Breaking Through Weight Loss Plateaus
It happens to almost everyone. You have successfully lost a lot of weight, but suddenly you are stuck. The scale simply refuses to move. You don't believe you could eat any less. How can this be? It was so easy when you started semaglutide. Now you are only five to ten pounds from you goal weight, but you haven't lost any weight in a month.
Unfortunately, you have entered a "weight loss plateau". There is one over-arching reason why you are stuck:
You are eating too much to lose weight.
You tell me that you "can't eat any less" and that you are "starving" already. The simple fact is: if you are stuck in a weight loss plateau, then you are in caloric balance. That means:
Energy Out = Energy In
Why is this happening? There are a variety of reasons that you are stuck. Here are the most common ones:
You are bored with weight loss. Weight loss programs over the long term can get dull. Less of the foods that you enjoy. More dreaded exercise. You just aren't giving it your "A" game anymore. The result is: you are eating more and moving less than you think.
Your metabolism has slowed down. Chronic "under-eating" can turn down the BMR.
How to get unstuck.
Let's look at getting "unstuck" from both sides of the equation:
Energy Out = Energy In
In order to lose weight, you MUST either decrease Energy In or increase Energy Out. Or mathematically:
Energy Out > Energy In
To decrease Energy In:
Do a calorie count. Calorie counting can give you accurate assessment of total caloric consumption. In theory, it should be easy to do - in practice, not so. To get accurate calorie counts, you must be completely honest with yourself and you need to actually know how many calories are in the food item you are logging. If you eat out regularly, this can be very difficult due to varying amounts, how many extra calories are in sauces or dressings, fat content of various cuts of meat, etc. But it is worth a try. MyFitnessPal is great app for counting calories (you only need the free version).
Take more medication. Semaglutide doses range from 0.25 to 2.5 mg per week. If you are taking less than 2.0, you should at least try taking more (but don't make big jumps in dosing - best to consult with me first). Increasing doses are often necessary due to decreased sensitivity to semaglutide which inevitably occurs over time.
Institute fast days. If you have done a calorie count and find that you are eating more than 500 calories a day (600 for men), then start introducing "fast" days into your regime. Start with one fast day a week and add second (non-consecutive) day if necessary. It is helpful to lay out what you are going to eat on the fast days the day before (so you know what are in for). Focus on lean meats, non-starchy vegetables and fruit during fast days. "Fasting" like this can often kick-start a new round of weight loss. Do not fast more than two days a week and do not fast on consecutive days. Note: this is based on the "Fast Diet" by Michael Mosley.
To increase Energy Out:
Energy Out is the sum of basal metabolic rate (BMR), activity expenditure, and energy spent/created digesting food (sometimes called the thermic effect of food). Mathematically that is:
Energy Out = BMR + Activity + Thermic effect
Let's tackle the "easiest" of these first. Activity. You simply have to move more or in ways that will consume more calories in the short run AND long run.
Use your step counter. Apple and Android devices have pre-installed step counters (in the Health app on Apple and GoogleFit on Android). These apps give you insight into how much you are moving overall. You may already have a baseline in your phone/watch. Open the appropriate app and check it out.
Incorporate strength training. Resistance training is the only way to build muscle. If you are over 60, then you need to incorporate resistance training. It doesn't have to be time consuming. Ask Dr Edman for more details and check out this simple, once-a-week program in the gym. Note: you have to challenge your muscles. Soreness 24-48 hours after a workout is a good sign.
Change your exercise routine. Your body gets "used" to same old workout. Do something different. Preferably moderately challenging.
Incorporate High Intensity Interval Training. I saved the best till last. High Intensity Interval Training or HIIT is hands down the best way to increase your burn. This may be due to the "after burn" that HIIT produces. Muscles will burn excess energy after a HIIT workout. Here is an example work out: edmanclinic.net/hiit
Next up is increasing BMR. Here we are somewhat restricted as the BMR isn't easily manipulated (at least safely). But here are few ideas:
Increase muscle mass. More muscle means your body needs to expend more energy to maintain it.
Increase caffeine intake. Caffeine is the only substance that I am aware of that can safely increase your BMR. Obviously, caffeine can not be consumed all day long but and we definitely don't want to disrupt sleep. Try to get in two to three cups of coffee before noon.
Get high quality sleep. It is not clear why good quality sleep improves BMR, but it probably has to do with release of growth hormone. Aim for 7-9 hours. Ask Dr Edman for suggestions/medications to improve your sleep if this is an issue.
Last up is increasing the thermic effect of food. Digestion consumes energy. Breaking down food to substrates that we can actually extract energy from requires at least some energy. However some foods require more energy input than others. Foods with a high thermic effect include:
Lean meats: Lean cuts of meat have a high thermic effect due to their high protein content.
Fish and seafood: For every 100 calories consumed from seafood, close to 30 calories are spent during digestion and absorption.
Eggs: Rich in protein and other essential nutrients, eggs have a significant thermic effect.
Low-fat dairy: Greek yogurt, cottage cheese, and other low-fat dairy products are high in protein and have a good thermic effect.
Legumes: Beans, lentils, and other legumes are high in both protein and fiber, contributing to a higher thermic effect.
Vegetables: While not as high as protein sources, vegetables like broccoli, asparagus, cauliflower, and leafy greens have a relatively high thermic effect compared to starchy vegetable.
Whole grains: Foods like oats, quinoa, and barley have a higher thermic effect than refined grains.
While increasing your intake of foods that have higher thermic effect may not contribute all that much to overall weight loss, certainly incorporating them can't hurt and in my experience most people are not consuming enough lean protein anyway.
Takeaways for getting unstuck.
Probably the most important takeaway for getting out of a weight loss plateau is to "do something different". You can't just keep doing the same thing.
"“The definition of insanity is doing the same thing over and over and expecting different results,” - misattributed to Einstein
So mix it up. Quantify your calories and movement. Increase your exercise. Change your exercise. Lift weights. Do some HIIT. Eat some high protein meals. Drink some (more) coffee. Sleep.
As long as you aren't gaining weight, most weight loss plateaus will correct with time. Be patient, you will get through it.
Lastly, if you haven't gotten on the "Semaglutide Train" and feel it it is time, click the button below to set up your first appointment.