Weight Stuck at a Plateau?

Merriam-Webster defines a plateau as “a usually extensive land area having a relatively level surface raised sharply above adjacent land on at least one side (or) a region of little or no change in a graphic representation (or) a relatively stable level, period, or condition.”  While the first reference certainly paints a graphic view of stasis, for the sake of a discussion regarding weight loss journeys, we will address the last two citations. 

Weight loss plateaus are the bane of a dieter’s existence and often contribute to the phenomenon of "yo-yo dieting.” Following an initial period of steady weight reduction, individuals can then experience a frustrating plateau where progress halts and regain of their lost weight begins. 

Whether plateaus happen for reasons or seasons, we do know they occur because of the body’s natural defense mechanism to conserve energy; often referred to as biological adaptation. From a medical perspective, weight loss is a complex process that not only involves ones diet and physical activity; but medical history, medications, genetics, metabolism, and environmental and psychological factors come into play, as well.

So, let’s talk science (again!) starting with adaptive thermogenesis. This is the body’s primary physiological process that contributes to weight loss plateaus by slowing (or halting) weight loss as the body's REE (resting energy expenditure) decreases to match a lower caloric intake. Simply put—it’s your body’s way of conserving energy. Some would argue that from an evolutionary perspective, it helps to retain stored fat to be used as a reserve in periods of food scarcity; and hence protects against any significant weight loss while food is unavailable. 

As you lose weight, your body has the innate ability to become more energy efficient, meaning it burns less calories with less weight demands on it. This results in a decreased resting metabolic rate; a smaller body requires fewer calories. 

Losing muscle also reduces metabolism, as muscle is more metabolically active than fat. That’s why it’s so important to add strength training into one’s exercise routine. Unfortunately, people on GLP-1 medications take a big hit with muscle loss. Their appetite and desire to eat are greatly affected by the effects of the medication, so their balance of nutrients can be way off, including their total protein intake that supports muscle health. Interestingly, studies have shown that patients taking GLP-1’s have a delayed response in experiencing a weight loss plateau; for them, it may occur a year after beginning treatment. Not sure why that happens. 

Hormones also affect weight loss. Thyroid hormones are metabolic regulators and can affect weight loss outcomes. Calorie restrictions and weight loss can disturb energy homeostasis by increasing ones hunger and holding onto fat stores. Here comes more science! The body’s own supply of the peptide, GLP-1, regulates appetite and energy expenditure. A reduction in GLP-1 and peptide YY levels change as you lose weight. These hormones play vital roles in the “dance” that occurs between the brain and the stomach. Ghrelin, known as the "hunger hormone” (I call it the growl hormone!) stimulates hunger and appetite, while leptin, the hormone that signals fullness, decreases. It usually takes 15 minutes for the communication to occur between these systems, but the system can get stymied by changes in weight. 

Perimenopause (starting in late 30’s) is a frustrating time for many women and is characterized by body composition changes, most notably due to fluctuations and/or decreasing amounts of estrogen. Natural losses of muscle tissue and bone integrity are common in perimenopause but can certainly be countered with lifestyle changes that include a healthy diet and regular exercise. Heads up—try to intervene with these changes before menopause sets in!

Weight-loss plateaus are normal phases in weight-loss journeys and should not be considered failures or dead ends. Having a strategy in place will help you physically and mentally get through the stages of it. The American Heart Association recommends monitoring dietary intake with food diaries, physical activity logs, and self-weighing logs.

Caloric needs are based on current weight (not what you started at) and recalculating ones caloric balance can help jumpstart the weight loss. Eating more fiber-rich foods makes your tummy feel fuller, and getting the recommended protein intake can help preserve lean muscle mass.

Increasing physical activity not only can induce a caloric deficit but it supports heart health. And building muscle through resistance training and strength-building exercises boosts metabolism and can improve insulin sensitivity. A win-win all around!

Meet with a registered dietitian who can offer you the most expert advice on the ways to promote a balanced lifestyle. Studies demonstrate that regular contact and support with behavioral counseling experts enhances patient compliance. But remember, not all progress shows up on a weight scale. Recognize and measure progress in the way your clothes fit; by better sleep patterns; improved energy levels and fitness; and decreased joint pain. It’s not just about a number. Unless it’s the Powerball!

In Good Health, 

Sophie