Hidden causes of continual weight gain?

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I am at my wits end. I went to my nurse practitioner for a routine physical about a 15 months ago. She weighed me in at 183. A few months later I went back for a sore throat and I was up to 188. About 2 months after that I came down with a sinus infection. I was 192. Then I had my annual physical. 198. She said she was getting concerned about this, so she asked me to come in every other month to get checked out. She takes my weight, temp, and BP every time. It keeps getting worse. Here are my weigh ins:

Feb 2009: 198

Apr 2009: 201

Jun 2009: 205

Aug 2009: 208

Now she's really alarmed. My weight keeps going up very consistently. I know for a fact that I will be over 210 next time. Breaking 200 was really embarrassing. She's ordered blood tests, and nothing ever comes back wrong. I really haven't changed my eating/drinking/exercise habits any. I did turn 30 about 2 years ago, and I wonder if it's just a metabolism slowing down kind of thing? The funny thing is, I don't look really fat. Honestly. I know a gain of 25 lbs has to show up somewhere, but I don't have stomach rolls or anything. Just a little wider and softer than before. It feels like most of the gain has come inside of me, and in arms, legs, etc.

But now it's reaching a critical point. She said that if I hit 215 I would technically be considered obese even though I don't necessarily look it. I asked about medication, but she said she won't prescribe it until she finds the root cause. At my last visit, she actually said she thought she heard a slight heart murmur with her stethoscope, which really scared me, so now I have to see a cardiologist too.

Does anyone have any idea what could be behind this big weight gain?

Thanks for your help.
 
Even though they were normal, was your TSH above 2.0? That could indicate a thyroid issue, even if it was considered within normal range. Were Free-T3 and Free-T4 both normal?

Are you on any medications? I've heard that birth control or antidepressants could cause continual weight gain.

You haven't changed your diet, but what does your typical day's menu look like? Metabolism does slow down start in one's mid-20's and really starts to become noticeable in the 30's. Could you be getting too many "extra" calories, such as adding sugar to your coffee every day, mayo instead of mustard on sandwiches, etc?

What about sleep-- do you get 8 hours each night? Do you feel pretty rested in the a.m.? Do you stay awake "unusual" hours, such as graveyard shift?
 
Plasmodiumovale, thanks for your response. I honestly don't know what the numbers for TSH, T-3, T-4, etc. were because the nurse practitioner just said nothing was abnormal. All that's written on the paperwork I have is stuff like weight, BP, temp, etc., not the blood test results. I can ask her though. And I am a male, so probably not a birth control issue! I need to figure this out though. I'm pretty sure I'm already up to 210.
 
Are you sure you didn't change your activity level? Consider what you do when you are not doing things that are normally viewed as "exercise". For example, did you change from a more active to a less active job, or a commute that required more walking to less walking? Did you used to live in a place where you had to walk up the stairs and now you don't?

Getting wider (presumably in the waist) and softer is not a good thing, since it indicates that at least some of the gained weight is fat, rather than (healthy) muscle. Although if you do not have obvious fat rolls, you may have started out with a greater than average amount of muscle. Do you know or have you been tracking your body fat percentage, or some proxy like waist size?

What is normally seen as age-related metabolism slowdown is in part due to loss of muscle mass, often due to people becoming less active as they age.

As others have suggested, thyroid irregularities are often blamed for metabolism slowdown.
 
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