Help, My Metabolism Is Low!

Abstract

Patients sometimes say they have “low metabolism,” which prevents them from losing weight. While there is substantial variability, metabolic rate is generally directly related to total body and lean mass. Ultimately, the difficulty in losing weight relates to greater energy intake than energy expenditure. While genetics and secondary causes of obesity are important, monogenic and secondary causes of obesity are rare. A thorough history and physical exam can help guide any necessary workup of weight gain due to medications or various endocrine disorders. To achieve weight loss, a patient must create a calorie deficit through dietary modification (i.e., calorie restriction), physical activity, or a combination of the two. Although patients often under-report their calorie intake, comprehensive lifestyle interventions can provide effective education and lead to significant weight loss. This chapter discusses new concepts in eating patterns such as intermittent fasting and time restricted feeding which are being studied in the context of weight loss. FDA-approved anti-obesity medications can also be excellent adjuncts to behavioral modification. Patient education and engagement are key to establishing a good provider-patient relationship and shared decision-making can provide patients who have weight struggles with the empowerment to successfully lose weight.