San Luis Obispo, California, USA:

I have type 1 diabetes, and I have been having a real struggle with my weight. I exercise three to five times a week and eat a pretty low carb, high protein diet. I have worked with nutritionists, trainers, etc. and the only time I have lost weight is by going on an all veggie diet. Obviously this didn’t last long; I regained weight and have been doing everything I can to lose weight. I am also insulin resistant, so I know I have to take extra insulin then the average person.

I am just completely frustrated — I can’t lose weight and I am starting to become very depressed. I need to take off at least 20 pounds, but I can’t. I am willing to do whatever it takes and am trying to do it in a healthful manner, but something isn’t right. What can I do?

I have been in the position of caring for patients with similar problems. The first thing to note is that there are no miracle cures. Secondary causes of obesity would include low thyroid or excessive cortisol levels that your physician can address. Secondly, weight loss is a gradual process. It doesn’t and shouldn’t occur rapidly. The benefit you receive from participating in exercise extends beyond any effect on your weight. Finally, there are two medications that have been approved by the FDA for long-term weight management. You should talk to your physician about these drugs and whether you could be treated with one of them.

It is often asked whether people in your situation have an “abnormality of my metabolism.” I can say that there is no such test as a metabolism test. It is true that genetics may play a large role here but there is no test to determine if that is why you are not losing weight. My advice is to be skeptical of any miracle treatments and set your goals at achieving reasonable responses over time.

JTL

[Editor’s comment: Since you say you have insulin resistance, you might ask your physician about adding [metformin] to your diabetes regimen.

SS]