As it turned out, most of the patients I encountered already had a good idea of what they should be doing to lose weight. They knew veggies trumped cookies, exercise trumped couches, and smart choices always trumped impulsive fridge-foraging at midnight. Truth is, a few people actually did everything right, but still couldn’t get the results they wanted.
That’s when it struck me there was another important part of the equation: WHY trumps WHAT.
What people are doing is less important than why they are or aren’t.
If you’re like most people who’ve had some success but then stalled, you probably started your plan hell-bent on success and full of confidence. You hammered your exercise plan and you stuck to your diet. But then something happened. That something is WHY you stopped doing what you were doing.
To me, there are four primary categories of barriers that prevent people from having success losing weight, but as is the case with any obstacle, there’s always a way to get around it.
The Problem: Physiological Barriers
Physiological barriers that stand in the way of weight loss often take the form of disorders, diseases, or the medications used to treat those issues. For example, polycystic ovarian syndrome (affecting up to 10% of young women) can make it hard for women to lose weight even with concerted efforts to reduce calories and exercise due to changes in their hormonal profiles. Diabetes can bring about worries of sudden blood sugar drops in those taking insulin making them hesitant to exercise. Heart conditions can make it difficult to exercise without concern about safety whether or not these fears are actually warranted. And that’s not even considering that some medications can actually lead to weight gain.
The Fix
First, if weight loss has stalled, you should see a doctor to make sure you don’t have some underlying condition that’s influencing your weight. And talk to your doc about medications that may cause weight gain. For example, some drugs related to weight gain include some forms of insulin, antipsychotics like clozapine and olanzapine (sometimes prescribed as sleep aids), tricyclic antidepressants such as amitriptyline, beta blockers like atenolol and metoprolol (sometimes prescribed for migraine prevention), and glucocorticoids such as prednisone. In many cases other medication options are available even within the same class of drugs and these may allow you to successfully lose weight.
The Problem: Mechanical Barriers
By far, the most common mechanical barrier is pain. This can be the result of arthritis, fibromyalgia, plantar fasciitis, back pain, or just a nagging injury that won’t go away. It can limit the amount of activity people are able to do and sometimes cause depression (which can also contribute to weight gain).
Another common example: Obstructive sleep apnea, which can affect people with modest weight gain and result in the blocking of the airway during sleep. What’s worse is that you might not even know if you have it. This issue can not only result in high blood pressure and risk of heart issues, but it can also make it even more difficult to lose weight. A recent study has suggested that sleep apnea can limit the response to a weight loss intervention even if you’re following the plan just as closely as someone without sleep apnea.
The Fix
If you have ongoing shoulder, neck, or back pain and it is preventing you from exercise, get it checked out. Many physiotherapists and other therapists can make a rapid difference in your pain and get you back to training in a hurry.
For more chronic conditions like arthritis that can’t be fully alleviated by medication or therapy, consider finding resources or people near you for cognitive behavioral therapy to help you better manage (and live with) the pain you do have. It won’t eliminate the pain, but will help you to get through it and hopefully be able to return to training.
If your weight loss is resistant and you’re experiencing a lot of snoring, daytime drowsiness and other symptoms of this problem, you should talk to your doctor about sleep apnea. Getting diagnosed and using a CPAP device to keep the airway open at night may be all you need to get your weight moving again.
That’s when it struck me there was another important part of the equation: WHY trumps WHAT.
What people are doing is less important than why they are or aren’t.
If you’re like most people who’ve had some success but then stalled, you probably started your plan hell-bent on success and full of confidence. You hammered your exercise plan and you stuck to your diet. But then something happened. That something is WHY you stopped doing what you were doing.
To me, there are four primary categories of barriers that prevent people from having success losing weight, but as is the case with any obstacle, there’s always a way to get around it.
The Problem: Physiological Barriers
Physiological barriers that stand in the way of weight loss often take the form of disorders, diseases, or the medications used to treat those issues. For example, polycystic ovarian syndrome (affecting up to 10% of young women) can make it hard for women to lose weight even with concerted efforts to reduce calories and exercise due to changes in their hormonal profiles. Diabetes can bring about worries of sudden blood sugar drops in those taking insulin making them hesitant to exercise. Heart conditions can make it difficult to exercise without concern about safety whether or not these fears are actually warranted. And that’s not even considering that some medications can actually lead to weight gain.
The Fix
First, if weight loss has stalled, you should see a doctor to make sure you don’t have some underlying condition that’s influencing your weight. And talk to your doc about medications that may cause weight gain. For example, some drugs related to weight gain include some forms of insulin, antipsychotics like clozapine and olanzapine (sometimes prescribed as sleep aids), tricyclic antidepressants such as amitriptyline, beta blockers like atenolol and metoprolol (sometimes prescribed for migraine prevention), and glucocorticoids such as prednisone. In many cases other medication options are available even within the same class of drugs and these may allow you to successfully lose weight.
The Problem: Mechanical Barriers
By far, the most common mechanical barrier is pain. This can be the result of arthritis, fibromyalgia, plantar fasciitis, back pain, or just a nagging injury that won’t go away. It can limit the amount of activity people are able to do and sometimes cause depression (which can also contribute to weight gain).
Another common example: Obstructive sleep apnea, which can affect people with modest weight gain and result in the blocking of the airway during sleep. What’s worse is that you might not even know if you have it. This issue can not only result in high blood pressure and risk of heart issues, but it can also make it even more difficult to lose weight. A recent study has suggested that sleep apnea can limit the response to a weight loss intervention even if you’re following the plan just as closely as someone without sleep apnea.
The Fix
If you have ongoing shoulder, neck, or back pain and it is preventing you from exercise, get it checked out. Many physiotherapists and other therapists can make a rapid difference in your pain and get you back to training in a hurry.
For more chronic conditions like arthritis that can’t be fully alleviated by medication or therapy, consider finding resources or people near you for cognitive behavioral therapy to help you better manage (and live with) the pain you do have. It won’t eliminate the pain, but will help you to get through it and hopefully be able to return to training.
If your weight loss is resistant and you’re experiencing a lot of snoring, daytime drowsiness and other symptoms of this problem, you should talk to your doctor about sleep apnea. Getting diagnosed and using a CPAP device to keep the airway open at night may be all you need to get your weight moving again.
The Problem: Financial Barriers
Purchasing lean proteins, fresh fruits and vegetables, and other healthy foods can get relatively expensive, especially for those with a limited income. Add in the cost of gym memberships, exercise equipment, personal training or weight loss programs and you’re looking at potentially expensive solutions for weight loss.
Also, with work weeks greater than forty hours becoming increasingly common and a large number of people commuting large distances to their jobs, time can often feel like the biggest constraint people face.
The Fix
Many of these barriers are actually more perceived barriers than real ones. With the large number of body-weight workouts available and information on the internet, gym memberships are no longer a requirement for getting fit. Recent studies indicate that shorter, higher intensity workouts that don’t require much time to complete can be just as effective for weight loss.
It also strikes me that while there are some who have very real financial struggles, the real issue for many is about prioritizing finances. I can’t even tell you the number of people I know who have big screen plasma televisions but still “can’t afford” to purchase good foods. I suggest tracking all expenditures for a month by category (i.e., groceries, rent, entertainment) and see where your money is going. More often than not, you’ll find out where your money is misspent and you can choose to invest it more wisely.
The Problem: Psychosocial Barriers
Many know psychiatric disorders can impact your ability to lose weight. Most notably, depression has been related to weight gain, and failure to deal with this very serious disease can potentially set you up for failure in any weight loss attempt. Attention deficit disorder (with or without hyperactivity) can lead to impulsive behaviors regarding food and activity and make it difficult even for the most determined person to stay on their plan. And stressful or even traumatic life events can have serious long term implications for weight loss. People sometimes maintain their body weight as a subconscious protection mechanism against those who might seek to harm them.
Completely separate from the more serious clinical issues, are the psychosocial barriers that result from interaction with those around us. Cultural norms for activity and intake and our perception of the need to comply with those norms can be one of the biggest barriers to weight loss. While some would point to stress eating as a big source of extra calories, I would suggest that this is just one of the emotions that lead us to consume more. Grief, sadness, anxiety, and even happiness can play a role in our intake. Social conventions can also have a profound effect.
Consider Christmas, Thanksgiving, and other seasonal holidays where we can easily justify to ourselves that we can eat more food and somehow get away with it. In many countries there are as many as 15 widely recognized holidays, not to mention birthdays, anniversaries, funerals, weddings, graduations, mid-summer barbeques, and dinners with friends. It probably wouldn’t be out of line to suggest that at least once every week or two there is a reason where we could easily justify to ourselves that eating more than we need is acceptable.
Contrast that with the fact that during most of these occasions activity is not only limited, but would actually be frowned upon. Imagine asking your friends and family to join you on Christmas for a hike and a dinner of reasonably portioned turkey and veggies…without gravy. I think you could easily expect to be eating alone.
The Fix
From a purely clinical standpoint, if believe you may have any of the aforementioned disorders or issues, see your physician to deal with them eliminate them as possible barriers to your success.
To deal with the more sociological issues, the first step is to begin journaling your food and beverage intake. More importantly, each time you eat, record why specifically you ate what you chose, and how much you ate.
While this is cumbersome, I think that you’ll find more often than not you choose to eat certain things at certain times not because you’re hungry, but because of things like availability of food, perceived cravings for specific types of food (not actual hunger), and just plain old social convention.
Once you are aware of these things you can begin asking yourself before eating why you’re eating and why you’ve chosen the specific item you’ve decided to eat. Focusing on eating foods primarily for true hunger will enable you to begin chipping away at the excess calories consumed for other reasons. More specifically, by writing it down will bring the reasons you eat to the forefront of your mind,allowing you to become accountable for your choices.
While barriers can often seem to stand between you and your goals, they are often there to allow us to demonstrate how badly we truly want to achieve those goals. Once you’ve identified your personal barriers to weight loss, you can blast through them to success.
