I once had a patient tell me that they had lost over 500 lbs. Prior to my congratulations she did admit laughingly that it was the same 25-50 lbs. lost repeatedly over the last few decades. While her sense of humor is refreshing the comment brings up several important questions.
Why is it so difficult to lose weight and then subsequently keep it off?
Why do we seem to be able to lose weight but ultimately, we begin to plateau making further weight loss difficult if not near impossible?
Why do some people lose weight faster than others, and is there an optimum speed for weight loss?
Why do so many of us lose a few pounds only to regain the weight shortly after returning to regular eating patterns and end up heavier than when we started?
Are there safe and effective medications that assist with weight loss?
I get asked these questions frequently and clients are sometimes surprised to hear that the answers are relatively simple. Once a basic understanding of the concepts of metabolism, calories per meal, calories to protein ratios and optimizing of individual protein to carbohydrate ratios are achieved then a lot of the usual pitfalls to weight loss can be avoided. These strategies can be used by a supervising healthcare professional or by an educated individual to assist with their durable total body weight loss.
Why calorie restriction alone doesn’t work for most people
During periods of calorie restriction, the human body will struggle to maintain its current resting metabolic rate by utilizing stored energy previously stockpiled for just this reason. Most of us would prefer that the body utilize the warehoused adipose tissue (excess fat) that we desire to be rid of but regretfully several variables need to be in place for the body to use (burn) these fat stores. It may surprise most of you that the body’s first inclination is to burn stored energy in the liver (called glycogen stores) during periods of starvation. Once these glycogen deposits are depleted the resting metabolic rate (RMR) is reset at a lower level. This lowering of RMR then causes decreases in energy levels and increases in appetite resulting in calorie intake (binge eating behavior) exceeding the requirements needed and resulting in addition of more adipose tissue or larger hips and thighs in some cases. This type of interval starvation dieting results in unsustainable weight loss measured by stool evacuation, and water loss. In my experience skipping meals and “starvation” dieting is the most frequent short-term weight loss strategy attempted by most of my patients. While gaining in popularity on social media interval starvation dieting is frequently unsuccessful in most of the patients I talk with and can lead to low metabolism followed by binge eating behavior and subsequent weight regain.
With prolonged calorie reduction (over 48 hours of severe caloric reduction) the glycogen stores (Liver) become depleted and the body will attempt to utilize the catabolism (breakdown of body tissue) processes available to maintain normal body function. Unless certain parameters are readily available, the body will find it easier to breakdown muscle tissue to use as a calorie source while at the same time reducing the RMR again resulting in more fatigue, muscle wasting and a smaller calorie requirement. Very frustrating!
It appears that the adipocyte (body fat cell) has plenty of energy inside (stored as lipids) and would be a better catabolism source but this cell has what appears to be a “locking” mechanism restricting the primary use of this stored fuel. Unless we can find the “key” to unlock the fat cell’s potential energy, the primary weight loss seen by most individuals using calorie restriction alone is muscle wasting. This is seen with rapid weight loss (think 30 lbs. in 30 days promotions), but regretfully rapid weight re-gains. Once a person resumes their usual caloric intake and eating behaviors the muscle is replenished and since very little fat stores were “burned” the resulting body weight is equal or slightly higher than before they started this process. This yo-yo effect of weight loss and re-gain is frustrating as well as unhealthy.
Strategies to break the YO-YO weight loss cycle
We all have misconceptions we have learned from various sources. Prior experience, our friends, television, NEWs ads, the internet and or school curriculum that was inaccurate, misunderstood, or incomplete. Sometimes we will attempt to modify other weight loss programs that don’t appear to be working or are too expensive for our current budget. Occasionally we will make erroneous assumptions like “if a little amount works… than more will work better.” When I ask my patients questions, I find that many or all the above items will factor into their misunderstandings regarding safe and long-term body fat reduction.
Re-education is sometimes the hardest part of successful weight loss. For example, an obese patient presented to my office and claimed that she had been on an 800 calorie/day diet for weeks and had not lost any body weight after the first few days (not an unusual complaint). She was complaining of fatigue, decreased energy, and a massive appetite. She desired that I provide a strong appetite suppressant to allow her to reduce her caloric intake even further. After a thorough history and exam, I began to explain the concepts of safe body fat reduction and metabolism. At some point during the discussion she interrupted me and asked if my advice was that she should eat more calories per day in order to lose weight? When I replied positively, she was doubtful because she could not allow herself the realization that an increase in calories would result in weight reduction. She stated that all her life she could achieve weight loss by skipping meals, eating low fat foods, avoiding “sweets”, avoiding high calorie drinks, and utilizing certain appetite suppressant medications prescribed by her provider. She admitted that her weight loss was usually short term and seemed to reappear after the appetite suppressants were stopped and she resumed normal eating patterns.
The above example is a common misconception to weight loss. By starvation methods (skipping meals, severe calorie restriction/day) we become more prone to binge eating behaviors, late evening and night eating, and poor food selection. This will ultimately lower our resting metabolic rate (RMR) and make it difficult for us to lose excess body fat.
In order to break this “Yo-Yo” weight loss cycle and to help prevent weight loss plateaus we need to re-train our bodies by utilizing mechanisms to increase our metabolism (RMR).
Calorie Counting (Count cal/meal vs cal/day)
The first hurdle is to avoid is daily calorie counting. This may sound like heresy to most but the concept of calories per day measurement is a poor weight loss technique. Our body finds it difficult to utilize more than 500-700 calories at one time and tends to place any unneeded calories into fat reserves immediately. A better strategy would be to limit our calories per meal and to eat 3 meals daily rather than the standard 1-2 meals most Americans admit to. Many of my patients tell me of being placed on 800-1200 calorie diets only to complain of severe appetite issues and minimal long-term body fat reduction. One of the most common mistakes of many weight loss attempts is the avoidance of meals like breakfast in order to reduce calorie intake. This will usually result in a lower metabolism and inhibit successful body fat reduction. Limiting portion sizes per meal by creating a meal calorie goal is an essential first step to controlling the protein to calorie ratio and increasing your metabolism.
Deficiencies
Another strategy is avoiding nutritional deficiencies. This is paramount to reducing barriers to reducing body fat and increasing metabolism. Deficiencies in Iron, Vitamin D, B complexes, certain hormones and proteins can contribute to an inability of the body to raise the resting metabolism and eliminate body fat. Checking for these deficiencies with simple blood tests is important to identify and remove the potential barrier.
Protein
A third strategy is protein supplementation. Let’s face it, we do not get the proper protein to calorie ratio in our usual diet. Concentrating on protein to carbohydrate ratios like the “Keto” or Atkins” diets can help but these diets are not selective enough to individual needs, concentrate too much on protein to carbohydrate ratios exclusively, and are difficult to maintain without significant cravings. Determining the proper protein to calorie ratio is usually best achieved by trial and error. If attempting to calculate this mathematical challenge per meal is attempted the process can be quite time consuming, frustrating and involves a lot of math. An easier plan is to initiate protein supplements at specific times of the day to assist with appetite control and raising your overall resting metabolism. This enables a better diet structure and allows you to find the right protein ratio to optimize your metabolism. This is an important aspect of the right dietary plan and can be tailored to serve as weight loss or weight maintenance strategies. In other words… qualifying protein supplements taken between meals will have less competition for absorption and will result in a better Protein : Carbohydrate ratio.
Exercise
For many decades health care providers have been recommending diet and exercise in combination to help reduce body fat. The question is what is the minimum amount of exercise and how does it effect weight loss? Most of my patients believe calories expended is the main goal of their exercise routine. Surprisingly calorie expenditure has little to do with the immediate reduction in body fat. The adrenaline released during the activity and the degree of muscle breakdown contribute to increasing an individual's metabolism and the bodies ability to utilize the fat cell for needed energy as opposed to the body’s glycogen or protein stores (muscle mass). This can get confusing and the information available can be contradictory at best. In order to simplify, l encourage my patients to achieve their target heart rate at least once daily through any activity (this will confirm adrenaline release) and to structure a 15-20 minute exercise program 2-3 times per week (muscle fatigue which helps to raise metabolism) for best results. This is the most individualized aspect of anyone’s weight loss programs and will need adjustments frequently, so best to work with a trained provider regarding your goals (weight loss vs strength building vs increasing endurance vs muscle building) as it relates to exercise and resistance training. Remember that without adrenaline the adipocyte (fat cells) will retain a locking mechanism and any weight loss via calorie restriction with be mainly muscle wasting. Getting an adrenaline dose daily will allow this hormone to bind with receptors on the fat cells to allow these to be "unlocked" and utilized for energy needs.
Medications
The utilization of medications can be used to assist with appetite control during caloric restriction and can also be beneficial to altering certain mal-adaptive eating behaviors. The use of these medications is voluntary and not without some risks. These medications should only be used by licensed providers with experience in their use, but they can help many of us to control our food portions, avoid problem foods, reduce "binging" activity, and maintain certain calorie intake goals. The risks and benefits of medications for eating behavior or appetite control should be properly explained before using them. Warnings should be discussed prior to initiation, and medications stopped or changed if adverse effects are suspected.
In recent years a multitude of prescription medications have been developed to assist with appetite suppression and enabling better compliance with the designed weight loss program. Stimulants like phentermine (Adipex, Qsymia, Bontril, Tenuate) are available but since these are a controlled substance then frequent monitoring is required by a provider. Bupropion/Naltrexone (Contrave) products are slightly less effective appetite controllers but are very good eating behavior modifiers. In 2005 GLP-1 products were developed and introduced by 2009 (Byetta, Victoza, Ozympic, Wegovy, Zepbound) in a subcutaneous shot delivery. These were found to quite effective in appetite control which led to the rising cost due to popularity and demand. In January of 2026 Oral Wegovy became the first oral semaglutide FDA approved for weight loss indications, this is a daily pill that has proprietary engineering to allow better absorption (these are usually not found in generic oral semaglutide ODT products. Because these are prescriptions medications, great care should be taken to acquiring these medications from a licensed provider and via a face to face encounter. I also advise care to avoid the many fraudulent products that are easily acquired from online sources, etc. Remember that these medications are tools and may not work for everyone, when a tool becomes non-functional or is associated with adverse events then consideration of a new tool should be offered.
These are just some of the strategies anyone can use to assist in long term, durable reduction of their total body fat and subsequent total body weight. Individualized modifications are important to maintaining success and avoiding weight loss plateaus that seem to afflict many of us when trying to lose weight. Remembering to keep weight loss goals realistic and utilizing appropriate supervision and maintenance is instrumental in long term success.
If you are interested in starting an individualized supervised weight loss program then please call 501-781-0772 in the Hot Springs, AR area for more info or to schedule a consultation. For more information on our approach to supervised medical weight loss clink the appropriate button below.
