Losing weight is easier than maintaining weight loss - this is due to the complex relationship between hunger, Leptin and Ghrelin
There are real scientific reasons why weight maintenance is more difficult than loss, and it has very little to do with will power or exercise - and everything to do with your body signalling it needs calories. Unfortunately (or fortunately) - surgical intervention is the only current manner to consistently change your hormonal profile long term
Being obese creates a series of hormonal changes that last beyond the weight gain and weight-loss phase.
The more you understand what those changes are, the better you can maintain weight loss. Sadly, approximately 1% of persons with a body mass index over 30 maintain weight loss long term.
Consider this graphic and make an honest assessment of your current stage. If you continue to gain weight
Leptin resistance will increase, causing long term inability to be full
Common cofactors like bad knees, hips or back become more prevalent, making matters more difficult
Comorbidities like diabetes and blood pressure become imminent, again making it harder
Weight gain in our current society where time and resource is low is completely understandable, read below if you are already obese and worried about next steps
Long term studies give even lower odds
“During a maximum of 9 years’ follow-up, 1283 men and 2245 women attained normal body weight. In simple obesity (body mass index = 30.0–34.9 kg/m2).
The annual probability of attaining normal weight was 1 in 210 for men and 1 in 124 for women.
The annual probability decreases to 1 in 1290 for men and 1 in 677 for women with morbid obesity (body mass index = 40.0–44.9 kg/m2).”
Home American Journal of Public Health (ajph) September 2015 Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Recordsource
Ozempic? Why doesn’t it work for everyone
If GLP1-RAs (ie, Semaglutide: Ozempic, Wegovy, Dulaglutide: Trulicity) were successful for you during use, but the weight was gained back, this is very normal.
GLP-1 RAs have multiple effects: These medications effect appetite, slow stomach emptying, and influence hormones that regulate hunger and satiety. When you stop taking them, these effects diminish.
The largest long term study to date showed: One year after the withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss: source
This level of weight gain often continues until the person is at or more than their original weight.
The facts about your long term choices
Gastric Bypass: Reduces stomach size and alters digestion. Leads to 35-50% total body weight loss, with maintenance possible long-term. Significant health improvements, but includes surgical risks. These risks have become much smaller with advances in the last 5 years. Longer hospital stay - usually for persons the need drastic change
Gastric Sleeve: Reduces stomach size and alters hormones. Leads to 25-35% total body weight loss, with maintenance possible long-term. Significant health improvements. Low surgical risks, and minimal hospital time.
GLP-1RAs + Surgical Intervention: This reduces surgical risks and allows the person to have improved results. This is often suggested in modern practices. Leads to Surgical weight loss + 10-15% additional weight loss, with maintenance possible long-term. Significant health improvements, with reduced surgical risk
GLP-1RAs: Mimic a natural hormone, reducing appetite and improving blood sugar. Results in 10-15% weight loss, but requires ongoing medication for maintenance. Improves health, less invasive than surgery, but can have side effects.
Lifestyle Changes (Diet & Exercise): Healthy eating and increased activity lead to 5-10% initial weight loss, and by 24 months this drops to 3-6% total body weight. There are health-associated improvements. Maintenance can be challenging. The least invasive protocol.
There is no shame in needing surgery
Take an opportunity to read why we gain back weight and understand that, in many circumstances its the safest measure to ensure your health. You can’t penalise a future version of yourself for understandable mistakes in calorie balancing.
Of all the interventions, surgery has shown the best long term results. Read more about it here