Why Can't I Lose Weight? The Root Causes Behind Weight Loss Resistance

Colin Renaud, PA-C and Dr. Sasha Rose, ND both said the phrase doing everything right needs a closer look, because it often means doing what you were taught years ago rather than what your body needs today. When the scale will not move, they look at blood sugar and insulin, thyroid function, sleep, stress, gut health, medication use, nutrient status, and muscle mass. Two people can follow the same diet and exercise plan and get different results, because their hormones and body composition are not the same.

Dr. Sasha Rose, ND said chronic stress can raise or disrupt cortisol, which keeps the body in fight or flight mode and makes it hold on to fat stores as a survival response. She also said that in her clinical experience it is rarely the whole answer. Patients often hope a high cortisol result will explain everything, and that can pull attention away from what and when they are eating and how they are moving. Cortisol gets checked when it is appropriate, as one piece of a bigger picture.

Dr. Sasha Rose, ND said one of the very first signs of perimenopause can be weight gain, and that this is not well understood by the general public or by much of the medical community. Many women expect hot flashes and night sweats to come first, but sleep disruption, fatigue, mood changes, and a shift in body composition often show up earlier. She said this can begin in the mid 30s and is common through the 40s, and that the perimenopausal shift can last over a decade.

Colin Renaud, PA-C said muscle mass supports metabolic health and gives the body a way to burn fat naturally. He also said it improves insulin sensitivity. Dr. Sasha Rose, ND added that bone mineral density suffers when muscle mass is too low, along with agility and general mobility. Both agreed that strength training is one of the better forms of exercise for long-term weight loss. Colin put it this way: if you want to live to be 100, be as strong as you can for as long as you can.

Colin Renaud, PA-C said new patients get over 80 biomarkers at their first visit. That covers blood sugar markers such as glucose, insulin, and hemoglobin A1C, thyroid markers, inflammation markers, cholesterol, the sex hormones, cortisol when appropriate, nutrient markers like vitamin D, B12, and iron, and liver markers. Dr. Sasha Rose, ND said the InBody scan adds what the scale cannot show, including water weight, muscle, fat, and visceral fat, which she linked to type 2 diabetes, fatty liver disease, and cardiovascular risk.

A live listener named Rita asked this. Dr. Sasha Rose, ND said it depends on the person and is often about managing side effects, so someone already prone to constipation might need extra fiber or a certain magnesium to keep motility normal. Colin Renaud, PA-C said he often adds creatine for muscle support, and sometimes magnesium, vitamin D, or omega-3 fatty acids, depending on the patient's goals. Both said this is general education and not personal medical advice, so talk with your own provider first.