Brief Answer:
TSH test recommended- some advice on caloric control

Detailed Answer:

Hello,

I understand your concern with the difficulty to lose weight and not regain it back.

Weight gain and its problems are very common and most of the times no specific reason or cause is found but it would be advisable that first you take a thyroid test called TSH to rule out thyroid problems (low thyroid function). When the thyroid is not working well than it is easier to gain weight and very difficult to loose it.

If the TSH is normal than some advises on weight loose and control are based on principles of caloric intake and consumption:

- it is better to do small changes a time- this will help do affordable changes that will not cause major difference in your daily life and will be easier to keep with. This would mean: do not stop all bread if you are having 3-4 slices of bread a meal. It is best to take off 1/4 of the portions (1 slice of bread a meal). Have the habit of taking portions that are only a little smaller than usual (1/4 smaller) and try to keep up with this regularly

- be active- it is important to loose calories we gain during the day. make sure you do activities that can be done walking not using your car but walking. Make sure you have a regular exercise program. it is important to do small changes at a time again. Do small walks every other days, than in 2 weeks increase to a bit longer walks and or quicker walks- do not run into very extensive exercises that you will do for a week or two and than give up. A trainer in a gym setting can help you with this also.

- for more specific advise on how many calories you take during the day and how many you need and how to balance this in the diet a nutricionist would be good to be consulted. He will calculate your basic metabolism based on age and gender and your daily activities and tell you your daily needs for calories. He can also give specific advise on food and their calories and how to combine them so it is better tolerated by you.

- finally- you have to be patient- healthy, easier to maintain weight loss happens gradually and with time so you have to be persistent in calorie intake and consumption calculation and time will reward you with the fruit of your actions.

So to conclude I would say:
- take a TSH test to rule out low thyroid function as a medical condition that makes weight control difficult
- be aware of caloric intake and consumption
- a nutritionists would help calculate your needs for calories in a day and how to adjust your diet so it is bearable and enjoyable but still be effective to loose weight
- a trainer in a gym setting will be a help to work you through the needed exercises so you can have regular exercises but adjusted to your stage of progress
- the first 2-3 weeks of starting an exercise program you might gain a couple of kg, no worries, this is due to protein increase in your muscles, go on and you will loose weight soon
- do small changes at a time and be patient and persistent
- avoid eating outside (as this can make it difficult to have control of caloric intake), avoid fast food (as these have high caloric index)
- fruit and vegetable are filling and have low caloric index but the nutritionist will give you more detailed information
- eat slow, this will help you to fill full and not overeat or feel hungry
- alcoholic beverages have high caloric index, try to avoid excess alcohol use
- drink at least 2 liters of water a day- it is found to help loose weight in some studies
- other methods of weight loss with surgical intervention or use of herbal products that are sold for weight loss can have many side effects and be dangerous while maintaining weight loss is not for sure after stopping the ingredient, so the above measures mentioned are healthy and can give you a stable weight loss if followed rigorously.

I hope this is helpful and answers your questions.

Regards,
Antoneta Zotaj
General & Family Physician

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