What's the First Thing I Look For When a Woman Can't Lose Weight?

When a woman schedules a consultation with me and says,

"Michelle, I've tried everything. I've cut calories. I've exercised. I've tried every diet I can think of, and I still can't lose weight."

I don't assume she's doing something wrong.

I don't tell her to eat less and move more.

And I don't automatically reach for a prescription.

Instead, I start asking one question:

Why isn't her body responding the way it should?

Because when someone is consistently making healthy choices and not seeing results, there's usually a reason.

My job is to find that reason.

The first thing I look for

Most people think I'm going to say thyroid.

Or menopause.

Or cortisol.

Those are all important, and I absolutely evaluate them when appropriate.

But the first thing I usually look for is whether the body is responding to insulin the way it should.

Why?

Because insulin resistance is incredibly common, especially in women over 40, and it's one of the most overlooked reasons I see women struggle with weight loss.

The frustrating part is that it often develops years before blood sugar becomes abnormal.

That means a woman can be told her labs are "normal" while insulin resistance is quietly making it harder and harder to lose weight.

Here's a recent example.

Just this week, I met with a new patient who was 10 months postpartum. She was still breastfeeding and was frustrated that she hadn't been able to lose the weight she gained during pregnancy.

She also mentioned something else that caught my attention.

She would occasionally get dizzy if she went too long without eating and often felt like she needed something sugary to feel better.

Her routine lab work looked reassuring.

Her fasting glucose was 95.

Her A1c was 5.4%.

Most providers would tell her those numbers were completely normal.

But I wasn't finished looking.

When we checked her fasting insulin and calculated her HOMA-IR, it was greater than 4, indicating significant insulin resistance. Her triglycerides were also elevated at 172, giving us another clue that her metabolism wasn't working as efficiently as it should.

Instead of immediately starting a GLP-1 medication, we decided to begin with my insulin resistance protocol. We'll give her body a chance to respond and then decide together if medication is even necessary.

Sometimes it is.

Sometimes it isn't.

The important thing is understanding why the weight isn't coming off before deciding how to treat it.

Why insulin matters

Think of insulin as the hormone that helps move sugar from your bloodstream into your cells where it can be used for energy.

When your cells stop responding to insulin as well as they should, your pancreas has to make more of it to keep your blood sugar looking normal.

That's why someone can have a normal fasting glucose and a normal A1c but still have significant insulin resistance.

Higher insulin levels also make it more difficult for your body to access stored fat for energy.

So even when you're eating healthier and exercising consistently, your body may still resist letting go of fat.

That doesn't mean calories don't matter.

They do.

But hormones matter too.

Insulin isn't the only thing I evaluate.

Weight loss is rarely just one thing.

After looking at insulin, I continue putting the pieces together.

I evaluate thyroid function because an underactive thyroid can contribute to fatigue, low energy, constipation, brain fog, and difficulty losing weight.

I ask about sleep because poor sleep changes hunger hormones and makes cravings harder to control.

I look at stress because chronically elevated cortisol can influence appetite, cravings, and where we store body fat.

For women in perimenopause and menopause, we also talk about estrogen, progesterone, and testosterone because those hormonal shifts can absolutely affect body composition, energy, sleep, and muscle mass.

Then we look at everyday habits.

How much protein are you eating?

Are you strength training?

Are you walking after meals?

How well are you sleeping?

How are you managing stress?

Sometimes the biggest improvements come from making a few simple changes in the right areas.

Every patient is different.

One of the biggest mistakes I see is assuming everyone needs the same solution.

One woman may primarily have insulin resistance.

Another may have thyroid dysfunction.

Someone else may simply need better sleep, more protein, or more muscle.

There isn't one perfect diet.

There isn't one perfect medication.

There isn't one supplement that works for everyone.

That's why I don't believe in one-size-fits-all weight loss.

I believe in finding out what's getting in the way for your body.

The bottom line

If you've been doing everything you know to do and still can't lose weight, don't automatically blame yourself.

There may be an underlying reason your body isn't responding the way you expect.

The first thing I look for isn't a lack of motivation.

It isn't a lack of willpower.

It's whether there's something happening beneath the surface that's making weight loss harder than it should be.

Once we identify what's standing in the way, we can create a plan that works with your body instead of constantly fighting against it.

Ready to Learn More?

If you're wondering whether insulin resistance—or another hidden factor—could be making it harder for you to lose weight, start with my FREE "Why Can't I Lose Weight?" Assessment.

In just a few minutes, you'll gain insight into some of the most common reasons women struggle with stubborn weight and learn what your next step might be.