Can't lose weight...check these scenerios out

Excerpt from http://www.nola.com/health/index.ssf/2010/10/diet_not_working_heres_five_re.html by Molly Kimball.

It's no secret that losing weight requires you to take in fewer calories than you burn. But it's not always just a numbers game.


If you're fairly certain that you're doing most things right but the extra weight still isn't budging, one (or more) of these common culprits might be behind those excess pounds.

1. Prescription medications

Certain medications can cause weight gain, or at least make it more difficult to lose weight. And unfortunately, it may take months -- and a gain of 10 to 20 pounds or more -- before you realize that a medication might be to blame.

Sal Scaccia, Pharm.D. and owner of Total Life Care Pharmacy in Harvey, lists six main categories of commonly prescribed medications that can cause weight gain:

Blood pressure medications, particularly certain alpha blockers and beta blockers. "Alpha blockers may increase appetite, and some beta blockers can decrease metabolic rate, inhibit the breakdown of fat and increase insulin resistance, all of which can lead to weight gain."

Antidepressants, particularly the older selective serotonin reuptake inhibitors (SSRIs), including Celexa, Prozac, Paxil and Zoloft. "These SSRIs can increase appetite -- carbohydrate cravings in particular, because they affect the body's serotonin and histamine activity, " Scaccia said. "And tricyclic antidepressants like Elavil and Pamelor not only increase carbohydrate cravings, but can also decrease metabolic rate."

Anti-seizure medications and mood stabilizers, including Tegretol, Neurontin, Depakote, Lyrica and Lithium. "They can decrease energy expenditure and inhibit the breakdown of fat, plus they can increase carbohydrate cravings and increase the conversion of carbohydrate and protein to body fat, " Scaccia said. He notes that 30 percent to 65 percent of lithium patients can gain as much as 33 pounds over a two-year period.

Birth control pills and menopausal hormone replacement medications. It's not clear why hormones may cause weight gain in some people, but it's probably a combination of an increased appetite and fluid retention.

Diabetes medications. "Insulin can lead to weight gain as a result of improved appetite, better use of blood sugar and an increase in the conversion of carbohydrates and protein to body fat, " Scaccia said. "And some of the oral diabetes drugs have been shown to increase appetite, fat mass and fluid retention."

Oral steroids. "Taking an oral corticosteroid like Prednisone for an extended period of time can impair glucose tolerance and can increase the amount of fat tissue in the body, " Scaccia said.

"People usually don't have the option of whether or not to take these medications -- their physical and mental well-being depend on these drugs. But the potential for weight gain is something that they need to be aware of and prepared for, so that they can adjust factors like diet and exercise to prevent or minimize weight gain, " he added.

2. An underactive thyroid

I've heard countless people say that they wish they had a thyroid problem to blame for their weight problems. They're joking, of course. Sort of.

"An underactive thyroid (hypothyroidism) affects the entire body, causing symptoms like fatigue, hair loss, dry skin, sensitivity to cold, constipation and menstrual irregularity, " said Dr. Sam Andrews, co-author of "Sugar Busters" and a staff endocrinologist at Ochsner Health System. "Other symptoms may not be so obviously linked to low thyroid function: elevated cholesterol, depression, slow heart rate and delayed reflexes."

Even subclinical hypothyroidism -- estimated to affect as many as 10 percent of all adults and 20 percent of people over 60 -- can result in negative health consequences. Symptoms may be subtle, but still can include sluggishness, elevated cholesterol, and gastrointestinal and reproductive issues.

If you suspect an underactive thyroid, ask your doctor for a blood test to measure levels of thyroid hormones, including TSH (thyroid stimulating hormone), free T4, free T3 and thyroid antibodies.

A high TSH level indicates low thyroid function, which can be treated with medication. "Even if the TSH is only mildly elevated, thyroid medication may still be warranted if the patient is very symptomatic, " Andrews said.

But don't expect the pounds to melt away. "Correcting an underactive thyroid may help someone lose a few pounds, but it's not a significant amount of weight loss, " Andrews said. "One of the biggest differences people will notice is that they feel better, their energy is improved, making it easier to be consistent with a regular exercise program."

3. Polycystic ovarian syndrome

This is a condition in which the ovaries, and sometimes the adrenal glands, make excess male sex hormones. Along with causing fertility problems, PCOS can lead to insulin resistance, which is associated with fat storage, especially around the waist. "Elevated insulin levels make it easier to store fat and more difficult to release that stored fat, " Andrews said.

Symptoms include acne, thinning hair, excess facial and body hair, irregular menstrual cycle, depression, difficulty getting pregnant and weight gain or difficulty losing weight.

If PCOS is suspected, your doctor will check for physical signs and may test blood sugar, insulin and sex hormone levels.

"Treatment often includes the diabetes drug Metformin to improve insulin resistance, along with birth control pills to regulate hormone levels -- unless a woman is trying to get pregnant, " Andrews said. "Losing weight can also help to manage symptoms, normalize hormone levels and reduce the risk of developing diabetes."

The recommended diet for PCOS is typically moderate to low in carbohydrates, since excess carbohydrates tend to be stored as fat, Andrews said. Regular exercise and supplementation with alpha lipoic acid, chromium picolinate and Vitamin D may also help to improve insulin resistance, he added.

4. Overestimating calories burned through exercise

The digital readout on the elliptical machine at the gym says you burn nearly 500 calories in your 30 minute workout. But don't count on it.

"Most cardiovascular exercise machines are calibrated for a 150-pound man, " says Sean Sellers, a local fitness equipment distributor with Fitness First. If you weigh less -- or if you're a 150-pound woman (women generally have less muscle mass per pound, so they tend to burn fewer calories per pound than men) -- you'll burn fewer calories than the readout shows.

Sellers says programs that allow you to enter your age and weight are more accurate, and it's even better when the machine can track your heart rate as well (the higher your heart rate, the more calories you burn).

Another option is to wear a heart-rate monitor that allows you to enter your age, height, weight and gender. The monitor then calculates calories burned based on your personal stats and the intensity of your workout, as reflected by your heart rate.

5. Taking the weekends off

It's only two days. How much damage can you really do? Plenty, if you're not careful. Researchers tracked people's food intake over the course of a year and found that, on average, they consumed an extra 236 calories on each weekend day. Clearly, those studies weren't conducted in New Orleans. Throw in a fried seafood platter, a couple of cocktails and a bag of peanuts during the Saints game, and you can easily add an extra 1,000 calories per weekend day. Spread over the course of the week, that's like adding an extra McDonald's Cheeseburger to your usual intake every day.

For a little motivation to avoid overdoing it on weekends, try stepping on the scale every Friday and Monday morning. If that's still not enough incentive, tighten things up a little more during the week. Saving extra calories during the week (skip the bread basket at dinner; forgo that evening snack) can help to offset weekend splurges.

End result: if you are not losing weight, see a licensed registered dietitian (RD) and get a calorimetry done to test your metabolism. The RD will work with you to develop an amazing eating plan that will enable you to lose weight, be healthier, and tastes good too!