Obstacles to Weight Loss
By Erica Zelfand

When Obesity isn’t a Choice, and Kale and Crossfit aren’t Enough

It’s no secret that Americans are big. We’re the fattest people in the world.
…And it’s a legitimate health issue. Obesity is, in and of itself, a disease, according to the World Health Organization (WHO). We are dying from diabetes and heart attacks – diseases that would seldom happen if we put down the Bryer’s and ran a few laps.

Yet every week in my practice I work with new patients who are hitting the gym, drinking water, eating their veggies, and are still overweight.
It is isn’t because they’re lazy. Or uninformed. Or doing something wrong.

Exercise and a clean diet can be dramatic game changers, yet when there are underlying health imbalances, weight loss still won’t occur.


Here are some of the conditions I commonly see that can make it very hard for people to lose weight:


Hashimotos / Hypothyroidism:

The thyroid gland sits at the front of the neck and controls metabolism. When it becomes weak or diseased, metabolic function significantly slows, making it very hard to get up off the couch and expend energy. Even when those with hypothyroidism do work out, their sluggish metabolisms can it very hard for the body to drop pounds.


Adrenal Fatigue/Insufficiency:

The adrenal glands produce cortisol and sex hormones, both of which give us energy. Often those with adrenal fatigue feel too tired to exercise because of a deficiency in the production of these hormones. Well-meaning friends and under-informed doctors might tell these people to just set an alarm and force themselves to exercise, thinking this will “jump start” the metabolism and help these people feel energized by a workout. But this can actually be harmful, as it exacerbates the adrenal burnout, much like whipping a tired horse. Those with adrenal fatigue tend to feel even more tired after exercising. What these people need is rest, and to have others stop judging them for it.


High Stress Levels, Not Enough Sleep, and Night Shift Work:

When stress is high, so is a chemical called cortisol. In the presence of cortisol, the body holds onto sugar, and guards its fat stores. This is why workaholics often have what I call a “cortisol belly” – a belly that sticks out like a pregnant belly (or they can just be generally overweight). Furthermore, when we’re under stress, our bodies think we’re in famine, making us crave high-calorie foods.


Low Testosterone:

Testosterone helps the body burn fat and build muscle mass. Testosterone levels decline normally as we age, but a growing number of men (and some women) bottom out earlier in life and notice fatigue, decline in sexual performance, depression, and/or trouble losing weight.


Type II Diabetes Mellitus:

After meals, the pancreas normally produces a signaling molecule called insulin, which helps move sugar out of the bloodstream and into the cells where it can be used to make energy. In Type II Diabetes, however, the cells ignore the insulin signal, in a phenomenon known as insulin resistance. This results in higher levels of both sugar and insulin floating around in the blood. Insulin inhibits the breakdown of fat, making it very easy for Type II Diabetic to become obese. Thankfully, eating healthy and exercising are excellent ways to reverse insulin resistance and treat diabetes. But the weight loss can sometimes be slower in these individuals than in the general population, because of the insulin resistance piece. This is even more so in the case of those diabetic who must inject themselves with insulin to stabilize their blood sugar levels.


Polycystic Ovary Syndrome (PCOS):

PCOS is a complicated condition resulting from a hormone imbalance in women. It is both genetically and environmentally influenced, and often ineffectively managed by conventional medicine. As with diabetes, insulin resistance is a hallmark of PCOS, making it extremely difficult for these people to lose weight, even when they eat a perfectly clean diet and exercise daily.


Cushing’s Syndrome:

In this condition, too much cortisol is present in the body. This can be a result of a tumor, of overuse of prednisone and other steroids, or from an adrenal gland imbalance. This results in fluid retention, rounding of the face, and fat deposition on the abdomen. Kale and crossfit will not cure this problem alone!


Chronic Pain, Chronic Fatigue Syndrome (CFS), and Neuro-Degenerative Disorders:

People living with chronic pain or chronic fatigue are among the most misunderstood. When movement hurts, when it’s hard work just to leave the house, and when even cutting up an apple is a task, it’s simply a matter of time before health becomes compromised in other ways. Obesity is but a symptom. When the body is focusing on just holding on to basic functions, burning fat is at the bottom if its priority list.


Stealth Infections:

If there is a smoldering infection anywhere in the body – from a root canal to undiagnosed Lyme disease – the body will hold on to extra weight.



Although most women lose weight when breastfeeding their young – especially when they do so past 6 months – some women idiosyncratically gain weight and cannot lose it until after weaning. This can be normal.


Food Intolerances:

Thanks to GMOs and environmental toxins, our guts are much more sensitive than they were for our grandparents’ generation. This has resulted in a growing number of food intolerances, which can contribute to us being underweight or overweight, depending on the person. After removing gluten from his diet, I once had a friend tell me, “Turns out I wasn’t fat at all, just really bloated!” In general I notice that once my patients cut out their identified food intolerances that they look much less “puffy” and burn body fat easier.


Pharmaceutical Medications:

Weight gain is a side effect of many, many medications, including antidepressants, diabetes drugs and insulin (ironically), blood pressure drugs, and prednisone.


Everybody can benefit from movement and a clean diet.

Indeed, I’ve cured patients of diabetes through nutrition and exercise alone, without the use of a single pharmaceutical.

That being said, the body of somebody living with one or more of these conditions might be slower to drop pounds than the body of somebody who isn’t working with these challenges.

My approach to healing incorporates a whole-person philosophy. Once we correct the underlying imbalance, the body begins to heal itself and usually the pounds come off on their own.

But cosmetic appearance isn’t my top priority for these patients. Health is. Feeling good is. Body size is just a symptom.