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Dieting to shed weight can be a matter of months of effort. Maintaining that weight loss often becomes harder as hunger increases, energy levels change, and the body begins using fewer calories. Many regain the weight despite maintaining the eating and exercise habits that led to the loss.
When you lose weight, your body is different. Your appetite is different. Your hormones are different. Your energy expenditure is different. These responses evolved to protect energy stores when food is scarce. The fall in body weight triggers the brain and hormonal systems to replenish energy stores, providing a constant physiological challenge to weight maintenance.
How Metabolism and Hunger Change
Leptin, a hormone secreted from fat cells, signals the brain about the energy kept in the body. Leptin levels fall with decreasing fat mass and this can increase hunger and decrease energy expenditure. Ghrelin, a hunger-stimulating hormone, may increase after weight loss. Signals that help us know when we're full can also backfire, making it harder to feel satisfied after eating.
The body also becomes more efficient at using energy. A smaller body requires fewer calories to function and some people find that they burn even fewer calories than you would expect just from their change in size. This adaptation is called adaptive thermogenesis and it can slow further weight loss and make it difficult to maintain weight.
Why Restrictive Diets Lead to Regain
Drastic calorie restriction, long periods without eating and diets that eliminate entire food groups can make you hungrier and more tired. As energy levels drop, people may move less throughout the day, which means fewer calories are burned from regular activity.
Losing muscle presents another complication. Without adequate protein and resistance exercise, dieting can result in reduced muscle mass in addition to fat. This has an effect on strength and lowers the energy requirements of the body.
Sleep, stress, availability of food and changes in daily routines may also contribute to weight regain. Such factors interact with the biological response of the body and make long-term weight maintenance difficult.
Effect Of Age and Metabolic Risk
Younger adults can have the same biological response to weight loss as older adults. You might be a young person, in your twenties or thirties, with obesity, accumulation of fat in the abdominal area, insulin resistance or fatty liver disease.
The South Asian populations are at risk of metabolic complications at lower levels of BMI than many of the Western populations. This makes it important to assess waist circumference, blood sugar, blood pressure and other metabolic markers in addition to body weight.
Building A Sustainable Road to Weight Management
You have to eat in a way that will provide enough nutrients to maintain your weight, but still allow you to lose fat slowly. Resistance training, consistent aerobic activity and protein intake maintain muscle and improve insulin sensitivity.
Walking, cycling, swimming and strength exercises are good for energy expenditure and metabolic health. Sleep also deserves attention, as poor sleep regulation affects appetite and increases food cravings. Consistent routines and stress management can help with long term progress.
If you are trying to lose weight but are struggling to keep the weight off, a medical assessment can help to identify contributing factors such as medications, hormonal issues, sleep issues or changes in metabolic health. Obesity is a chronic disease whose treatment may include nutritional support, behavioral care and medication over the long term.
Bariatric Surgery and Novel Surgical Techniques
Bariatric surgery is a recognized treatment modality for patients with severe obesity and comorbidities. Sleeve gastrectomy and gastric bypass reduce the size of the stomach and affect gut hormones involved in appetite, satiety and glucose homeostasis. These effects may help explain why surgery can lead to greater sustained weight loss than dieting alone in eligible patients.
Weight regain is still possible with surgery. They may be related to changes in eating patterns, decreased physical activity, hormonal adaptation and other medical or psychological factors. Specialist follow up and ongoing nutritional surveillance are still essential.
Robotic and laparoscopic techniques let surgeons perform bariatric procedures through small incisions. These techniques are employed for the surgeries like sleeve gastrectomy and gastric bypass for the treatment of obesity and improvement in related metabolic disorders.
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BMI and Long-term Health Assessment
Metabolic complications can occur at lower body weights in South Asian adults, so BMI thresholds help guide treatment. In appropriate clinical situations, bariatric surgery could be considered at a BMI of 29 kg/m2 or above when conditions such as type 2 diabetes, obstructive sleep apnea, fatty liver disease or hypertension are present. People with a BMI of 35 kg/m2 or above may also be considered depending on overall clinical assessment and applicable guidelines.
Weight gain is a response of the body to weight loss, changes in appetite, energy expenditure, muscle mass and daily habits. These are factors to be addressed together in long term treatment. Continued care is usually necessary to sustain weight loss, and lifestyle changes, medications, or bariatric surgery are chosen based on health needs.
(By Dr. Ashish Gautam, Principal Director, Robotic and Laparoscopic Surgery, Max Super Speciality Hospital, Patparganj, New Delhi)
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