Episode 129: Clinical Conversations:

Some patients can do well with lifestyle, but most patients can't.

And I think there's a difficulty with patient perceptions about weight maintenance.

In fact, a common statement will be patients come in, I just need something to get me started, a jumpstart.

And I know once I lose that weight, I'll be able to keep it off.

So why is that wrong?

It's a great question.

And I hear that so often as you do.

And I wish that were the case, but this is really just a misunderstanding of what obesity is in that this is a chronic relapsing disease.

There's persistent physiologic change after we start to lose weight.

And even before we start to lose weight with initial weight gain, there's physiologic changes mal-adaption.

And then as we lose weight, our bodies and our hormones and all of that just conspire to have us try to regain weight.

And so it's not a temporary problem.

It's a chronic relapsing problem.

And so having to just get the weight off and somehow it will just stay off just isn't how we physiologically work.

So If you look at some of the data, there's a great study from about 15 years ago.

It's an older study, but it's a classic study.

And it really showed that hormone levels are maladapted to keep the weight off even 12 months after we lose weight, which is to say that we've lost some weight, but our hormones are not happy with that.

And that persists for even 12 months after we lose weight.

Maybe we've already started to regain weight.

but some of our hormones are saying, regain weight, get hungry again, start to, you know, get back to the weight that you were, something's not right.

And so it's really tough to expect that the weight will just stay off with that in place.

Right.

It's really a very complex situation.

You have those neurohormonal responses with increasing in hunger hormones, decreasing in satiety signals.

And so that adds to the, The challenge, plus as you lose weight, your resting metabolic rate goes down.