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.
After years of discussing weight loss, depression, anxiety, and addictive patterns with patients I have noticed that we are all full of excuses when it comes to making changes in our lives. When I have contemplated changing things in my own life the first thing that often comes into my mind is some sort of excuse. We all have created many internal excuses for why we cannot improve our lives. These excuses are designed to discourage us from tackling the unknown. We feel powerless.
If you are honest with yourself about the difficulties you are having with some aspect of your life you will realize that you are holding onto a lot of useless suffering. So why not opt for some useful suffering? There is also no absolute evidence that what you will do will be in fact difficult. It is just as likely to be easy as it is to be difficult.
That brings me to the most common excuse that I hear from others. This excuse is simply that change will be too difficult or hard. When it comes to weight loss, people often say that it will be too difficult because of how much they have to lose, or because their wife only makes certain kinds of foods, or because they have too many sugar cravings. The list of reasons why it will be too difficult for them to make the changes are dizzying and endless. The funny thing is that they know that they are just making excuses and I think that they know that I know that they are just making excuses.
So is it really harder to change a habit? A little perspective can help.
Start by just thinking about all the things that you have to do to maintain the habit that you would like to change. A smoker, for example, has to have packs of cigarettes with them, dispose of ashes, earn extra money to support the habit, go to the store to buy them, have access to an ash tray, have a lighter, stand outside, worry about others getting exposed, the smell, social connotations, stained teeth, chronic cough, and an endless list of physical ailments. On the other hand, the useful suffering that is needed to change this habit is to simply choose in the moment not to smoke. Now, I ask which choice is actually harder in the long run!
The same holds true for weight loss. All it takes is to obtain correct dietary information from someone who has expertise in the area (such as myself) followed by making the daily choices to follow the process. The alternative often entails poor sleep, heartburn, joint pain, poor energy, deconditioning, feeling terrible, social stigma, poor self-confidence, earning extra money to support the extra food, heart disease, diabetes, high blood pressure, buying medications, and much more.
The key is to love yourself enough to make every decision in your life consciously and then count the benefits and the cost. Over the long run we suffer much more and encounter many more difficulties by maintaining a habit than by changing one.
You can decide today to cast out all the mountains of useless suffering you are experiencing and substitute a little useful suffering.
For those that need support through this process I am happy to help.
Before starting to read this article please make sure to read my previous article from last week entitled "Are you fearful, anxious, depressed, or addicted? There is Hope!". In that article, I implored you to examine the source of fear, anxiety, depression, or addiction which is the sense of powerlessness or hopelessness. I then asked that you keep a journal to write down all the feelings that tend to cause you fear, feed an addiction, or lead to depression or anxiety. If you have not started that process I would urge you to do so today.
Once you have started the process above it is important to know that you can absolutely change the way you feel. We all understand that we can learn new things. Some of us have learned to play an instrument or are talented artists. Some have learned to make finely crafted furniture or to knit a beautiful blanket. Some of us have also learned bad habits or addictive behaviors. We all know that mastery of the particular positive skills that we have developed took hundreds and sometimes thousands of hours of practice.
However, few of us stop to think about how we can change our thinking patterns or that we can learn new thinking behaviors. We tend to think that our thoughts and feelings are on autopilot or that we were born with them and that the only way to change them is through medications or by trying to suppress them. While for a minority of us medications may be necessary, the vast majority of us have the ability to create new ways of thinking that are empowering, energizing, grateful, loving, and giving.
It starts by realizing that we are in charge and have the power. One of the biggest things that I have realized from my examining my own thinking patterns and from talking to patients is that is very easy to feel powerless when dealing with depression, anxiety, or habits. It may seem that there is no way out of the feelings they we are having and this makes us feel even more depressed or fearful. I have felt this way myself.
But it doesn't have to be this way. We are not powerless. Powerlessness is a myth that we tell ourselves that prevents us from making the necessary changes in our lives. While we may have developed this myth to help protect us as children so that we would fit into our family or tribe, it no longer serves as adults. These patterns, which were once self-preserving, are now self- destructive.
So how we can we start to change our thinking patterns?
In my experience, there is nothing that will have more impact on our lives than what we think. How we perceive our life experience will in large part determine our happiness. But this doesn't mean that we should suppress bad thoughts. Thought suppression may make these thought patterns worse. In my view, it means creating new thought patterns that are empowering. It means seeing the abundance of goodness that is already in you and around us instead of the seeing the scarcity of badness in our lives and in others. There is really nothing bad in our lives. There are only results. Every event in our lives can be perceived as an opportunity to learn and grow and give. We can thrive no matter what the circumstance.
When I think about how many blessings I have in my life at any one moment I usually can find at least 99 things that are going good for every one thing that is perceived as inconvenient. Yet, I have found that most of us including myself tend to focus on the negative one thing and disregard all the rest. We tend to disregard the abundance in our lives and focus on the scarcity.
I have a daily reminder of this in one of my bathrooms in my house. In that bathroom there are three light bulbs. Two are burning brightly and one is burned out. I could easily focus on the burned out bulb but instead I have left that bulb in place to serve as a reminder to focus on the things that are burning brightly in my own life.
The great news is that there are some practical ways to start down the road to appreciation. A good place to start is to begin a daily ritual of being grateful and appreciative of all the things that are going right. I start every morning by spending 5-15 minutes meditating about things I am grateful for. I do the same thing in the evening.
Being grateful starts with appreciating the simple things in our lives like the beating of our heart, the ability to breath, the feeling in our bodies, or the simple necessities that we enjoy like food or clothing. We can think about the wonderful experiences we are having or have had in the past that have made a great impact for the good in our lives. It is also helpful to visualize how we will continue to thrive no matter what happens in the future. Shorter versions of this practice can be utilized throughout the day whenever we begin to experience self-doubt, anxiety, or fear. Some people even have gratefulness reminders like beads that they leave in their bedroom and before they go to bed they count the things that they were grateful for that day.
With this practice I caution you to not have expectations or need of immediate and permanent changes in your outlook. Learning to change your outlook from one of expectation to appreciation is a process and most people tend to overestimate what can be accomplished in a short period but underestimate what can be accomplished over a long period. We all want immediate results but persistence is the key. It is okay to want and desire change but it can be self-defeating to have a self-imposed timeframe for certain changes to occur.
With this in mind, I now tell patients when they come for weight loss that it is great that they desire and want to lose weight and they certainly will if they follow the daily process. However, they should not expect an absolutely certain amount of weight to be lost by a certain time. Nobody has control over how much weight they will lose. The same is true with any change in our lives including our thoughts.
In conclusion, I want to express to my wife and kids how appreciative I am for them. I have experienced unconditional love from my wife that has saved my life. Her encouraging words have kept me going in times when the path ahead seemed untenable. Her patience has been extraordinary and her love and compassion for others has been a great example for me. My children are all great in their own ways. They each have the shining light of unconditional love that has helped show me how to love others. They bring great joy to my life.
For those looking for a good example of a morning exercise that I have personally found to be very helpful go to the following link provided by Tony Robbins.
For those looking to improve their health or need assistance feel free to call our office. Otherwise, the time is now to have a great day!
Our brain learns through our experiences to promote pleasure and avoid pain. For example, we learn to avoid the hot stove after we experience the pain, smell the burning skin, and see the blister. This experience is reinforced for us by having daily painful reminders as the burn heals. Conversely, our minds crave the pleasure that comes from activities such as eating a great meal, sex, doing a physical activity, or feeling or giving love.
To this day I can remember vividly falling off my bike as a child and landing on my face on the pavement. This experience left a scar on my face and an imprint on my brain.
We also have emotional scars that are even more powerful. I remember an experience when I was trying to learn how to water-ski and I wasn't as successful as some of my brothers or cousins. I couldn’t get up out of the water very well and I struggled. I was also constantly compared to them. I think my family members were trying to motivate me through competition or sibling rivalry. However, I translated these comparisons into feeling unworthy, inadequate, and unlovable. As a result, I avoided learning to water-ski until I was much older so I would not have to face the pain of my own feelings of inadequacy.
All of us have these moments.
With this in mind, it is helpful to remember that our brain is primarily concerned with preserving us and the species. Otherwise, mankind would not have been here as long as it has. We are largely thriving as a species because we have a strong propagating and preserving instinct. We also have a large "thinking" brain that sets us apart from all other species and allows us to make real choices. This part of our brain allows us to make choices that can even contradict the preserving and propagating part of our brain.
The "old" or as some people like to call it the "reptilian" brain is largely set on automatic and we have little control over it. This part of our brain is the area of the brain stem that is responsible for regulating our heart and respiratory rate without any conscious effort on our part. It is also the part of the brain that we would sometimes like to shut off but it is important to know that we cannot. The impulses that come from this part of the brain will always be there. These impulses may be able to be modulated or overridden to a certain degree but they cannot be totally removed. Nor should they be as our life depends upon it.
Any addict will probably tell you that they would probably love to shut their brains down in an attempt to heal their addiction. The sex addict would like to remove their sexual impulses, the food addict would like to shut down their appetite, the alcoholic would like to shut off their opioid receptors, and the list could go on and on. We are all addicts in our own little ways. It is just that some addictions are more socially acceptable than others. One of the more off-the-wall addictions that I have encountered is the one recorded by a popular addiction expert Dr. Gabor Mate in his book "In the Realm of Hungry Ghosts" who admitted he was addicted to the purchasing of classic music CDs.
It is key to remember that for most of us the fear, anxiety, depression, and addictive behaviors we experience in life come as a result of our brain trying to preserve us. It is pain based. It is an attempt to respond to deep and searing physical or emotional experiences from our past and present. They are attempts by the brain to prevent us from taking an action that could result in suffering or even more powerfully in the case of addiction promote activities that are certain to bring pleasure and cover over pain at least temporarily. The problem is that these solutions tend to run out of steam.
In my experience, people that try to avoid life "stressors" because of a desire to feel completely safe often tend to be either depressed or anxious. This is because there is no safety or security in life. There is virtually no activity in life that is 100 % safe or secure all of the time. Eventually, the list of safe activities that are tolerable for avoiders dwindles down and down until, for some, they cannot leave the house or even their bed. The bed becomes the last safe zone. Thus, some people that avoid things tend to become more and more reclusive over time.
The same happens for addicts. The addictive activity tends to be less effective over time at masking the pain that is underneath and more and more of the activity is required. That is why for an addict it doesn't matter how much of something they have. They could have 15 million dollars or 150 million dollars of discretionary spending. They could have sex or be watching pornography and then 30 minutes later be desiring more. It doesn't matter.
Both of these activities bring painful consequences for the person and acting on these impulses and thoughts bring diminishing returns over time. They also impair our ability to magnify our true potential and to help others because as we grow personally our competency and ability to serve others also grows.
So how do we begin the road to overcoming fear or addiction?
The first thing to realize is that you are a unique and special person worthy of feeling loved and capable of changing your patterns of behavior. You can definitely be successful as you work on confronting your fears and addictions.
One potential starting point in beginning the process to overcoming your fears or addictions is to find the source of the pain that these behaviors are attempting to mask. Some people may say that they behave in a certain way because they are masking the pain of a divorce, death of a close family member, loss of childhood, having an abusive father, or a mother who didn't care. On a more surface level these may be some of reasons but they are not the deepest reasons.
According to Gary Zukav, the deeper reasons that are important to uncover include "feeling inadequate to be in the world, a pain of feeling ugly inside, a pain of wanting to belong and not belonging, a pain of needing to love and feeling that you are not capable of loving, the pain of needing to be loved and knowing that you are unlovable. It is the pain of feeling defective, inherently flawed, broken and not worth repairing. It's not wanting others to see as you really are inside yourself because they wouldn't want to have anything to do with you if they did."
Gary Zukav goes on to say that this pain is the "pain of powerlessness" and "that everybody has it...Every frightened part of your personality strives to cover that pain of powerlessness. So when you become angry, for example, and when you shout or when you withdraw emotionally you are attempting to mask from yourself the pain of powerlessness, the pain of the world not being the way you want it to be, and what the frightened parts of your personality need the world to be in order to feel safe and valuable."
I have personally found it very powerful to write in a journal all the things that tend to get me anxious, depressed, fearful and any addictive tendencies that I may have. I would urge you to do the same. I would then ask yourself why you experience these emotions and try to get as deep as you can. You can follow this exercise with asking yourself if these fears are well founded or exaggerated? Are they empowering or immobilizing in the present? If they are immobilizing then they are holding you back.
Finally, I know that there is hope for everyone to greatly benefit from this process and there is support out there if you need it. Please consult with your physician for additional support before engaging in this activity or feel free to call if you have any questions or would like to schedule a consultation.
Stay tuned for more articles to come in the following months on this subject.
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