marie or Nutrichoice.	Avoid snacks at this time like deep fried murukkus or mixture or bajji/bonda.
7 PM – dinner (earlier the dinner, the better. Try and eat at least 1-2 hours before going to sleep)	Same as breakfast.
Bedtime	A glass of milk, with a fruit if hungry.

Its my thyroid doctor - thats why I can't lose weight

The really short answer - no its not! This is the common statement I hear at least 5 times day. Someone who has been diagnosed with a mild under activity of the thyroid gland (so called "hypothyroidism"). This person thinks that all their myriad problems are due to the thyroid. They start taking thyroid replacement medicines in all good faith. They feel a little lighter initially - this is mainly the body losing excess water. But there it stops. No better how high you increase the dose of thyroid tablet - the weight does not come off. And why not? Because the thyroid problem did not cause the weight gain in the first place. This is such an important, but misunderstood concept, that I am going to repeat it again - THE REASON FOR THE WEIGHT GAIN IS NOT THE THYROID!!
In fact recent research has started to show that gaining weight may cause the body's TSH to increase. Why this happens, is not clear, at least to me. I think, that when you gain weight, it is because you have had too much to eat with too little exercise. This is a stressor for the body. Just like weight gain can increase your blood sugar, blood pressure, joint pains cholesterol, it can also increase the TSH. A raised TSH is used to diagnose hypothyroidism or under activity of the thyroid gland. This is how the confusion occurs.
So, what is the truth regarding the thyroid and weight gain? The truth is out there - seek and ye shall find!!
1. The body tends to retain water when the thyroid gland is under active. This is what causes the puffiness of the face and ankles that can be seen commonly. Once you start thyroid replacement, this excess water drains away. However this water retention may cause 3-5 kg weight gain at the most.
2. Thyroid underactivity is believed to affect the metabolic rate. This is true to some extent. However the mild degrees of under activity that we see daily - TSH 4 or 5 - may not affect the basal metabolic rate at all. Initial studies regarding the effect of the thyroid on the metabolism were done using animals that were profoundly hypothyroid. this is degree of under active thyroid - with TSH of say 100 or 150 - is set right with thyroxine replacement in most people. 
3. There is no short cut to losing weight. We all have to plug away at our diet and exercise in a consistent manner to see results. Just taking the thyroid tablet, is not going to do this miraculously. 

The unhappy micro biome

I have started this blog to answer queries that I am asked daily and to answer questions that raise themselves in my mind daily. I am an Endocrinology and Diabetes Specialist, which I means I get to see a lot of people with "hormonal" issues. Many problems get lumped under "hormonal" problems, specially ones that other doctors cannot find an easy answer for! A common reason why people come to see me is that they are not happy with their weight. I mostly see people who want to LOSE weight, but I also see a few who want to GAIN weight. There seem to be a LOT of misconceptions regarding diet.
Just today, I saw a young woman, who has been working out religiously, and who I thought has been losing weight at a steady pace. She has lost some 5 kgs since the start of her exercise and diet regimen 2 months ago. I thought this was marvelous - catch me losing 5 kg, I will be on my way to Mars! However, she is not happy, as she has been told by her dietitian/nutritionist coach that she should have lost more weight by now. She has given up rice, is gluten free, has mainly vegetables and fruits and the occasional millet (more than one grain I hope!).
I have recently been thinking a lot of our bacterial microbiome. This is the bacteria that occupy our guts and skin, and which are responsible for a good many things in our body, starting with our digestion. More and more research is being done on how important the microbiome is for our health. Research is showing that different microbiomes may be responsible for obesity, diabetes, and gut diseases. I wonder what the microbiome of this young lady was thinking. Having been used to a traditional South Indian, vegetarian carbohydrate based diet for the past 30 years, the bacteria are probably crying their eyes out without rice!
Imagine what happens after we take a course of antibiotics for an infection. Most of us lose the sense of taste, food tastes bad or bland, some of us develop runny stools. All this happens because the normal bacteria in our gut is wiped out, and bacteria that are normally kept in check take over. The good bacteria re-establish themselves soon enough. Probiotics which contain a lot of the "good" bacteria are useful in this process. This is simple curd or yoghurt to you and me. Our bacterial microbiome is established at birth. People who are born naturally have a different set of bacteria, as compared to those who are delivered by C-section. This is because the baby gets colonized by different types of bacteria during the birth process. If our bodies are used to a certain type of diet, it may not be very wise to blitzkrieg the bacteria with a completely alien diet! The bacteria would revolt and decide to metabolize everything differently, or go slow, so that you may not lose much weight. There is nothing wrong with rice, rasam, sambar, curd, vegetables, dal. Restrict the quantity of rice to 1 cup. Try hand-pounded rice. Your bodies (and your microbiome) will be happier with this!