Treatment-Resistant Obesity – A Clinical Approach

We teach why a calorie deficit doesn’t always work – and what to do in practice.

This advanced nutrition course focuses on one of the hardest problems in modern practice: lack of weight loss despite dieting and a calorie deficit. The programme is based on current scientific evidence from physiology, endocrinology and nutritional psychology.

You will learn about mechanisms such as metabolic adaptation, hormonal disorders, the influence of the gut microbiota and psychological factors that can block weight loss. The course teaches a practical clinical approach that goes beyond “eat less, move more”.

Content is based on publications in endocrinology and position statements of The Obesity Society, among others.

The course takes an interdisciplinary approach focused on solving problems and restoring normal biological function. Our goal is nutrition therapy with lasting results.

Course programme

Module 1. Why you’re not losing weight

• metabolic adaptation (slowed metabolism)
• errors in calorie counting and NEAT
• the role of resting energy expenditure

Hall et al., 2016: a drop in energy expenditure can persist long term.

Module 2. Hormones and body weight

• insulin and insulin resistance
• leptin and leptin resistance
• cortisol and stress

Sumithran et al., 2011: after weight loss, hormonal changes occur that increase appetite.

Module 3. The gut and inflammation

• the gut microbiota and metabolism
• chronic low-grade inflammation
• the effect of diet on gut flora

Turnbaugh et al., 2006: the microbiota may influence how efficiently energy is stored.

Module 4. Nutritional psychology

• binge eating
• chronic dietary restriction
• mechanisms of compulsive eating

Polivy & Herman, 1985: restrictive diets increase the risk of overeating.

Module 5. Treatment strategies

• reverse dieting (gradually increasing calories)
• diet breaks
• changing strategy instead of cutting calories further
• personalising the plan

Peos et al., 2021: diet breaks may help maintain results and improve metabolism.

Key takeaways

• a calorie deficit doesn’t always work in a linear way
• the body adapts to weight loss
• hormones and stress are crucial
• the gut and inflammation affect metabolism
• the mind is as important as the diet

Who is it for?

• dietitians
• personal trainers
• skin therapists working on body contouring
• anyone working with clients who are overweight or obese