The Truth About Weight Loss Is It’s Not Really About Weight
Weight loss is one of the most common topics discussed in healthcare and one of the most misunderstood.
Most advice revolves around calories. Eat less. Move more. Count everything.
Whilst energy balance clearly matters, I have increasingly come to believe that focusing solely on calories misses the bigger picture. If weight loss were simply a mathematical equation, far fewer people would struggle with it.
The reality is that weight management is influenced by hormones, inflammation, sleep, stress, muscle mass, food quality and metabolic health. Understanding these factors helps explain why some approaches succeed whilst others fail.
Perhaps the biggest misconception is that all body fat is the same.
It is not.
The Fat We Should Be Talking About
Most people judge their health by looking in the mirror or stepping on the scales. Yet the fat that concerns me most is often the fat we cannot see.
Visceral fat accumulates deep within the abdomen around the internal organs. Unlike the fat stored beneath the skin, visceral fat is metabolically active. It releases inflammatory chemicals and hormones that contribute to insulin resistance, type 2 diabetes, cardiovascular disease, fatty liver disease and a state of chronic inflammation.
In many ways it behaves less like a passive energy store and more like an active organ.
Visceral fat is also considered a form of ectopic fat, meaning fat that is being stored where it was never intended to be stored. Similar fat deposits can occur within the liver, pancreas, skeletal muscle and around the heart.
These ectopic fat deposits are strongly associated with metabolic dysfunction and many of the chronic diseases that dominate modern healthcare.
This is why I encourage patients to think less about weight and more about body composition, which simply refers to what the body is made of — fat, muscle, bone and water — rather than weight alone.
The number on the scales tells us surprisingly little. It cannot tell us how much muscle we have. It cannot tell us what our bone density is. It cannot tell us how much visceral fat we are carrying. It cannot tell us whether our metabolic health is improving.
Why BMI Often Misses the Point
This is also why I have become increasingly sceptical of relying solely on Body Mass Index (BMI).
BMI simply compares height and weight. Whilst it may be useful when studying large populations, it tells us very little about an individual person’s health.
It cannot distinguish muscle from fat.
It cannot identify visceral fat.
It cannot tell us where fat is being stored.
Two people can have exactly the same BMI and vastly different levels of metabolic health. One could have a high proportion of muscle and very little visceral fat. Another could have the same BMI but carry significant visceral fat and very little muscle. Who is metabolically fitter?
For this reason, waist-to-height ratio is often a far more useful measure. Excess abdominal fat is one of the strongest indicators of insulin resistance and metabolic dysfunction, making waist-to-height ratio a simple but powerful marker of future health risk.
The goal should not simply be to become lighter.
The goal should be to become healthier.
The Role of Insulin
To understand weight gain, we need to understand insulin.
Insulin is one of the body’s most important hormones. Its role is to help move nutrients into cells and store energy when food is plentiful. In a healthy system, this works beautifully. The problem arises when insulin remains elevated for much of the day. When insulin levels are high, fat cells receive a signal to store energy. Accessing those energy stores becomes more difficult.
To release stored fat, insulin levels need to fall.
This is one reason why I advocate fasting.
For most of human history, periods of feeding and fasting were entirely normal. Food was not available from dawn until bedtime. The body evolved mechanisms that allowed us to switch between storing energy and using it. It is part of religious practice all over the world. It is not a new concept or fad, but a natural physiological process that allows the body time for repair, recovery and metabolic regulation.
Today many of us live in a constant state of feeding. Breakfast. Snacks. Lunch. More snacks. Dinner. Something in front of the television. Our physiology was never designed for that pattern.
Periods of fasting create a different hormonal environment from simply eating smaller portions throughout the day or calorie restriction. With prolonged calorie restriction, the body may adapt by reducing metabolic rate and breaking down muscle as well as fat. Fasting appears to trigger different hormonal pathways, allowing insulin levels to fall and stored fat to become more accessible.
Fasting is not starvation.
It is simply allowing the body time to do what it was designed to do.
Inflammation: The Missing Link
One of the reasons visceral fat is so harmful is that it contributes to chronic low-grade inflammation.
Inflammation is a normal and essential part of human biology. It helps us fight infection and repair damage.
The problem occurs when inflammation becomes chronic.
Many of the foods associated with weight gain are also among the most inflammatory. Refined sugars, ultra-processed foods and refined carbohydrates provide large amounts of rapidly absorbed energy with relatively little fibre, protein or nutritional value.
They also tend to trigger larger insulin responses and contribute to a cycle of hunger, inflammation and energy storage.
When we remain in a state of chronic low-grade inflammation, many of the body’s normal repair and recovery processes become disrupted.
I often joke with patients that if most of the food on your plate is beige, we may have a problem. Bread. Biscuits. Pastries. Cakes. Sugary cereals. Crisps. Processed snacks.
Instead, try to focus on foods that look as though they came from nature.
Vegetables. Legumes. Nuts and seeds. Eggs. Fish. Good quality protein. Healthy fats such as olive oil, avocado and oily fish. Fruit.
In many ways, the Mediterranean diet remains one of the most extensively studied dietary patterns in the world. It is not really a diet at all. It is simply a way of eating based on whole, minimally processed foods that humans have eaten for generations.
Why Exercise Matters
Another common misconception is that weight loss is primarily driven by endless aerobic activity.
Whilst aerobic exercise undoubtedly has cardiovascular benefits, resistance training is often the missing piece of the puzzle.
Muscle is metabolically active tissue. Muscle improves insulin sensitivity. It supports metabolic health. It helps maintain mobility as we age. It protects bone density.
Most importantly, resistance training helps preserve muscle, the very thing many people lose when they diet aggressively.
The goal should not be to become a smaller version of yourself.
The goal should be to become a stronger version of yourself.
For many people, resistance training combined with regular walking or steady-state exercise, alongside occasional higher-intensity interval training (HIIT), provides an excellent balance for improving cardiovascular health and promoting body recomposition in a sustainable way.
The Role of Sleep and Stress
Many people do everything right on paper and still struggle with their weight. When that happens, I often ask about sleep and stress. Poor sleep alters hormones such as leptin and ghrelin, increasing hunger and reducing feelings of fullness. Chronic stress raises cortisol levels, encourages cravings and may contribute to abdominal fat accumulation.
Once again we find ourselves back at inflammation and metabolic dysfunction. The body cannot distinguish between a genuine emergency and the relentless pressures of modern life. Work. Finances. Relationships. Caring responsibilities. Poor sleep.
This is why successful weight management is rarely just about food. Calories in and calories out. How many steps we get in.
It is also about recovery. Sleep. Stress management. Mental wellbeing. Healthy relationships. These factors influence our hormones every bit as much as the food we eat.
A Different Way of Thinking About Weight Loss
Perhaps the biggest shift in thinking is this: weight loss should not be the primary goal. Improving metabolic health should be the primary goal.
Reduce visceral fat. Preserve and build muscle. Improve insulin sensitivity. Lower inflammation. Sleep better. Manage stress. Eat whole foods. Create daily periods of fasting.
When these things come together, we create resilience, better health, strength, wellbeing and mental recovery.
We may see a drop on the scales and often we will. But the number is not the most important outcome.
Instead of asking, “How much weight have I lost?”, perhaps we should be asking:
- Have I reduced visceral fat?
- Have I improved my insulin sensitivity?
- Have I preserved muscle?
- Am I sleeping better?
- Do I have more energy?
- Am I metabolically healthier?
Because ultimately the number on the scales is only one measure of health.
Health is far bigger than a number.
Where to Start
For most people, the best approach is not to make dramatic changes overnight.
Start simply.
Aim for a 12-hour overnight fast. For example, finish eating at 8pm and have breakfast at 8am.
Once that feels comfortable, some people choose to gradually extend this to 14 hours and later 16 hours, allowing insulin levels more time to fall between meals. During fasting periods, water, black coffee and unsweetened tea are generally acceptable. The goal is not deprivation. The goal is to recreate the natural cycle of feeding and fasting that humans have experienced throughout most of history. Equally important is what happens during the eating window. Focus on whole foods, adequate protein, plenty of fibre, healthy fats and minimising ultra-processed foods.
Small sustainable changes repeated consistently will almost always outperform extreme approaches that cannot be maintained.
Thank you for reading.
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Notes from a GP 