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The science behind weight loss and regain

Learn how changes in the body make it difficult to keep weight off over time


Why is it so hard to keep the pounds off? Well, there’s more to weight management than meets the eye. People may see results when they limit calories, by reducing the size of meals, for example. And find ways to increase physical activity, like taking regular walks around the block. Science has shown the body responds in surprising ways when a person loses weight. It reacts to weight loss by trying to regain weight, making weight management a constant tug-of-war. Metabolism slows down and gets more efficient, requiring fewer calories to do its job. Hormonal signals can also change. The body increases a hunger hormone, called ghrelin, which tries to get you to eat more calories. And the hormones that tell the brain it's time to stop eating, the “feeling full” signals, decrease. These are just some of the factors that make weight regain so common.

Dr. Robert Kushner explains factors that make it hard to keep weight off


You know one of the most common misbeliefs about obesity is that it’s a problem of will power and moral failure and indeed that is the farthest from the truth, it turns out that obesity is considered a chronic disease with multiple determinants such as genetics, biology, heritage, behaviors such as: what you eat and how you move your body around and your culture. It’s also a “tug-of-war” between what you eat and what you burn and changes in metabolism as you lose weight. People can lose weight short term by changing their behavior, but the problem of obesity is that there is a change in metabolism, and people tend to get hungrier and burn less calories. That’s why we think of it as a chronic long-term disease.

I hope that perspective and understanding helps you realize that you would benefit from additional support and resources to help manage your weight.

Talking to a health care provider

Dr. Robert Kushner discusses partnering with a health care provider on weight management


If you are comfortable and trust your health care provider, tell him or her how you feel. Tell him or her that it is not as simple as eating less and moving more. That there are multiple determinants when it comes to weight control and that partnering with someone to get support is vital. I would tell you there’s zero tolerance however for any shame or prejudice that goes on during the encounter.

Most health care providers are sensitive may not know how to bring up weight or be trained enough in weight management. If the health care provider is empathetic and concerned about your weight, that interaction should be positive. That partnering will lead to increased weight loss, long-term weight control and an improved therapeutic encounter with your health care provider. The bottom line is however, if you are uncomfortable with your health care provider, find someone else who you trust and is supportive.

And remember, good communication is a two-way street and if you’re prepared to have this conversation with your health care provider, remain positive…things are likely to go well.

Dr. Robert Kushner has tips for starting a conversation with a health care provider


If your health care provider does not bring up the topic of weight, I would encourage you to be assertive and bring it up yourself. Tell the health care provider that you are looking for additional support and ask them “are they able to do so?” Tell them why you’re concerned about your weight and if you can, what kind of help you’re looking for. For example, do you need more guidance on diet or physical activity, or behavior change or emotional eating?

Then, of course it's up to the health care provider how they would respond. If they respond, "Yes, I can help you," then you may want to have some of the questions ready to ask as appropriate as follows:

  • Which of my medical problems are related to my weight?
  • Do any of my medications cause weight gain?
  • Will any of my medications need to be adjusted if I lose weight?
  • Will I need any lab tests repeated as I lose weight?
  • Do you have any additional weight-management tips that you can help me with?
  • Can I begin an increased physical activity program? Are there any precautions that I should take?
  • If I need additional help with my food intake, increased physical activity, or health behaviors, will you be able to refer me to the right person?
  • If I would benefit from medication to treat my weight, can you prescribe that for me or refer me to an obesity medicine specialist?

Hear from people like you

Listen to Donna's perspective on why the time to start a weight-management plan is now

...don't be ashamed because this is not something that has to do with your willpower or how much you try.


I will always live with obesity. I may look like I have a normal weight now, and right now I am able to manage my weight, but I will always live with obesity. I will always have to seek different ways to manage this disease and right now the tools that I am using are working for me, but I don’t know if that’s going to be the case in the future, so I think it’s important to remember that this is something, this is a lifetime disease. Don’t wait. Do something about it now. Go to your health care provider and ask them for help. And don’t be afraid, don’t be afraid to ask for help, don’t be afraid, don’t be ashamed because this is not something that has to do with your willpower or how much you try. It has to do with a disease that can be treated and there are many tools available and life is so much better once you have it under control.

Hear why Patty was motivated to start her science-based treatment plan

...I started looking for science-based, evidence-based treatment, and fortunately I found it.


You know, I’ve had obesity since I was a child. I don’t remember a time when I didn’t have obesity. It’s not a choice. I had done so many diets over the course of my lifetime, I had failed so often and each time I failed I felt more ashamed and embarrassed that I decided I’m done, I’m giving up. And when it became so difficult for me to move at the weight I was at, I finally got up the courage to try it one more time, and that’s when I started looking for science-based, evidence-based treatment and fortunately I found it. Um, very few people are as fortunate as I am to have found it and that needs to change.

Listen to Reneé talk about the importance of finding the right tools to manage weight.

I wish individuals living with obesity knew that there is information out there that can help them overcome


I wish individuals living with obesity knew that there is information out there that can help them overcome. You just have to find a healthcare provider to help you find the right type of tools. It's not just one tool that you may need—whether it's a dietician, whether it's exercise, whether it's medication. That information is out there to help you because there is no finish line. That obesity is a chronic disease, and it's a disease that you would need help with for the rest of your life.