I’ve tried everything – why am I not losing weight?

Why is it so hard to lose weight?

There are several reasons why weight loss can be difficult. Obesity is regarded as a complex, chronic condition where genetics, environment, and hormonal factors interact. When calorie intake decreases, the body's energy-saving mechanisms are activated, which can lead to reduced energy expenditure and increased hunger.

These so-called metabolic adaptations can make it harder to maintain a calorie deficit over time. Therefore, lifestyle changes are sometimes not enough, and additional support may be needed to achieve sustainable weight loss.

The body’s “set point” – why weight loss often plateaus

The body has mechanisms that help regulate and stabilise body weight over time, sometimes described as a "set point". These are influenced by factors including genetics, hormones, and environmental factors.

During weight loss, physiological adaptations occur that can counteract further weight loss, such as reduced energy expenditure and increased appetite. This can contribute to weight loss slowing down or stopping over time.

Simultaneously, the basal metabolic rate adapts to a lower body weight, and spontaneous daily movement (NEAT) may decrease, further affecting total energy expenditure.

Hormones that affect weight

Hormones play a central role in regulating body weight, including by affecting appetite, food choices, energy expenditure, and fat storage. They function as chemical messengers that coordinate the body's energy balance.

One important hormone is ghrelin, which is primarily produced in the stomach and signals hunger to the brain. During weight loss, ghrelin levels can increase, which may contribute to increased appetite. At the same time, levels of leptin – a hormone from fat tissue that signals satiety – decrease, which can further affect appetite regulation.

In cases of obesity, there is often a reduced sensitivity to leptin (leptin resistance), which can contribute to impaired satiety signalling.

Hormonal conditions such as thyroid disease and PCOS can also affect weight.

Stress and lack of sleep also affect the hormonal system. Elevated cortisol levels can contribute to increased appetite and altered fat distribution, which can make weight loss more difficult.

Why exercise is not always enough

Physical activity has many positive effects on health and contributes to increased energy expenditure and improved body composition. However, exercise alone often leads to more limited weight loss than many expect, even though the health benefits are significant.

One explanation is that the body can partially compensate for increased energy expenditure, for example, through increased appetite or reduced spontaneous activity during the rest of the day. This can make it harder to achieve a lasting calorie deficit.

Exercise is nonetheless an important part of treatment. Strength training in particular helps preserve muscle mass during weight loss, which is important for basal energy expenditure and for maintaining weight over time.

Is it my fault I haven't lost weight? I’ve tried both large and small changes

No, losing weight and maintaining it is not solely about willpower or discipline. Research shows that body weight is influenced by a combination of genetic, biological, and environmental factors. Heredity is estimated to account for a significant portion of the variation in body weight and can influence factors such as appetite, energy expenditure, and fat distribution.

At the same time, many people live in an environment where energy-dense food is easily accessible and physical activity is not always a natural part of everyday life. Explaining weight solely as a lack of discipline is therefore a simplified view.

Obesity is today regarded as a chronic condition, and for many, medical treatment can be a relevant complement to lifestyle measures to lose weight and keep it off.

When can medical help be an option?

Medical treatment for weight loss can be an option for individuals with a BMI ≥30, or ≥27 in combination with at least one weight-related comorbidity such as hypertension or sleep apnoea.

If lifestyle measures have insufficient effect, medications that affect the body's appetite and satiety signals – for example, via GLP-1 or GLP-1/GIP receptor agonists – can be considered. These treatments can contribute to reduced energy intake through increased satiety and decreased appetite.

The choice of treatment should always be based on an individual medical assessment, taking into account efficacy, tolerability, and the patient's circumstances. In many cases, a multidisciplinary approach can therefore contribute to a more sustainable treatment result for losing weight.

What can you do moving forward?

To promote sustainable weight loss, it is important to focus on long-term lifestyle habits, such as a nutritious diet, regular physical activity, sufficient sleep, and recovery.

An adequate intake of protein and fibre can contribute to increased satiety and the preservation of muscle mass during weight loss. Sleep and stress management are also central factors, as they can affect appetite regulation and energy balance.

It is also important to adapt strategies based on individual circumstances. If there is no effect despite lifestyle changes, it may be appropriate to consider a medical assessment and potential complementary treatment options.

Frequently Asked Questions (FAQ) about why you are not losing weight 

Why does weight loss suddenly stop?

There are several reasons why weight loss may plateau. A common explanation is the body's metabolic adaptations, where energy expenditure decreases as body weight drops. Simultaneously, appetite regulation can be affected, leading to increased hunger.

Changes in physical activity, dietary habits, or stress levels can also contribute to weight loss levelling off over time.

Can you eat too little to lose weight?

A calorie deficit is required for weight loss, but if the deficit is too large or continues for a long time, it can have negative effects. The body adapts by lowering energy expenditure, including through reduced spontaneous movement and loss of muscle mass.

At the same time, hunger-regulating hormones can be affected, increasing appetite and making it harder to maintain a calorie deficit over time. This can, in turn, increase the risk of overeating and make weight loss less sustainable.

How do I know what my body's set point is?

The term "set point" is used to describe the body's tendency to regulate weight within a certain range. However, it is not an exact or fixed level; it is influenced by factors such as genetics, hormones, lifestyle, and environment.

In practice, it may correspond to the weight where the body tends to stabilize over time without active weight regulation. This can, however, change depending on lifestyle habits and treatment.

How does menopause affect the ability to lose weight?

During menopause, oestrogen levels decrease, which can affect body composition through reduced muscle mass and an increased tendency for fat storage, especially in the abdominal area. This can contribute to lower energy expenditure and make weight loss more challenging.

At the same time, weight is also affected by factors such as age, lifestyle, and activity levels, meaning the changes can vary between individuals.

Do you have to take weight medication for life?

Obesity is regarded as a chronic condition, and for many, long-term treatment may be necessary to maintain weight loss. However, how long medication is needed varies between individuals and depends on treatment results, tolerability, and individual circumstances.

Treatment should therefore be regularly evaluated in consultation with the treating physician.

References

Hall et al., The Lancet 2011 The Lancet.
Quantification of the effect of energy imbalance on bodyweight.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60812-X/fulltext

Sumithran et al., NEJM 2011 New England Journal of Medicine.
Long-Term Persistence of Hormonal Adaptations to Weight Loss.
https://www.nejm.org/doi/full/10.1056/NEJMoa1105816

Müller et al., Nature Reviews Endocrinology 2022 Metabolic adaptation to weight loss: implications for the athlete and beyond.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3943438/

Pontzer et al., Current Biology 2016 Current Biology. Constrained Total Energy Expenditure and Metabolic Adaptation.
https://www.cell.com/current-biology/fulltext/S0960-9822(15)01577-8

Garvey et al., Endocrine Society Guidelines Pharmacological Management of Obesity: Clinical Practice Guideline.
https://www.endocrine.org/clinical-practice-guidelines/pharmacological-management-of-obesity