It’s Not Just Willpower: How Hormones Can Affect Your Weight

By Ashlyn Smith, MMS, PA-C, DFAAPA, LSC

ELM Endocrinology & Lifestyle Medicine

Have you felt frustrated by your weight despite doing “everything right?” If so, you are not alone and it isn’t in your head. Managing weight is complex, with hormones playing a major role. At ELM: Endocrinology and Lifestyle Medicine, we take your concerns seriously and develop a compassionate, root-cause approach to understanding weight concerns beyond the scale and BMI.

Beyond BMI: Metabolic health evaluations depend on more than just the scale.

No Longer Calories In, Calories Out

Most of us have heard, “You just need to move more and eat less.” This approach (however well-meaning) is outdated. Yes, nutrition and physical activity are important and should be incorporated to managing all metabolic conditions including overweight and obesity. However, factors such as biology, genetics, environment, psychology, and past dieting history all play a role in balancing weight. For many people, there can be a hidden driver contributing to weight gain and difficulty losing weight: hormonal imbalance.

Beyond BMI

At ELM, we understand that weight management is more complex than BMI. BMI uses weight and height, which are easy measures to take. However, this does not account for body type of body weight distribution. Someone may have a high BMI but have low fat mass as muscle weighs more than fat. Another person might have a high BMI but a weight distribution in the hips and thighs, which is lower risk than abdominal fat. Low-cost tools such as smart scales are available for home use that measure more than weight, such as body fat percentage, muscle mass, bone mass, and body weight percentage. Many of these tools even integrate with a personal app and can be synced with your healthcare team.  

Importantly, no two people with overweight or obesity are the same. Because weight issues are complex, some individuals with slight excess weight have multiple metabolic conditions while others with significant excess weight may have no metabolic conditions. Investigation into health beyond the scale is essential to understanding your risk and the best treatment approach.

Which Hormonal Conditions Could Be Contributing to Weight Gain?

·       Insulin resistance: A common driver of weight gain that is intertwined with prediabetes, Type 2 Diabetes, and PCOS.

Insulin is a fat-storing hormone. When the body is not responding to insulin appropriately, the body resorts to making more insulin to compensate. While this is a protective mechanism (your body’s way of trying to avoid high blood sugar), the net effect is a high insulin, high fat-storage state. This state can be self-propelling as higher insulin leads to higher weight, higher weight leads to higher insulin needs, and so on.

·       Polycystic ovary syndrome (PCOS): a condition that can affect your female hormones and insulin resistance.

As above, insulin resistance in PCOS can cause unexpected weight gain out of proportion to food intake in addition to menstrual irregularities. Typically, PCOS contributes to increased weight around the belly and can also lead to high androgen symptoms such as acne, increased facial hair, and hair loss. Left untreated, PCOS can lead to infertility, obesity, and Type 2 Diabetes.         

·       Thyroid dysfunction: Low thyroid level can slow metabolism leading to weight gain, high cholesterol, and fatigue.

This can also be self-propelling because when we as humans are fatigued, we often struggle to make healthy food choices and engage in physical activity. Interestingly, sometimes even high thyroid levels can cause weight gain in those who have known or even undiagnosed glucose issues—such as a family history of diabetes or underlying PCOS or prediabetes.

·       Adrenal dysfunction: An emerging underlying cause of weight gain and abnormal glucose.

Several circumstances naturally raise cortisol, such as stress, poor sleep, and illness. Temporary increases in cortisol are unlikely to cause long-term issues. However, when cortisol is elevated over a prolonged period of time, one can see increased abdominal weight, muscle wasting, and high insulin or glucose. Beyond chronic increases in cortisol, underlying disorders can cause high cortisol and be a secret driver of conditions such as insulin resistance and diabetes. The medical community used to think that these cortisol disorders were rare, but we have recently learned that excess cortisol occurs more often than we originally thought.

·       Menopause and andropause: Downward shifts in estrogen and testosterone lower muscle mass, lower bone density, increase fat distribution, and increase the risk of metabolic conditions such as Type 2 Diabetes, high blood pressure, high cholesterol, obesity, and heart disease.

·       Obesity itself affects hormones: Fat tissue itself releases hormonal and inflammatory signals that interfere with the body’s normal weight-regulation systems.

Typically, the hormone leptin helps lower appetite. However, in obesity the body becomes resistant to leptin, leaving appetite abnormally high. That means that your body is telling you that you are hungrier than normal—It is not in your head! Many other hormonal disruptions occur including insulin resistance, increased inflammation causing further metabolic dysfunction, and interference with the main pituitary hormone axis (the “master hormone gland”).

A Comprehensive Treatment Approach

Essential to ELM is a whole-person approach to managing weight. This includes an underlying hormonal and metabolic evaluation, a well-rounded body composition assessment, tailored lifestyle intervention including nutrition and activity as well as other factors such as sleep optimization and stress management, and potentially medications or medical procedures to aid in management. Medications may be aimed at the underlying hormonal disorder, such as thyroid hormone treatment or medications to improve insulin resistance. They may also be aimed at the underlying disease of overweight and obesity itself. Some agents do all of the above. Depending on your specific body type, metabolic condition(s), hormonal disruptions, and risk factors, we will work together to develop an individualized treatment approach

How I can help with weight management

·       I take a whole-person approach to weight management

Excess weight is more than just a check box that we discussed diet and exercise. We will get a true measure of your body composition beyond weight or BMI to understand the true starting point and what our goals need to be. At ELM, I treat overweight and obesity as the medical conditions they are with real underlying drivers that need to be evaluated and addressed.

·       There is no shame or blame

Weight management is a marathon, not a sprint. There will be times where this comes easier than others. There will be times when you feel motivated and others when you feel discouraged. There will be times when you have done “everything right” and progress has stalled, and other times where other priorities have gotten in the way of weight management. This is expected, and this is real life. We will work together to help reduce any negative self-talk and deal with the reality of weight biases in our culture. At ELM, your value is not in your body weight, BMI, or degree of success. You are a whole person managing the complex chronic disease of overweight or obesity.

·       We collaborate on your care plan together

The good news is, you are not in this alone! We will explore your specific needs, wishes, body composition, hormonal status, and metabolic state to truly understand your whole-health picture. We will discuss a comprehensive treatment plan that makes sense for you right now. Maybe that involves big changes like a devoted meal plan and medication intervention. Maybe that involves setting a goal to move for ten minutes each day. Maybe that means first addressing stressors, anxiety, depression, or other barriers that make it difficult to feel like yourself. Maybe that looks like engaging in structured nutrition, exercise, or eating disorder support. Maybe that means first changing the language to treat yourself and your body with love and compassion. Whether the steps are small or big or somewhere in between, they will be tailored to what you need in your journey right now. When those needs change with time, we will work together your plan with attainable realistic goals.

Take Home Message

If you are struggling with weight and feeling frustrated that your efforts to get healthier aren’t working, I hear you and I am here to help you. Hormonal and metabolic health are critical pieces to the weight management puzzle. Tools are available to accurately evaluate your current metabolic health, evaluate contributing factors, establish realistic and relevant steps, overcome barriers, and gain traction toward your health goals. At ELM, we partner with you to uncover the “why,” support the “how” with evidence-based medicine and a compassionate comprehensive approach, and we never forget the “who”— you at the core as a whole person beyond disease or disorders.  

Have more questions about weight management? I am here to help—let’s connect on a free educational consultation to discuss further!

Access additional information on obesity as a disorder from the Obesity Action Coalition.

Disclaimer:

The content on this blog is for informational purposes only and is not intended to provide medical diagnosis, treatment, or replace professional medical advice, diagnosis, or care. Always consult a qualified healthcare provider with any questions regarding a medical condition or treatment.