I swam competitively in high school with up to four hours per day of heavy training, ate as little as possible, and still gained. I continued to swim in college and met with doctors, trainers and nutritionists who claimed I had a healthful and appropriate diet and got plenty of exercise despite my ever increasing weight.

Today, I continue a steady routine of exercise — a minimum of two hours each day doing both strength and aerobic activities. I mix up the routine so my body won’t get adjusted to doing the same thing every day. During weekends and vacations, I increase my activity levels.

I’ve studied to become a trainer, read anything I can get my hands on about how to exercise properly and tried many, many ways to lose weight. I started with the basic expend more calories than you consume. I used a weightlifter’s competition diet of 1,000 calories a day for three weeks and gained six pounds. I’ve weighed, measured, and kept a food journal in order to keep my calories at a minimum.

My doctor has ordered all sorts of blood work that always comes back normal. It was discovered that I have an airway-obstruction issue (apparently my tongue is too big for my mouth), and my physician told me that the sleep issue caused my weight issues and that a CPAP machine would help. I started using this in November and have put on 10 pounds since then.

I continue to question my doctor, but he maintains that if I reduce my calories enough, I will lose weight. I don’t drink soda or alcohol, nor do I eat white flour or sugar. At one point in a depressed, desperate mood, I consumed 500 calories per day for two weeks, kept up my workouts, and gained four pounds. Needless to say, I was crabby.
I’m sad, depressed, and at my wits’ end. I’m seriously disappointed with my ability to conquer this hurdle. What is wrong with me?

DEAR READER: It certainly appears you have done all the right things and even some “not so right” things to keep your weight down .

There are several reasons why individuals can experience difficulty losing weight, including the consumption of too many calories without expending them, hypothyroidism, alcohol use, certain medications, emotional factors such as depression, slow metabolism, Cushing syndrome and more. Some individuals may even be weight-loss intolerant.

Based on your letter, I don’t believe you are weight-loss intolerant. The fact that you continue to gain weight despite drastic calorie cuts is a concern to me. It indicates that either you are not being truthful about your diet and exercise habits or there is some underlying medical problem causing the unintentional weight gain. For the record, I would like to say, that I do not believe you are being untruthful and the sheer desperateness of your letter is proof of that.

You claim to have had blood work but because you did not elaborate, I do not know what you were tested for. Because of this, I will again review some of the testing you should undergo or perhaps have repeated.

First, a complete blood count and work-up should be done. Several endocrine disorders such as hypothyroidism and Cushing syndrome can lead to unwanted weight gain and difficulty losing weight as well as other problems. Hypothyroidism is often easy to resolve with inexpensive prescription hormone replacement. Cushing syndrome is more complex. It often results from a benign pituitary-gland tumor, a benign adrenal gland or an ectopic adrenocorticotropic hormone (ACTH) secreting tumor (typically found in the lungs, thyroid, thymus gland or pancreas).

Alcohol use, quitting smoking, depression and certain medications may be contributing factors. I believe your current issues with depression are stemming from the persistent weight gain, not the other way around.

In my opinion, your physician is being negligent about your situation. Despite your repeated attempts to get help, he has essentially ignored the situation. Now is the time to find a new physician who will take you seriously and work with you to get to the bottom of this very frustrating problem.

To provide related information, I am sending you copies of my Health Reports “Thyroid Disorders” and “A Strategy for Losing Weight: An Introduction to the No Flour, No Sugar Diet.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each copy to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.