If you or a loved one has unexplained weight gain or is having trouble losing weight, check out these potential medical causes. (See your health-care provider for a diagnosis and treatment options.)

1. Hypothyroidism (underactive thyroid)
2. Polycystic ovarian syndrome
3. Cushing's syndrome
4. Lack of sleep
5. Stress and anxiety
6. Depression
7. Medications
8. Family history of obesity

1. HYPOTHYROIDISM

Located in the front of the neck just below the larynx, the thyroid gland secretes hormones that control metabolism. If the gland doesn't produce enough of these hormones, you have hypothyroidism and could gain weight as a result.

Hashimoto's thyroiditis, a disease that causes the immune system to attack the thyroid gland, is the most common reason for the condition.

Doctors diagnose hypothyroidism with one or more blood tests. Treatment includes medication and periodic hormone-level monitoring. Untreated hypothyroidism can lead to heart disease, increased risk of infection and miscarriage, and even a potentially deadly coma.

2. POLYCYSTIC OVARIAN SYNDROME

PCOS, also called polycystic ovarian disease (PCOD), sclerocystic ovarian disease, Stein-Leventhal syndrome or syndrome O, is a leading reason for female infertility. Doctors don't know what causes it, though Dr. Virji notes that it may result from elevated insulin levels. For whatever reason, a woman's eggs fail to mature and be released. They accumulate as cysts in the ovaries.

PCOS usually develops shortly after puberty, but it's "often underdiagnosed in the primary-care setting," says Dr. Virji. "I have picked up a number of these patients in my weight-management clinic that were left undiagnosed." Your health-care provider will need to rule out other causes of your symptoms before deciding on PCOS, says Dr. Brantley. "The diagnosis is clinical and should be a diagnosis of exclusion."

Treatment includes weight loss (which is harder because of the condition so be patient with yourself) and medications. If you don't treat it, possible complications include sterility, complications associated with obesity and complications associated with abnormal periods, including cancer.

Also, PCOS may increase your risk for developing metabolic syndrome, notes Dr. Virji, with symptoms including abdominal obesity, high blood pressure and high blood sugar.

3. CUSHING'S SYNDROME

Longterm corticosteroid use and certain tumors can cause Cushing’s syndrome, also called hypercortisolism. Treatment depends on the cause and may include medications, surgery, radiation, chemotherapy or simply a slow decrease of your corticosteroids.

Untreated, Cushing’s syndrome can lead to diabetes, serious infections, kidney stones and even death.



4. LACK OF SLEEP

According to the National Sleep Foundation, 63 percent of American adults don't get the recommended eight hours of sleep a night. And the less you get, the worse your weight-gain odds are.

Sleep deprivation appears to result in decreased leptin, a hormone thought to regulate appetite and metabolism, and increased ghrelin, a hormone that likely stimulates appetite. Thus, the following studies, both from November 2004, make sense:

• Columbia University researchers found that people who get four or fewer hours of sleep a night are 73 percent more likely to be obese than those who get seven to nine hours. The researchers studied records of over 6,000 people ages 32 to 59. Get a whopping six hours a night? Count yourself 23 percent more likely to be substantially overweight.
• In a study from the Annals of Internal Medicine, 12 young men who slept only four hours a night for two nights had a 24-percent increase in hunger, compared to when they were allowed two 10-hour nights. Cravings for high-calorie, high-carb foods especially increased.

Getting enough sleep sounds like a simple solution. For some people, though, it's not. "I find that obstructive sleep apnea is quite common and often missed as a diagnosis when not looked for," says Dr. Virji. If you think you get enough sleep but don't feel like it, you could have sleep apnea (interrupted breathing), insomnia, restless leg syndrome (urge to move your legs) or a number of other sleep disorders. See your health-care provider to determine if anything is wrong and what you can do about it.

"Additional effects of sleep deprivation," says Dr. Brantley, "could include worsening of diabetic control, hypertension and significant changes in one's ability to think and process information." Sleep apnea can cause even worse results, says Dr. Northup. "There is increased strain on the heart and lungs and patients with sleep apnea have higher rates of sudden death."

5. STRESS AND ANXIETY

"Virtually every organ system in your body can be adversely affected by chronic stress," says Dr. Brantley, "including your heart, brain, thyroid and immune system, among others."

But does it affect your weight?

The National Women's Health Information Center also offers the following stress reducing tips (not to replace any needed medications or psychotherapy):

• Unwind with yoga, meditation, massage therapy, music or a book.
• Make time for yourself—at least 15 minutes a day for a bubble bath, walk, or calling a friend.
• Sleep.
• Exercise.
• Talk to friends.
• Keep a journal.
• Help others.
• Get a hobby.
• Set limits (don't be afraid to say no).
• Plan your time.

6. DEPRESSION

Remember what we said about stress, cortisol and weight? The same applies here. And left alone, long-term depression can wreak havoc in your body, says Dr. Brantley. "There are good medications, as well as counseling options, that can be quite helpful and possibly life saving," Dr. Virji says, adding, "There are some medical diseases which could be causing your depression which should not be ruled out."

The vast majority of people benefit from treatment—and might lose weight, to boot. Talk to your health-care provider about your options. In times of crisis, an emergency-room doctor can provide temporary help.

Have a friend who's depressed? Here are some tips on how to help.

7. CERTAIN MEDICATIONS

"Medication-induced weight gain is very common," says Dr. Virji. "This is unfortunate since there are many medication alternatives ... that can be substituted to aid in a weight-loss effort." Medicines that can lead to increased weight, he says, include steroids and certain diabetic, blood-pressure, antidepressant and migraine medications.

"In addition," says Dr. Bray, "anticonvulsants and antipsychotic drugs can also produce weight gain."

To learn potential side effects of your medications, talk to your health-care provider or visit www.pdrhealth.com, a site run by the same folks who provide the respected Physician's Desk Reference. Of course, don't stop any medications unless your doctor tells you it's OK.

8. FAMILY HISTORY OF OBESITY

If your parents are overweight, you're more likely to carry extra pounds, too. But are genes the villain, or is it your environment? Actually, it could be either. For many, nurture is the sole culprit. For some, nature takes its toll.

But don't jump too quickly on the inheritance bandwagon. Obesity prevalence has more than doubled in the last 40 years, but "genes do not change that fast," says Dr. Virji. "It takes about 10,000 years to see genetic changes affecting physical [characteristics]."

Even if you are predisposed to being overweight, "The degree to which this component actually affects patients in real life is fervently argued among bariatric experts across the country and even the world," says Dr. Virji. "I strongly believe that the majority of the problem exists in poor lifestyle choices, which happens to be very modifiable."

Obesity has many causes, he asserts, "and there are many things that can be done to help people lose weight."

Last updated and/or approved: September  2010. Original article appeared in spring 2005 former print magazine. Bios current as of spring 2005. This article is not meant as individual advice. Please see our disclaimer.

The Experts

D. Allen Brantley, M.D., endocrinologist (hormone doctor) with the Mecklenburg Medical Group in Charlotte, North Carolina.

George Bray, M.D., former and first executive director of the Pennington Biomedical Research Center in Louisiana, where he remains as a faculty member and researcher, focusing on obesity and diabetes.

C. Joseph Northup, M.D., bariatric surgeon and assistant professor of surgery at the University of Virginia

Ayaz Virji, M.D., author of The Skinny Book: The 6-Step Methodology for Weight Management
(Verona, 2004, $7.50), and medical director of Morton Plant Mease Primary Care Weight Management in Florida.

References

Comments (3)

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Thank you
written by Leigh Ann Otte , May 27, 2010

Judy: Thank you for the feedback and support. It's much appreciated.

Dr. Di Saia: Yes, time and energy--both major issues and challenging to fix. Although we do have some tough love solutions at least to the fitness aspect here:
http://familydoctormag.com/fitness/201-your-exercise-personality-expert-tips-for-procrastinators-and-more.html
(Scroll to "Constantly Busy.")

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Good but might I add.....
written by John Di Saia MD , May 26, 2010

(1) Running out of time...time to cook healthy foods to avoid thereby eating fast food and time to workout

(2) Running out of energy to do the same

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Awesome list!!
written by Judy Rodman , May 26, 2010

Great list and a wonderful antidote to the typical "just eat less and exercise more" advice that leaves people feeling bad about themselves, when this is not the cause of their obesity.

Will share it around!

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