Excess weight (fat) is now a rapidly expanding health crisis, like the expanding waste (waist) lines, affecting both the over-nourished and the malnourished. It has spared only those with a strictly disciplined diet and a sustainable, active lifestyle. Cheap, ultra-processed, hyper-advertised, attractively packaged, calorie-rich, nutritionally poor food, combined with a sedentary lifestyle, is sought to be managed with unsustainable weight fads. At the other end of the spectrum are the unfortunate, deprived, starving, and undernourished people in poorly governed, strife-torn, remote, and drought and disaster-prone areas.
UNEXPLAINED WEIGHT GAIN OF CONCERN
A rapid weight gain of 2.5 kg within a week, or more than 5% of total body weight within a single month, without modifying diet or physical activity, needs attention. Sudden weight gain accompanied by any of the following complaints requires prompt medical assessment:
•Severe shortness of breath, chest pain, or a cough that worsens on lying flat.
•Marked swelling or pain localized to one leg may indicate a deep vein thrombosis (DVT).
•Extreme fatigue, dizziness, fainting spells, or sudden confusion.
•New-onset severe headaches, vision changes, or profound muscle weakness.
Unexplained weight gain can be due to
•Hormonal Imbalances such as hypothyroidism (underactive thyroid gland), Polyendocrine Metabolic Ovarian Syndrome (formerly PCOD, PCOS), Cushing’s Syndrome (prolonged steroid use, or overproduction of the stress hormone cortisol).
•Congestive heart failure, kidney disease (renal failure), and liver cirrhosis and failure can cause dramatic weight fluctuation due to severe fluid retention.
•Certain prescription drugs (corticosteroids, certain psychiatric medications, and diabetes therapies) lower metabolic efficiency, escalate appetite, or promote fluid retention.
•Sleep deprivation, stress, and insulin resistance can elevate circulating insulin and hunger hormones ghrelin and leptin, leading to craving for calorie-dense foods and fat accumulation.
UNEXPLAINED WEIGHT LOSS OF CONCERN
Unintentional weight loss of more than 5% of body weight over 6 to 12 months without modifying diet or physical activity implies an underlying body energy imbalance. Sudden weight loss accompanied by any of the following complaints requires prompt medical assessment:
•Persistent low-grade fevers, recurring night sweats, or unremitting fatigue.
•Severe or localized abdominal pain, chronic diarrhoea, progressive difficulty swallowing (dysphagia), or blood in the stool or vomit.
•New-onset severe headaches, changes in vision, localized weakness, or cognitive changes.
•Chronic cough, coughing up blood, or sudden shortness of breath.
Involuntary weight loss can be due to many reasons
•Cancers release pro-inflammatory cytokines that induce cancer cachexia, a metabolic state that accelerates muscle wasting and fat degradation while depressing appetite.
•Gut diseases such as Inflammatory Bowel Disease (IBD), Celiac disease, and chronic pancreatitis alter the structural integrity or function of the gut, leading to chronic calorie deficits.
•Hormonal imbalances such as hyperthyroidism (excess thyroid hormone), type 1 or uncontrolled type 2 diabetes can cause calories to be burned faster than they can be consumed, using fat and skeletal muscle tissue for fuel.
•Persistent infections like Tuberculosis, HIV/AIDS, and subacute bacterial endocarditis (infection of the heart valves) cause profound metabolic wasting.
•Psychosocial factors and cognitive decline, as seen in depression and anxiety, dementia or Alzheimer’s disease, and advanced Parkinson’s disease, frequently alter a person’s relationship with food, mechanical ability to eat, or natural appetite pathways.
•Polypharmacy (five or more drugs for a single patient), especially in older adults, can inadvertently cause weight loss. Certain prescription drugs induce chronic nausea, alter taste and smell perceptions (dysgeusia), reduce saliva production, or directly suppress appetite.
SUSTAINABLE METHODS OF WEIGHT LOSS
Discipline and self-control are essential for both health and wealth. Gradual lifestyle adjustments that prioritize steady body fat loss of 0.5 to 1 kg per week, while preserving and strengthening bones and muscles, are natural and sustainable methods to achieve an ideal body weight (IBW). Unlike quick-fix crash diets, drugs, and procedures, permanent lifestyle habits that nourish the body and maintain metabolism avoid cycles of weight regain.
Balanced, nutritious food within limits, not starvation, ensures long-term compliance. Starvation forces the body’s metabolism into a thrifty mode, preventing weight loss and instead causing lethargy, fatigue, and a craving for calorie-rich sugary foods.
A diet of sprouts, whole grains, vegetables, and fruits is very filling (especially sprouts), and naturally limits overeating and frequent snacking. To reduce hidden calorie intake, replace sugary drinks, sodas, and juices with water, which has zero calories but calories are consumed to handle it. Strictly avoid alcohol.
•Gorging on a watermelon can lead to weight loss, whereas a sweet or confectionery can cause weight gain. The watermelon contains a lot of water that has to be warmed to body temperature, burning more calories than the fruit provides. More calories are then burned to absorb it from the gut, circulate it in the blood, and then rid the excess in urine. Whole foods take longer to digest, so you do not feel hungry for many hours. A sweet or an ultra-processed snack requires minimal digestion, causes a quick, sharp rise in blood sugar, accompanied by a sharp increase in insulin, followed by calorie storage as fat and a rapid drop in sugar levels, causing frequent craving to snack.
•Another method the author has found very effective is maintaining a log of body weight every morning. If the weight goes up, remember what you ate and drank the previous day and avoid or reduce that. If the weight drops, repeat the calorie-burning activities you did the previous day and the calorie-restricted diet.
This is self-motivating. Eat slowly, stop eating before you are full, and avoid snacking unless hungry. The problem with a diet sheet is that it requires you to measure every item consumed and follow the dietician’s instructions.
•A combination of strength training exercises at least two days a week and cardiovascular exercise, such as brisk walking, cycling, climbing steps, or swimming, 150 minutes weekly, ensures optimal cardiovascular and metabolic health. Read my article dated March 2, 2025, for the classification of exercises. Also, refer to my article “How to use your body weight to gym at home to stay fit” dated December 14, 2025. Maximize NEAT (Non-Exercise Activity Thermogenesis) by increasing your general physical activities, like taking the stairs instead of the lift, walking short distances instead of driving, or trying gardening.
•The psychological approach to eating determines how well weight is maintained over the years. Practice mindful, slow eating and thorough chewing, and turn off screens during meals. This allows the brain time to register natural fullness cues. Track and record manually or use digital tools to build awareness of meal portions and timing, emotional eating patterns, and interval or late-night snacking habits. Meals of nutrient-dense whole foods may permit occasional treats.
•Prioritize restorative sleep as sleep deprivation elevates ghrelin (the hunger hormone) and reduces leptin (the fullness hormone), driving intense cravings. Chronic stress elevates cortisol levels, stimulates the appetite, and encourages the accumulation of deep abdominal fat. Manage stress levels with deep breathing, yoga, or spend time in nature or with hobbies.
POPULAR YET UNSUSTAINABLE METHODS OF WEIGHT LOSS
Unsustainable weight loss methods rely on extreme restrictions that result in a rapid, short-term drop in weight from water loss and muscle wasting, rather than actual body fat reduction. They trigger intense hunger, leading to a cycle of rapid weight regain (yo-yo dieting).
•Crash dieting triggers a starvation response (energy thrift by low calorie burn), conserving fat.
•Extreme liquid cleanses and detoxes, replacing solid meals entirely with fluids, eliminate essential macronutrients like protein and fibre. Liquid fasts, restricted to only juices or specialized liquids for extended periods, lead to muscle loss and significant fluctuations in blood sugar. Laxatives or diuretics artificially speed up digestion or increase water excretion, resulting in weight loss due to dehydration and not fat loss.
•Elimination of entire food groups like carbohydrates or fats leads to severe nutritional deficiencies and binge-eating cycles.
•Excessive exercise or physical exertion (marathons, mountaineering, etc) or prolonged high-intensity activity combined with inadequate nutrition and rest, leads to physical burnout due to muscle breakdown and elevated stress hormones like cortisol.
•Relying on unregulated, “quick-fix” weight-loss substances (supplements/herbals/drugs) to artificially suppress appetite or raise heart rates (metabolism) risks cardiovascular, liver, kidney, and metabolic complications. Any temporary weight loss is regained once its use is discontinued.
Focusing on moderate calorie deficit, balanced nutrition, and consistent physical activity is a sustainable way to achieve healthy, long-term weight management.
*Dr. P.S. Venkatesh Rao is a Consultant Surgeon, Former Faculty CMC (Vellore), AIIMS (New Delhi), and a polymath in Bengaluru, drpsvrao.com
