Whys and Hows to Weight Loss
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Dec 12, 2024
- 19 min read
Updated: Aug 6
Being overweight takes a toll on a person.
Are you or someone you know troubled by excess weight? Let's talk. The conversation may be challenging, but it’s rooted in care and honesty. Still, I am going to try to inspire you to lose weight by examining the social and physical consequences of being overweight or "obese", by looking at the many social and physical benefits of weight loss, by reviewing different causes of weight gain, and by discussing the many different approaches to weight loss.
If you are overweight, or obese. You can join about 74% of the United States population (NIH, 2020). Today, the overall number of overweight people hasn't changed much, and 40.3% of those people are considered "obese." The latter has actually gone down 1-2% since 2020. (Are people becoming more aware of unhealthy eating habits and discarding them, are they exercising more or are the oral antidiabetic/weight loss medicines drugs making that much of an impact?)
The stigma of being overweight can taint a person's quality of life in many ways. The discrimination associated with negative stereotyping can affect a person's social and personal life, and even financial well-being. While some cultures actually view overweight and obese people in high regard, associated with wealth, abundance, social status, fertility, and sometimes, power - our society does not: The words and concepts of "overweightness" and, especially, the term "obesity" often have negative connotations. Weight-related stigma can deeply affect mental well-being, self-esteem, and self-image ("Sorry Barbie, I am not sexy like you are"). In fact, according to an NIH publication, weight stigma in the U.S. often includes deeply harmful and inaccurate stereotypes. These include perceptions of individuals with obesity as “lazy, weak-willed, unsuccessful, unintelligent, lacking self-discipline, having poor willpower, or being noncompliant.” These views are not only false but damaging to mental and physical health—and they contribute to discrimination in healthcare, employment, and social settings.
Perhaps, more challenging is the poor physical quality of life that overweight people suffer. Many people with chronically excessive weight are literally faced with a future of disease and, for some, premature death.
Body Mass Index (BMI) is a fat calculation based on weight and height. According to many sources, it is not entirely accurate because it fails to take into consideration body and muscle mass as well as sex assigned at birth, but it is still used routinely.
The Lancet estimates the following potential for years lost for the following BMI s:
>30 = 3.5 potential years lost
>30-34.9=4.7 potential years lost;
>40=7.7 potential years lost.
That looks a little bleak bleak, but the good thing is that something can actually be done about it.
You can calculate BMI HERE at the National Heart, Lung, and Blood Institute site.
Please note: If your BMI is less than 18.5 and you have concerns about being overweight, you should consult your healthcare provider to rule out underlying medical problems. If underlying health issues are ruled out, discuss the weight problem with a dietitian and mental health specialist. (this web page is about overweight and obese people and likely not what you are looking for). The information in the following discussion is generally for people with a BMI greater than or equal to 30.
Not only BMI but abdominal obesity, determined by measuring the waistline with a measuring tape, is another method to determine visceral fat as a risk factor for disease. A person is considered at risk when the waistline increases above 40 for men and 35 inches for women.
Instead of looking only at before and after pictures, happy faces, diet, and exercise information, it is essential to look into some of the risks that overweight people face. The list below is not meant to make the reader mad or sad but is an effort to motivate people to lose weight: An attempt to explain the potential dangers of being overweight and obese. I hope, at the end of your reading, you will say to yourself, "I really need to do this!" "I really want to do this."
MEDICAL AND MENTAL HEALTH PROBLEMS ASSOCIATED WITH EXCESS BODY WEIGHT: Why You Want to Lose Weight
As mentioned, overweight people often pass away at an earlier age than those of normal weight. And, excess weight (especially obesity) can certainly cause some pain and suffering along the way. Consider these:
Joint problems and osteoarthritis- especially of ankles, joints, and hips. The soft tissue/cartilage becomes damaged, resulting in inflammation and bone erosion. Every extra pound of weight places four pounds of pressure on the knees (1) – that means that, for five pounds you lose, you take 20 pounds of pressure off your knees!
Weight loss usually improves mobility, decreases pain, and slows the progression of osteoarthritis. Interestingly, an overweight patient who underwent knee surgery several months before she visited with me mentioned that "not one of the orthopedists recommended that I lose weight." Would you like to give those hips and knees a break?
Cardiovascular disease: When a person has excess weight, fat and cholesterol deposits accumulate in their arteries, sometimes even blocking blood flow, causing atherosclerosis, heart disease, and peripheral vascular disease. Cardiomyopathy is yet another potential problem: The heart muscle of an overweight person has to work so hard to pump blood through the body and organs of a heavy person, causing the heart muscle to become enlarged. You might think this should strengthen the heart, but it can pump just so much blood before it tires out and fails (heart failure). Give that heart a break.
High Blood Pressure – Among other things, the heart has to pump harder to get blood to all the cells throughout the body. Therefore, the pressure to pump becomes greater (the systolic pressure measures how hard the heart has to pump or the "top" number of the blood pressure reading, i.e.120/80). Additionally, atherosclerosis ("hardening of the arteries") can also decrease vascular compliance, so the heart has to work even harder to get blood through the vessels (a measure of vessel mailability is the diastolic or "bottom" number of a blood pressure reading, i.e., 120/80). Several other factors of obesity account for high blood pressure. Several hormonal changes in obesity also cause elevated blood pressure.
Stroke risk increases with obesity-related cardiovascular disease and/or from high blood pressure related to excess weight. Strokes are often debilitating.
Gallbladder disease – Fat sometimes causes gallbladder dysfunction and gallstones. This, in turn can cause abdominal pain, nausea and vomiting.
Fatty liver disease: This liver problem is not due to alcoholism but, instead, due to excessive fat deposits in the liver. Since the liver cannot process much fat, it tends to accumulate there. Fatty liver can develop into cirrhosis and sometimes liver cancer.
Being overweight can cause chronic migraines
Digestive problems related to obesity include ongoing gastroesophageal reflux - GERD, a hiatal hernia, Barrett's esophagus and esophageal cancer, and heartburn, among others.
Immune compromise, due to a decreased immune response seen in overweight people, can sometimes cause difficulty healing and an increased risk of infection. Obesity can also cause autoimmune problems to develop: Too much fat in the body can cause chronic inflammation, which, in turn, activates the immune system. The immune system remains overactive and sometimes attacks healthy cells and organs. People are more at risk for rheumatoid arthritis, multiple sclerosis, psoriasis, asthma, diabetes and thyroid problems, among others.
Cancer: Excess weight causes chronic inflammation, which can result in increased cell proliferation, DNA damage, and decreased immunity - all instrumental in causing certain cancers: Esophageal, gastric, colorectal, pancreatic, liver, gallbladder, multiple myeloma, ovarian, thyroid, endometrial, uterine, breast (in postmenopausal women), kidney and meningioma (brain).
Erectile dysfunction (ED): Obesity can decrease testosterone and cause blood vessel dysfunction, which may translate to erectile dysfunction.
Urinary and bowel incontinence may occur because a larger abdomen places excessive pressure on a person's bladder, bowel, and surrounding structures, sometimes weakening those structures.
A change in hormones secondary to obesity can cause infertility. Follicular development, egg implantation, and embryo development may be affected in women. In males, temperature and hormonal changes (androgen, estrogen, and others) can cause a low sperm count and problems with sperm quality.
Depression and anxiety are commonly associated with obesity. Sometimes, mood problems lead to obesity, but sometimes, obesity lends to mood problems (or they are simultaneous). Lack of self-esteem due to increased body weight can cause depression or anxiety. Eating more food (especially calorie-rich carbohydrates) stimulates an increase in some neurotransmitters, such as serotonin and endorphins (the "happy hormone"). Both of these are known to alleviate some depression. So we eat for comfort.
Type 2 diabetes is often caused by excessive weight. When high blood sugar causes the pancreas to secrete more Insulin, the overworked pancreas starts to wear down. It cannot produce enough Insulin; simultaneously, cells become Insulin resistant - unable to use available glucose.
Physical can instability, related to obesity also contributes to a greater risk for injury (NIH): A greater risk for falling, stooping, kneeling, walking, bending, and trying to physically respond quickly.
Obesity is a major cause sleep apnea (inadequate breathing during sleep). This occurs primarily because, in obesity, more tissue accumulates in the neck which, in turn, compresses the airway which results in lower oxygen getting to the lungs and to the rest of the body like the heart and brain.
We are very, very lucky that we have modern medicine to offset some of these consequences.
Some people really do not care if they have pain or suffering now or in the future. Some are not concerned about having a long life. Even if it doesn't mean a lot now, a person's health and wellness may mean a great deal to those who are close: to the kids and their kids, maybe to friends. It may mean a lot to potential family caregivers and a person's future finances.
SO, WHAT CAUSES WEIGHT GAIN?
Many factors can cause weight gain, from a person's lifestyle and behaviors to environment, disease and medications, genetics and age.
Lifestyle: As mentioned above, certain cultures actually appreciate obesity. Other cultures (including ours) equate love with feeding the family (which often means feeding the family a lot). Socioeconomic factors can come into play: When a person has less money for food, they tend to eat more carbohydrates like pasta, bread, sugars, and saturated fats than those with an adequate means to buy healthier foods. Some people find eating socially enjoyable: indulging in tasty but calorie-laden foods from restaurants (it can be challenging to find healthy, low-calorie restaurants!). Or, perhaps we learned the wrong way to eat: The food pyramid was wrong when it indicated that people were supposed to eat 6-11 servings of carbohydrates like bread, rice, pasta, and other carb-rich foods that cause weight gain. Now we are supposed to eat more fruits, grains, vegetables, protein, some dairy or soy.
Medical problems can cause people to gain a lot of weight: For example, hypothyroidism (slows your metabolism), diabetes, PCOS (polycystic ovarian syndrome causes excessive hormone, androgen), Cushing's and pituitary problems (too much cortisol leads to increased fatty deposition), and medical issues that contribute to a more sedentary lifestyle.
Medications: Some medications can contribute to weight gain (this does not mean you should come off your medicine right away – speak to the prescriber about this).
1) Psychiatric medications are classic for causing weight gain, including antidepressants, antianxiety and antipsychotic drugs. Some cause more weight gain than others; however, everyone has a different response to these drugs: Some people may not experience weight gain at all. These medications often cause changes in serotonin, dopamine levels, and sometimes prolactin levels some of the older antipsychotics can cause the latter).
Taking these medications for mental health can be a "risk versus benefits" situation. The benefit of these medications can be far greater than the risk of weight gain. Instead of discontinuing your medication, there are a lot of alternatives available. Discuss these with your healthcare provider. In Addition, exercise and/or counseling may help with mood and weight if you choose to take route, but don't just stop your medication cold turkey! It can throw you into a tailspin.
2) Steroids like prednisone or dexamethasone, can increase hunger. They are used for many different types of inflammation. Taken long-term and sometimes short-term, they cause fluid retention and often increase hunger, increased caloric intake, and weight gain. While the best approach is prevention, the weight gain with long-term use is usually reversible over time.
3) Hormonal birth control can cause weight gain – Some birth control forms (Depo-Provera, implants and progestin-only birth control pills) contain progestin, which causes fluid retention and hunger, both of which have the potential for weight gain. If this is a concern, there are plenty of other birth control products that do not have these side effects.
4) Anti-seizure drugs, gabapentin, pregabalin, valproic acid, vigabatrin, and possibly carbamazepine, may cause weight gain. Keppra is one of the "newer" seizure medications. If you feel you are gaining weight from your anti-seizure medication, do not stop your medication, but speak to your prescriber about substituting other seizure medications.
5) Certain blood pressure medications: Beta-blockers (the "olols")-also used for some arrhythmias or irregular heartbeats- slow down metabolism and may decrease energy which can initially lead to weight gain (according to Mayo, about 2-3 pounds within 6 months to a year). This does not seem to happen with the newer beta blockers like Bystolic.
6) Calcium channel blockers are used for blood pressure and sometimes arrhythmias (some kinds of irregular heartbeats). They can cause water retention, translating into weight gain and "puffinessor edema: Diltiazem, verapamil, nifedipine. This weight, however, should come off when medication is stopped. Do not come off your medication without discussing a substitute with your prescriber.
7) Antidiabetic medications such as Insulin and glipizide (Glucotrol XL) can cause weight gain. Others can actually cause some weight loss (see below)
8) Migraine medications that more commonly cause weight gain include amitriptyline, verapamil and valproate,
9) Antihistamines like cetirizine (Zyrtec), fexofenadine (Allegra), Claritin (loratadine) and Xyzal (levocetirizine), among others, when used long-term and regularly, can cause significant weight gain.
Heredity - Studies show that severe obesity has a 40-60% chance of heritability – multiple genes typically contribute to this.
Menopause causes a decline in estrogen and a slowing of metabolism. The typical weight gain is 1.5 lbs every year after 50
The Gut Microbiome - microbiota (the microorganisms that live in the gastrointestinal system) - produces and regulates neurotransmitters like serotonin, dopamine, and glutamate, which can cause weight gain.
Mental Health Issues (stress, anxiety, depression) can cause weight gain. Many neurotransmitters and hormones in the brain send signals throughout the brain and body that "tell" it what to do. They are not only responsible for are responsible for feelings of anxiety and depression, but some stimulate appetite and hunger as well. One of these, serotonin, signals to you how much to eat and how full you feel: low levels of serotonin in the brain tend to cause depression and also increase hunger. Interestingly, 95% of the body's serotonin is found in the gut, where it is partially responsible for motility, absorption, and storage of food and is responsible for fat burning. Higher levels of serotonin in the gut seem to slow down functions and metabolism here, so they tend to cause more obesity. When taking SSRIs (serotonin reuptake inhibitors), there clearly needs to be a delicate balance between increasing levels in the brain and the gut. It is essential that other efforts to maintain a normal weight need to be made as well (2).
Currently, there is a lot of focus and research being done on the "mind/ gut connection." Research is discovering more and more about their close relationship. that they are closely intertwined.
Dopamine is another neurotransmitter that affects eating and obesity. Many dopamine and dopamine receptors are found in the brain and help control our but there are others throughout the body. Dopamine is responsible for several brain functions, including hunger control and impulsivity. When dopamine levels are decreased, the "reward center" of the brain is signaled by dopamine to "want more." This stimulates hunger (especially for notoriously high-caloric carbohydrates/sugars and fats). In essence, low levels of dopamine can essentially cause both depression and obesity. This can be a vicious cycle because obesity also reduces dopamine levels! Since diet (foods high in tyrosine, less saturated fats, fewer carbohydrates), sun, music, exercise, and sleep can increase dopamine levels, these things may help – not only the brain but also the weight.
Stress Eating: High levels of stress tend to increase weight. Essentially, stress increases hormones and cortisol levels in the body, which, in turn, stimulates the appetite and rewards the center of the brain to "want more." Chronic stress is a particular culprit in the development of obesity. This can also be a vicious cycle because sugars, caffeine, and carbohydrates can make you want to eat more! The idea is to try other ways to decrease stress. See stress and anxiety.
Alcohol may make you feel good for a minute but can ultimately lead to all kinds of problems like weight gain and obesity. Alcohol is, basically, all calories and no nutrients: it is like drinking a glass of calories. Not only does it increase your calories, but it can also trigger the brain to want to eat more. Moreover, alcohol slows the metabolic rate and slows fat burning. The frequency of alcohol intake is associated with BMI: That is the more you drink, the heavier you get.
Cooking for the family: Just a note. You need will power here: When cooking for the family, you are cooking for yourself." The kids would love to have some brownies, and you put them on a dish on the counter," then "I just can't let these leftovers go to waste."
Lack of willpower is one of the most significant causes of weight gain and obesity. Overweight people know they have to control their caloric intake, but…how?? It is not really a lack of willpower: What feels like a lack of willpower is both your body and brain telling you that you want to eat more. Starving yourself – or just cutting back – increases cravings, and somehow, you need to honor those cravings to shut off the voices that are telling you to eat. Healthy snacking (see below) and various simple therapies (see below) have helped many people get beyond the weight gain and into a weight loss mode.
Exposure to endocrine-disrupting chemicals can cause weight gain. Notable disruptions include estrogen and testosterone, both of which play a role in weight gain. The endocrine disrupting chemicals are the ones you always hear about in your food and water and in various other products we are exposed to. It typically takes chronic exposure to these substances, which include PFAS and BPAS - the more rigid plastics. Try to avoid plastics (such as food containers); do not use plastic in the microwave or dishwasher; use glass containers for food and drinks when possible. Phthalates (in food, drink, lotions, nail polish, skin creams, shampoo, air fresheners, and other). has been restricted by the federal but you can be sure they are still out there.
These days, so many people have extremely unhealthy lifestyles: Poor diet, lack of exercise, an increase in sedentary behavior, and exposure to lots of stress ("life in the fast lane") and chemicals cause us to put on the calories and grow…and grow…and grow.
MANAGING WEIGHT LOSS
Now that you know why to lose weight, learn how in this second part of Whys and Hows to Weight Loss
There are plenty of things you can do.
Things to consider:
If you are overweight or obese, you probably know that weight loss can help you avert and alleviate many of the problems discussed above. It's frustrating, but it can be done. The following is a jumping-off point for you. By now, you know why to lose weight; let's move on to the most difficult part: How to lose weight, outlined in the practical guide below. If one approach does not work for you, move on to the next. Just don't give up.
If you want to lose weight to lower your blood pressure (or to avoid high blood pressure), know that for every 2.2 pounds, blood pressure typically comes down about 1 point. Do the math. It might be worth it: No one wants to take medications (not to mention that medications might cause unwanted side effects). It might be a bit tougher when you fight against genetics, but even in that case, some decrease can be accomplished.
Life will likely be easier if you have a normal weight. You will feel better about yourself, and your body will feel better too.
Approaches to Weight
Diet
Consider joining Weight Watchers or another group that will give you support and healthy ideas for dieting (they now include consultants and prescribers for the newer GLP-1s or weight loss medications). They also have online support groups if you think working with other people with the same problems and goals will help you. You will need to be diligent in your efforts here and it can be a little bit time-consuming, but it may well be worth the effort
Count points or calories and try to offset those by gradually adding exercise (see below).
Try eating differently: Carry and eat small, healthy, and filling snacks for times when the little voice in your head tells you that you are hungry—things like popcorn or nuts, boiled eggs, or Greek Yogurt. You may be able to satisfy some of the urge to eat. You will get used to it.
Change the way you eat. Many of us were raised on the old 1990s food pyramid, the foundation of which was based on 6-11 servings of bread, rice, cereal, and pasta - A bunch of "carby" stuff. No wonder so many people have type 2 diabetes today. Now, the basis for the food pyramid is fruits, vegetables, grain, some dairy or soy and is, otherwise, more protein-based.
What the heck is the "Mediterranian diet"? The Mediterranean diet is considered to be one of the healthiest diets around the world. It limits red meats and processed foods; instead, it recommends fruits, vegetables, whole grains, legumes, nuts, and seeds, and using olive oil as the primary source of fat. Some people I know would say, "I can't eat this rabbit food!" but on this diet, you can have a few servings of meat every month and, more frequently, omega-3-rich fish like salmon or tuna. That's not quite a meat and potatoes diet, but if you keep eating a LOT of meat and potatoes, some doctor, somewhere, will likely end up telling you that you NEED to be more selective in what you eat because you have high blood pressure, diabetes, kidney failure, cholesterol problems and are obese – that you may die an early death. When that happens, the control is out of your hands. (Provided that you go to a doctor in the first place: "I'm in the best shape of my life: Haven't seen a doctor for years". What??? I hope you have a physical and some lab work done every year or two if you are over 30 because there are often many hidden problems within a person's body that cannot be seen from the outside!
When you eat a meal, try to stick to portions the size of your fist; that may help a bit.
When you are hungry, drink water. When your body signals your mind to eat, a lot of times, it is actually a signal for thirst.
Find your triggers and try to avoid them, or have something around to eat as a substitute.
About those restaurants-
Interestingly, I live near a bigger city, and I Googled "healthy restaurants," and there are very, very few that came up in my search - there should be more. Many "popular" restaurants are all about "fill," how much you get on your plate, not the quality of food. I would say that about 2/3rds of the people who frequent those places are at least overweight, and maybe even obese.
Tell your family to stop bringing home cake and cookies. "Don't order a fried appetizer for both of us that is breaded and full of saturated fat, and don't bring home a bunch of beer."
Can't do one of those diets? If you have the means to do it, find a nutritionist who can walk you through the steps of weight loss, decent foods, menus, and portions.
Exercise
When I see an older person - say in their 70s - in my clinic who looks in good physical health, I ask them how they stay healthy. I want their secrets. The answer is almost always, "I walk a mile every day" (once in a while, you can throw in some longevity genes). It doesn't matter what you do – get up. Walk around. Do it on your own or, if groups motivate you, try a class in aerobics, martial arts, strength training, yoga…join a gym (but make sure you get your money's worth by actually going).
Most sites agree that you can burn about 400 calories if you walk 10,000 steps a day (the bigger you are, the more calories you burn). Start low, increase the steps by 1000 per day, and increase to at least 10,000. If you have a Smart Watch, you can easily track these.
It is good to know that even without weight loss, exercise reduces health risks!
So exercise is not your thing? Next:
Counseling
"I'm a big dude, and I don't need no counseling. Counseling is for the weak". Just saying it may help, and many people use counselors these days for all kinds of things.
Note: If you feel your obesity or weight problem is due particularly to trauma, consider connecting to a mental health counselor.
Try some counseling…some cognitive behavioral counseling. Make that call. Counselors are all over the place online these days, and some specialize in weight loss. Perhaps one of the most interesting counseling approaches is solution-focused therapy. The questions you can ask yourself:
What was life like when I did not have this problem?
How have I dealt successfully with this problem before?
Also, envision yourself as the person you would like to be and (realistically) in the body you would like to have. What would be different, and how would you feel?
Over-the-Counter Medicines
These are typically geared to boost metabolism (often caffeine), suppress appetite (often green tea), or enhance fat burning.
These should be used with low-calorie, low-fat diets and exercise
Examples:
Alli - a fat blocker
Nobi Nutrition Green Tea Extract Fat Burner (boosts metabolism and reportedly reduces appetite). This product comes in several forms.
Hydroxycut Products (esp Hardcore Elite). Caffeine and Green Tea.
Be aware that these have potentially unusual and untoward side effects. Be sure to read about these and discuss the use of these products with a healthcare provider.
Considered Herbal Remedies for Weight Loss
A few of the following are proven to help lose weight, yet may be worth mentioning:
Fiber supplements may fill you up, but do not necessarily decrease your appetite. Examples are Psyllium (2 tsp twice daily), Glucomannan from the Konjac root (Skinny Fiber), and others.
Green tea may slow down absorption: Caffeine acts as a metabolic stimulant
Hydroxycitric acid (from Garcinia cambogia) – Thought to interfere with fat metabolism and decrease fat deposits. Gymnema (Gymnema sylvestre) changes the sweet taste of food on your tongue, reportedly helps burn fat
Green Tea
Ginger
Berberine
Garcinia Cambogia
Tumeric/Curcumin
Evening Primrose
Medications
In the 1990s, researchers learned that the venom of the Gila Monster contained a hormone that increased Insulin and regulated the appetite: A hormone GLP-1. At first, few pharmaceutical companies were interested, but in the 2000s, the benefits were finally recognized: They were very successful for type 2 diabetes and weight loss.
Today, there are several popular medications in this category: Ozempic, Mounjaro (for diabetes), Wegovy, Zepbound (for weight loss), and others $$$$.
According to the British Medical Journal, In 2023, 174,000 people were taking this medication for obesity. Numerous others have been successfully taking it for type 2 diabetes. Many people have had great success with these medications.
As with many medications, most are not without some reservations:
There are requirements for use in obesity for insurance coverage: A person must have a BMI of > 30
The medications have not been out all that long; therefore, potential long-term side effects may not be known, so people hesitate to use them (and some providers hesitate to prescribe them)
Like all medications, there are potential side effects, many of which involve the gastrointestinal system.
To optimize weight loss, you still have to use other measures, such as watching your diet and exercising.
Harvard Health has more information online about the GLP-1s if interested.
If you are quite overweight or obese, this is a medication worth considering. Discuss the risks versus benefits with a healthcare provider.
Medications used in the past by people include Wellbutrin, Topiramate, phentermine, Xenical, and others. Some people find these medications helpful. If interested, speak to your healthcare provider.
Bariatric Surgery
Bariatric surgeries are procedures that help individuals with severe obesity lose weight by altering the digestive system. Common types include gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. These surgeries work by either restricting the amount of food the stomach can hold, reducing nutrient absorption, or both.
While these surgeries often have the benefit of losing weight, they can also cause some long-term complications such as bleeding, nutritional deficiencies, gallstones, bowel obstruction, ulcers and others. It is important to continue a diet regimen and exercise.
If you have not found an approach here in the Whys and Hows to Weight Loss (above), speak to a primary care provider. They may be able to help.
