‘Eat less, burn more’ may not always work for weight loss

Published on Saturday, June 1, 2024

By: Rachel Vanderford, rvanderford@umc.edu

As swimsuit season approaches, many may find themselves trying to shed a few pounds in pursuit of their ideal “beach body.”  

However, some might find that the hurdle to losing weight may present as more of a challenge than what mere willpower can overcome. While it is often depicted as a simple equation of calories in versus calories out, the reality is that losing weight is more complicated than that. 

“What I think people should know is that it’s not as simple as ‘eat less, exercise more,'” said Dr. Elizabeth Fryoux, obesity medical director and lead physician for the Cardiometabolic Center at the University of Mississippi Medical Center. “It’s way more complicated than that. It is very hard. Obesity is a chronic disease that needs chronic management. And people shouldn’t be afraid to reach out for help—that's what we’re here for.”  

You may know that socioeconomic factors such as lack of access to affordable, healthy food and safe, walkable neighborhoods can contribute to weight gain. But did you know that your body can also work against your efforts to slim down? 

According to the CDC, in 2018 roughly 70% of adults in the United States aged 20 years or older were overweight (33.9%) or obese (36.3%), with the highest prevalence in the South and Midwest regions. Globally, approximately 55% of increases in BMI can be attributed to rising BMI in rural areas, where distances between residences are farther from supermarkets, health care facilities and recreational opportunities. 

Mississippi has the second highest rate of adult obesity in the nation at 37.3%. The state’s obesity rate is also a contributing factor to its high rates of type 2 diabetes, coronary heart disease and stroke, hypertension, arthritis and obesity-related cancer.  

Between the vast amount of highly processed foods, larger than life serving sizes, the plethora of sugary-sweet beverages, and fast-food restaurants on every corner, maintaining a nutritious diet can be challenging. With limited access—whether physically or economically—to healthy food, individuals are often forced to rely on cheaper, processed alternatives that are high in sugar and fat.  

More than just having access to proper nutrition, the stressors associated with financial instability, perceived lack of safety, and other socioeconomic factors can trigger emotional eating and disrupt sleep patterns, both of which are detrimental to weight management. Studies have shown that individuals facing economic hardship are more likely to experience chronic stress, which can lead to hormonal imbalances and increased cravings for comfort food that is high in calories.  

“When you’re chronically stressed, your cortisol levels are elevated,” said Fryoux. “High cortisol levels in the body contribute to weight gain in many ways but put simply: it makes your body hold onto fat, making weight loss very difficult.” 

Biological factors wield considerable influence over weight loss outcomes. The body is an intricate balance of genetic predispositions, hormonal fluctuations, and metabolic variations, all of which play pivotal roles in determining an individual's ability to shed excess weight.  

Certain gene variants have been linked to obesity and metabolic disorders, making weight loss a difficult feat for those genetically predisposed to carrying extra pounds. Also, hormonal imbalances, such as insulin resistance and thyroid dysfunction, can sabotage weight loss efforts by altering metabolism and promoting fat storage.  

Among some of the more common medical conditions that can lead to excess weight gain are hypothyroidism, polycystic ovary syndrome, Cushing’s syndrome, sleep apnea and mental illnesses such as depression and anxiety. Prader-Willi and Bardet-Biedl syndromes, though rarer diseases, are two examples of single gene mutations that can cause weight gain. 

Even without a genetic disease or hormonal disorder, when it comes to trying to lose weight, the body is enduring a constant game of tug-of-war. A disruption of the hormone ghrelin, which stimulates hunger, and leptin, which reduces appetite, is just one of the known biological hinderances to weight loss.  

“It’s a vicious cycle,” said Fryoux. “When trying to lose weight, ghrelin levels can increase, driving hunger, while leptin levels may decrease, causing you to feel hungry more often. You can also have leptin resistance. Elevated ghrelin levels may signal the body to conserve energy by slowing down your metabolism. Decreased leptin levels can reduce your body’s ability to regulate your energy expenditure, which also leads to a slowed metabolism.” 

When your metabolism slows down, it’s not only more difficult to burn calories efficiently, but it can also make you tired and feel less enthusiastic about hitting the gym.  

“If you have insulin resistance, instead of bringing the sugar into the cells to use as energy, the sugar just stays in your bloodstream to be stored as fat instead,” Fryoux said. “You can have adipose tissue dysfunction, in which the dysregulation of adipocytes, or fat cells, can lead to a variety of metabolic disorders. Studies have shown that the gut microbiome also plays a huge role in gaining and losing weight.  

“Sleep deprivation is also a big one,” she said. “If you’re not getting enough sleep, it’s hard to lose weight. But also, if you’re overweight, it’s harder to get good sleep. It’s a big circle. There’s just so many things that go into it and we’re still learning more every day.” 

UMMC Weight Management encourages lifestyle changes such as eating more whole foods, exercising regularly, and adopting habits for better sleep. Fryoux recommends that her patients journal what they eat and incorporate moderate aerobic activity into their routine. Creating attainable goals can also reduce stress by providing a sense of accomplishment and satisfaction. In addition to lifestyle management, the clinic offers pharmaceutical and surgical treatments for weight loss. 

For more information or to schedule an appointment with UMMC Weight Management, call 601-984-1285 or go online here.

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