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My wife is in great shape, but she has gained 15 lbs in the last 2 years. She eats clean and works out (Crossfit 3-4x week , spinning 1x week) but she can't lose the weight that she has put on the past few years.

Her metabolism is normal to slightly above normal, and she eats about 1800-1900 calories/day. With her metabolism and activity level, she should be able to eat 2,300 calories/day and maintain her weight. She eats less than that and is gaining weight.

Her thyroid level is a little lower than normal, but a doctor put her on meds. This didn't help her weight gain stop, so she got off the meds.

She is frustrated and sad with her not being able to control this situation and lose the weight. I think she looks great, but that doesn't seem to help her fears that she will continue to gain weight.

Any suggestions? Thanks!

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Might be helpful to describe what she's eating (not just how many calories) and how you determined that her metabolism is "normal to slightly above normal". –  Greg Aug 8 '13 at 13:57
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Also, as a side note hypothyroidism can take a while to resolve, or see benefits from supplementation. Stopping her supplementation (I assume it's T4) is probably not the best idea without the doc's ok. –  Greg Aug 8 '13 at 13:58
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@BrianR - Paleo, south beach, grapefruit, those are all fad diets. If she is eating more calories than she is burning, she will gain weight. If she burns more than she eats, she will lose weight. It really is that simple. My fitness pal is one of the better apps, but it still an estimate (How big is a "medium" apple?) Keep a diary, weigh food on a scale, if you make a mixed dish (such as a stew) calculate calories before mixing ingredients, figure out how many cups and divide to get calories/cup, etc. –  JohnP Aug 8 '13 at 14:55
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@Shauna - No, I consider that a dietary preference. It was not "created" with the sole purpose of selling books and information centered around it. I may not think it's a great diet to follow, but that's my personal opinion. –  JohnP Aug 8 '13 at 16:15
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Just a consideration, around menopause women tend to put on weight. Also, just a small change like eating a handful of candy or adding sugar to the coffee you used to drink black can make quite a difference over time. –  Nathan Wheeler Aug 8 '13 at 20:16
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Go back to the doctor, get other bloodwork done. Women are prone to a couple of different endocrine issues that are related to weight gain - namely PCOS and hypothyroidism. Both are very often under- or misdiagnosed. For PCOS, you need at least the following bloodwork - DHEAS, fasting insulin, and fasting glucose. Ideally, she should also get free testosterone levels checked, as well. For hypothyroidism, TSH testing isn't enough, get the free T3 and T4 tests done, as well. At the very least, this will rule out medical issues.

Hammer down on the food tracking. That she's eating Paleo and tracking is great, but she can probably do better. After all, it doesn't matter if she's eating chicken and broccoli all day, if she's eating too much, she's going to gain. At the very least, measure everything. Even better - weigh it. This gets her the most accurate numbers she can get. Also, don't substitute. If the food item isn't in there, or doesn't match what is on the package or in a cross-referenced source, then either update the entry or add a new one.

Get a heart rate monitor. MyFitnessPal is notorious for wild estimates for calorie burn. Get a heart rate monitor and use it for any and all exercise. Use its numbers over MFP's.

Eat the calories back. If she's using MFP's system for calculating calories, and her workouts aren't figured into the calculation, then follow how MFP does it and when she exercises, she eats more to account for them. MFP builds in the deficit when you configure it, exercise above and beyond the configured value is gravy.

Double-check other medications. Is she on birth control? Most hormonal birth controls are known to cause weight issues, and Depo Provera is often the worst offender. Does she take any other medications? Check them for weight issues and see if they can either be phased out (with doctor's supervision) or changed to something that doesn't cause weight issues.

Go back to Paleo basics. As, Humans are not broken puts it you might be getting too good at Paleo. If the SAD-style "treats" have worked their way back in, though technically Paleo, they might be causing issues (particularly if they have some kind of sweetener in them). Do a Whole30 to get back to the basics and force a habit change. At the very least, go through your typical meals and cut the chaff and stick to the powerhouse foods.

Tweak macros. Paleo isn't necessarily low-carb/high-fat, and some people do better on low carb, while others do better on higher carb. This will partially depend on what the aforementioned bloodwork comes back with, though. If she shows signs of insulin resistance, then lower carb will probably be her best option. If she doesn't, then she's more free to try increasing the carbs (depending on where she's at now).

Change up the workout routine. It's possible that the intensity of Crossfit, plus the spinning classes are too much and too intense. Try dropping one and do some dedicated power lifting or strength-oriented body weight training, or just drop one for something less intense altogether. Mark Sisson puts it elegantly - "move frequently at a slow pace." You don't need to power through an hour of spinning at top speed, when an hour walk or leisurely bike ride will suffice and won't cause your body as much stress (and thus, cortisol production).

Be patient. It took 2 years to gain those 15 pounds. They're not going to come off overnight. Give any changes at least a month, before giving up on them. And if she's anything close to normal weight, it might take longer to see the scale move. Fifteen pounds in 2 years is just over half a pound a month. Don't expect it to come off much faster.

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Thanks. The frustrating thing for her is that she did the whole 30 diet for a month and didn't lose any weight. She also changed her birth control to a troupe with lower hormone levels I think. Nothing is helping her and she is fearful of continued weight gain. I just want to help her gain control of this so her confidence returns. –  Brian R Aug 8 '13 at 16:46
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I think a very real question is whether she looks like she's gaining weight. In other words, is the scale going up but she still looks thin. That speaks toward lean mass gains which can be water weight or muscle gain. If she's looking softer now, it very well could be fat related. Any major surgery or pregnancy can change a woman's hormonal makeup. My wife went through major metabolic changes with both cases (in the case of pregnancy she lost her allergy to chocolate). –  Berin Loritsch Aug 8 '13 at 19:47
    
@BrianR - I'd definitely have her go to the doctor, then, especially given your previous comment about where the fat is being stored. Weight gain in the stomach area is often indicative of impaired insulin resistance (which can happen in "normal weight" individuals, as well). –  Shauna Aug 8 '13 at 19:51
    
I think it is premature to give an answer. We don't even know what she is eating or what her workouts are. My wife uses puts in her calories into some iphone app... and I would def not go before a grand jury and swear everything is true. –  Tom Aug 8 '13 at 20:00
    
@Tom - Worst case scenario with going and getting bloodwork is that the bloodwork comes up clean. Ruling out medical issues is a far cry different than swearing an oath in front of a grand jury. Additionally, doing one thing (getting bloodwork done) does not exclude doing other things (buckling down on tracking accuracy). –  Shauna Aug 8 '13 at 20:13
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