Every day I hear from people who try really hard, and just can't seem to lose weight. There are a number of "hidden" reasons this might be happening to you. That's the topic of my Today Show segment （check back later for the video）.

    I've found these can pop up in four different areas: your eating, your activity, your behavior, and your biology （body）. Let me know if you agree - or have other hidden reasons you've discovered!

    YOUR EATING

    Confusing "heart-healthy fat" or "fat free" with low calorie. Switching to olive oil from butter is a heart healthy choice, but won't save you any calories. To lose weight, it's important to cut the amount （instead of a tablespoon at 120 calories, try a teaspoon at 40 calories, since it's so flavorful）. Fiber rich, whole grains are a great choice, and fat-free, but the calories add up we don't stop with ? - 1 cup serving. The only solution to this is label reading for calories per serving; when you see that reduced-fat peanut butter has just about the same calories as regular peanut butter, you won't be fooled by clever ads.

    Poor calorie "eyeballing" （studies show 50% too low）. We all feel we're good at estimating portion size, but the cues to do so set us up for failure. Studies show we are at least 50% too LOW in our estimates – even when professionals do it.

    Skipping Meals. Too busy, or choosing to skip a meal to save calories? The problem with meal skipping is you get over-hungry for the next meal – "I didn't realize I was so hungry", once you start eating.

    YOUR PHYSICAL ACTIVITY

    Too much exercise is a biological stimulant for hunger. This is very common for dieters who only want to focus on exercise as a way to cut calories Rigorous exercise stimulates appetite to "refuel" for metabolic balance. I'm talking 2 hours of more intense activity. Plus, like the poor "eyeballing" of food, most of us aren't skilled at estimating how many calories are used for activity. Just remember it can take 5 minutes to eat a 500 calorie piece of pie, and nearly 2 hours to exercise it away!

    On the other end of things, no exercise is a diet disaster. Whether it's lack of time, or lack of interest - only 100 cal a day – a 20 minute walk – helps you lose 10 pounds in a year! Even a small drop in physical activity （that people ignore） packs on the pounds. Here's an example I recently heard from a patient of mine: "I used to park blocks away in a cheaper parking lot. I got promoted, and get the corporate lot. I've gained 5 pounds in 3 months."

    YOUR BEHAVIOR

    Lack of sleep is a huge problem – when we're tired, we eat for energy. When we're tired, we lose our focus, and discipline, and lose the mental control needed to stay on track. Between-meal snacks to "wake up" are the solution when a power nap would be better. Our body's have 24-hour rhythms in many hormones and pathways - like body temperature - that don't "reset" and get out of balance with lack of sleep.

    Poor stress management - a lof of mindless eating comes from the lack of focus due to mental stress. We often confuse business with poor stress management. "I feel overwhelmed" say many patients. We eat to soothe, to reward ourselves, and to indulge in extra calories. Food DOES make us feel better, but we have to learn to self-soothe in other, non-food ways as well.

    Lack of consistency （5 days on, 2 days off）. "I'm trying but lifestyle isn't working". Some general awareness every day is needed to avoid what I call "weight creep". It takes only 100 calories extra a day to gain 10 pounds in a year. Most often, people "relax" their lifestyle on the weekend, and can easily pack on a couple of pounds a month – 7000 calories （that's 2 pounds） – over 8 weekend days – only about 850 calories more a day.

    YOUR BIOLOGY （BODY）:

    Medications can cause weight gain as a side effect, when they are started. Some stimulate appetite, and others slow your metabolism. A range of medications from antidepressants; antipsychotics some antihistamines, as well as insulin and blood sugar drugs, some blood pressure medicines, and anti-inflammatory drugs can pack on the pounds. Check with your doctor when starting a new medication, and always ask if weight gain is a reported side effect - there may be another medication you can take without this side effect. This happens only at the beginning of a new medicine. If you're started a new medicine, and gained 4 pounds or more in a month, check with your doctor……It's NOT the cause if you've been taking a medicine, and then find suddenly you're gaining weight, months after you've started.

    Undiagnosed Mood Disorders. Undiagnosed depression or anxiety is both behavioral and biological. While many think depressive symptoms are only the "classics": loss of appetite, insomnia, and weight loss, a large subgroup sleeps more and eats more. Oftentimes thyroid gland problems are linked to mood disorders （see below）, and can result in weight gain.

    Thyroid Function – The thyroid gland is your body's "furnace" and sets the thermostat. This is regulated by a signal from the brain to release thyroid hormone into the system. Either resting or stimulated thyroid gland activity can be a problem, and result in slow, steady weight gain.

    Elevated fasting insulin. This is known as "insulin resistance" or " metabolic syndrome" and often found in people with an "apple" shape （weight accumulates in the middle）. It's invisible unless you get a blood test. Blood insulin levels can be high, with blood sugar levels being normal （everyone knows that number）. It does not mean diabetes （where blood sugar is high）, but is a sign of pre-diabetes. This can greatly sabotage a solid weight loss effort - and correcting the problem （with medication for starters） makes that weight loss effort easier. A further plus - more weight loss alone can help lower your fasting insulin - getting you off the medication to correct the original problem!

    每天我都聽到人們努力減肥卻無功而返的消息。當中有很多隱藏的原因。這就是我今天要跟大家討論的話題。

    這些原因體現在四個不同的方面：飲食、活動、行為以及身體內。請讓我知道你是否同意我的觀點-或者還有其他我沒有注意到的原因。

    你的飲食

    認為"利于心臟的脂肪"和"無脂肪"就等同于低熱量。的確食用橄欖油要比牛油健康得多，但這并不代表會降低你所攝取的熱量。想要減輕體重最重要的一點就是減少攝取量（以一茶匙40卡路里代替一大湯匙的120卡路里會更令人開心）.谷物富有膳食纖維并且無脂肪，但是我們不會因為它熱量的增加而減少每餐食用的分量。唯一的解決方法是閱讀產品標簽上表明的一份卡路里含有量；之后你就不會因為那些廣告而相信減少脂肪含量的花生醬會比普通花生醬的熱量低了。

    不佳的熱量目測能力（研究表明我們比實際預估少了50%）.人們都認為自己非常擅長預估分量的大小，但是這種心理暗示反而導致了失敗。研究表明人們在預估的過程中通常比實際值少了50%-即使是專家也是如此。

    不吃正餐。難道你認為因為太忙、或是選擇不吃正餐就可以減少熱量的攝取嗎？問題是在下一頓正餐時你會加倍地饑餓-當你開始吃飯的時候會發現自己從來沒有這樣感到饑餓過。

    你的身體活動

    過多的運動會讓你的身體感到更加饑餓。這點在那些期望只依靠運動來消耗熱量的人們身上非常普遍。劇烈的運動會刺激你的胃口為身體補充燃料來達到新陳代謝的平衡。人們會覺得我做了2個小時的密集運動就消耗了很多熱量。但就如同人們不善于目測食物的實際卡路里值一樣，人們也不擅長估算運動到底能消耗掉多少卡路里。請記住你只需要5分鐘就可以吃掉一個含有500卡路里的派，但卻要花上2個小時做運動才可以消耗掉它。

    另一個具災難性的想法是根本不做運動。盡管因為你沒有時間，或者是不感興趣，可是僅僅每天20分鐘的散步就可以消耗掉100卡路里的熱量，而這將會幫助你每年減掉10磅的重量！同樣的如果你只是減少了一點常規運動也會如實地體現在你的體重增長上。曾經有一位患者對我說："以前我每天上班需要在幾條街區之外的停車場停車。但自從我晉升可以停車在集團的停車場內之后，我在3個月內增加了5磅重量。"

    你的行為

    缺少睡眠是很嚴重的問題-當我們感到疲憊，就會通過食物來獲得能量。人們感到勞累，就不能集中注意力，不能遵守規定以及無法控制精神來進行日常工作。要解決這種疲憊，小睡會比下午茶得到更好的效果。我們身體中的好像荷爾蒙和神經的運作節奏例如：體溫，不會因為不睡覺而停止，而會超負荷地工作。

    不佳的抗壓能力-精神壓力會導致注意力渙散而造成你在無意識狀態下進食很多東西。我們常常將事業與壓力管理混淆。許多患者常說："我要崩潰了".人們通過吃來放松、獎勵自己，然后便沉湎于這些多攝取的熱量中。食物的確能夠讓我們感覺好點，但更需要學習的是除去用食物自我減壓的其他方法。

    不能持之以恒（三天打魚，兩天曬網）."我很努力地去嘗試了可是這種生活方式不起作用".這種被我稱作"體重隱患"的現象需要作為一種意識天天提醒人們。盡管每天只要消耗100卡路里，一年就可以減少10磅的重量。但大多數情況下，人們在周末時會好好的放松自己，這就會導致一個月增加幾磅的重量-例如8個休息日增加7000卡路里（2磅）-就等于是每天增加了850卡路里熱量！

    你的身體

    當你開始使用某些藥物的時候，副作用可能會導致體重的上升。其中一些會增加胃口，另一些減慢你的新陳代謝。很多類藥物會讓你增加數磅，例如：抗抑郁類、安定類、抗組織胺類、胰島素和血糖類、降血壓類等等。

    請跟你的醫生確認你的藥物會不會產生增加體重的副作用，有沒有其他不會有此類副作用的替代藥物。這種副作用只會在服藥初期出現。如果你在新服用此藥物的第一個月內增加了4磅或以上的重量，請立即跟醫生聯系…在服用數月之后的體重增加原因不應該是藥物的原因了。

    未診斷出的情緒失控。這些為診斷出的消極或焦慮情緒會體現在行為和生理上。消極情緒的癥狀一般體現在：沒有胃口、失眠、體重下降、睡眠質量不佳以及吃得過多。但有時，甲狀腺類疾病也會導致情緒失控而使得體重增加。

    甲狀腺的功能-甲狀腺就好像人們身體中的"爐子"來自動調節溫度。人們的大腦會控制釋放信號給它來分泌甲狀腺荷爾蒙到體內。甲狀腺素分泌過少或過旺都會導致緩慢且穩定的體重上升。

    空腹胰島素升高。這也被稱作"胰島素抗藥性"或者"代謝綜合癥",并且通常在"蘋果"體型（脂肪聚集在人體腹部及臀部）的人群中會發生。這種隱形的疾病只有在通過血檢的時候才會發現。血糖指數（每個人都知道）雖然正常但是血液中的胰島素含量非常高。這并不說明你得了糖尿病（血糖高才是）,但卻是有得糖尿病的危險。它會極力的破環你為減肥所做出的努力-而糾正這個問題（使用藥物或是啟動器）會使減肥計劃輕松很多。再深入地補充一點-頻繁的減肥會降低你的空腹胰島素水平-讓你擺脫藥物來治療從根本上解決這個問題。