“My labs are mostly normal, so why do I still feel like crap and why can’t I lose weight?”
This is where the weight loss conversation gets more complicated.
In Part 1, we talked about insulin resistance. In Part 2, we talked about thyroid dysfunction and thyroid hormone resistance. Now we need to talk about something that can contribute to both of them: chronic inflammation.
Inflammation is not inherently bad. It is one of the ways your immune system protects you. If you cut your finger, develop an infection, or injure a muscle, inflammation helps your body respond and repair the damage.
The problem is when that inflammatory response does not shut off.
Chronic, low grade inflammation can quietly affect metabolism for years. Research has increasingly connected chronic inflammation with adipose tissue dysfunction, insulin resistance, and metabolic disease.
And sometimes difficulty losing weight is one of the clues.
Chronic Inflammation Does Not Always Look Like Inflammation
When most people hear the word inflammation, they think of swelling, redness, pain, or an obvious injury.
Chronic metabolic inflammation can look very different.
You may simply feel exhausted. Your joints may ache. Your brain may feel foggy. Your weight may slowly creep upward, particularly around your abdomen. Your cholesterol, triglycerides, insulin, or blood sugar may begin changing. You may feel like your body does not respond to diet and exercise the way it once did.
Inflammatory signaling can influence insulin sensitivity, lipid metabolism, adipose tissue function, and energy regulation. So when someone is struggling with their weight, I do not just want to know what they are eating.
I want to know what else is happening in their body.
Your Fat Is Not Just Sitting There
This is one of my favorite pieces of physiology because most people were never taught it.
Body fat is not just a storage locker for extra calories.
Adipose tissue is metabolically and hormonally active tissue.
Fat cells communicate with the rest of your body by releasing signaling molecules, including adipokines and inflammatory mediators. Healthy adipose tissue plays important roles in energy storage and metabolic regulation. But as adipose tissue becomes dysfunctional, particularly with increasing visceral fat, its signaling can change dramatically.
Fat cells can enlarge. Immune cells can infiltrate adipose tissue. Pro inflammatory cytokines can increase. Insulin signaling can become impaired.
And this can create an ugly little feedback loop.
Inflammation can worsen insulin resistance. Insulin resistance can contribute to further metabolic dysfunction and visceral fat accumulation. Dysfunctional visceral fat can produce additional inflammatory signaling.
Around and around we go.
Visceral Fat Is Different
Not all body fat behaves the same way.
The fat underneath your skin, called subcutaneous fat, is metabolically different from the visceral fat that accumulates deeper in the abdomen around your organs.
Visceral adipose tissue is particularly associated with metabolic dysfunction and inflammatory signaling. As this tissue expands and becomes dysfunctional, immune cells can accumulate within it and contribute to chronic low grade inflammation.
This helps explain why abdominal fat tells me more about someone’s metabolic health than the number on the scale alone.
Two people can weigh exactly the same amount and have very different metabolic health depending on their muscle mass, visceral fat, insulin sensitivity, inflammation, and where their body stores fat.
The scale cannot tell you any of that.
Inflammation and Insulin Resistance Feed Each Other
This is where Part 1 of this series comes back into the conversation.
Inflammatory signaling can interfere with the pathways your cells use to respond to insulin. As insulin signaling becomes impaired, your pancreas may compensate by producing more insulin.
Now we have insulin resistance.
At the same time, insulin resistance and dysfunctional adipose tissue can contribute to additional inflammatory signaling.
This is why I do not like looking at weight, insulin, inflammation, hormones, and thyroid function as completely separate problems. The body does not work in separate departments. These systems talk to each other constantly.
What Causes Chronic Inflammation?
This is also where I think we need to have an uncomfortable conversation about the standard American diet.
The amount of added sugar and highly processed food in the typical American diet is staggering. Added sugars are everywhere, including foods people do not even think of as “sweet.” Sauces, salad dressings, breads, cereals, flavored yogurts, coffee drinks, snack foods, protein bars, and countless packaged foods can contain significant amounts.
And that matters metabolically.
High intake of added sugars, particularly when it contributes to excess energy intake, can promote insulin resistance, increased liver fat, higher triglycerides, visceral fat accumulation, and metabolic dysfunction. Those changes can, in turn, promote chronic inflammatory signaling.
So while I do not believe one bite of cane sugar suddenly sends your body into an inflammatory crisis, I also do not buy the idea that the enormous amount of added sugar consumed in the modern American diet is metabolically harmless.
It is not.
Other contributors to chronic inflammation can include:
- Visceral adiposity and metabolic dysfunction
- Insulin resistance
- Diets high in added sugar and highly processed foods
- Autoimmune disease
- Chronic infections
- Poor sleep and sleep disorders
- Smoking and excessive alcohol consumption
- Sedentary behavior
- Certain chronic diseases
- Gut and gastrointestinal disorders
- Chronic physiologic stress
These factors do not necessarily operate independently. A diet high in added sugar can contribute to insulin resistance. Insulin resistance can promote visceral fat accumulation. Visceral fat can increase inflammatory signaling. Inflammation can further interfere with insulin signaling. That is how a dietary problem can become a metabolic problem, and eventually a much bigger health problem.
This is why I do not want to simply tell patients to “reduce inflammation.” I want to know what is driving it.
What Might Chronic Inflammation Feel Like?
Chronic inflammation does not have one specific symptom pattern, and many of these symptoms can have other causes. But depending on what is driving it, I pay attention to things like:
- Persistent fatigue
- Brain fog
- Joint or muscle aches
- Difficulty recovering from exercise
- Abdominal weight gain
- Difficulty losing weight
- Gastrointestinal symptoms
- Poor sleep and headaches
- Changes in blood sugar, insulin, cholesterol, or triglycerides
- Symptoms of autoimmune disease
This is also where laboratory testing can sometimes help us see a larger pattern.
For example, I frequently look at high sensitivity C reactive protein, or hs CRP, along with metabolic markers, insulin, glucose regulation, lipids, thyroid hormones, nutrient status, and the patient’s overall clinical picture.
One abnormal inflammatory marker does not tell me the cause. It tells me there may be another question worth asking.
Why Does This Matter for Weight Loss?
Because weight loss is not happening in a vacuum.
Imagine trying to lose weight while you are insulin resistant, exhausted, inflamed, sleeping poorly, losing muscle, and struggling to recover from exercise. Then imagine being told you simply need more discipline.
That is the part of conventional weight loss advice that drives me crazy.
Nutrition matters. Calories matter. Exercise matters. But physiology matters too.
Chronic inflammation can contribute to insulin resistance and metabolic dysfunction, while metabolic dysfunction and visceral adiposity can contribute to more inflammation. The relationship can become self reinforcing.
So sometimes the answer is not another 200 calories removed from someone’s diet. Sometimes we need to figure out why their metabolism is struggling in the first place.
The Goal Is Not to “Detox” Your Inflammation
Please do not buy a seven day inflammation detox. Your liver and kidneys would like a word.
Addressing chronic inflammation means identifying what is actually driving it.
For one person, that might mean improving insulin sensitivity and reducing visceral fat. For another, it may mean addressing an autoimmune condition, sleep apnea, chronic gastrointestinal problems, smoking, excessive alcohol use, or another underlying medical issue.
Nutrition and exercise absolutely belong in that conversation. Adequate protein, whole foods, fiber rich plants, healthy fats, resistance training, regular movement, adequate sleep, and building or preserving muscle can all support metabolic health.
But I do not believe in treating inflammation as if it is a disease by itself. Inflammation is often a signal. I want to know what is creating the signal.
Final Thoughts
If you have cleaned up your diet, you are prioritizing protein, you are exercising, and you are genuinely trying to lose weight but your body is not responding the way you expect, do not assume the only possible explanation is that you are eating too much.
Look at the bigger picture.
Insulin resistance can make weight loss harder. Thyroid dysfunction can make weight loss harder. Chronic inflammation can contribute to both while creating metabolic problems of its own. These problems frequently overlap.
That is why I do not treat weight as an isolated symptom. I want to understand the metabolic environment that allowed the weight gain or weight loss resistance to develop in the first place.
Because sometimes stubborn weight is not the problem. It is one of the clues.
Next in the Series
In Part 4, we will tackle a major contributor: perimenopause, menopause, and andropause, and how declining sex hormones can change metabolism, muscle mass, insulin sensitivity, and where your body stores fat.