This is a common and real experience

difficulty losing weight is not a lack of willpower. The body defends its weight, and there are causes that can be found and dealt with.

Why doesn't my weight come down when I eat little?

• Hidden calories: sweetened karak, juices, coffee with condensed milk, snacks between meals, tasting while cooking, and gatherings. In one study, people who felt they could not lose weight on a diet underestimated how much they ate by about half without realising it, and under-estimating intake is common May help
• The body adapts: after each diet it burns less and feels hungrier, which is why weight usually plateaus after 3–6 months.
• Muscle loss with harsh diets, low protein and little activity.
• Poor sleep and stress increase hunger and sugar cravings.
• Medicines that can increase weight: insulin, some diabetes tablets (such as gliclazide, glimepiride and pioglitazone), steroids, some antidepressants and epilepsy medicines, and the contraceptive injection. Never stop a medicine yourself; discuss it with your doctor.
• Medical causes your doctor checks: thyroid, insulin resistance, polycystic ovary syndrome, menopause, and rarely other hormone conditions.
• Day-to-day changes of 1–2 kg from water are normal.

Practical steps for the first 4 weeks

• Record everything you eat and drink for two weeks, photograph every meal and drink, and bring it to clinic Proven
• Stop liquid calories: reduce sugar in karak and tea gradually to none, and choose water instead of juices and fizzy drinks Proven
• Protein at every meal (eggs, fish, chicken, laban, legumes); it keeps you full and protects muscle Proven
• Half the plate vegetables at lunch and dinner.
• Strength exercise twice a week Proven, and daily walking building up to 7,000–8,000 steps.
• About 7 hours of sleep.
• Weigh yourself and measure your waist once a week at the same time; the waist may shrink before the scale moves.
• Ask your doctor to review your medicines and check your thyroid and HbA1c.

A moderate low-carbohydrate plan

Carbohydrates are reduced to about 50–130 g a day, less than half the usual amount, with enough protein and plenty of vegetables. This is not keto and is easier to keep up. The simple rule: one fist-sized portion of starch at one or two meals a day only.

If you have type 2 diabetes

• Fewer carbohydrates improve blood sugar and weight over the first 6 months Proven, and some people return to normal sugar levels, especially with large weight loss early in the disease.
• Before you start: see your doctor if you use insulin, gliclazide or glimepiride, because the dose may need reducing to avoid low sugar Proven
• If you take dapagliflozin or empagliflozin, do not cut carbohydrates sharply without your doctor's agreement.
• Check your sugar more often in the first two weeks. If it falls below 70 mg/dL (4 mmol/L), take half a glass of juice or 3 teaspoons of sugar, recheck after 15 minutes and repeat if still low, and tell your doctor.
• Discuss Ramadan fasting with your doctor in advance so medicines can be adjusted.
• Apple cider vinegar may lower fasting sugar slightly in small trials May help, but it does not replace medicines and is not for people with slow stomach emptying.

If you have polycystic ovary syndrome (PCOS)

• Losing 5–10% of your weight improves cycle regularity, fertility and blood sugar Proven
• No single diet is best; the most important is the one you can keep to Proven Cutting fast carbohydrates (white bread, sweets, juices) and choosing slow ones (oats, legumes, brown bread) suits many women.
• Protein at breakfast reduces hunger and sweet cravings later in the day.
• Your doctor may prescribe metformin or another treatment depending on your situation Proven
• When planning pregnancy: take folic acid, and avoid harsh diets and keto during pregnancy.
• Emotional eating and mood changes are common with PCOS, and talking about them with your doctor is part of treatment.

Other conditions that affect weight

• Fatty liver: any weight loss helps, and losing 7–10% reduces liver inflammation Proven
• Underactive thyroid: treated with medicine taken on an empty stomach, but once controlled it is rarely the only cause of weight.
• Menopause: the body burns less and fat gathers around the waist; strength exercise and protein matter more than ever Proven
• Knee or back pain: water walking, a stationary bike or chair exercises are good alternatives, and weight loss eases knee pain Proven
• Snoring and breathing pauses during sleep: these increase tiredness and hunger; ask to be tested if you snore heavily or feel sleepy in the day.
• Depression or binge eating: treating them is part of treating weight, not a weakness.
• After stopping smoking: a gain of about 4–5 kg in the first year is common, and the benefit of quitting is far greater than the harm of that gain.
• Inflammatory bowel disease after steroids: some weight comes off as steroids are tapered; avoid harsh diets while the disease is active.

When do we consider extra medical steps?

If your weight has not come down after 3–6 months of real effort, your doctor may discuss weight-loss injections, or obesity surgery when your BMI is 35 or more, or 30 or more with diabetes or metabolic disease, with lower thresholds for people of Asian origin Proven These are treatments for a chronic disease, not a personal failure.