Each November the Gallup news organization conducts a weight loss poll. The results over the past decade have been very consistent – six out of every ten Americans would like to lose weight. Most of the others want to maintain their current weight; less than five percent want to gain weight.

When Americans speak of weight loss they almost always mean loss of body fat. Likewise, the term “weight control” means control of excess body fat. When I use the terms “weight loss” and “weight control” in this article it is important to recognize that I am referring to loss and control of body fat rather than overall body weight.

Athletes who spend hours working out in the gym are not doing so to lose weight; they are seeking to build muscle, something that typically results in weight gain. When the percentage of body fat is low, weight becomes irrelevant.

Determining body fat percentage is difficult. It is much easier to measure weight and height and convert those numbers to what is called the body mass index (BMI), a figure that is often misleading.

Many people who want to lose weight do not need to do so and would be better off maintaining their current weight. In my January 2008 article on ideal body weight I explained why the BMI standard used in the United States to determine desirable body size is far too stringent and cannot be met by muscular athletes or short women. I showed that people who are classified as overweight by BMI live longer than those who fall into the “normal” or “ideal” category. I also demonstrated that waist to hip ratios were far more indicative of a person’s state of health than weight to height comparisons.

There is a huge demand for products and services that promote weight reduction. The weight loss industry in the United States boasts over $40 billion in annual revenue. Unfortunately, money invested in weight loss aids rarely pays long-term dividends. Success is short-lived. Half of those who embark on a weight loss program are back to their initial weight within a year. Ninety-seven percent have found all of the pounds that were lost and are at or above their starting weight within five years. Clearly, achieving and maintaining a healthy body weight is not easy.

It is commonly said that the formula for successful weight loss is simple. One just has to observe the two Es: eat less and exercise more. The importance of eating less is found in the Talmud, “In eating, a third of the stomach should be filled with food, a third with drink and the rest left empty.” The need for exercise in a weight control plan is seen in the sage advice of Winne the Pooh, “A bear, however hard he tries, grows tubby without exercise.”

In regard to the two Es, it is commonly taught that weight control is a matter of simple mathematics. It is assumed that body metabolism is a constant. That being the case, one pound of fat contains 3,500 calories. Walking one mile consumes 100 calories. Therefore, walking one mile a day for one year will result in a weight loss of just over ten pounds. (100 calories/day X 365 days = 36,500 calories. 36,500 calories divided by 3500 calories/pound = 10.4 pounds.)

Alternately, one could simply choose to eat less. An advertisement for a meal replacement product a couple of years ago began with the statement, “If everyone would simply eat one meal a day of less than 100 calories our nation wouldn’t have a weight problem.”

Unfortunately, metabolism is not a constant and body weight is not subject to the laws of mathematics. I have known many individuals who have undertaken an activity program only to gain weight. One need only consider the fact that nearly a third of the population routinely skips breakfast to disprove the “one meal a day of less than 100 calories” theory.

Clearly, successful weight management is neither easy nor simple. Consider the example of Israel “Iz” Kamakawiwo’ole, the Hawaiian musician who died of morbid obesity at the age of 38. He and many others have tried unsuccessfully to attain a healthy body weight through supervised diet and exercise. The formula for successful weight control is more complex – much more. Among the factors influencing body fat percentage are crash dieting, drug use, vitamin and mineral deficiencies, sleep disturbances, chronic stress, addition, insulin resistance, thyroid challenges, and leptin resistance. These are barriers to weight control that must be addressed if one desires to achieve lasting results.

Crash dieting is defined as consuming less than 1200 to 1500 calories daily. Doing so triggers a decrease in the body’s metabolic rate that is difficult to reverse.

Thyroid hormone plays a major role in determining the body’s metabolic rate, the rate at which fat stores are burned for energy. The storage form of thyroid hormone in the body is called T4. Under normal circumstances T4 is converted to T3, the primary active form of thyroid hormone, at the tissue level. T4 can also be converted to the mirror image of T3, which is called reverse T3 (RT3). Reverse T3 is inactive.

In times of famine the body can conserve body fat and energy by converting T4 to RT3 rather than T3. Since the active form of thyroid hormone is not being produced, the metabolic rate slows increasing the chances of survival until food once more becomes plentiful. Unfortunately, the body cannot tell the difference between a forced famine due to a shortage of food and the voluntary famine of a crash diet.

When someone goes on a crash diet he or she initially experiences rapid weight loss. As the diet continues, however, the rate of weight loss slows as the body shifts to an energy conservation mode. When the crash diet is stopped and normal eating resumes the body does not automatically return to its former metabolic rate. It continues to produce RT3 at a higher rate than before the “famine” began. As a consequence, the crash dieter typically finds himself weighing more following the diet than he did before the diet started.

If the person goes on another crash diet the body will often respond by converting a higher percentage of T4 to RT3 to conserve energy for the next anticipated famine. Repetitive crash dieters have great difficulty attaining and maintaining healthy body fat ratios. A program of intense physical exercise is the most effective means of restoring normal metabolism, but it takes time. Many become discouraged and give up before achieving their objective.

Many drugs promote weight gain. The mechanisms by which they do so are complex and not well understood. In many instances the increased weight will persist when the drug is discontinued. It is therefore important that alternatives to drug use be considered before the medication is started.

Psychiatric drugs are among the most notorious for causing weight gain. This is true of nearly all antidepressants. Bupropion (Wellbutrin) may be an exception, although some users report weight gain with it as well. The weight gain is often substantial. Some studies have reported an average weight gain of between 15 and 20 pounds over time. I have known many individuals who have gained over fifty pounds as a direct result of taking an antidepressant medication.

Antipsychotics, which have traditionally been prescribed to control conditions such as schizophrenia, cause incredible amounts of weight gain. A 2008 study published in the Journal of the American Medical Association found that children and adolescents gained an average of 1 ½ pounds per week while on the medications. Weight gain can occur rapidly; a 15 % increase in body weight can occur in the first three months of use

This is particularly alarming when one recognizes that the drugs are no longer limited in their use. A new generation of antipsychotic agents, including Abilify, Risperdal, Seroquel, and Zyprexa, are being prescribed with increasing frequency. The four drugs had combined sales of over $12 billion in 2007 and sales have continued to rise over the past two years. In addition to schizophrenia, they are being prescribed for bipolar disorder, depression, autism, attention deficit hyperactivity disorder, and other behavior disorders. .

Anticonvulsants also tend to cause weight gain. As in the case of antipsychotic medications, anticonvulsants are increasing being prescribed for conditions unrelated to their primary indication of controlling seizures. This is particularly true of carbamazepine (Tegretol), divalproex (Depakote), gabapentin (Neurontin), lamotigine (Lamictal), and topiramate (Topamax). Neurontin is prescribed primarily for control of chronic pain, while the others are now commonly prescribed for management of bipolar disorder, control of migraine headaches, and as add-on drugs in the management of depression.

I am alarmed that eight of the top twenty drugs in the United States by sales volume are psychotropic agents (antidepressants, antipsychotics, and anticonvulsants). Depression, anxiety, and schizophrenia are real illnesses and should be treated, but those illnesses alone cannot account for the widespread use of these drugs.

I believe that psychotropic agents have become the “go to” drugs of choice when physicians don’t know how to successfully restore the health of a patient. It is easier to write a prescription for a mood-altering drug than it is to continue looking for the underlying causes of conditions such as fibromyalgia, irritable bowel syndrome, premenstrual syndrome, or persistent fatigue. The price paid by those who take the medications is high, however, as the changes in metabolism triggered by the drugs do not automatically reverse when they are stopped.

If your physician hands you a prescription for a psychotropic agent I encourage you to look for a different answer to the challenge you are facing. In many, if not most, instances the solution lies in correcting a condition that is not a politically correct diagnosis in mainstream medicine. Imbalances in the body’s flora (micro-organisms), thyroid abnormalities, nutritional deficiencies, adrenal fatigue, and energetic challenges are rampant in our society, but these conditions are never recognized or corrected by physicians schooled only in diagnoses and treatment measures that are profitable to the pharmaceutical industry.

Corticosteroids, such as prednisone, can cause substantial weight gain within days. This is most noticeable in the face, on the back of the neck, and in the abdomen. People who take cortisone-like drugs by mouth or by injection can often be recognized by the roundness of their face, a feature referred to as a “moon face”. Corticosteroids are often prescribed for short – 10 to 14 day – courses. Weight gain in this case is generally mild and reverses quickly once the drug is stopped. Longer-term use of corticosteroids is usually reserved for severe, life-threatening or disabling conditions. Nevertheless, it is worth seeking a second opinion before embarking on a prolonged course of steroid treatment.

Nearly all diabetic medications, including insulin, tend to cause weight gain. Ironically, as weight increases it becomes more difficult to control the underlying disease. This can create a vicious cycle in which the drug regimen causes weight gain, which leads to a need to increase the dose of the drug, which promotes even greater weight gain.

Fortunately, some of the newer drugs including metformin (Glucophage) and sitagliptin (Januvia) do not cause weight gain. Another, exenitide (Byetta) actually encourages weight loss. Januvia and Byetta are significantly more expensive than older diabetic drugs, but the absence of weight gain may result in better diabetic control and fewer complications over time, making the investment worthwhile.

Birth control pills are commonly thought to trigger weight gain, but studies have failed to demonstrate any significant weight gain with oral contraceptive use. The injectable birth control agent, Depo-Provera, does cause weight gain in many women. It is reported that approximately 70 percent of those using Depo-Provera gain weight at least five pounds over the course of a year. A weight gain of ten pounds or more is not unusual.

One other family of drugs is associated with significant weight gain. Beta blockers are drugs that are widely prescribed for the management of high blood pressure. They are also commonly prescribed to lower the risk of a heart attack. Beta blockers have been shown to reduce the rate at which the body burns calories by up to ten percent. They also reduce fidgeting, which further reduces the amount of energy spent during the course of the day. This can result in substantial weight gain in people using the drugs. In most instances, an acceptable alternative to beta blocker therapy is available, and should be sought.

Vitamin and mineral deficiencies often present a barrier to weight control. They do so by causing an insatiable craving for refined carbohydrates (sugar and starches). An abnormal appetite for substances is called pica.

Pica is often due to iron deficiency. This presents most commonly during pregnancy. I was taught in medical school that women in the Deep South often ate red clay during pregnancy. The craving for red clay was due to iron deficiency. The body saw the red clay as a potential source of iron and created a desire for it. The most common presentation of pica due to iron deficiency today is a craving for ice, something that happens quite frequently during pregnancy.

Carbohydrate craving is a form of pica. Wheat, rice, sugar cane, and beets are rich in B vitamins and minerals such as magnesium, chromium, and vanadium. Those nutrients are required by the body to process the sugars and starches the foods contain. Unfortunately, those foods are usually “refined” before being consumed. The refining process strips away the vitamins and minerals and leaves behind granulated sugar, white flour, and white rice. A few B vitamins are sometimes added to the finished product, which is then labeled “enriched” even though it is, in fact, impoverished.

When refined sugars, flours, or grains are eaten, the body looks for the vitamins and minerals that should accompany them. When it fails to find them it creates an appetite for the foods that should normally contain the missing nutrients. Eating more refined food creates an even greater demand for the needed vitamins and minerals. Intense carbohydrate craving develops, which often leads to substantial weight gain.

Dietary iodine content declined dramatically over the last two decades of the twentieth century. A decrease in the iodine content of bread appears to have been a major factor. Prior to 1980, bread makers routinely used iodine in their recipes, as it made the bread easier to knead. In 1980 most commercial bakers abruptly discontinued this practice, apparently due to concerns about iodine toxicity. In subsequent years potassium bromate has been commonly used. Bromide and iodide are in the same chemical family and therefore compete with each other for absorption. This means that the changes in commercial bread recipes had a duel impact on iodine levels. One of the most significant sources of dietary iodine lost and a competitor was introduced that limited the body’s ability to absorb iodine from other sources. It is worth noting that chlorine and fluoride, which are added to the water supplies of many cities, also reduce iodine absorption.

The change in dietary iodine content has led to widespread iodine deficiency in the United States. This is rarely recognized, as it is assumed that iodized salt provides adequate dietary iodine. Salt, however, is sodium chloride. Chloride, like bromide, completes with iodine for absorption, and since it is a smaller molecule it has an advantage.

Iodine is critical to thyroid function. Since the thyroid gland plays a major role in the regulation of metabolism, inefficient thyroid hormone activity will cause progressive weight gain. I believe that declining iodine levels have played a major role in the increased incidence of obesity in the United States.

Crash dieting, drug use, and vitamin and mineral deficiencies are some of the barriers to weight control, but many more exist. I will address others next month, and this series of articles will conclude with a strategy for successfully eliminating the barriers so that long-term weight control can be achieved.