Chronic illness, autoimmune diseases, sickness, and health struggles in general can do a number on our weight and self image.
Being transparent, I have experienced both unwanted weight loss and gain, multiple times at different points with my health. This has not only been difficult for me physically, but mentally and emotionally as well. Especially as these weight fluctations started only a year or two after recovering from the eating disorder I had in high school.
I didn’t have very long to establish a healthy relationship with food or my body before my progress came crashing down, and I know many people can relate to this experience.
If you are tired of:
- Hearing comments like “Eat less, move more”, “Calories in, calories out”, or “You are what you eat”
- Feeling like your body is the enemy and you’re constantly fighting it
- Being overwhelmed by your relationship with food, weight fluctations, and body in general
Then this two-part post series is for you!
We’re going to do a deep dive into the many individual factors that may be contributing to your weight gain, and how to address each component holistically, so you can:
- Help your body heal
- Truly nourish yourself
- Restore your relationship with food and your body
- Reach your body’s healthy set point weight
Let’s go!
How to Understand Weight Gain from a Holistic Perspective – What Nuanced Factors Are Involved?
At its core, the popular saying “Calories in, calories out” is true. If you are taking in more energy (calories) than you are burning, your body stores the excess energy as fat. In order to see weight loss, you must take in fewer calories than you are burning.
What most people don’t understand, however, is just how many biological factors are involved in the amount of calories a person takes in and burns in a day. If even one or two factors are “off”, losing weight can become extremely difficult to impossible.
It can be so frustrating to feel you are doing everything right to lose weight, only to see no results.
1. Genetics
Certain genetic variants can cause a predisposition towards an effecient (slower) metabolism, which requires fewer calories than average to perform essential body functions. Having a lower Base Metabolic Rate (BMR) than average for your biological sex, height, and weight, can create a disconnect between the amount of calories your body is burning at rest, the amount of nutrients your body needs, and your hunger and fullness signals.
Genetics can also be involved in the amount of hunger hormone (ghrelin) and fullness hormone (leptin) your body naturally produces. A greater than average amount of ghrelin will make you experience more frequent and intense hunger, while a smaller than average amount of leptin will make it more difficult to get and stay full.
For some people, genetics account for as little as 25% percent of their predisposition to a certain weight, while for others, genetics account for up to 70-80%.
2. Biological Sex and Body Composition
In the United States, women are about 6 inches shorter than men on average. The taller you are, the greater your BMR will be. Consequently, the shorter you are, the lower your BMR will be.
Men also have a greater percentage of lean body mass and a lower percentage of body fat compared to women, who require more body fat for reproduction and hormone regulation. According to the American Council on Exercise, a healthy body fat percentage for women who are not athletes falls between 21-31%. For men who are not athletes, however, the healthy range is lower at 14-25%.
Muscle tissue burns more calories than fat tissue, so women’s higher body fat percentages further reduce their BMR compared to men.
Having a lower BMR doesn’t mean you will be less hungry and get full more easily, however. Ghrelin and leptin are influenced by many factors, so women may have a more difficult time getting and staying full on a smaller amount calories. It can also be more difficult to get enough complex carbohydrates, healthy fat, protein, vitamins, and minerals while consuming a smaller amount of calories per day.
Interestingly, women burn approximately 100-300 calories more per day than their usual BMR during their luteal phase, the second half of their menstrual cycle. As a result, women may need more food to meet their energy needs during this time of the month.
3. Diet and Nutrition
Fiber, fat, and protein play a huge role in satiety – the body’s ability to get and stay full.
Our hunger hormone ghrelin isn’t only designed to kick into gear when we need more calories, it’s also designed to send hunger signals when we need more nutrients – complex carbohydrates, healthy fat, protein, vitamins, and minerals.
Likewise, our fullness hormone leptin is designed to kick in not only when we have had enough calories, but when we’ve taken in adequate complex carbohydrates, healthy fat, protein, vitamins, and minerals.
Consuming a lot of energy-dense food that is high in calories, but low in nutrients, and a lack of nutrient-dense food can cause dysregulation of our hunger and fullness hormones. You may be getting more calories than your body needs, but your body will continue to send hunger signals and prevent you from feeling or staying full because your body is deficient in the nutrients it needs.
If you aren’t getting enough complex carbohydrates, fiber, healthy fat, protein, vitamins, or minerals in your meals and snacks, you’re likely to get hungry frequently and not get full easily.
A diet high in refined carbohydrates can also cause blood sugar fluctuations – a blood sugar spike after eating, followed by sudden dip.
This kind of blood sugar roller coster can cause frequent, intense hunger throughout the day.
You could be out of touch with hunger and fullness cues due to a lifetime of dieting or disordered eating habits, or even your upbringing.
Perhaps growing up, your family always ate at specific times of day whether they were hungry or not, and you were made to finish your plate even if you were full. Maybe you weren’t allowed to eat a snack when you were hungry. Perhaps you learned to stuff yourself at meals, because you never knew when you would be able to eat again next.
It’s possible to go your entire life without ever knowing what a healthy amount of food for you looks or feels like.
Another common misconception is that if someone has gained weight, they must be significantly overeating.
It actually doesn’t take much of a calorie surplus at all for weight gain to happen gradually over time. If you’re only consuming an extra 200-250 calories a day than your body needs (equivalent to about 2 Tbsp of peanut butter), you’ll gain around 2 lbs a month. This turns into 25 lbs of weight gain in a year, and in 4 years, you could find yourself 100 lbs heavier than you were before.
In the United States, where highly processed food is readily available and whole, nutrient-dense food is more expensive, it’s easy to get this amount or more of a calorie surplus in your diet without ever having any idea.
At Chick-fil-A, you could get an average-sized meal of a Chick-fil-A sandwich on a regular bun, medium fries, and medium lemonade, and that comes to 1110 calories. More if you add sauce for your fries. That’s over half the amount of calories a typical woman needs in a day, just in one meal. For me, it’s 2/3 of the calories I need in a day to maintain my weight.
In contrast, you could get a similarly-sized meal of a grilled chicken sandwich on a whole wheat bun, fruit cup or side salad (with light dressing), and 1/2 lemonade 1/2 unsweet tea for 550 calories, only half of what the first meal came to. The only thing that would have changed is what you ate, not how much.
4. Health Conditions
A wide array of health conditions can influence metabolism and weight, including:
- Hypothyroidism – Thyroid hormones control our metabolism, so low levels of thyroid hormones slow our metabolism way down
- PCOS – Often involves insulin resistance, excess androgens, a slowed metabolism, and disrupted appetite regulation
- Chronic stress (psychological or physical) – Frequently causes elevated cortisol, subsequent weight gain around the abdomen, and insomnia/sleep disturbances
- Cushing’s Syndrome – A disease in which the body products an extremely high amount of cortisol, sometimes triggered by autoimmunity
- Hypoglycemia – Low blood sugar episodes trigger the body to send frequent, extreme hunger signals to bring blood sugar back up, so people with hypoglycemia often find themselves having to eat a lot, and frequently, in order to feel better
- Insulin Resistance and Prediabetes – Insulin is not able to effectively push sugar in the blood into the cells to produce energy. This sometimes causes the body to exhibit symptoms of hypoglycemia (including frequent, extreme hunger) because cellular energy is low, even though blood sugar is not.
- Depression and Anxiety – Mental illness often causes changes in appetite, including an increased appetite at times
- Poor Gut Health – A gut microbiome imbalance, called gut dysbiosis, can affect how the body processes food, stores fat, and regulates hormones, all of which can lead to weight gain. Altered gut motility, nutrient malabsorption, and inflammation are often factors, as well.
- Inflammation – Chronic inflammation interferes with metabolic processes, hormone regulation, and appetite control
- Poor Mitochondrial Health – Mitochondria, known as the “powerhouses” of our cells, are literally the mechanism through which our bodies create energy from the food we consume. When mitochondrial function becomes compromised, this can lead to lowered energy output, increased fat storage, and general metabolic dysfunction.
- POTS/Dysautonomia, EDS, Asthma – Conditions like these place limits on physical activity, so often they can cause reduced muscle mass and a lower Base Metabolic Rate
- Metabolic Damage – A lifetime of yoyo dieting and calorie restriction can cause your metabolism to get significantly more efficient at performing basic bodily functions on a subpar amount of energy/calories (ie. slow down a LOT)
- Disordered Eating – Long term restrictive dieting impacts the metabolism by making it more effecient, so our body can perform essential functions with less energy (as a response to constantly restricted energy intake). Once your metabolism is slower, it becomes more difficult to lose or maintain weight on what would be a healthy amount of calories for you.
Before you assume the above health conditions are rare, consider these statistics:
Between 5%-20% of women, depending on age range, have Hypothyroidism. About 80% of Hypothyroidism cases are found in women, while 20% are found in men.
5-15% of women have PCOS. Up to 70% of affected women remain undiagnosed.
Approximately 40% of the American population is insulin resistant.
Up to 24% of women and 11% of men in the United States report having been treated for depression.
32.7% of American women and 24.4% of men report having anxiety symptoms, while 23.4% of women and 14.3% of men report a lifelong anxiety disorder.
In 2023, Gallup News found that 53% of women and 45% of men in the United States reported feeling chronically stressed.
65% of American women between the ages of 25 and 45 engage in disordered eating habits.
If you take a weight-first approach when you are struggling with one or more underlying health conditions, you are likely to face an uphill battle and may end up in an even worse state of health than before.
5. Medication
Several types of medication such as Antidepressants (commonly SSRIs or SNRIs), Corticosteroids (used to treat autoimmune diseases), Antipsychotics (can also treat severe anxiety, balance disorders, and nausea), Diabetes medication, Anticonvulsants (such as Gabapentin), Beta-blockers, and certain Antihistamines have been shown to cause weight gain.
6. Lifestyle
Maybe you are out of touch with hunger and fullness cues due to a lifetime of dieting or disordered eating habits.
Perhaps you struggle with emotional eating (using food as an emotional reward, for endorphins or a domapine hit, in an imbalanced way).
You may be accustomed to using food as a reward or for meeting an emotional need that would otherwise go unmet.
Maybe you’re chronically stressed, experiencing poor sleep, or you find it difficult to stay hydrated.
It’s possible to struggle to build or maintain a healthy lifestyle for a number of reasons:
- Struggling with a lack of time
- Experiencing a lack of money or resources for healthy food
- Having limited cooking skills
- Struggling with lack of energy or bandwidth
- Having a busy schedule or heavy workload
- Struggling with the taste or texture of healthy food
- Using unhealthy coping mechanisms in place of healthy habits and addressing the root cause
- Struggling mentally
- Having an unsupportive community
Multiple factors can layer one top of one another to push someone into overweight or obesity, where one factor alone might not. For example, someone with a genetic predisposition to a lower weight may get Hypothyroidism and not become overweight or obese, but for someone with a genetic predisposition to a higher weight, developing Hypothyroidism on top of that may push them into overweight or obesity.
How can you be there for a friend or family member who is struggling with their weight?
A gentle reminder for us all is to have compassion towards people who are struggling with their weight, regardless of whether you know them personally.
Diet culture messaging can be so toxic. At points when I have been my most unhealthy – battling Anorexia Nervosa in high school or losing 20 lbs unintentionally in only a few months due to Celiac Disease and becoming underweight for years, etc. are when I have received the most compliments on my appearance. People gushed about how skinny and photogenic I was and how lucky I was to be able to “eat whatever I want” and never gain weight.
People who have struggled with overweight or obesity are often congratulated on any weight loss, even if it is due to an eating disorder that’s ruining their health or a severe, devastating illness like cancer. And sadly, they’re looked down upon even if they may be living their healthiest lifestyle yet, but haven’t achieved the “skinny” body diet culture says we must attain in order to be acceptable.
Whether it is due to diet/nutrition, lifestyle, health conditions, mental health, medication, genetics, lack of resources, or a combination, struggling with overweight or obesity is HARD. Trying to make changes and lose body fat is HARD. Never assume someone with overweight or obesity has not tried or isn’t trying to make changes.
People who are struggling with their weight are constantly bombarded with harmful societal messages, such as that they are lazy, unmotivated, undisciplined, gluttons, failures, worth less due to their size, an inconvenience, people to be ridiculed. That they don’t deserve to have models who represent people their size, clothing that fits them, access to fashionable clothes, or to look and feel beautiful, etc.
You don’t have to perpetuate these harmful lies.
Understand that people are not generally motivated by being “called out”. Much of the time, what you think they need to be “called out” on is probably not accurate. You never know what someone is going through until you’ve walked a mile in their shoes.
