This is my fourth blog on the subject of weight management. 
For so many years, you have been told the same lame idea that it’s all about calories and exercise. This implies everyone who remains overweight must be overeating and lazy. I guess we’re all just a bunch of liars.
Let’s dig a bit deeper.
If you have already dedicated yourself to a good foundation of diet (avoiding processed sugar and wheat-based carbs, etc.) and exercise, I will go through a stepwise plan to get things moving in the right direction.
1. Thyroid: Get a full thyroid lab panel that includes TSH, free T3 and free T4 at a minimum and do some research through this blog and other sources. You should try to find a practitioner with an approach that goes beyond the simple. Optimally managing the thyroid does not typically lead to a 50-pound weight loss, but it is a crucial piece to the puzzle.
2. Evaluate for Food Sensitivities: Most people over 35-years-old have foods they consume on a regular basis that cause inflammation and unintended weight gain. This can include foods we assume are healthy like oatmeal, turkey, tomato sauce, asparagus, black beans and salmon. You could get Lyn Genet-Recitas’ book The Plan to go through her 20-day plan to identify those foods and/or get IgG food sensitivity testing done through an outside laboratory. I have been using this type of testing for years and the results are different for each individual.
3a. Do a Full Hormonal Evaluation: Get Sara Gottfried’s book The Hormone Cure and take the questionnaire early on in the book to get some sense of whether estrogen dominance, progesterone resistance and other factors are playing an important role in your weight.
3b. Stress Management: Stress leads to higher than normal levels of the “stress hormone” cortisol. Cortisol promotes weight gain and fat redistribution. You can walk, exercise, meditate, improve sleep, work less, etc. or you can try to objectively assess your adrenal/cortisol status. The best way to check this issue is a salivary cortisol test that measures the level at 3-4 different times during a 24-hour period.
4. Tweak your Microbiome: Research is building that imbalances of our internal gut flora contribute to weight and metabolic variation. When comparing Americans to certain native groups in Africa and other ethnic groups who have a more indigenous diet, our microbiome is significantly less diverse with an opposite ratio of the two main types of bacteria Firmicutes and Bacteriodetes. Our individualized internal microbial balance interacts with our brains and affects our metabolisms in many ways we are beginning to understand. There is research that certain probiotics can help with weight loss, but we are too early in our understanding to easily recommend a specific probiotic that would have the most value.
In a never-ending quest to expand my knowledge and find the best options, some areas have been more challenging than others. Weight loss is a more complex topic than most realize. These blogs should give you some understanding of how to individualize your approach. 
Andrew Lenhardt, MD