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Sunday, May 19, 2013
Obesity and Weight Management
My daughter (36) can`t lose weight
My daughter has been battling weight gain for about the last 3 to 4 years. She is now 36, married, with 1 child and weighs over 200 lbs (5`4"). She has been working with a doctor trying to regulate her thyroid and is taking synthroid. She has also been taking progesterone. Right now, she is becoming very depressed because her weight keeps creeping higher. She keeps track of what she eats and keeps her caloric intake under 2,000 calories a day. She was dieting and extercising regulary--one hour per day--but never lost more than 3 to 4 lbs. at a time and then gained that back and more. She was even a team leader for ediets but after seeing everyone else lose weight she stopped. She`s becoming more and more upset and depressed. In the past, she has also suffered from Alopecia, and I have a history of autoimmune problems (Hashimoto`s Disease, Sjogrens Syndrome).
We live in the Cincinnati area, and I work at the Univ. of Cincinnati. Can anyone give us advice or recommend someone for her to consult regarding this problem.
You daughter's story is shared by so many women. You mention several factors that are making her weight loss efforts challenging.
First, it is important for her thyroid to be under control. Having hypothyroidism (an under-active thyroid) can make weight loss difficult. Hypothyroidism can contribute to weight gain.
Second, the progesterone tends to promote weight gain. Progesterone-only birth control methods, such as Depo provera, have been reported to cause a 5-15 pound weight gain.
The third factor is depression. Either preexisting depression can contribute to weight gain, or the weight gain could have led to depression. Either way, it is extremely important to address the emotional and psychological aspect of weight management with counseling. Many women use their weight as protection from intimacy, most often because they have been abused. Also, some women use food as source of comfort. Seeking out a weight loss program that has a counseling component or doing adjunct counseling will increase weight loss success.
Finally, it is important to remember that weight loss occurs when the number of calories taken in are less than the number that are burned. It is not healthy to lose a large amount of weight at
one time. It is recommended that weight loss should happen at about 1 to 2 pounds per week. This will give the body a chance to adjust and minimize the chance of regain. Removing 500 kcal from the diet every day will lead to a pound weight loss by the end of the week.
What often happens too is that people lose weight and then hit a plateau. This just means that the number of calories that they are eating is equal to the number that is being burned, and their weight remains stable. In order to stimulate more weight loss, the number of calories being eaten have to be reduced even more and exercise should have some muscle building component.
Also, it is more helpful to track the waist inches instead of weight alone. This is because as one builds more muscle, their weight may not change, or it may increase because muscle weights more than fat tissue.
Esa M Davis, MD, MPH
Adjunct Assistant Professor of Family Medicine
School of Medicine
Case Western Reserve University