Diet Resistant Spots

Four Fitness-Resistant Spots That Just Need Surgery

On a weekly basis, I consult with patients who are looking to contour one area or another of their bodies. In most cases, the patient has been trying to fix things on their own, through diet and exercise. I will hear things like, “I have been working out regularly, and I am getting much more fit overall, but this thing just doesn’t seem to go down.” They continue to describe dieting efforts, targeted weight-training, and various other strategies, all ending with the helplessness of feeling like they are getting nowhere. In many cases, they are not wrong.

While overall health and fitness are greatly impacted by working out and nutritional optimization, there are body areas that can resist all of that hard work. Whether genetically determined or hormonally supported, these are the spots that can really bend your brain. While they are usually fatty areas with disproportionate fat stores, they do not release that fat as readily as other areas when the patient loses weight overall. In some cases, even with large volumes of weight loss, the bulge can remain stubbornly in place, barely smaller than it used to be. In these cases, the only way to remove it, usually, is through surgery.

One of the best examples of this type of area is the double-chin. I have had patients who weigh 100lbs come in with a huge fat deposit on their necks, to the point where it is difficult to imagine how that got there. Sometimes, the problem is the ankle, where contour prevents a separation between the calf muscles and the slimmer ankle, and everything just looks like a solid block on the way down. The love handles are another prime spot, especially for men, where even after three hundred crunches a day, the results may be flat out defeating. The belly is tough to imagine being diet and exercise resistant, because the fat inside the abdomen (under the muscles) responds so quickly, even in real time, to large meals or big workouts. But the fat right under the skin, especially in the lower abdomen, is particularly stubborn, especially in women who have had children. Those are the stores that the body creates for baby-care; and those are the stores that it will refuse to let go of until the bitter end.

Patients tell me all the time, “I know I am consulting for surgery, but maybe I should just work out more, right?” In some cases, that is the truth. But in many cases, the contour frustration that they are experiencing is not the result of lack of willpower or determination. Sometimes it is just the luck of the draw, and there is nothing they could actively do to get rid of the problem. This is especially frustrating after putting in all that work in the first place. Faced with a motivated, healthy, fit patient, who just has a simple contour problem that could be fixed in a few hours, my answer is often the same: “What better reward could there be for all of your hard work?” After all, no one will see that 8-pack if it’s trapped underneath a layer of grandpa’s gut for all of eternity.

Profiles of a woman of two different weights facing herself.

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