Integrative Health Blog

Why Is it So Hard to Lose Weight?

Posted by Denia Tapscott MD on Tue, Apr 23, 2019


The short answer is…..because we assume it is due to excess calories and not enough exercise.

And although these are factors, they are often not THE answer.

It is also not about the total calories but rather, where the calories are coming from.  In other words, what types of foods you are eating.  We can all agree that 200 calories worth of Oreo cookies does not provide the same health benefit as 200 calories worth of broccoli.  In fact, most of today’s current diets have more in common than not.  They are all filled with non-processed, real foods and a variety of colorful fruits and vegetables.  

But what if you are one of those people already on this healthy diet, eating clean and getting in daily activity but still can’t lose weight.  You then have what we call, “resistant weight loss” which is much more complex and best treated through a functional medicine approach as this article will discuss.

Resistant Weight Loss and a Functional Medicine Approach

There are several potential causes of resistant weight loss.

  • Nutritional Deficiencies
  • Insulin Resistance
  • Hormonal Imbalances
  • Stress
  • Toxins
  • Gut Infections and Food Sensitivities

Nutritional Deficiencies

The body requires specific nutrients to function.  This is essentially why we eat.  In order to help make energy to burn fat we need fuel which comes from phytonutrients, vitamins and minerals in the foods that we eat.  There are many reasons why most of us are lacking in at least one (but often times more) vitamin or mineral.  One widespread factor is incomplete digestion of our food.  This stems from an eating pattern of quick on the go meals, inadequate mastication (chewing) and eating while we are in a fight or flight mode instead of a parasympathetic state of rest and digest.  As we age, our digestive enzyme production also declines, even if you are not on anti-reflux medications.


  • Increase colorful vegetables in your daily routine and add a functional food to supplement what you may be lacking.
  • Add a nutraceutical grade multivitamin/multi mineral supplement.
  • Relax when you are eating and chew your food well.
  • Drink liquids before your meal and wait 30 minutes after your meal to drink again. This will limit the dilution of your gastric enzymes needed in digestion.
  • Know what vitamins and minerals you are lacking by undergoing functional nutrient testing.
  • Test your digestive capacity to determine if you would benefit from supplemental enzyme support.

Insulin Resistance

Many people have insulin resistance even before the onset of actual diabetes.  When this happens the body goes into fat storage mode as the insulin drives the sugar out of the bloodstream into the fat cells.


  • Follow a diet with lower carbohydrate intake and watch out for hidden sugars in foods.
  • Get tested with fasting insulin and HgbAIC and aim for an insulin level below 10.
  • Work with a functional medicine practitioner on the use of intermittent fasting . When done correctly, the body will become metabolically flexible and learn to preferentially use fat for fuel instead of glucose.

Hormonal Imbalances

Our hormones generally decline with age which can adversely affect many biological systems.  In both men and women, this can result in weight gain (especially around the mid-section) as well as muscle loss, poor sleep, memory problems, and sexual difficulties.

Some women have a condition of estrogen excess with symptoms such as breast tenderness, premenstrual syndrome, fibroids with associated heavy menstrual bleeding and fluid retention.


  • Cholesterol is the precursor for testosterone and other sex hormones so make sure to eat healthy fats such as nuts, seeds, avocados, extra virgin olive oil, and clean meats.
  • Bulk up on fiber such as flaxseed to balance hormones.
  • Undergo appropriate urine and blood testing to determine your hormone levels and decide if bioidentical hormone replacement could benefit you.


We are constantly dealing with daily stressors.  Cortisol hormone, released from our adrenal glands, increase in response to this.  Unfortunately, our ancestral bodies were designed mainly for a quick “fight or flight” stress response in order to run away from the saber tooth tiger.   But when the tiger chases us every day, our bodies are ill equipped at responding appropriately.  Chronically high cortisol levels are the result of this and can ultimately lead to glucose dysregulation.  As we discussed, this excess glucose is deposited as fat leading to unwanted weight gain.


  • Get in 8 hours of uninterrupted restful sleep.
  • Incorporate mindfulness, meditation, yoga, or deep relaxation into your daily routine.
  • Undergo lab testing to determine the status of your hypothalamic, adrenal, pituitary axis (HPA) function.
  • Add adrenal supplements and vitamins to support function.

Environmental Toxins

Beginning in the 1940’s, the US has introduced a few thousand new chemical products into the market each year.  This equates to about 85,000 chemicals that our great grandparents were never exposed to and that our bodies now have to process.  Such chemicals can be found in the foods we eat, the inside and outside environment in which we live, and the personal care products that we place on our bodies. 

These toxins can damage the energy producing mitochondria in the cells of our body.  When this happens our biological systems do not work as well resulting in a slower metabolism. Toxins can also adversely affect our hormones, and brain function which can result in weight gain.

The body tries to protect us from the harmful effects of these toxins by shunting them out of the bloodstream into fat cells for storage.  With weight loss, these toxins can be released back into the blood.  It is therefore essential that we have a robust detoxification system to help clear toxins from the body through sweat, stool and urine.


  • Eat clean, organic animal products that are grass fed or pasture raised.
  • Eat a wide variety of colorful fruits and vegetables. Follow Environmental Working Group’s list of the “Dirty Dozen and Clean Fifteen”. 
  • Drink filtered water and make sure to have regular bowel movements daily.
  • Sweat to excrete toxins.
  • Test to find out how your body is doing with its detoxification process and what nutrient deficiencies might need to be addressed.
  • Add supplements to help with detoxification. This may include oral or IV treatments.

Gut Infections and Food Sensitivities

The ecosystem in our digestive tract known as the microbiome is filled with billions of bacteria, parasites, viruses and fungi that make us humans.  The microbiome plays a fundamental role in many of our biological systems to include immune health, hormonal balancing, brain functioning, metabolism and much more.  When there is dysbiosis or imbalance in this ecosystem, we don’t function properly. Many foods, medications, infections, and even stress can irritate the GI system and cause an inflammatory response triggering insulin resistance and diabetes. Some bacteria in this ecosystem extract more energy from food, leading to weight gain, while others extract less resulting in weight loss.  Establishing a healthy balance can therefore affect how you maintain your weight.


  • Follow an elimination diet for 4-6 weeks to find out what foods your body is sensitive to. You can also undergo food sensitivity testing (different from allergy testing).
  • Work with a functional medicine practitioner to determine what other GI triggers could be causing inflammation.
  • Eat an anti-inflammatory diet with omega 3 rich foods, and a colorful plate of fruits and vegetables.
  • Feed the good bacteria with prebiotic fibers and add fermented foods such as sauerkraut and kimchi.
  • Undergo functional medicine testing to determine what your ecosystem looks like in order to treat any dysbiosis.

Weight loss can be challenging especially if you think of it in terms of calories and exercise.  The body is far more complex and the contributing factors to resistant weight loss need to be addressed individually for each person.  Work with a functional medicine doctor to navigate your health, get the right testing and create a personalized treatment plan for you. 


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Tapscott_functional_med_doctor_Maryland_WashDCDr. Denia Tapscott, M.D., is board certified in internal medicine and provides personalized treatment with a functional medicine approach to get to the root cause of issues and begin the journey towards wellness. Her areas of interest include: Functional Medicine, Adult Holistic Primary Care, Obesity Medicine and Weight Loss, Cardiovascular Disease, Diabetes Prevention & Metabolic Syndrome, Executive "functional" physicals, Chronic Disease Management, Pre and Post Bariatric Surgery Care  and Diet and Lifestyle focused care.

Topics: weight loss, functional medicine, Dr. Tapscott