Before having weight loss surgery, many patients have found it difficult to lose weight and ultimately keep it off. In fact, many of my patients, pre and post-bariatric surgery, will say that they have done everything; "I've gone through all the different weight loss programs. I've tried weight loss pills. My doctors have done all kinds of tests. I will lose weight for some time, and then weight always comes back - what's wrong with me?" 

Well, I am here to tell you that nothing is wrong with you. Let's break this down from a historical perspective and start to understand why it is so difficult to lose weight.

The History Behind Fat Stores

First of all, you have to understand that fat tissue, called adipose tissue, is a necessary origin. Adipose tissue is our backup fuel source and is the regulation of our energy stores. The gasoline that gets us through our day is glucose because it is the easiest thing for our bodies to break down and run on. But glucose wasn't always available in prehistoric times.

Think about humans in the first few thousand years of existence. It was a time when people had to forage for food to eat. And when they couldn't find anything, and they had used up their circulating glucose, then they had to rely on their fat stores to bridge them or keep them alive until they could find food again. 

So our brains, which went to their formal processing and programming thousands and thousands of years ago, learned that adding more fat tissue would be a survival advantage—the more fat you have on you your body, the longer you could survive in the absence of food. Therefore, our brains and bodies became very efficient at taking in excess calories and creating more fat stores. Our brains' processing has made it difficult to lose weight in the modern day where we have fast food on every corner, Georgia sweet tea and soft drinks, and all these different delivery restaurants. 

Why It is Difficult to Lose Weight

Almost every day, we consume more calories than our bodies actually need. We are taking these excess calories, and we're creating more fat stores. The problem with this is that every time you've added fat throughout your life, your brain will recalibrate that as your new "normal", ultimately making it more difficult to lose weight. 

What does that mean? Our brains keep us alive by managing normal levels in the body. If I drew your electrolytes today, I'd know pretty close to what those numbers would be. I also know that if I checked them a year from now, they would be the same amount because your brain needs all your electrolytes to be within a specific range to keep you alive. 

Similarly, if you donated blood today, we would decrease your circulating red blood cell levels, and if I rechecked you in a week or so, you're going to be right back where you started, and there's nothing you could do to prevent that. Nobody would ever say, "well, you didn't have enough willpower to keep your hemoglobin down."

All your body tissues, everything about your body, live within specific parameters, and your brain keeps it there. So if you wake up one day and decide you need to shed some pounds yet quickly find that it is difficult to lose weight, it is because your body has adjusted to being “set” at that weight.

If you are looking to lose weight through a change in your diet, you will likely quickly realize how challenging it is to maintain consistency and willpower. There are many different types of diets currently out there; you can go on the low-carb diet, keto diet, or high-protein diet. All of these different eating methods are designed to help you take in less glucose or spread out your time between meals to get rid of your circulating glucose. 

So you ultimately end up spending more time using fat as your primary fuel source, and in doing so, you are decreasing your fat stores. 

But here is the problem. When you have gone on these strict diets, you will generally notice that you will lose weight for a short period, and then all of a sudden, the weight loss stops. 

You’ll also notice that after a period of a few weeks, the diet just got really hard. You will begin to feel hungry all the time, and you may even start eating things that are “off-limits” on the diet because you feel so deprived. You may have also experienced a loss of motivation to work out, and you begin feeling tired and drained. 

“What’s going on? I’m doing everything I’m supposed to do. I just can’t lose any more weight loss!” 

A couple of physiological processes have occurred here. It doesn’t matter if you start with 2% body fat or 50% body fat, your brain will only allow you to use a certain percentage of your fat stores until it tries to conserve it. This is why it is so difficult to lose weight. You will lose weight for a certain period then your brain will slow your metabolism to the point where you are not going to lose any more fat. 

What’s happened also is that not only has your metabolism slowed, your hunger hormones have become elevated, and they will remain in this elevated state for a few months until you put that weight back on. Unfortunately, not much can be done about this, which is frustrating for someone trying to lose weight. 

It’s not about food volume nor about the types of food you are eating. Your weight is going to be maintained by your body because that is your body’s job. So where then does bariatric surgery come in? Bariatric Surgery will create a metabolic shift in your body to decrease your resting weight, or how much weight your brains think you should be carrying around. Surgeons and researchers have thoroughly studied this phenomenon and how bariatric surgery creates a physiologic shift in how much fat your brain thinks you should have. 

If you find it difficult to lose weight, even after trying all kinds of fad diets and intense exercises, weight loss surgery may be an option for you should you qualify. We also recommend you speak with your primary physician or a board-certified endocrinologist/bariatrician to understand more about the mechanisms that affect your metabolism and your weight loss.