I have a patient in my office who is gaining weight, but it seems to me like she's already doing everything right. I'm looking for any insight that could be helpful! Thanks so much

34 year old female- 5 foot 1, about 250 pounds.

Her max weight was 380. She initially lost 150 lbs+ on weight watchers. When she switched to "primal weight watchers" her weight loss slowed. When she stopped weight watchers, and strictly followed a primal type of diet, she started gaining weight.

She has done a "whole 30" and continued to gain weight throughout. (but this is whens he felt best)

She claims to be consuming about 1200-1300 calories per day- including some raw dairy. All meat is grass fed/free range. She eats about 2-3 servings of fruit/day. (one whole grapefruit and sometimes an additional serving)

She has been seadily gaining weight since going primal and has gained about 50 pounds total since last fall.

She has hypothyroidism, and is on medication for this. Only other medication is birth control.

She is also having her adrenals tested

Currently I'm thinking there might be an autoimmune issue?

Has anyone out there dealt with anything similar to this? What recommendations would you have for this frustrated patient? elimination diet? Any other suggestions for me in terms of tests I should have done?

Thanks so much in advance.