Obesity has become a major health crisis in the United States. In the last two decades, obesity rates have doubled among adults. As many as 60 million people, or 30% of the adult population, are now obese. Youth are at risk too. Since 1980, obesity rates have doubled in children and tripled in adolescents. And all of this is happening while our country is on one big, continuous diet.

What if all this advice about diet and exercise was wrong? Here are four medical issues than can cause weight gain unrelated to diet and exercise.

Thyroid imbalance

One very common cause of weight gain not related to diet or exercise is hypothyroidism. When the thyroid gland is sluggish and not producing enough thyroid hormone, it can cause energy levels to plummet. Skin becomes dry, hair becomes brittle and starts thinning, joints ache, and depression sets in. Weight gain can often be the first sign that something is going awry with the thyroid. While hypothyroidism is common, it often goes undiagnosed because the most commonly ordered blood test "the TSH" misses the majority of low thyroid patients. Even worse, even when a patient is diagnosed with hypothyroidism, most doctors treat the disorder improperly or suboptimally with T4-only medications such as Synthroid, Levothyroxine, or Levoxyl.

When patients with hypothyroidism are treated with the right medication and nutritional supplements, they can see increased energy, weight loss, an improved sense of wellbeing, enhanced immunity, and significantly reduced risk for cancer and heart disease. The most effective treatment for hypothyroidism uses medications that contain T3, including bioidentical thyroid hormone combinations of T4/T3.

Leptin Resistance

Leptin is a hormone that acts as a major regulator of body weight and metabolism. When it's working correctly, leptin stimulates your metabolism, reduces appetite, and tells the body to burn fat. As a person gains weight, leptin is secreted as a signal to the body to stop storing fat. In some individuals, however, the signaling function doesn't work properly. Studies have shown that the majority of overweight people have some degree of leptin resistance, meaning that the body doesn't respond correctly to the increasing leptin levels. The severity of leptin resistance appears to be directly related to the degree of obesity and difficulty losing weight.

Leptin resistance can be diagnosed with a simple blood test. Leptin levels greater than 12 ng/dl indicate leptin resistance. And, as with insulin resistance, the higher the leptin levels are, the more severe the leptin resistance.

Leptin resistance also results in hypothyroidism at the cellular level that is not detected by standard thyroid function tests. Leptin resistance can cause decreased TSH levels, an increase in reverse T3 (RT3), and a suppressed conversion of T4 to T3, and can also increase insulin resistance and inhibit fat breakdown. A person with leptin resistance may appear to be "normal" based on standard thyroid lab tests, and yet have significant hypothyroidism.

Insulin Resistance

Insulin resistance is a decreased ability of the body's cells to respond to insulin. When a person eats, the body's blood sugar levels naturally rise. The body produces insulin to allow the cells to open and take in glucose, effectively bringing blood sugar back to a normal level. With insulin resistance, however, the cells do not open up to accept the glucose, and the body produces more and more insulin in an attempt to regulate blood sugar levels. Because insulin is a fat-storing hormone, excess levels of insulin in the blood cause weight gain. Patients with insulin resistance will typically gain weight in the abdomen, and will also have difficulty losing weight. Insulin resistance is associated with high blood pressure and high triglycerides, along with low HDL (the "good cholesterol"). It is a risk factor for heart disease and Type 2 diabetes.

Like leptin resistance, insulin resistance causes a reduction in the ability to convert T4 to T3, along with an increased conversion of T4 to RT3, further reducing the level of thyroid hormones at the cellular level. The elevated insulin levels also suppress TSH levels, making it inappropriate to use the TSH as a reliable marker for thyroid hormone levels.

Many doctors treat insulin resistance with drugs normally used to treat Type 2 diabetes, such as Metformin. Patients often find that a diet with reduced carbohydrates can help lower blood glucose levels and thus decrease insulin levels. One of the more innovative treatments for insulin resistance involves the use of straight T3 thyroid hormone. Studies have shown that treatment with T3 can help improve T4 to T3 conversion, and can significantly reduce some of the cardiovascular risk factors, including cholesterol levels.

Malfunctioning Set Point

The body's "set point" is a built-in weight regulating mechanism that works to keep your weight at a physiologically established comfortable range. When the body's set point malfunctions, a person's typically "normal weight" becomes higher. Numerous medications can increase the body's weight set point and stimulate weight gain. These include antidepressants such as Paxil, Celexa, Zoloft, and Lexapro; SNRIs such as Cymbalta, Effexor, and Savella; mood modulators such as Abilify and Seroquel; anti-seizure or pain medications such as Neurontin or Lyrica; birth control pills; synthetic hormone replacement; and diabetic medications that stimulate insulin, such as glyburide and Amaryll. Blood pressure medications can also cause the body's set point to increase, as can many other drugs

The good news is that there are medications that can have the opposite effect, actually lowering the body's weight set point. These medications can be used to aid in weight loss. Naltrexone is the most recent medication shown to decrease the body's set point. Originally used as a treatment for narcotic overdose and to reduce the incidence of relapse in alcoholism and opiate addiction, Naltrexone, when used at a very low dose, can serve as an effective immune modulator. As such, it is an effective treatment for autoimmune diseases. At lower doses, but higher than the immune modulation doses, Naltrexone has been shown to reduce the body's set point and cause significant weight loss. This effect is further enhanced when used in combination with buproprion (Welbutrin).

Losing weight is not about willpower and lifestyle choices

If eating a healthy diet and doing regular exercise for two to three months does not seem to be having a positive effect on your weight, there's a good possibility that you are dealing with a metabolic condition that is causing you to be overweight. Whether it's thyroid imbalance, leptin resistance, insulin resistance, or even a malfunctioning weight "set point," treatments are available that can help you correct the issue and begin to see healthy results.

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