Not losing weight despite clean eating? Top GI surgeon suggests checking 7 hidden medical clues

You eat well, avoid junk, track portions, squeeze in your workouts, and even have fixed your sleep cycle — yet the scale won’t budge. Imagine the demoralizing disappointment!

You blame fate, you find faults in your patterns, and you end up stressing yourself out more.

But before you blame your body, your motivation, and your willpower, get this — your body might be sending quiet medical signals that block weight loss.

Dr. Anshuman Kaushal, known by many as the “angry_doc” on social media, a surgical gastroenterology and bariatric expert at Apollo Hospitals, agrees and warns that hidden medical issues can quietly sabotage your weight-loss efforts, even when your lifestyle seems spot-on. According to him, unexplained weight gain or stagnation often signals deeper biological imbalances, not a lack of discipline.

In fact, in a recent video on Instagram, Dr. Kaushal shared seven “red-flag” medical tests that people frequently overlook — but which could explain why the scale refuses to budge. From insulin resistance and thyroid dysfunction to stress hormones, inflammation, and vitamin deficiencies, these tests can unmask root causes behind persistent fat, cravings, and slow metabolism. His take: Unless you fix these internal issues, clean eating alone may not deliver the results you dream of.

“Clean eating” focuses on food quality, which matters. But weight is controlled by many systems — hormones, sleep, and the gut microbiome, among others. When one of those systems is off, your body can hold on to weight or resist fat loss despite a good diet.

According to Dr. Kaushal, clean eating and working out may feel like they should guarantee weight loss — but they only address calories in versus calories out. What many people ignore are the internal systems that regulate how the body processes food, stores fat, and uses energy. When these systems aren’t working properly, healthy habits alone may not be sufficient. He emphasizes that frustration, cravings, and weight stagnation are not personal failures — they often reflect real biological stress. As he puts it: if these root causes are not addressed, “you’re fixing the calories but not the chemistry.”

Dr. Kaushal suggests a comprehensive checklist of seven tests, which he calls crucial starting points for individuals struggling with weight loss despite a healthy lifestyle.

Dr. Kaushal recommends testing fasting insulin levels and calculating HOMA-IR (a measure of insulin resistance). He warns that when HOMA-IR goes above around 2, weight loss becomes significantly harder.

Why it matters: High insulin makes the body store fat, particularly around the belly, and reduces the ability to burn it. PCOS combines hormonal imbalance with insulin resistance and commonly blocks weight loss.

What to ask for: Fasting insulin, fasting glucose, HbA1c; for women, evaluate for PCOS (clinical signs + hormone tests).

While most people check TSH (a common thyroid test), Dr. Kaushal points out that low T3 or even autoimmune thyroiditis (thyroid inflammation) may be missed. These issues can slow down metabolism even if TSH looks “normal.”

Why it matters: A slow thyroid lowers metabolism and makes weight loss harder.

What to ask for: TSH and free T4 blood tests.

Elevated cortisol, which is the body’s primary stress hormone, promotes fat storage, especially around the belly, and interferes with weight loss. It also causes a wide range of health problems, including diabetes, high blood pressure, a weakened immune system, and mental health issues like anxiety and depression. Dr. Kaushal explains that chronic stress, not just poor habits, can biologically prime the body to hold on to fat.

Dr. Kaushal also advises checking ApoB levels. An ApoB level is a measure of the number of particles in your blood that carry cholesterol, fats, and other lipids, such as LDL and VLDL. High ApoB levels are linked to an increased risk of cardiovascular disease because they indicate a greater number of these potentially harmful particles. Unlike regular cholesterol tests, ApoB gives a more accurate picture of “bad” lipoproteins that may contribute to fat storage around internal organs.

A “sluggish” or fatty liver can impair metabolism. It disrupts your body's ability to metabolize and burn fat, leading to further fat accumulation and making weight loss difficult. According to the surgeon, fatty liver disease is a silent epidemic, and it slows down how the body processes fat and drains energy.

Vitamin D and B12 matter, Dr. Kaushal warns. Deficiencies in these can reduce energy, lower fat-burning capacity, impair insulin sensitivity, and generally make it harder to lose weight. Low vitamin D is linked to insulin resistance and inflammation, while B12 deficiency may impair fat metabolism and can cause fatigue, making it harder to exercise and maintain a healthy diet.

Chronic, low-grade inflammation is another major barrier. Elevated CRP (C-reactive protein) indicates inflammation, which makes the body more likely to store fat rather than burn it. Chronic inflammation is detrimental to weight management because it disrupts the body's energy expenditure, energy storage, and hormonal balance, leading to weight gain and making it harder to lose fat.

Talk to your doctor: Don’t dismiss unexplained weight issues as a lack of effort. Ask for the tests Dr. Kaushal recommends — especially if you’ve tried “eating clean” and still not losing weight.

Get tested: Consider fasting insulin, HOMA-IR, thyroid panel (including T3), cortisol levels, ApoB, liver function, vitamin D and B12, and CRP.

Treat the underlying causes: If the tests show imbalances, work with a specialist — endocrinologist, gastroenterologist, or bariatric surgeon — to correct them.

Reframe your mindset: Understand that this is not about blame or willpower. It’s about biology. Healing the root causes may help your healthy habits finally pay off.

Be patient and persistent: Once you treat these root causes, weight loss may accelerate, cravings may reduce, and the progress will feel more sustainable.