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!

    每天我都听到人们努力减肥却无功而返的消息。当中有很多隐藏的原因。这就是我今天要跟大家讨论的话题。

    这些原因体现在四个不同的方面：饮食、活动、行为以及身体内。请让我知道你是否同意我的观点-或者还有其他我没有注意到的原因。

    你的饮食

    认为"利于心脏的脂肪"和"无脂肪"就等同于低热量。的确食用橄榄油要比牛油健康得多，但这并不代表会降低你所摄取的热量。想要减轻体重最重要的一点就是减少摄取量（以一茶匙40卡路里代替一大汤匙的120卡路里会更令人开心）.谷物富有膳食纤维并且无脂肪，但是我们不会因为它热量的增加而减少每餐食用的分量。唯一的解决方法是阅读产品标签上表明的一份卡路里含有量；之后你就不会因为那些广告而相信减少脂肪含量的花生酱会比普通花生酱的热量低了。

    不佳的热量目测能力（研究表明我们比实际预估少了50%）.人们都认为自己非常擅长预估分量的大小，但是这种心理暗示反而导致了失败。研究表明人们在预估的过程中通常比实际值少了50%-即使是专家也是如此。

    不吃正餐。难道你认为因为太忙、或是选择不吃正餐就可以减少热量的摄取吗？问题是在下一顿正餐时你会加倍地饥饿-当你开始吃饭的时候会发现自己从来没有这样感到饥饿过。

    你的身体活动

    过多的运动会让你的身体感到更加饥饿。这点在那些期望只依靠运动来消耗热量的人们身上非常普遍。剧烈的运动会刺激你的胃口为身体补充燃料来达到新陈代谢的平衡。人们会觉得我做了2个小时的密集运动就消耗了很多热量。但就如同人们不善于目测食物的实际卡路里值一样，人们也不擅长估算运动到底能消耗掉多少卡路里。请记住你只需要5分钟就可以吃掉一个含有500卡路里的派，但却要花上2个小时做运动才可以消耗掉它。

    另一个具灾难性的想法是根本不做运动。尽管因为你没有时间，或者是不感兴趣，可是仅仅每天20分钟的散步就可以消耗掉100卡路里的热量，而这将会帮助你每年减掉10磅的重量！同样的如果你只是减少了一点常规运动也会如实地体现在你的体重增长上。曾经有一位患者对我说："以前我每天上班需要在几条街区之外的停车场停车。但自从我晋升可以停车在集团的停车场内之后，我在3个月内增加了5磅重量。"

    你的行为

    缺少睡眠是很严重的问题-当我们感到疲惫，就会通过食物来获得能量。人们感到劳累，就不能集中注意力，不能遵守规定以及无法控制精神来进行日常工作。要解决这种疲惫，小睡会比下午茶得到更好的效果。我们身体中的好像荷尔蒙和神经的运作节奏例如：体温，不会因为不睡觉而停止，而会超负荷地工作。

    不佳的抗压能力-精神压力会导致注意力涣散而造成你在无意识状态下进食很多东西。我们常常将事业与压力管理混淆。许多患者常说："我要崩溃了".人们通过吃来放松、奖励自己，然后便沉湎于这些多摄取的热量中。食物的确能够让我们感觉好点，但更需要学习的是除去用食物自我减压的其他方法。

    不能持之以恒（三天打鱼，两天晒网）."我很努力地去尝试了可是这种生活方式不起作用".这种被我称作"体重隐患"的现象需要作为一种意识天天提醒人们。尽管每天只要消耗100卡路里，一年就可以减少10磅的重量。但大多数情况下，人们在周末时会好好的放松自己，这就会导致一个月增加几磅的重量-例如8个休息日增加7000卡路里（2磅）-就等于是每天增加了850卡路里热量！

    你的身体

    当你开始使用某些药物的时候，副作用可能会导致体重的上升。其中一些会增加胃口，另一些减慢你的新陈代谢。很多类药物会让你增加数磅，例如：抗抑郁类、安定类、抗组织胺类、胰岛素和血糖类、降血压类等等。

    请跟你的医生确认你的药物会不会产生增加体重的副作用，有没有其他不会有此类副作用的替代药物。这种副作用只会在服药初期出现。如果你在新服用此药物的第一个月内增加了4磅或以上的重量，请立即跟医生联系…在服用数月之后的体重增加原因不应该是药物的原因了。

    未诊断出的情绪失控。这些为诊断出的消极或焦虑情绪会体现在行为和生理上。消极情绪的症状一般体现在：没有胃口、失眠、体重下降、睡眠质量不佳以及吃得过多。但有时，甲状腺类疾病也会导致情绪失控而使得体重增加。

    甲状腺的功能-甲状腺就好像人们身体中的"炉子"来自动调节温度。人们的大脑会控制释放信号给它来分泌甲状腺荷尔蒙到体内。甲状腺素分泌过少或过旺都会导致缓慢且稳定的体重上升。

    空腹胰岛素升高。这也被称作"胰岛素抗药性"或者"代谢综合症",并且通常在"苹果"体型（脂肪聚集在人体腹部及臀部）的人群中会发生。这种隐形的疾病只有在通过血检的时候才会发现。血糖指数（每个人都知道）虽然正常但是血液中的胰岛素含量非常高。这并不说明你得了糖尿病（血糖高才是）,但却是有得糖尿病的危险。它会极力的破环你为减肥所做出的努力-而纠正这个问题（使用药物或是启动器）会使减肥计划轻松很多。再深入地补充一点-频繁的减肥会降低你的空腹胰岛素水平-让你摆脱药物来治疗从根本上解决这个问题。