The most important fact we wish to emphasize when it comes to thyroid disease and obesity is that it is extremely common for all obese persons to wonder whether their thyroid is "making them fat." This chapter will help you sort out whether your obesity predates your thyroid problem, is aggravated by a thyroid problem, or is the result of one. Obesity refers to a body size that is too overweight for good health. Obese people have greater incidences of type 2 diabetes, heart attacks, strokes, peripheral vascular disease (circulation problems, leading to many other health problems), and certain types of cancers. Hypothyroidism can aggravate obesity and complications from obesity. Hyperthyroidism or thyrotoxicosis, however, may cause an unhealthy type of weight loss, aggravating other conditions that may be linked to obesity, such as heart disease (see Chapter 25) or type 2 diabetes.
It is not known how many people with thyroid disease are obese; but it is clear that the majority of obese people do not have thyroid disease. It is important to check for thyroid disease if you are obese, but keep in mind that there are many different causes for obesity, and your thyroid tests may be normal. Nevertheless, many who are overweight may indeed be suffering from unrecognized or untreated hypothyroidism. If you're reading this chapter and wondering whether your weight problem is the result of a thyroid problem, request a thyroid function test from your physician (see Chapter 2).
When obesity is a result of hypothyroidism, most people will find that they start to return to their normal weight once their hypothyroidism is treated. Of course, anything that causes you to gain additional body fat, such as pregnancy or hypothyroidism, may contribute to long-term obesity even after the initial cause is gone or treated. This is why you need to pay careful attention to diet and exercise, even though you are taking the proper amount of thyroid hormone to have normal thyroid hormone levels and a normal TSH.
Feelings of tiredness and low energy, which are symptoms of hypothyroidism, may cause you to crave carbohydrates and quick-energy foods, which are higher in fat and calories. When you are hypothyroid, your activity level will decrease as a result of your fatigue, which can also lead to weight gain or aggravate preexisting obesity. The craving for carbohydrates is caused by a desire for energy. Consuming carbohydrates produces an initial "rush" of energy, but then it is followed by a crash, which is sometimes known as postprandial depression (or postmeal depression), exacerbating or contributing to hypothyroid-induced depression. Even in those with normal thyroid function, depression can cause cravings for simple carbohydrates such as sugars and sweets. In the absence of overeating, some of the weight gain in hypothyroidism is bloating from constipation. Increasing fluid intake and fiber will help the problem, which we discuss more in Chapter 20.
The problem for most people who are battling both obesity and hypothyroidism is that their obesity often predates their thyroid problem, indicating that there are other factors involved in their weight gain. Stack a thyroid problem on top of that, and it may exacerbate all kinds of other behaviors that led to the initial weight gain, as well as aggravate risks associated with obesity in general.
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