“Doc, I Hardly Eat Anything And I Still Can’t Lose Weight!”

Every now and then an overweight patient tells me he can’t lose weight even though his typical daily food intake is two pieces of plain toast, a cup of grapes, a hard-boiled egg, and three celery stalks. That’s 530 calories. Most adults eat between 1200 to 3000 calories a day.

Even if he lays around on a couch all day watching TV with a remote control channel changer, I know my patient’s basal metabolism requires at least 1,000 calories daily to keep him alive. He says he’s eating only 530. His body must have, and will get, the extra 470 calories from his fat stores. Over time, he must lose weight as his body converts his fat into basal metabolic energy to keep him alive.

Yet he swears he’s not losing weight, and, in fact, may be gaining. I don’t believe he’s lying to me. What’s going on here?

The answer is suggested by a study published in the New England Journal of Medicine. Ten similar “diet resistant” obese people – nine women, one man, average weight 189 pounds (86 kg) – were carefully studied by a team of researchers. They were taught to record all food intake over time in a diary. When the foods eaten were totaled up, average self-reported intake was 1,000 calories daily.

A highly accurate method of measuring calorie expenditure, called “doubly labeled water,” proved that average calorie intake was actually 2,000 calories daily. Furthermore, they over-reported their physical activity by 50 percent. The authors of the study note that while many people under-report their caloric intake, the degree of under-reporting is greater in obese people. They admit that “the mechanisms responsible for this phenomenon are not well understood.”

Their conclusion:

People who just can’t lose weight despite “severe calorie restriction” are in fact eating more calories than they think.

How can we overcome this tendency? One solution is to keep a food journal.

Steve Parker, M.D.

Reference: Lichtman, Steven, et al. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. New England Journal of Medicine, 327 (1992): 1,893-1,898.

4 responses to ““Doc, I Hardly Eat Anything And I Still Can’t Lose Weight!”

  1. I second the notion of a food journal – I use a great piece of software that is a food and exercise journal and when I cook at home I have and use a scale for everything. You can find great taring scales that are accurate to a gram for about $25 these days.

    I’m in a long term weight maintenance phase of life after a serious weight loss. I’ve been successful, but learned that it was critical to journal as, left to my own devices, I’d be overeating relative to my current needs. It is something of a struggle, but is worth the effort.

  2. I write down everything I eat- every calorie, I keep a food journal. I rarely eat fast food or junk food. I eat lots of fruits and vegetables. I cut out sweet tea and cokes. I exercise 5x a week. I STILL CANT LOSE WEIGHT. I dont care what anyone has said , weight loss is not easy. Its the hardest thing in the world to do for some people. Maybe not everyone struggles to lose weight, but some people do. And many people think people like myself are just lazy or not being honest about what we eat. I am one of those people. It took me 5 years to lose 85 lbs, so yes, I guess I can lose weight. But I still have 30 lbs to lose that simply won’t come off. I am such an active person too. Even despite having lyme disease and fibromyalgia, I force myself to be active.It has to be something other than calories in and out, because it isn’t true. At least not for me.

    • Amen to that, Meade!
      I’ve got three diet books on the market now, and none of them proclaim that weight loss is easy. It is not. One of the tricks that has helped some of my patients in your situation is to start a resistance (strength) exercise program. Someone with fibromyalgia would have to start very gently and progress slowly. I’m increasingly convinced that strength training alters the hormonal and epigenetic milieu in favor of burning excess fat.