Weight Loss Resistance: What Your Genes and Metabolism Are Trying to Tell You.

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I have a confession: in my practice when an overweight patient returned for their follow up visit and had not lost weight or gained, my initial impression was that they were simply not all-in on their weightloss target. Frequently, it was an unvoiced rationale that morphed into a blanket indictment of character: insufficient compliance, possible subterfuge on caloric tallies or just a deficit of willpower. But an article I recently stumbled upon has completely revolutionised my view of this ubiquitous practice. What we often refer to as a failure of personal conscience is, as it turns out, quite frequently a very real and scientifically verified biological phenomenon. Studies show that between 5% and 20% of people experience a failure or even counterproductive response to weight loss programs, paradoxically increasing their body weight despite strict compliance with a meal plan and the implementation of regular exercise.

Our genetic code dictates the parameters of our physiological responses.

But individual differences do show up loud and clear, even under tightly controlled experimental conditions. In twin studies, where caloric intake and exercise were carefully tracked down to the minute, weight loss varied greatly from one person to another under identical conditions — losing as little as one kilogram or as much as eight. This stark similarity between twins suggests that our innate responsiveness to the benefits of diet and exercise is, for the most part, written into our DNA. For the “non-responder,” the body doesn’t work like a simple bank account — where eating less equals losing weight without fail — but rather as a dynamic, complex entity. In some people, this system unleashes extreme adaptive tactics to save energy, automatically making changes in the control of appetite and heat generation that help the body resist change.

Ghosts of Times Past Still Run High

Someone who continuously has difficulty losing weight will often have higher perceived stress levels, an increased resting heart rate and a history of extreme restriction in their diets. This is where the story gets a little cyclical: Going on and off diets can leave a lasting sort of “metabolic imprint.” In the most extreme cases, such as when subjects were members of highly publicized weight loss competitions, scientists have noticed that the resting calorie-burning rate — basal metabolism — in those people drops dramatically and doesn’t return to fully recover even years later. There is a huge gap between what energy expenditure you might expect and what actually happens. More: The health of our gut bacteria, the quality of our sleep and even exposure to environmental chemicals stored in fat that are released during weight loss all serve as invisible forces against progress.

Cultivating a New Clinical Empathy

In order to successfully navigate obesity management we have to stray from universally applied guidelines and toward a precision medicine model. But for patients in whom conventional ways yield little or nothing, the traditional approach is simply unhelpful — and it’s maddening. It becomes important to lower expectations and understand that success is not only reflected in a number on a score board, but also by the changes in markers for heart and metabolic health, and, most importantly, an improved sense of psychological well-being. The basic prescriptions to eat well, exercise and sleep enough are critical. Yet this particular segment of the population is one for whom those recommendations need to be accompanied by empathetic outreach and personalized modifications that recognize their resistance is not an issue of weak will but a deep biological truth warranting special attention and diverse strategy.

We need to figure things out and pivot every single day. For me, this medical revelation has dramatically changed how I treat overweight patients and moved me to more easily relate with them. It is remarkable that 20% of patients do not experience weight loss for factors outside their control, a figure that challenges preconceived notions and urges us to find opportunities for improvement. To patients, the most vital message I wish to convey is this: do not feel guilty if you have made sincere efforts, adjusting your eating plan and physical activity. Now that we are clear on the fact, it is really important to maintain a good stress management in your daily routine as its an evil when trying to lose weight. Also, you should prioritize good and enough sleep; bad sleep is one major appetite booster! Lastly, do an honest assessment of yourself: are you eating out of anxiety or depression? If so, tackling this emotional component as soon as possible is vital, as it constitutes one of the chief reasons that many people are unable to lose weight successfully and get back on track towards their healthy weight goals.