I don’t think it’s a surprise to anyone that a large population of the world is overweight. Here are some quick facts from the World Health Organization:

• Worldwide obesity has nearly tripled since 1975.
• In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
• 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
• Most of the world's population live in countries where overweight and obesity kills more people than underweight.
• 41 million children under the age of 5 were overweight or obese in 2016.
• Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
• Obesity is preventable.

Being overweight leads to increased risk of cardiovascular diseases (mainly heart disease and stroke), diabetes, musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative disease of the joints), and some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon).

Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.

If someone wants to lose excess body fat, what should they do? This question is posed and supposedly answered many times a day. Just look at headlines and advertisements. Everywhere you look, you are inundated with the latest weight loss strategy, diet, shake or pill.

But where does the body fat go when you lose it? How does it magically disappear? According the research, you breathe it out! When somebody loses 22 lb (10 kg) of fat, 18.5 lb (8.4 kg) of that is exhaled as CO2. Lungs are therefore the primary excretory organ for weight loss. The rest is excreted via urine, sweat, and feces.

So the question then becomes, how do we get our body to exhale all the extra body fat that we have? You eliminate the things that cause your body to want to hold on to this excess weight. Here are some of the top reasons you may not be losing weight:

Lack of Sleep

When sleep-deprived, a person’s endocannabinoid (eCB) system levels (a key player in the brain’s regulation of appetite and energy levels) are increased. During a study done in 2016 by the National Institute of Health, after four days of less than eight hours of sleep, the test subjects consumed more and unhealthier snacks in between meals. This is when eCB levels were at their highest, suggesting that eCBs were driving hedonic, or pleasurable, eating.

The researchers explained that if you see junk food and you've had enough sleep, you may be able to control some aspects of your natural response. “But if you're sleep deprived, your hedonic drive for certain foods gets stronger, and your ability to resist them may be impaired. So you are more likely to eat it. Do that again and again, and you pack on the pounds.”

Inflammation

I’ve written about chronic inflammation many times in the past, especially around cutting out foods that cause it. While sugar can be inflammatory, is more quickly metabolized than vegetable oils. The more I learn about vegetable oils, the more I think that they may be worse for you to eat than sugar!

Large bodies of evidence indicate that stress can also activate inflammatory response. Cortisol also plays an important role in human nutrition. It regulates energy by selecting the right type and amount of substrate (carbohydrate, fat, or protein) the body needs to meet the physiological demands placed on it. When chronically elevated, cortisol can have deleterious effects on weight, immune function, and chronic disease risk. You can keep an eye on your cortisol levels by monitoring your heart rate variability (HRV). An HRV app will give you your fight-or-flight value. Lower resting-state HRV scores signify an activated Sympathetic “fight-or-flight” response. Don’t forget that too much exercise can cause a negative stress response as well.

Inflammation is a low-level swelling in which the tissues hold on to extra water, which in itself can increase your weight. So it makes sense that if you have chronic inflammation from eating vegetable oils or living in a stressful environment, you are going to have trouble shedding excess pounds.

Not Mixing-Up Workout Routines

The body adapts in a specific fashion to the specific demands that are placed on it. For example, if one runs a lot, one will adapt to the specific skill and strength demands of running. Any adaptation is specific to the imposed demands, so if you want to lose weight you have to take your system outside of its comfort zone and force adaptations to occur, this will force your body to use fat as a recovery tool and energy source. Keep the body guessing by doing complex movements, mixing heavy and light weights, exercising at different times of day, move from the treadmill to the road or the trail, or try a new class at the gym.

Glycemic Variability

This term refers to your blood glucose levels throughout the day. If there is too much variation, the body will either transfer sugar into muscles, or more often, convert it and store it as body fat. For those wondering, in people without diabetes, mean glucose is typically 100 mg/dl or less, which corresponds to an A1C of less than 5.7% (the cutoff for diagnosing prediabetes).

Knowing one’s average glucose over a period (A1C) of time is kind of like knowing the average temperature over the course of a month or the average speed over a road trip – it doesn’t tell you what happens in different moments or what to change. What you want to do is limit the glucose spikes throughout the day. This means aiming for deviation that is less than one third of the average glucose number. For instance, for someone with a mean glucose of 90 mg/dl, the target deviation is 30 mg/dl or less. Unless you are taking glucose readings throughout the day, or have a continuous glucose monitor, you will not be able to determine your glycemic variability. But there are some things you can do to assure that you are keeping it low.

• Cut out or limit sugars and processed carbohydrates
• Don’t eat throughout the day (no grazing)
• Strength train
• Workout in the morning in a fasted state
• Take a casual walk after high-carb or sugary meals
• Stand instead of sitting when possible
• Include plants, herbs and spices with meals
• Include cinnamon with meals
• Take Gymnema sylvestre, Berberine or Apple cider vinegar as supplements

Hormone Imbalance

Hormones can impact your ability to use calories for energy, balance blood sugar, boost metabolism, burn body fat, and feel satisfied from foods. Before you start worrying or changing your dieting plan, get a test from a functional medicine practitioner and check the 5 hormones listed below.

Leptin plays a huge role when it comes to satiety. Research shows that lower levels of leptin can lead to over eating and weight gain. Leptin is stimulated by ample fats in your diet and is produced most effectively when stress levels are managed. Corn syrup, agave, and other refined fructose sources can disrupt your leptin hormones, which lead to lack of satisfaction.

Estrogen plays a huge role in attaining supple skin and maintaining bone health, as well as belly fat and increased fat storage. Many hormones can be converted into others, so testosterone, for example, can be processed through an enzyme and into estrogen. Fat stores are acting in hormonal ways and excess belly fat leads to an increased conversion of estrogen.

Reduce excess estrogen by ensuring your animal and dairy products are hormone-free, as well as avoiding plastics and estrogen-related compounds, such as soy isolate. Eat foods rich in fiber, such as beans, leafy greens, nuts, and seeds to aid in trapping and detoxifying estrogen.

Cortisol was mentioned earlier – read more under the Inflammation section.

Adiponectin is made in the body’s fat stores and plays a role in how efficiently the body metabolizes calories. It creates thermogenesis (caloric burn) through increased temperature and is found in that hard to lose grey fat in the body. Adiponectin helps your body use glucose and insulin more effectively, which in turn decreases body fat. Boost your body’s adiponectin with ample sleep (8 hours is recommended), yoga, and resistance/weight training. For a food-as-medicine approach, eat foods with monounsaturated fats, such as olive oil and incorporate turmeric root into your diet.

Dopamine plays a role in your desire for cravings. This hormone often gets depleted during a stressful day, which leaves you wanting to fill the void and ultimately results in a food coma. Maintain adequate dopamine levels by managing stress and providing your body with L-tyrosine, the precursor or building block for dopamine in the body. Seaweed, eggs, and wild fish are great sources.

The Thyroid

Hypothyroidism has long been associated with weight gain (and hyperthyroidism with weight loss), but the exact biochemical cause of this link is not completely clear. Managing your weight can be a challenge with an underactive thyroid, which may be caused by Hashimoto's. Thyroid hormones normally help the body break down fat, and they help the liver and pancreas function to metabolize stored calories to be used for energy. This can be disrupted when you have decreased thyroid hormones or diminished thyroid function. Along with symptoms of low energy, the body also holds on to calories, storing them as fat, which is especially difficult to burn off and metabolize. While hormone replacement medication treatment can help you lose some of the weight you have gained, it takes planning, hard work, healthy eating, exercise, and getting enough sleep to shed a number of pounds.

Food Intolerances

When you repeatedly eat foods your body can’t handle, it creates a system-wide immune response. And when your immune system remains fired up on a regular basis, chronic inflammation is the result. As you read earlier, chronic inflammation can cause you to hold on to those extra pounds. But how do you know which foods to avoid? I suggest doing The Whole30 to find out. If you are strict with the 30 days and bring back foods one at a time, you will easily identify any food intolerances you have. During the reintroduction period, it will help to keep a log of the symptoms that you’re feeling. Sometimes, foods are very obviously causing problems. Other times, their effects are subtler. Digestion related issues (including constipation, diarrhea, cramping, and bloating), headaches, acne, changes in mood, an increase in sugar cravings, the return of joint pain, low energy or fatigue, a change in sleep quality, or a return of medical conditions or symptoms are all signs of a food intolerance. The response may be delayed and may not be as obvious as an allergic reaction (such as itching, swelling, hives, or anaphylaxis). This method of finding food intolerances is much more reliable than a food allergy test.

Common foods that that people have intolerances for are Gluten, Dairy, Soy, Eggs, Corn, Peanuts, Sugar and Artificial Sweeteners

I want to thank Ben Greenfield for giving me the idea to white this blog post. He discussed this topic on a recent podcast and I was inspired to share some of the information with my readers.

While losing weight can lead to a longer, healthier and more satisfying life for most people, you must be careful not to compare yourself to others. Everyone’s body is different. You know if you are overweight or suffer from chronic pain, fatigue, sleep disorders or any other symptom that can result from carrying too much weight. Make the choice to lose weight the right way by eating foods as close to their natural state as possible. But don't let it rule your life. Eating disorders are very serious and the number of people suffering from Orthorexia (condition that includes symptoms of obsessive behavior in pursuit of a healthy diet) is on the rise. Be smart about your weight loss and you will be able to maintain it for the rest of your life.