Fact check on weight loss: Why simple expl­ana­tions don’t work

In clinical prac­tice, there is often a discrepancy between effort and results when it comes to weight loss. Pati­ents exer­cise more, eat healt­hily, and are highly motivated—yet their body weight remains stable. This can also lead to frus­tra­tion on the part of doctors, as it is not uncommon for them to suspect a lack of disci­pline. However, the error in thin­king often lies elsewhere.

Miscon­cep­tion 1: Weight is a valid marker for thera­peutic success.

Body weight is easy to measure, but it says little about fat distri­bu­tion, insulin sensi­ti­vity, inflamm­a­tory status, or cardio­me­ta­bolic risk. Nume­rous inter­ven­tions improve precisely these para­me­ters without causing any signi­fi­cant change on the scales. If success is measured solely in terms of weight, rele­vant health effects remain invi­sible – and effec­tive measures are mista­kenly considered to have failed.

Miscon­cep­tion 2: More effort leads to more weight loss.

This assump­tion sounds plau­sible, but often does not stand up in prac­tice. An energy deficit trig­gers a physio­lo­gical counter-regu­la­tion: resting energy expen­diture decreases. At the same time, beha­vior and well-being change – those affected uncon­sciously move less outside of planned acti­vi­ties, for example by sitting more or moving less spon­ta­neously. This compen­sates for part of the deficit. More effort ther­e­fore does not auto­ma­ti­cally lead to more weight loss.

Miscon­cep­tion 3: Losing weight is prima­rily a beha­vi­oral problem.

This view overe­sti­mates will­power and unde­re­sti­mates biology – and thus also the psycho­lo­gical strain. Studies show that the body actively regu­lates weight and fat mass. Hunger, energy consump­tion, and storage adapt to the nutri­tional situa­tion, regard­less of moti­va­tion, insight, or good inten­tions. For many affected indi­vi­duals, a lack of success ther­e­fore feels like personal failure, even though it is a biolo­gical reaction.

Does this sound fami­liar from your own experience?

Three errors in thin­king, many disap­pointed expec­ta­tions. In the follo­wing articles, we clas­sify these findings based on evidence.

Müller MJ, Bosy-West­phal A. Adap­tive ther­mo­ge­nesis with weight loss in humans. Obesity (Silver Spring). 2013;21(2):218–228.