How do I manage weight despite being on a diet at 38?

Question

Hi doctor,

I am a 38-year-old male, and over the past five years, I have steadily gained weight despite trying to eat a balanced diet and exercising occasionally. My current weight is 238 pounds, and my height is 5.6 feet, giving me a BMI of 36.5 kg/m². I feel constantly tired, and climbing stairs or walking short distances leaves me breathless. I have noticed increased sweating, joint pain in my knees and lower back, and occasional snoring at night.

My recent blood tests showed a fasting blood sugar of 112 mg/dL, HbA1c of 6.2%, total cholesterol of 245 mg/dL, and triglycerides of 210 mg/dL. My blood pressure is consistently around 145/90 mmHg. I have a family history of type 2 diabetes and heart disease.

I am concerned about the long-term health risks, such as diabetes, heart problems, and sleep apnea. Could you advise the most effective ways to manage my weight? Are medications or bariatric surgery options suitable for someone with my BMI and laboratory values? What lifestyle changes would give the best results for long-term weight control?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I completely understand your concern and how discouraging it can feel to see your weight increasing despite your efforts to eat well and stay active.

The symptoms you describe, including fatigue, breathlessness, joint pain, and snoring, along with your blood test results, suggest that your body may be under metabolic strain. Your current BMI (body mass index) indicates obesity, which can increase the risk of developing diabetes, high blood pressure, heart disease, and sleep apnea over time.

The good news is that meaningful weight loss, even as little as five to ten percent of your current weight, can significantly improve your blood sugar, cholesterol, and blood pressure.

The most effective long-term approach combines dietary changes, regular physical activity, and behavioral strategies, and those include:

A diet rich in vegetables, lean proteins, whole grains, and healthy fats, while limiting refined sugars and processed foods, can make a real difference.
Structured plans like the Mediterranean or DASH (dietary approaches to stop hypertension) diets have been shown to improve both weight and heart health.
Regular exercise, such as brisk walking, swimming, or cycling for at least 150 minutes a week, along with some strength training, helps improve metabolism and preserve muscle mass.

Given your BMI and borderline blood sugar, weight loss medications such as GLP-1 (glucagon-like peptide) receptor agonists may be appropriate and can help reduce both weight and diabetes risk.

Bariatric surgery could also be considered, especially if lifestyle changes and medications are not enough, since it is generally recommended for people with a BMI above 35 with obesity-related conditions.

Because you also have symptoms of possible sleep apnea, a sleep study may be helpful, as treating it can improve energy levels and support weight management. It is understandable to feel anxious about the health risks, but with a clear plan guided by your doctor and consistent lifestyle changes, many people in your situation see real improvements in weight, energy, and overall health.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.