You are trying hard to lose weight. You have changed your eating habits, and you have been doing more physical activity than you used to. But a few weeks or even a few months have gone by, and the scale isn’t budging. Why?! What are you doing wrong?! What are the common reasons why you can’t lose weight?
You start by making small changes to your diet. You drink a green smoothie every day, and you stop eating dessert. You don’t lose weight! So you decide to do something drastic, and you order a bunch of expensive, chemical-laden weight loss drinks from the internet. Nothing happens!
You commit to counting every calorie that you put in your mouth. The scale doesn’t budge!
Body weight is regulated mainly by the number of calories consumed and the number of calories burned off. But there are a number of other things that influence weight, and some of them can make it difficult to lose weight. This article explores what some of these are and how to overcome them.
Keep in mind, too, that people come in different shapes and sizes. You don’t necessarily have to be “thin” to be healthy, but losing some excess fat can improve your health in a number of ways. Talk to your health-care team about your weight-loss goals and about what a healthy weight is for you.
Frequent episodes of hypoglycemia, or low blood glucose, contribute to overweight because of the calories needed to treat hypoglycemia. The general recommendation for treating hypoglycemia is to eat or drink something containing 15 grams of carbohydrate, wait 15 minutes, then check your blood glucose level again with a meter to see if it has risen. Sometimes another 15 grams of carbohydrate is needed, particularly if the blood glucose level was very low when hypoglycemia was detected.
Some common causes of hypoglycemia include taking too much insulin (of any type), taking too high a dose of an oral diabetes medicine, skipping or delaying a meal, increasing the amount of exercise done without decreasing the amount of diabetes medicine taken or increasing the number of calories consumed, and “insulin stacking,” or taking a second dose of insulin before the previous one has finished working.
If you are having frequent hypoglycemia, work with your health-care provider to adjust your diabetes treatment regimen. The potential consequences of frequent hypoglycemia include not just weight gain but also falls, accidents, and, in some people, hypoglycemia unawareness (the loss of early signs and symptoms of hypoglycemia). It’s important to work with your diabetes care team to find the reasons for frequent hypoglycemia and to fix them.
Not enough sleep
Getting less sleep than your body needs can contribute to weight gain and make weight loss difficult. In a study of 68,000 middle-aged women called the Nurses’ Health Study, it was found that women who slept 5 hours per night were 32% more likely to experience major weight gain (defined in the study as about 33 pounds) and 15% more likely to become obese over the course of the 16-year study than those who slept 7 hours per night. Women who slept 6 hours per night were 12% percent more likely to have major weight gain and 6% more likely to become obese. (No significant difference in weight gain was found among the women who reported sleeping 7, 8, or 9 hours or more.) There were no differences between the groups with relation to physical activity and calorie consumption.
There are many reasons people don’t get enough sleep. Having a busy life with many activities and obligations can lead to habitually going to bed late or getting up early. Consuming too much caffeine during the day or too close to bedtime can contribute to poor sleep. In the Nurses’ Health Study, the nurses who slept fewer hours were more likely to have worked overnight shifts.
Sleep apnea, in which breathing repeatedly stops for several seconds at a time during sleep, can contribute to inadequate sleep. Signs and symptoms of sleep apnea include loud snoring during sleep and daytime sleepiness. Because sleep apnea is so common in people with Type 2 diabetes, and because it is associated with so many health problems, some medical professionals now believe that all people with Type 2 diabetes should be screened for it.
Drinking too much alcohol can disrupt sleep. Although many people believe that alcohol makes it easier to fall asleep, in fact, alcohol is a stimulant and can cause you to wake up more frequently during the night.
There are also many ways to increase the amount of sleep you get. One is to adopt a pattern of going to bed and waking up at the same time every day. Another is to make your bedroom as dark and quiet as possible. Reducing caffeine intake, especially late in the day, can help, as can reducing alcohol consumption. Practicing a relaxation technique during the day or just before bedtime can also help. It can be a formal technique, such as meditation, or an informal practice, such as listening to soft music or reading before bed. Getting sleep apnea treated, if you have it, can make a big difference.
Getting regular physical activity can help with sleep quality. Usually, people with insomnia are advised against working out too close to bedtime, because exercise has an arousing effect and can make it harder to fall asleep. However, in a small study reported in 2008 at the annual meeting of the Associated Professional Sleep Societies, study participants with insomnia who performed a session of moderate aerobic activity a few hours before bedtime had increased sleep time and a reduction in the time it took to fall asleep once the lights were out. The study found that moderate aerobic activity, such as brisk walking or biking, worked better than heavy aerobic or strength-training exercises at improving sleep.
Having an underactive thyroid can make losing weight difficult. The thyroid is a gland in the neck that secretes hormones that regulate the body’s metabolic rate. It is stimulated to produce these hormones by another hormone called thyroid-stimulating hormone, or TSH, which is produced in the pituitary gland. To see how well the thyroid is functioning, doctors measure the TSH level in the blood. A TSH value that is too low may indicate an overactive thyroid, and a value that is too high may reflect an underactive thyroid.
Signs and symptoms of underactive thyroid, or hypothyroidism, include fatigue, weakness, weight gain, constipation, brittle nails, cold intolerance, and memory problems. Once the condition is treated, by replacing the deficient thyroid hormone, weight loss is possible with lifestyle changes.
If you dine out frequently, therefore, you may be taking in more calories than you realize. Limiting how often you eat out, if possible, can help with weight loss. It can also help to periodically weigh and measure portions of food at home to train your eye to recognize appropriate portion sizes. Knowing how much you want to eat ahead of time, and having a mental image of the portion size, can help you control calories at restaurants. Once you’ve figured out how much of your restaurant portion you want to eat, put the extra food aside to take home and enjoy later.
Not enough physical activity
Increasing the amount of physical activity you do can get stalled weight loss going again. The American Heart Association recommends that people with Type 2 diabetes perform a minimum of 150 minutes (2 1/2 hours) of moderate-intensity physical activity each week or at least 90 minutes of vigorous activity a week. Doing resistance-training exercises three times per week is also encouraged.
Keep in mind that if you don’t currently do this much, you will need to build up to it gradually. It’s also a good idea to get your doctor’s OK before increasing the amount or intensity of physical activity you do. Certain activities may not be advised for people who have diabetes complications such as eye or kidney disease. Also, because physical activity usually lowers blood glucose, you may need to take steps to prevent hypoglycemia while exercising. Some of the ways to do this include cutting back on insulin or oral medicines before exercising, having a snack before or during exercise, or changing your meal schedule to accommodate your exercise schedule. Checking your blood glucose before, during, and after physical activity will help you determine which of these steps may be most effective.
Too much alcohol
Large studies done in Great Britain and Finland have found that heavy alcohol intake is associated with weight gain and obesity in men. Given that alcoholic beverages are often high in calories, this news is perhaps not so surprising.
A serving of alcohol is considered to be one 12-ounce beer, 5 ounces of wine (excluding dessert wine), or 1 1/2 ounces of 80-proof distilled spirits such as gin, whiskey, vodka, or rum. Each of these servings contains about 14 grams of pure alcohol and roughly 100–200 calories. Any caloric mixers, such as fruit or vegetable juices, soft drinks, cream, coconut milk, or sugar, raise the calorie count. The American Diabetes Association recommends that those who choose to drink alcoholic beverages limit themselves to one alcoholic drink (or one serving) a day for women and up to two alcoholic drinks (or two servings) a day for men.
To minimize calories from alcoholic beverages, consider drinking light beer in place of regular beer and using diet soda, seltzer, or club soda in place of caloric mixers in mixed drinks. Limiting quantities to one drink per day for women and two drinks per day for men — or less — will help with weight control.
One step at a time
Many possibilities have been presented in this article, and not all of them will apply to everyone. To avoid getting overwhelmed, think carefully about which of these possibilities is (or are) most likely to be affecting you, and focus on actions you can — and are willing to — take. Then come up with a plan for how you’ll carry out those actions. In some cases, you may need the help of your diabetes care providers to diagnose a problem or come up with a solution, so making an appointment with one of these professionals may be the first step in your action plan. Whatever the plan, break it into manageable chunks, take time to evaluate the effectiveness of each step before you go on to the next, and give yourself a pat on the back for making the effort to control your diabetes and improve your health.