Why can’t I lose weight? Here’s why.


For years I have watched my loved ones struggle with this question, even go to doctors and have blood drawn to find out why. Why can’t they lose weight like everyone else? Is it thyroid? Genetics? David, you’re a doctor – how come I can’t lose weight?

Honestly, I have dedicated the better part of my career to understanding and answering this question. So, here it is.

1) First, the question is probably flawed. Most of the people you are looking at likely did not lose weight – they have more likely been like that forever. Not that many people actually lose weight – less than 5 in 100 tries. So, the assumption that lots of people are losing weight is off. They aren’t.

2) Second, a complex biological response emerges every time you try. Every time you restrict your calories and/or start new exercise – a series of events occur:


a. Hunger hormones. The hunger hormone system coordinates a response that overwhelms you. The body is wired to survive, and when new exercise starts with or without less food a hormone assault is unleashed. Ghrelin goes up, leptin goes down, and the desire to seek food overtakes everything. Importantly, this response is not present in the already lean folks that try the same thing.

b. Thermogenesis. When you eat less your body slows down it’s calorie burning. Yep. It fights you every step of the way. You cut 500 calories from your diet and your body burns LESS calories to try and offset it. Again, the already lean person’s body just hums along at the same rate so they don’t have to deal with this.

c. Gut Microbiota. Overweight people often absorb more calories from a given piece of food than not. So, when you say, “I could eat the same little food as Skinny Sally over there, and still gain weight!” You’re right.

d. Stress. Stress hormones make you hungry. The body figures something unusual is happening here and we may need to go without food for a while, so stock up now.


There you have it. 95% of folks quit their diets because of this coordinated biological response. It cannot be overcome on your own.* It’s like holding your breath under water. At some point the body’s signals for air consumption win out and you burst to the surface for a big breath. Likewise, the longer you can stand the decreased calories and new exercise, the more likely you are to burst into a McDonald’s for relief.

Don’t worry though, scientists have figured out how to get past this. Stay tuned for the next post 😊. Love you all!


* Ok, everyone knows someone who white knuckled through a diet and lost weight. If they did, they probably gained it back – and if they didn’t they are an outlier. We are talking about most people here.


How people are actually going to lose weight in 2018.


I have written a lot lately describing why our diet failure rate is at 95%. Admittedly, I have been nearly obsessed with making the point that folks who cannot lose weight have a d#$% good reason why that is. That they face challenges many lean folks don’t feel, and that to shame or condescend them is nonsensical (let alone ethically deplorable).

That said, almost every post is followed by comments asking, “OK, so what do I do know?”, and “Is there anything at all that works to overcome this barrier to weight loss?” Indeed, there is.

First, procedures work. It is important to start here because this is how we learned all of the stuff from the other posts. There is no “willpower” implantation procedure. These new procedures work by altering the hormones and metabolism that otherwise stop folks. Bariatric surgeries, interventional obesity procedures (bariatric artery embolization, cryovagotomy) bypass the response that has stopped so many, for so long.

Second, medications work. We are a long way from phen-fen. Also, stopping medications work.  Common medications like antihistamines are often significant contributors to weight gain. Obesity medicine physicians have a long list of medications that we often stop or change at the first visit as “low hanging fruit.” *

Finally, retrograde neuroplasticity works. It specifically overcomes attrition. Plainly said, changes made to the body will modify the brain. This is the opposite of what we have been doing all along. “Change starts from within,” “mind over matter,” and “no pain, no gain,” were all misdirected sentiments. It is not surprising that we have such a high failure rate with our current approach when we come to the realization that it is literally backwards, that success follows change from the outside-in.

And what are those principles? Attention to recovery, flexibility in diet and exercise, and the C-PASS principles: Capacity, Progress (not perfection), Accountability, Self-monitoring, and Stimulus control. These are the things you can do at home to directly address the body’s response that would otherwise make you quit. It’s like taking an anti-anxiety pill so you can make it through an MRI. See you again soon!



* Do not stop medications on your own. Talk with your doctor please.