Ask the Doctor: I’m not losing weight – are my hormones to blame?

By | February 10, 2020

Q I have been trying to lose weight recently and have been eating properly. My sister is a dietitian and has given me advice on what and how much to eat. She checks in and says that my diet should be helping me to lose weight. I also have started exercising – weight training twice a week and I walk for about an hour a day. The problem is that the scales are not moving. Nor are my clothes getting any looser. I am 45 years old and don’t think I am close to menopause but I wonder if my hormones are out of whack. I haven’t felt right since I had my children, who are now in school. Could this be the reason I am not losing any weight?

A On paper, it looks like you are doing all the right things to shed those unwanted extra pounds. The natural aging process is going against you, as our metabolism slows by 2pc per decade. I think you probably need to tweak things a little bit. In general, people need to ‘learn to feel hunger’ for a few hours every day. It is only when you are hungry that your body will start to go into gluconeogenesis, forming energy from within your body.

It sounds cliché but people who manage to cut their calories to 1,600 per day notice weight loss within a few weeks as they start to shed their stubborn fat cells. This is not an easy thing to do, but if you are determined to change your body shape then persevere with the weight training, brisk walking for an hour and take the dietary advice from your sister, a registered dietician. Under her guidance, I assume you are on a balanced, nutrient-dense, low-calorie diet, with excellent portion control and no alcohol or sweetened beverages (hidden calories). Remember, you will not need to be this strict all your life, just for a few months. You need to set an overall target such as 5-7pc of your total body weight, with gradual weight loss of one to two pound per week.

To expand on those few tweaks I suggested, firstly you want to be in a ketotic (fasting) state before you go weight training. That means you must fast for at least two hours before your weight training (first thing in the morning before eating anything is ideal) and here’s the crunch, at least two hours after! Take plenty of water and maybe a tea/coffee but no sugar or milk. I also suggest you do weight-resistance training for only 15-20 minutes, ideally three days per week and focus on the buttocks and legs, the largest group of muscles in your body. But remember you must calorie-restrict throughout the whole day in order to lose weight. You cannot out-train a bad diet.

Keep up the fat-burning cardiovascular exercise that you currently enjoy in the form of brisk walking but ensure that you maintain a steady active state and ideally sweat a little during this hour. You don’t need to do cardiovascular exercise every day. Your body will thank you for a few rest days every week. Your diet is more important.

There are a few endocrine disorders than can make weight loss very difficult. You definitely need to get a routine set of blood tests with your GP to assess your thyroid function, cortisol hormone level, follicle stimulating hormone (FSH) and luteinizing hormone (LH), serum testosterone, oestrogen and sex hormone binding globulin (SHBG) levels. Hypothyroidism can make it very difficult to lose weight, but this is easily corrected by taking daily medication. The cortisol blood test is to assess your adrenal gland function, as Cushing’s syndrome can sometimes be the underlying cause for difficulty in shifting the stubborn fat cells. FSH, LH and oestrogen can help determine if you are perimenopausal. The last few blood tests can assess for polycystic ovary syndrome (PCOS) as it is well known that this condition leads to increased body mass index (BMI).

Remember everything that crosses your lips for the next 12 weeks counts. But once you achieve your weight-loss target, your diet and exercise regimen will need to change so that you can focus more on maintaining that hard-earned weight loss. With professional help and the right advice, I believe anyone can do it.

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