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Any clinician who works with patients struggling to lose weight or to maintain weight loss has observed a common paradox: that, on the basis of how much our overweight or obese patients may tell us they are eating and exercising, we believe they should be losing weight, but they aren't. In fact, in this process of expending more energy than they consume, sometimes our patients actually gain weight. Unfortunately, clinicians may conclude—mainly out of frustration—that these patients are not being completely truthful (either with us or themselves) or that all they need is more willpower. This article introduces a framework that a naturopathic doctor (ND) may use to treat overweight or obese patients who are in this predicament.  … the equation calories in < calories out = weight loss is an oversimplification for some patients.   In general, NDs consider that the equation calories in < calories out = weight loss is an oversimplification for some patients. In addition to the relation between caloric intake and activity, several other factors contribute to a patient's overall health and, therefore, to his or her actual ability to lose weight in a sustainable and healthy way. These factors include:   Psychological stress levels   Exercise history   Dietary history   Hormone balance   Quality and amount of sleep   Toxic chemical exposure (for example, alcohol, tobacco, processed foods, caffeine, and pharmaceutical drugs)

Healing Metabolism: A Naturopathic Medicine Perspective on Achieving Weight Loss and Long-Term Balance