A few days after the new year, a middle-aged patient came back to our clinic for follow-up, around six months after her last. Based on her chart, her weight increased from 55 to 66 kg. Her body mass index (BMI), a measure to determine if one is overweight or not, increased from 24.8 to 28.9, a jump from just being marginally overweight to significantly overweight, bordering on obesity.
She admitted having thrown caution to the winds during the holidays, and made a firm resolve to lose the extra pounds she gained. She thought ballroom and Zumba sessions would work, but apparently they didn’t.
Probably one of the most popular New Year’s resolutions is to lose weight. It can be truly challenging for many people to lose weight permanently. Some fall into the “yoyo” trap—they lose some pounds after strict dieting and exercise, then gain back more than what they lost after a few days of binge eating.
Watching the numbers on the weighing scale gradually creep upwards can really dampen our spirits.
In most instances, it’s a matter of supply and demand. We shouldn’t gain weight if we spend more calories than we’re taking in. But if we take in more calories (by over-eating) than we’re losing through exercise, then we have to make a more serious effort to address this problem.
If we’re sure the problem is not over-intake of calories, then we have to look for other possible culprits:
1. Unmanaged stress. Everyone is exposed to stress, but some people manage stressors more effectively than others. It’s not the stressor, but how one responds to it. When stress is not managed properly, our bodies shift to a survival mode, and release the stress hormone cortisol.
An effect of cortisol is increased appetite, the reason some people instinctively resort to what they call “comfort food.” Usually, high-calorie food like chocolates, candies, ice cream and the like seem to offer more “comfort” than healthier options like fruits and vegetables. So, one shouldn’t wonder why one is gaining weight during stressful times.
2. Sleep deprivation. Lack of sleep due to insomnia may come with stress, but in some instances, it may simply be because one does all sorts of things instead of going to bed early. Television, Facebook, gadgets are distractions of the modern world that make us stay up late without us realizing that we’re trading in good sleep for these distractions.
Scientists tell us there are two reasons why sleep-deprived individuals gain weight. First is the release in hormones that increase hunger and decrease satiety, the feeling of fullness after eating. Second is that when we’re up late, we tend to take more snacks than we should. We don’t only lose track of time; we lose track of what we’re eating and drinking.
3. Medicinal drugs. There may be drugs, including prescription drugs, that can make one gain weight. These include steroids, anti-arthritis drugs, antidiabetic medications, antidepressants and other drugs for mental problems.
Steroids, anti-arthritis and some antidiabetic drugs can make one gain weight through salt and water retention. This side effect is aggravated if one eats salty food, including instant meals and canned and processed food while taking these medications.
Antidepressant and other antipsychotic products may also cause hormonal changes which can increase one’s appetite, although it is also possible that improved emotional well-being can lead to better appetite. Depression, by itself, may also cause weight gain. So, it’s really best to increase physical activity and exercise, which will not only burn excess calories, but will also release feel-good hormones to improve mental and emotional conditions.
How about contraceptive pills? Some are quick to blame them for any increase in weight. Combination estrogen-progestin pills may cause some weight gain initially due to salt and water retention, but studies have shown that this effect is only short-term and usually dissipates with time. If one continues to gain weight more than six months after taking contraceptive pills, she and her doctor should look elsewhere for a reason.
4. Concomitant medical conditions. Medical conditions like hypothyroidism (or an inadequately functioning thyroid gland), Cushing’s syndrome and polycystic ovary syndrome (Pcos) may cause weight gain ins some.
Our thyroid is the butterfly-shaped glandular organ just below our Adam’s apple. When it’s hyperfunctioning, one loses weight despite increased appetite. When it’s hypofunctioning, one tends to gain weight despite a limited intake of calories.
A hypothyroid individual also feels sluggish, tired, cold and weak. This is because the low levels of thyroid hormone slow down one’s metabolism, leading to weight gain and decreasing energy. This can be treated with medications, reversing the weight gain and other symptoms.
Cushing’s syndrome is an abnormal condition which increases the level of the hormone cortisol. It may be due to a tumor of the adrenal glands, or it may be drug-induced, like in those taking steroids for bronchial asthma or allergies. It has a peculiar type of imbalanced weight gain, usually prominent around the face (moon faces), neck, upper back or waist.
Pcos occurs in women during the child-bearing age, wherein multiple small cysts form in the ovaries. This also results in hormone imbalance, and one of the complications is resistance to insulin, so PCOS patients tend to develop diabetes. They gain weight, especially around the belly (visceral obesity), a cardiovascular risk factor, since hormones predisposing one to heart attack and stroke may also be released.
Can menopause cause weight gain? This is a common belief, but it may not be due to the menopause per se, but the aging process and a decrease in the body’s metabolism. Some women also tend to be less active physically after menopause—hence, the tendency to gain weight.
When one quits smoking, it may be true that some weight gain may be expected initially due to increase in the sensation of hunger, but this should not be a reason to resume smoking. The weight gain is only short-term, and may no longer be significant after a few months. Definitely, the hazards of smoking are more than a hundred-fold compared to the health risk of gaining a few pounds.