Very low levels of thyroid hormone usually indicate an autoimmune reaction to the thyroid gland itself. This means you’ll have to take thyroid hormone supplements orally, usually the stable form T4 (Levaxin), which your doctor can prescribe for you. Your body will transform this into the active T3 hormone when necessary. The supplement dose should be adjusted so that you reach normal hormone levels (TSH, T3, T4) and sufficiently alleviate symptoms – though a few people feel best when keeping TSH slightly below normal.
The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more calories than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein and carbohydrate is then evenly divided across the meals.[36]
Social conditions such as poverty, social isolation and inability to get or prepare preferred foods can cause unintentional weight loss, and this may be particularly common in older people.[43] Nutrient intake can also be affected by culture, family and belief systems.[28] Ill-fitting dentures and other dental or oral health problems can also affect adequacy of nutrition.[28]
A study from Canada’s McMaster University (partly funded by  Dairy Farmers of Canada) put women on several different diets (lower protein, low dairy; lower protein, medium dairy; higher protein, high dairy) and found they all lost the same amount of weight — but that the higher-protein, high-dairy group lost the most belly fat while also gaining and holding onto the most muscle mass. “It seems… increasing calcium and protein in the diet may help to further promote loss of fat from the worst storage area in the body,” said Andrea Josse, lead author of the study.
The trick here is not only to avoid all obvious sources of carbohydrate (sweets, bread, spaghetti, rice, potatoes), but also to be careful with your protein intake. If you eat large amounts of meat, eggs and the like, the excess protein will be converted into glucose in your body. Large amounts of protein can also raise your insulin levels somewhat. This compromises optimal ketosis.
Cortisone as an oral drug is another common culprit (e.g. Prednisolone). Cortisone often causes weight gain in the long run, especially at higher doses (e.g. more than 5 mg Prednisolone per day). Unfortunately, cortisone is often an essential medication for those who are prescribed it, but the dose should be adjusted frequently so you don’t take more than you need. Asthma inhalers and other local cortisone treatments, like creams or nose sprays, hardly affect weight.

Boredom is dangerous and so easily leads to weight gain. While free time gets perceived as relaxing, it actually makes me feel anxious, which can lead to bad eating habits. My busiest days are the ones when I tend to focus less on my food and more on what I need to get done. That's why I always try to fill my schedule with things that make me feel productive—so I don’t find myself rummaging through the pantry for a lack of something to do.
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