Most people who walk in here have already tried dieting. Some have tried very hard, multiple times.
The question worth asking isn't "Why don't you have more willpower" — it's "Why is your body holding on to weight despite your efforts?"
The answer is usually metabolic: insulin resistance, hormonal imbalance, sleep disruption, medication side effects, or a combination. Treatment follows from the cause, not from a standard calorie chart.
Body Mass Index (BMI) is a screening tool, not a diagnostic. A "normal" BMI with central obesity (belly fat) can still carry metabolic risk — which is why waist circumference and metabolic markers matter as much as the number on the scale.
Most diets fail because they treat weight as a willpower problem when it's often a metabolic one. A medical approach starts by understanding why you're gaining weight - it could be insulin resistance, thyroid issues, sleep apnea, medications, or hormonal imbalances. Once we identify the root cause, we build a plan around it. That's why it sticks.
Very likely. Heavy snoring with daytime tiredness is a classic sign of obstructive sleep apnea, which is strongly linked to excess weight, especially around the neck and abdomen. The good news is that even a modest weight loss of 5-10% can significantly improve sleep apnea symptoms. It's worth getting evaluated.
It depends on the stage. Early fatty liver (simple steatosis) is reversible with weight loss, dietary changes, and exercise. But if left unaddressed, it can progress to inflammation and eventually liver scarring. There's no specific medication for fatty liver - weight management and lifestyle changes are the primary treatment.
Yes, this is actually more common than people think and it does carry health risks. Central obesity - fat concentrated around the waist - is associated with insulin resistance, metabolic syndrome, and heart disease risk even when your overall BMI looks fine. Waist circumference and waist-to-hip ratio are often better indicators than BMI alone.
Not everyone does. For some patients, structured dietary guidance and exercise planning are sufficient. Medications are considered when lifestyle changes alone aren't producing results, or when there are obesity-related complications that need faster intervention. Any medication is always paired with lifestyle changes, never used as a standalone fix.
A safe and sustainable rate is typically 0.5–1 kg per week, depending on your starting point, metabolic profile, and how closely the plan is followed. Anything more aggressive tends to bounce back. The focus isn't just the number on the scale - it's improving your metabolic markers, energy levels, sleep quality, and joint comfort. Many patients find that these improvements matter more than the kilograms lost.
Insulin resistance — a root cause of weight gain in many patients — is closely connected to diabetes and prediabetes risk. [See Diabetes Care & Management →]
Thyroid dysfunction is one of the first things we rule out in patients who can't lose weight despite genuine effort. [See Thyroid Disorders & Women's Health →]
If you're looking for a structured 12-week programme with regular monitoring and a multidisciplinary team, see the RESET Program. [See the RESET Program →]
Dr. Shalini Joshi, MD (USA) is a Senior Consultant in Internal Medicine at Fortis Hospital, Bannerghatta Road, Bengaluru.
Evening consultations are available at Akshaya Nagar, South Bangalore.
Video consultations are available for patients across India.
Corporate wellness talks available on request.
Specialising in diabetes, obesity, thyroid disorders, and preventive health.