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.
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