Why You Struggle To Lose Weight.

The reasons people fail to lose weight are usually obvious but often not easy to fix.

Over the last few months, I have gained weight, and I needed to lose it.

The weight gain was intentional, as I was attempting to add muscle mass.

But I overshot.

Not by a huge amount, but I ended up about 5 kg (11 lbs) over where I was six months ago.

Sure, some of that was muscle mass but by no means all of it.

I needed to drop some of that excess weight, so what did I do?

In my case, what to focus on was pretty easy, given that I had actively been consuming additional high-protein food even when I was not hungry in an attempt to add mass, and I also ate things I am usually more careful about.

But the weight didn't drop as fast as I had expected.

So, I decided to track my calories, macros and exercise more carefully over the next few weeks, which soon got me to my target.

But initially, there was clearly a difference between what I ‘thought’ I was eating and what I ‘actually’ was.

My calorie tracking was off.

However.

I can already sense the feedback.

“Weight loss is not about calories.”

“A calorie is not a calorie!!!”.

“You need to read the most recent science”.

Sigh…..

In order to lose weight….

You must.

I repeat MUST be in a calorie deficit.

The easiest way to achieve a calorie deficit is by reducing caloric intake.

You can do it by increasing expenditure, but it is WAY harder.

But What Diet Should You Eat?

Mediterrean? Low Carb? Keto? Atkins? Ornish? Low Fat? Paleo? Vegetarian? Intermittent Fasting? Vegan? Pescatarian? Pesca-Pescatarian? (Fish that only eat other fish ;) )

The answer is…

All of the above.

As long as they get you into a calorie deficit and have reasonable amounts of protein.

(And don’t drive your ApoB/LDL-C through the roof).

Multiple trials have shown that when you control for calories, the type of diet you eat doesn’t really matter when it comes to weight loss¹.

What matters is that you choose one that works for you.

So, whatever camp you are in.

Sure. Go with that one.

The big pushback to counting calories is that at two years, more than half of people gain back about 50% of the weight they lost².

This figure rises to 80% at five years.

Average time course of weight regain after a weight loss intervention.

“See…. Counting calories doesn’t work!“

To examine this criticism in more detail, we need to consider two points.

Firstly, from a dietary perspective, those who criticise calorie counting tend to promote an alternative dietary strategy such as low carb or vegan, etc. (which I have said I have no issue with).

The problem is that the dietary failure rate is equally as high in each of these groups.³

Calorie counting does poorly at two years but so does EVERY OTHER dietary strategy.

Secondly, it's not that any of these diets don’t work.

They do.

We just don’t stick to them.

If you again consider a range of dietary interventions, you will find that, on average, most of the weight change will be the same at 12 months⁴.

But if you look carefully, you will see that the average weight change masks an important piece of information.

For many of these dietary interventions, there are those who lose substantial amounts of weight and maintain that weight loss at 12 months.

The question is, why?

The answer is compliance.

In simple terms. They did what they aimed to do.

And continued to do it.

If you look at the same set of dietary interventions, the higher the compliance, the greater the degree of weight loss at 12 months.

The same holds true for exercise-based interventions.

It's not that the exercise stopped working.

It’s that people stopped exercising.

To me, the real question is:

Did people knowingly stop adhering to their exercise and nutrition strategies, or did they think they were continuing to do what was needed but just didn’t realise that they weren’t?

So, let’s go back to my situation, where I cut my calorie intake but wasn’t hitting my target.

This raises an important question.

How good are we at estimating our caloric intake and exercise expenditure?

The answer is pretty terrible.

Some people are classified as ‘diet resistant’, meaning they have tried a diet that severely reduces caloric intake but is ineffective, and they fail to lose weight.

When these people are carefully tracked in a lab, you discover that they routinely underestimate calorie intake by close to 50% and overestimate calorie expenditure by 50%⁵.

The study subjects thought they were consuming 1028 Kcal per day when, in fact, they were consuming 2081 Kcal per day.

A close to 1000 Kcal difference.

This is a huge difference.

The key takeaway here is that we do a horrible job at estimating caloric intake.

This is why my weight did not drop as fast as I thought it should have.

I am terrible at estimating caloric intake.

Just like everyone else.

There are two key points I would take away from this data.

Number 1.

When it comes to losing moderate amounts of weight, the problem usually boils down to inaccurate tracking of inputs and outputs.

This is why, although tracking them is important, what matters more is what happens to the output metric of interest, e.g. weight.

And in simple terms, if your weight is not dropping, your caloric estimation is off.

In general, you need to reduce caloric intake even more using whatever dietary strategy you prefer.

And remember, you are possibly overestimating your caloric intake by close to 1000 Kcal, so you probably have room.

Number 2.

When it comes to losing substantial amounts of weight, ie treating obesity, tracking calories and dietary interventions will be helpful when adhered to.

But they may not be enough over longer periods of time.

In this instance, the addition of obesity treatments such as GLP-1 agonists such as semaglutide (Ozempic/Wegovy), etc., may be necessary.

For sustained substantial weight loss, you will need to ensure either very strict long-term compliance with dietary and exercise regimes or the addition of medication to facilitate that process.

Remember.

These medications are tools.

Just like nutrition is a tool.

Just like exercise is a tool.

Obesity medications are tools.

You just need to know when to use them.

So, if you are struggling to lose weight, you need to ask yourself:

Are you accurately tracking your caloric intake?

Are you accurately tracking your energy expenditure?

Is your weight responding to those changes?

Are you adhering to the nutrition and exercise patterns over extended periods of time?

In addition to modifying exercise and nutrition, are additional therapies warranted?

This is an area where millions struggle.

But in my view, needlessly.

It’s not to say that it is easy.

But there is a solution.

Track. Measure. Modify.

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1. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials. BMJ. 2020 Apr 1;369:m696.

2. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am. 2018 Jan;102(1):183-197.

3. Program adherence and effectiveness of a commercial nutrition program: the metabolic balance study. J Nutr Metab. 2010;2010:197656.

4. Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction: A Randomized Trial. JAMA. 2005;293(1):43–53.

5. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med. 1992 Dec 31;327(27):1893-8.