A common refrain I hear from patients when they discuss their weight loss challenges is that they have hit a weight loss plateau. By this they mean that they have been working on losing weight but have stalled out and got stuck at a certain weight. They often tell me that they are eating just as carefully as when they started losing weight and have even been working out and still cannot lose weight. Obviously, this can be really frustrating and perplexing for patients and clinicians. But there are answers and potential solutions to this predicament.
So why do we get stuck?
Before we get into some potential solutions it is key to understand the factors that might be at play that can lead to a weight loss plateau.
First and foremost our bodies are very smart and some of the strongest regulatory processes we possess are designed to prevent us from starving to death. Orexigenic hormones (hormones that stimulate appetite) such as Ghrelin increase in response to purposeful weight loss. Conversely, anorexigenic hormones (hormones that suppress appetite) such as Insulin and Leptin down-regulate in response to purposeful weight loss. These changes lead to differences in many metabolic processes that may influence our responses to food cues and our ability to experience satiety. The changes in these hormones may also make us hungrier. In addition, our resting metabolic rate or the amount of calories we burn at rest goes down and the efficiency of our skeletal muscle increases. This means that overall our energy expenditure will go down more than would be normally expected from loss of body weight and lean muscle mass. All of this translates into needing to further reduce calorie intake and to be more vigilant about monitoring hunger cues as we lose weight.
However, the most important factor related to an early weight loss plateau is how precise people are about there diet and exercise regimen. In an interesting paper in the American Journal of Clinical Nutrition it was noted that "intermittent lack of dietary adherence, not metabolic adaptation, is a major contributor to the frequently observed early weight-loss plateau." The study also observed that this plateau happens at about 6 months. In my experience it often happens much sooner.
This paper highlighted the importance of strict adherence to a diet and weight loss program as a potential key to breaking through a weight loss barrier.
With that in mind here are my top 10 ways to break through a weight loss barrier.
1. No cheating: As evidenced in the paper I cited above intermittent or occasional loss of diet control can seriously impact successful weight loss. An alcoholic knows how significantly one drink can set him or her back. Intermittent dietary cheating can have the same impact.
2. Tracking: Along with no cheating I have often found that people assume that they are eating a certain number of calories when in fact they are eating a lot more. Many studies show that people significantly underestimate the calories that they consume. If you are stuck at a plateau start tracking what you eat religiously for 1 week with a calorie tracker such as Cronometer. You may be surprised.
3. Increase your protein: Protein has been shown in many studies to aid in weight loss and prevention of weight regain. Protein takes significantly more energy to digest and there is no significant storage form for protein as there is for fat and sugar.
4. Decrease your calories further: As you lose weight your energy expenditure will go down. This means that inevitably you will run into a weight loss plateau if your calorie intake is too high. Try lowering calories further. Please keep in the mind that significant decreases in your caloric intake (below 1500 calories/day) should only be done under supervision of your physician.
5. Increase your exercise: Exercise is an obvious way to burn calories. Exercise may also help preserve a higher proportion of lean muscle mass. Becoming more consistent with an exercise and overall activity regimen is essential.
6. Strength Training: While it is often touted as a way to increase your metabolic rate it is probably not as significant as a contributor to increasing your basal metabolic rate as many people assume. That being said you can clearly burn some calories with strength training and as you increase the size of your lean muscle mass your resting metabolic rate will increase.
7. Be Patient: Short weight plateaus are very common during weight loss in part due to changes in fluid balance, stress, bowel habits, sleep, and other factors. It can sometimes take a week or two to break through some apparent plateau. The rate of weight loss also slows down as we loss more and more weight. So just be patient!
8. Weigh yourself weekly, not daily: This goes along with being patient. From a day to day standpoint weight will fluctuate. Have faith in the process. The weight will come off. Over a week or two period you should generally see some weight loss if you are sticking to the process religiously.
9. Thyroid problems/Health issues: If you have followed all the other steps outlined above and are still not having any progress then you could have a hormone or other metabolic disturbance. I would follow-up with your doctor for further evaluation.
10. Poorly designed program for weight loss: The final issue that I often see is that people may have misunderstandings of how to eat, structure a diet, and exercise. When I talk to these people it is often easy to find a few quick things that can be changed that are causing the issue.
So there it is. My top ten list for ways to break through a weight loss barrier. For more information about my weight loss programs feel free to email or give me a call.
Before starting any weight loss or diet program please consult with your physician.
It has been a little while since I last wrote. I apologize for this absence. Thanks to those that have encouraged me to keep writing. I plan to write much more over the next few months.
As you may or may not know I have a few weight loss programs at my practice. I love working with patients on diet and weight loss. I would also say that there seems to be few things more satisfying for patients than when they lose a lot of weight and start feeling great. It doesn't take long for patients to notice increased energy, vigor, and improved stamina. This process is soon accompanied by an increase in confidence and hope for the future. The long term transformations can be simply life altering.
I have been occasionally blown away by what dedicated patients are able to accomplish. I have had some patients who have been on multiple diabetes medications for years who have been able to get off all their medicines in periods as short as a month. Truly radical changes are possible. In my experience we often underestimate what is possible especially with sustained and consistent effort.
When I was heavier I used to suffer from sleep apnea, low energy, depression, lethargy, poor cognitive performance, decreased impulse control, joint pain, inability to take care of household tasks, and much more. I could go on and on. After losing weight these symptoms disappeared. Unfortunately, despite the great benefit I observed I slowly gained all the weight back and had to struggle to lose it all again. This story is not uncommon.
Interestingly, one of the reasons that obese people tend to struggle with weight may be in part related to a propensity to seek immediate gratification (at least in terms of food) at the expense of long term benefit. Why people do this can be for many reasons including emotional eating, responses to stress, accessibility, and many other reasons. To some degree it is also biological because our hunter-gatherer ancestors didn't have much reason to focus on the long-term effects of weight or diet as they were mostly concerned with eating as much as possible of the food they encountered as soon as possible. They also preferred foods that provided as much caloric density as possible such as foods high in sugar and fat. This explains to a large degree why our brains are hard wired to prefer foods like ice cream or pizza which are high in calories, fat, and sugar. Basically, when we eat these foods we are following the pattern of our ancient ancestors to take advantage of the availability of calorie dense foods.
The problem is that in modern society our biological preference to favor high calorie dense foods with high amounts of sugar and fat can now become detrimental to our health especially as we generally lack periods of scarcity and have an abundance of these foods available to us at all times. This contributes to obesity.
So how do we combat this natural and biological tendency?
The answer lies in part due to something called "time preferences."
In theory, our modern stable society-where we can expect to have a reasonably long life expectancy and some semblance of stability-should permit us to make decisions that favor our long term success or the success of our future selves.
However, most of us still prefer to do things that have short time preferences meaning that they provide more immediate rewards and consequently favor our present selves at expense of our future selves. This explains why illicit drugs and fast food are so prevalent as they favor this time preference. It also explains why people people eat pizza and ice cream so readily.
However, is this time preference really what will provide us with more meaning, satisfaction, personal pride, dignity, and the ability to love and serve others?
When most of think of the drug addict we can easily see how favoring the short term drug high is seriously detrimental. But when we overeat or indulge in any other unhealthy habitual behavior we are doing the same thing. It is just not as socially stigmatizing.
One of the greatest insights I have come across is how many of our ancient stories such as those contained in the Bible focus on the idea of sacrifice or time preference. One of the lessons of the stories of Cain and Abel and Abraham and Isaac is the idea of how the willingness to produce a correct and worthy sacrifice of the most prized immediate possessions will provide long term success, meaning, and prosperity. When you think about it this a truly astounding insight and not shared by any other animal species. Many of the bible stories reveal how much better our lives can become over the long term if we sacrifice short term gratification, pleasure, and evil. The ultimate example of this came in the form of Jesus who willingly sacrificed his life for the long term benefit of humanity.
This bring me to a technique that some researchers call "Episodic future thinking". This technique relies on our innate human ability to vividly imagine the future and has been shown in many studies to help people lose weight and make better food choices in the moment. This is a technique that I practice. At a basic level it means that prior to eating any food you take a few moments to imagine positive future events that you like to have happen. These events don't necessarily have to involve eating. They could involve imagining running on a beach or attending your children's wedding. Focusing on future potential positive events that you would like to have happen can help overcome the urge to satisfy short term urges and put you in a future favoring position.
I personally find it even more powerful to vividly imagine the worst possible results of making the wrong decision repeatedly and contrast that with outcome of making the right decision repeatedly. I tell patients to run away from their own nightmare scenario and toward their own ideal future. I do this practice immediately before I go to eat food. I generally can be fairly certain that I am making the right decision if I can be proud about that decision one hour, one day, one month, one year, and even ten years from now. Both the present and future have to be prioritized.
One other visualization strategy that I picked up in a podcast from health guru Ben Greenfield is to imagine that you are the protagonist in a movie and that the crowd in the theater is watching your behavior and rooting for your success. It can be useful to visualize how they will react to a potential good choice versus a bad choice. I have also found it useful to visualize taking advice from my future self who is the person that faces the ultimate consequence of my current actions.
I encourage you to try these techniques as much as possible when you are tempted to satisfy any unhealthy habit including eating behaviors. As I mentioned earlier I have many weight loss programs and would be happy to help you in your weight loss journey. Stayed tuned for future posts on weight loss and weight loss strategies.
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