So, you’ve started on a weight-loss journey, and you’ve done your research: read books by trusted sources, consulted blogs by leading thinkers, and calibrated your daily routine accordingly. You’re going slow and steady, because you know crash diets usually result in rebound weight gain. You’re eating whole foods and performing a sustainable cardio routine. You’re committed and consistent, and, according to what you hear around the office and at family gatherings, a similar approach worked for colleagues and your Aunt Carla.
Yet you’re not reaching your weight-loss goals.
With weight loss, as with so many things, the reason is highly individualized — there are a lot of factors tied to your unique physical, mental, and emotional status that could either stall or spur your progress.
Take, for example, blood-sugar regulation. High blood-sugar and insulin levels wreak havoc on weight-loss efforts, but not everyone responds in the same way to the same foods.
In 2015 the journal Cell published a study that tracked the effects of 46,000 meals on blood-sugar levels in 800 participants and found an astonishing range of responses to identical foods. This is why the nutrition guidelines that helped Aunt Carla manage her blood sugar may not work for you.
Or take exercise. Functional-medicine nutritionist Cindi Lockhart, RDN, LD, IFNCP, says her clients often ramp up their exercise regimens when their weight-loss efforts stall — but for some, this slows weight loss even more. Aggressive workouts stress the body, she explains, and if stress is one reason you have trouble losing weight, more of this type of exercise can work against you.
Such cruel paradoxes abound. “Clients will contact me, asking, ‘When will I lose weight?’” says Lockhart. “But the truth is, we don’t know when that switch will turn on. It depends on how long the underlying problems have been going on.”
If you’re on a weight-loss journey and the numbers on the scale aren’t budging, don’t beat yourself up. There are a lot of factors at play beyond good nutrition and exercise that often get short shrift, including these nine.
Missing Link No. 1: Adequate Sleep
If you’re eating well and exercising during the day, your problem might be occurring at night. Sufficient, high-quality sleep is essential for weight loss.
What’s enough sleep? Most experts agree that seven to eight hours nightly is adequate. And going to sleep at approximately the same time each night is important, since our bodily rhythms need to stay in sync to get the deep rest we need. (For more on synchronizing circadian rhythms, see “Get in Sync.”)
When you’re even slightly sleep deprived, you tend to feel hungrier. This is partly because the hormones ghrelin and leptin become dysregulated, which increases appetite and decreases satiety, explains integrative physician Akil Palanisamy, MD, author of The Paleovedic Diet. Just one night of sleep deprivation can trigger this hormone imbalance, according to a 2008 study in the Journal of Sleep Research.
So, when we’re short on sleep, we tend to eat more (often late at night) and feel less satisfied by what we eat — and then we eat even more. In addition, the blood-sugar crashes that follow late-night eating can interfere with sleep and the cycle repeats itself, notes functional-medicine practitioner Leo Galland, MD, author of The Fat Resistance Diet.
The damage caused by one night of insufficient sleep doesn’t stop there: A 2016 Journal of Sleep Research report found that a night of partial sleep impairs insulin sensitivity, which Palanisamy notes has been shown to cause “fat storage and weight gain.”
“All roads end in sleep,” says exercise physiologist and strength-and-conditioning coach Pat Davidson, PhD. “Sleep is an enormous factor in body composition.”
Make sleep as high a priority as good nutrition and exercise. And eat your main meal before 3 p.m., advises Palanisamy. A 2013 study in Obesity found that those who ate their largest meals earlier in the day lost significantly more weight than those who ate big evening meals — even when total caloric intake and all other behaviors were the same.
Missing Link No. 2: Stress Management and Relaxation
Chronic stress is another archenemy of healthy weight loss. Not only can it disrupt sleep, but it also triggers a hormonal cascade that prompts the body to store fat.
When we’re in fight-or-flight mode, the adrenal glands pump out cortisol, signaling the liver to release glucose into the bloodstream. Our prehistoric ancestors would’ve used that glucose to deal with an imminent threat, such as fleeing a tiger on the savannah. But few stress experiences today are followed by a bout of vigorous exercise that burns off glucose. (If you did try to fight or flee your boss during a stressful meeting, you might successfully manage your glucose but put your job in jeopardy.)
Stress elevates cortisol and blood-glucose levels — and that triggers the release of insulin, which promotes fat storage. Over weeks and months of chronic stress, the effects add up.
And then there’s stress eating. A 2007 study in Psychoneuroendocrinology linked high cortisol reactivity with increased food intake during stressful times.
Some stressors — parenting a newborn or caring for a sick parent, for instance — can’t be avoided. But when weight loss is a goal, make any small changes you can to help reduce stress: Scale back the number of commitments on your calendar, schedule a monthly massage if you can afford it, or just set aside a couple of hours weekly for yourself, even if all you plan to do is solve a crossword puzzle.
Once you reduce your everyday stress, says Davidson, you can add in the healthy stress of exercise, which will help you lose weight. And when you’re able to exercise, you will be better fortified against the inevitable daily stressors when they do crop up.
As for the demands you can’t change, “find what helps you step back, look at what’s going on, and change how you think about it,” suggests Galland. Remembering that “this too shall pass” almost always helps put difficult times in perspective.
Missing Link No. 3: An Individual’s Carb Tolerance
Low-carb regimens, such as the paleo and ketogenic diets, help many people lose weight. Others lose weight easily with high-carb, high-fiber vegan diets. But some folks have tried one, or both, or some combination of the two and still found little success.
“One thing that has been lost in the low-carb-versus-high-carb battle is that these diets work for different people in different circumstances,” says paleo-nutrition expert Robb Wolf, author of Wired to Eat.
How can a specific diet be so successful for some and ruinous for others?
There are two primary reasons. First, successful weight loss depends on steady blood sugar, and research shows that individuals can have wildly different blood-sugar responses to the same foods. Some people have to limit all carbohydrates just to keep blood sugar stable; others can tolerate healthy carbs from unprocessed whole-food sources; and a few can eat pretty much anything without boarding the blood-sugar roller coaster.
The second reason is satiety. Weight loss requires consuming less energy than you expend, but calorie restriction alone almost always backfires. It puts your metabolism into starvation mode, which causes your body to cling to every last calorie.
The key is figuring out which healthy, whole-food meals satisfy you while keeping blood sugar steady, says Wolf. These may be low-carb paleo or high-fiber vegan. Find the foods that work with your metabolism and keep you feeling more balanced.
You can tell a lot about your blood-sugar response to particular foods by how you feel. If you feel tired right after you eat something, that’s a good indication of a blood-sugar spike and crash.
For precise feedback, use at-home blood-glucose testing, which measures your exact blood-sugar response. These monitors are relatively inexpensive and easy to use, says Wolf, and despite the commitment (and skin prick) of testing blood-sugar levels after each meal, many of his clients enjoy the practice. It gives instant biofeedback on certain foods and food combinations, and it fosters healthy motivation: Breakfast sent my blood sugar higher than I’d like. Can I do better at lunch?
Missing Link No. 4: Enough Food Fats
For decades, eating fats was considered the primary factor in weight gain. Today, we know that consuming quality dietary fats can actually spark weight loss.
To sustain a well-functioning metabolism and develop the capacity to lose weight, we need balanced hormones, says Julie Brown, RD, national nutrition program coordinator for Life Time. That balance is predicated on well-managed stress, the right exercise program, and — importantly — eating enough high-quality fats within a well-balanced diet.
“Without enough healthy fats coming in, production of certain hormones goes down,” she explains. “And since hormones tell the body how to operate on a cellular level, we won’t get the greatest outcomes without them.” That includes our ability to lose weight.
A 2013 study in JAMA by endocrinologist David Ludwig, MD, found that diets with sufficient healthy fats helped people who had recently lost weight keep it off; other studies have reached similar conclusions.
And in 2016 the journal The Lancet Diabetes & Endocrinology reported research suggesting that a diet of unrestricted calories and plentiful fats.
For the greatest overall health benefit, focus on quality fats from avocados, nuts, seeds, olive oil, and other plant sources, as well as low-mercury salmon and small, oily fish, such as sardines.
As with your carbohydrate consumption, how much fat you can optimally incorporate into your diet will depend on your individual needs and unique physiology. Increase your intake if you feel hungry soon after eating (fat is satiating), or decrease it if you feel so sated during meals that you’re leaving phytonutrient-dense food on your plate.
For precise feedback, ask your doctor to run lab tests to check your lipid profile. Genetics may prevent a small percentage of the population from effectively processing dietary fat.
Missing Link No. 5: Healthy Thyroid Function
Because the thyroid gland determines how efficiently we burn calories, it plays an essential role in helping us maintain a healthy weight. “The thyroid hormone is a master hormone that regulates metabolism,” explains Lockhart.
But the vast majority of the estimated 60 million American adults with thyroid problems don’t know they have them, which makes “missing” the operative word when it comes to this missing link. (For a list of symptoms, see “Repair Your Thyroid.”)
There are a couple of reasons so many thyroid cases go undiagnosed. Many doctors often use outdated reference ranges when assessing thyroid lab results, unaware that the ranges once considered normal have been narrowed in recent years, notes functional-medicine endocrinologist Sara Gottfried, MD, in her book The Hormone Cure.
And many practitioners run only one test — measuring thyroid stimulating hormone, or TSH — to assess a patient’s thyroid health. Though TSH is important, it doesn’t provide enough information on its own to rule out dysfunction.
“Only testing TSH is like sending cans of food to a country in need — but not sending a can opener,” says Lockhart. “We have to consider the whole pathway.”
That wider pathway includes checking the thyroid hormones free T3, free T4, and reverse T3, as well as the thyroid antibodies thyroid peroxidase and thyroglobulin. These antibodies signal that the body is attacking the thyroid. They can be present for many years before TSH moves out of a healthy range.
“In my practice, we use seven different measures for thyroid health,” says Palanisamy. And when tests turn up thyroid dysfunction in its early stages, he notes, it is much easier to address without medication.
If you suspect your thyroid might be playing a role in weight-loss resistance, ask your doctor to run a full thyroid panel. Together, these lab numbers will provide a more accurate picture of your thyroid health and allow you to address subtle imbalances or early-stage dysfunction before problems worsen.
Missing Link No. 6: Strength Training
Conventional wisdom holds that as long as you’re getting some exercise, it will regulate your metabolism. But the full story runs a little deeper.
“The truth is that there are a lot of qualitative boxes that need to be checked off when it comes to movement,” says Davidson.
When weight loss remains elusive, strength training is often the missing link. Most forms of strength training build fast-twitch muscle fibers, which are highly dependent on sugar as a fuel source. And the more sugar your muscles burn, the more your blood-glucose levels will remain in check (see missing link No. 3). Increased muscle mass also burns more fuel of all kinds, even when you’re at rest.
So get familiar with the weights at your health club or gym. If you’re unsure about lifting weights or swinging a kettlebell, consult with a trainer.
Finally, don’t sacrifice movement variety in your quest for weight loss. You still need cardio. “We are variable creatures, and we can produce different forces and velocities,” says Davidson.
And while cardio may be less important for body composition, it’s critical for your overall health. “Human beings evolved to move,” he emphasizes, noting that we need at least 8,000 steps a day to maintain metabolic balance.
If 8,000 steps is good, is 16,000 better? Not really, says Davidson. “Doubling low-level aerobic activity doesn’t seem to help weight loss.”
Incorporate strength training into your exercise routine to build muscle, which will burn fat and sugar and help keep your blood glucose stable. And make certain you’re maintaining a baseline of aerobic activity every day — carry laundry up and down the stairs, walk the dog, and park far away from the office — all will make it easier to get in those 8,000 steps you need to maintain metabolic balance.
Missing Link No. 7: Intermittent Fasting
Many health experts emphasize eating frequent small meals throughout the day, but this approach isn’t right for everyone. Intermittent fasting (IF), which involves cycling between fasting and eating (different methods split the day or week into eating and fasting periods), can also be a powerful tool in the weight-loss arsenal.
Research has found a couple of IF benefits, specifically for those struggling with obesity. A 2013 study in Nutrition Journal suggested that alternate-day fasting can be cardio-protective and support weight loss in obese adults. A 2009 study in the American Journal of Clinical Nutrition reported similar results.
“Intermittent fasting, when used correctly for the right person in the right time frame, can be fantastic when weight loss is the goal,” says Brown. But, she continues, the key phrases in that sentence are “right person” and “right time frame.”
She suggests that anyone who experiences big swings in blood-sugar levels avoid IF. And people with hormone imbalances or thyroid issues may not respond well to the practice, adds Lockhart, because calorie restriction can further stress the delicate endocrine system (see missing link No. 5).
Gender may also play a role. Brown and Lockhart agree that fasting can be a useful tool for men and women, but on the whole, men tend to respond better to it as a weight-loss intervention. Fasting is more likely to trigger hormonal imbalance in women.
It’s equally important to remember that fasting and intermittent fasting are not meant to be practiced in the long term. “Long-term fasting should never be done without a well-educated medical professional,” says Brown. “Executed by the wrong person, long-term fasting can do more harm than good.”
Time-restricted eating — such as avoiding food from 8 p.m. until 8 or 9 a.m. the next day — is generally considered safe and is a fairly common pattern for many people already. But don’t undertake a serious fasting regimen without consulting a qualified healthcare provider. If your blood-sugar levels fluctuate dramatically or you have a history of hormone imbalance, have your thyroid function checked before starting.
If you continue using intermittent-fasting protocols for more than a month or two, ask your doctor to run your labs again to ensure that you’re not triggering a stress response or imbalance.
Finally, don’t let the fasting mentality (I fasted, so I now deserve this giant doughnut!) be an excuse to eat whatever you want during your eating hours. Focus on high-quality, nutrient-dense whole foods that support your health.
Missing Link No. 8: Reduced Toxic Exposure
The thyroid, pituitary, and adrenal glands help control metabolism, stabilize blood glucose, and maintain energy levels. These are the organs most often associated with the endocrine system, but research has recently uncovered another endocrine organ: our fat cells.
Adipose tissue, composed of fat cells, secretes hormones and sends biochemical messages. This means when something interferes with our endocrine system, it can also interfere with how much fat we store.
Several factors confuse endocrine function, including too little dietary fat, chronic stress, wonky blood sugar, and lack of sleep. But one troublemaker gets little attention when it comes to weight loss: toxins.
Endocrine-disrupting chemicals (EDCs) — plasticizers like bisphenol A, or BPA; dioxins; phthalates; and pesticides like DDT — disrupt the endocrine system. You’ll find them in plastic water bottles, lawn chemicals, receipts, metal food cans, new furniture, cosmetics and body-care products, and nonorganic foods and beverages. These chemicals have been so strongly associated with overweight and obesity that they’ve been dubbed “obesogens.”
Obesogens promote fat accumulation by disrupting communication between hormones and fat cells, increasing the size of fat cells, and dysregulating the hormones that affect appetite. What’s more, they are lipophilic, or fat loving, and the body tends to store these toxins in fat tissue. So, when EDCs disrupt metabolism and increase fat production, they are actually building their own safe storage facilities.
To support your weight-loss goals and overall health, try to avoid or minimize exposure to environmental chemicals. This doesn’t have to be complicated. Choose organic food when possible, forgo lawn chemicals and toxic pesticides in your yard and home, use plant-based body-care products, and employ nontoxic household cleaning products.
Missing Link No. 9: Genetics
Our genes shape every aspect of our physiology, including our weight. Experts estimate the heritability of weight issues at anywhere between 40 and 70 percent.
In recent years, our understanding of the genetic influence on weight has matured. Researchers have identified variations — also known as single nucleotide polymorphisms, or SNPs (pronounced “snips”) — that are associated with obesity. For example, two relatively common variants increase the general risk of obesity by 20 to 30 percent, including the risk of childhood obesity, overeating, and greater long-term weight gain. (For more on SNPs, see “Making Sense of SNPs.”)
Yet DNA is not destiny. SNPs set the stage for specific health conditions, but your environment and lifestyle put things in motion. That’s because chronic conditions, including overweight and obesity, are multifactorial: You may be genetically predisposed to gain weight, but what you eat, how much you exercise, and how carefully you pay attention to other missing links can help mitigate your genes’ natural inclination.
Recent research suggests that genes also play a role in determining which microbes colonize your gut, so it may be possible to address inherited conditions like obesity by nurturing healthier gut microbiota.
“One of the species of bacteria that is most associated with heredity and leanness is Christensenella minuta,” says Galland. This bacterium is more common in lean individuals, and when it is given to obese mice, it helps make them lean.
But Christensenella minuta was discovered only within the last decade. “So we haven’t found the dietary factors that impact the growth of Christensenella minuta — yet,” he says. (It’s also not currently available as a supplement.) “We’re on the cusp of something important happening,” he continues. “It’s an exciting area to explore.”
Don’t assume your genes set your fate. Experts agree that the skyrocketing rates of obesity in the past 40 years are less about our genes, which take a long time to change, and more about our changing environment. This has been shaped by cultural, political, social, and economic factors that have led us to eat more, exercise less, and feel more isolated and anxious. Hence, genes cannot be solely responsible for the dramatic rise in obesity rates. While obesity-related SNPs are real, they’re more disposition than destiny.
And although research on genes and the microbiome are in their earliest stages, it’s safe to conclude that the microbiome plays its own role in achieving a healthy weight. Tend to your gut health as part of your weight-loss efforts, because stabilizing your overall well-being is the best thing you can do for your weight.