More on Unexplained Weight Gain

Thank you to everyone who replied to my question about your experiences with unexplained weight gain....i.e. weight gain that can't be tied to specific outside causes like a side effect of meds or birth control, etc. 

I personally experienced a major unexplained gain like this, and I was curious to see how many others had also experienced it.  Thank you for sharing your stories both in comments and in private emails; it's reassuring to know that many others have experienced it too.

Honestly, I thought our stories would all be very much alike, and for the most part there are common threads running through many of them. But while there were some similarities, there were also differences at times.  So my speculation is that while most stories are related to a couple of common paths, there can also be other paths to major weight gain, paths we have yet to discover. 

But first, let's talk about the most common paths.

Possible Causes of Unexplained Weight Gain

The most common causes of unexplained weight gain seem to be two-fold:

• Hypothyroidism (overt or borderline)
• Polycystic Ovarian Syndrome (PCOS). 

(Since I'm about to start a new series about PCOS, I was particularly interested to hear about weight gains associated with that one.)

These two causes seemed to be echoed in the stories sent in.  Most gains in the stories were later discovered to be associated with hypothyroidism or PCOS.  Many of the stories showed how hard it can be to get major gains diagnosed and taken seriously.

But it's not always clear what causes a major weight gain; it's not always due to PCOS and/or hypothyroidism. Best guess is that there is a complex interplay of hormones and metabolic issues, many of which we probably haven't discovered yet. The stories people shared made it clear that sometimes there seems to be something else going on too, something we can't put our finger on. 
My top suspects for unexplained weight gain include adrenal issues, insulin-related issues, and perhaps pituitary issues (since that's the "master gland" that controls everything else). But who knows?   The only thing that is clear is that we have much more to learn about the issue.

According to online sources, other possibilities for unexplained weight gain include:

• Cushing's Syndrome (body produces too much cortisol, which tends to cause weight gain)
• Adrenal or Ovarian Tumors (disturb hormone production, which can cause weight gain)
• Food Allergies/Sensitivities (some people experience weight gain with food sensitivities)
• Lack of Sleep/Sleep Apena (can cause biochemical changes which impact weight)
• Stress (chronic stress increases cortisol production, which tends to cause weight gain)
• Blood Sugar Issues (reactive hypoglycemia, unstable blood sugar, and too much insulin)

It's also worth noting that many medications do result in unexplained weight gain, including some forms of birth control, corticosteroids, antidepressants, anti-seizure meds, heartburn meds, migraine meds, blood pressure meds, and certain diabetes meds.  And of course, fluid retention due to edema, kidney issues, or congestive heart failure can be serious source of very sudden gains. 

But what we are most concerned about here is unexplained weight gain ─ weight gain not clearly related to outside causes like medications, quitting smoking, weight gain left after pregnancy, obvious disease, or poor eating. 

My Story

For me personally, my unexplained gain was probably due to a combination of both hypothyroidism and PCOS at once.  Although always considered "overweight" by the charts, I was never that heavy as a child or young teen ─ I was more of an "in-betweenie." But that changed a few years after puberty.

My large weight gain started in my mid-to-late teens, just after my PCOS symptoms began appearing, and worsened as my PCOS symptoms worsened.  By my early 20s, I had gained a total of about 100 lbs. or so, despite everything I did to try to reverse it.  That's one heck of a weight gain, and that was despite working extremely hard to try and reverse it.

Yet I couldn't get a doctor to take any possible metabolic causes seriously. When I pushed for testing to see what was going on, I was told I was "looking for an excuse for being fat."  Although I eventually got tested and we found "borderline" thyroid levels, no doctors were willing to treat that, despite my overwhelming symptoms of hypothyroidism. And not one doctor ever mentioned the possibility of PCOS to me. 

However, they were all happy to give me diet advice, telling me to do things I was already doing.  When I would try to tell them that, they wouldn't believe me.  So I quit going to doctors to try and figure it out.

Eventually, the weight gain slowed and stopped, then went into a pattern of fluctuating. In time, I finally found a doctor willing to do a trial of thyroid meds, based on my symptoms and my "borderline" labs.  Oh, I felt soooo much better!  After that, my weight was so much more stable. And treating the hypothyroidism seemed to lessen many of my PCOS symptoms.  Truly, it was a "win win" situation for me, even though it didn't make me skinny.

Of course, TSH diagnostic levels are controversial; different providers use different scales to diagnose with, and many care providers do not believe in treating "borderline" levels.  However, I'm a total believer in treating borderline numbers in symptomatic patients now.  In my opinion, too many people have been helped by it to ignore this possibility.  [Always ask for your exact results and the scale they used to diagnose you, and then research the controversy over diagnostic ranges; don't just accept the care provider's word about your thyroid levels being "normal."]

But that's my story.  It has many things in common with other people's stories, including the difficulty in getting care providers to consider such gains as anything other than sloth and gluttony.  But of course, not every story is exactly the same, and your causes may be different than mine.

Conclusion

Large, unexplained weight gains are certainly not unusual among people of size.  Most often, they seem to be connected to borderline cases of hypothyroidism and/or PCOS, but there are probably other causes as well, things doctors fail to consider or don't yet understand.

We need to get doctors to take unexplained gains more seriously so we stop blaming everything on over-indulgence, laziness, and eating disorders.  Those are relevant sometimes, but there has to be some sort of physiologic basis for why some people are so susceptible to gains that are unresponsive to normal nutrition and exercise.

I also wish we could offer better advice to those who experience this distressing situation.  All I can say to someone experiencing it is that you are not alone, there are others who have experienced large gains like this, and it doesn't mean you are a "bad" or "weak" person.  It's just a mystery that we don't understand yet.

Although the understandable response to a large weight gain is to try to lose that weight, it's important to remember that this may not work for you long-term if the underlying cause of the gain isn't discovered and addressed. That's why I encourage people to continue to push to investigate possible physiological causes, and to not be afraid to switch to a new care provider if the old one is unresponsive to your concerns.

And remember that the diet you use to lose the extra gain may end up resulting in even more gain in the long run, even when you only do "healthy" diets and exercise and "lifestyle changes."  All too often, the things you do to deal with the gain only end up amplifying the gain.  How is that advantageous?

So it's not easy to know what the best thing to do is in the face of an unexplained gain like this ─ live with the gain as is and put up with the discomforts and potential health risks, or try to lose the extra weight and risk ending up heavier than you began.

I would not presume to tell you what you should or should not do with your own body; you do what seems to make sense for your body and your situation.  However, I would point out that weight loss is not your only choice. 

A gain doesn't have to mean giving up and being unhealthy; nor does it mean you have to punish your body through starvation, mutilating surgery, or other extreme measures. You can focus on being healthy in nutrition and exercise without centering that on weight loss.  That way, you pursue better health while avoiding worsening the situation via a lot of yo-yoing.

Unexplained weight gains are so mysterious and frustrating.  They are not universal among people of size, but they are pretty common.  Wouldn't it be nice if care providers would actually believe us when we say something is wrong, or better yet, focus on trying to understand these gains better so we could prevent them in the first place?