Not long ago, I was sitting at lunch with two business colleagues - a female in her late fifties who had had a hysterectomy the year before, and was struggling to keep weight off, and a 34 year old, muscular guy with pecs the size of two, small European countries, and biceps that protruded from out beneath the seams of his short sleeves in an annoyingly similar way to how Pam Anderson’s cleavage begs recognition in a button up blouse. It was just too much muscle for his 5′8″ frame, and I always felt he must be overcompensating for either his lack of height, or perhaps other anatomical parts.

He was the type of guy who carried liquid protein meals with him everywhere he went, ensuring that he never went longer than two hours without a precise amount of protein grams being ingested into his chiseled body. At meal times, he ate lean protein and vegetables, but little fat and no carbs. He wasn’t a competitive body builder but he might as well have been. It wasn’t just his fat to muscle ratio - his fake, spray tanned skin was begging to be posing on some stage vying for the Mr. Olympia title. The worst part was that the size of his ego matched the strength of his eight pack-abs.

He was this little solid package of “too much”. Too much perfection. Too much arrogance. Too much protein. Too much tan. Too much muscle. Too much working out. Too much Napoleon complex. Too much bragging about his hot girlfriend. You name it. 

But that day at lunch, he decided to add too much ignorance to the list, in a scenario that is altogether common in our society, which is why I want to address it. As our female colleague was perusing the menu for a suitable option for the diet she was on, it led to a discussion about her struggle with keeping weight off since entering menopause and having her hysterectomy, in spite of doing daily exercise. To this, Mr. Too Much, a.k.a. Mini Arnold, commented that weight loss is as simple as calories consumed and calories expended. He continued on about how he thought people made too many excuses, and with proper diet and exercise she shouldn’t be having a problem. The insinuation was that she was either cheating on her diet or not exercising as much as she said she was. 

The woman was deflated and I was incensed that the pompous jackass across from me, could be so insensitive. I was even more surprised that someone who knew as much about the human body as he seemed to, and as much about the endocrinological processes involved with weight control and insulin resistance as he did, could be so ignorant to the hormonal component relative to a woman’s metabolism. It was easy for him to judge. He had not yet experienced the effects of hormonal decline for men, known as andropause, and one day when he does, he will probably never experience the effects of it to the same degree as the average woman, let alone a woman who has had a hysterectomy.

So I chose that moment as my opportunity to educate him. Was I successful? Let’s just say he won’t be playing judge and jury again, over a menopausal woman’s weight gain any time soon. I think this scenario highlights the reasons why women have such guilt and shame around their weight. Because often, the people around them are of the opinion that weight loss is just a matter of having willpower, and doing the work. That’s true to a point, but a myriad of complex processes can go awry, making it that much harder to have willpower than the average person. And, even when someone does exhibit the proper restraint around food, if metabolism is out of whack due to hormonal imbalance, losing weight will be an uphill battle.

So let’s talk about just one of those processes with one of those complex hormones. Leptin. Leptin is a hormone that is a major regulator of body weight and metabolism. It is secreted by fat cells and the levels increase with the accumulation of fat. The leptin is supposed to signal the hypothalamus that there are adequate fat stores, to tell the body to burn fat rather than continue to store it as energy. Leptin resistance in certain individuals, prevents this signaling from taking place. Leptin resistance causes a leptin deficiency in the hypothalamus, which is perceived as starvation, so the body increases fat stores to compensate.

The majority of overweight people who have difficulty losing weight, are shown to have varying degrees of leptin resistance. Not only that, but it has been proven that the severity of leptin dysfunction correlates to the degree of obesity. It’s kind of a cyclical chicken and egg scenario, whereby the more fat one gains, the more leptin resistance may be taking place, yet the leptin resistance may be causing one to get fatter.

The metabolic effects of leptin resistance are complex, but essentially, it causes problems with thyroid function and the feed back mechanism between the pituitary and hypothalamus whereby thyroid functioning can be out of whack, without looking like it is. In other words, a patient may show a normal TSH level on a blood test, while still being thyroid deficient. If the leptin level is greater than 10, then TSH is unreliable.

So, if you are having trouble losing weight, you may have a complex case. There are many complex hormones that could be at play. Hormone specialists recommend a metabolic panel of tests consisting of: leptin level, TSH, free T4, free T3, reverse T3, TPO antibody, antithyroglobulin antibody, glucose, insulin, HgA1c, IGF-1, testosterone, CRP, TNF-alpha (highly sensitive), IL-6 (highly sensitive), CRP, homocystine, SHBG, and lipids. 

These results, in the hands of a good hormone specialist will get you on the right path to becoming Fit After Thirty - the kind of *f.a.t. you want to be!