Ugh! The Dreaded Weight Loss Plateau

It seems like a dirty trick. Our patients work hard to lose weight and then nothing. Nothing at all. No more pounds come off, and they become increasingly frustrated and less motivated. It helps if we can explain to them what’s going on. Very likely they have forgotten that along with the pounds, their calorie needs have dropped. Their new, slimmer body requires fewer calories to maintain its current weight. What was once a 500-calorie deficit became only a 400-calorie deficit, then 300 and so on. Thus if they consume the same number of calories as they did with their initial weight loss, they will not see similar results. This is part 1 of the problem.

Part 2 is that many people – probably most - relax their dieting behaviors once some weight falls off. They may not have any idea that this has happened. Maybe they have portion creep where ½ cup has crept to 2/3 or ¾ cup. Maybe they’re taking more nibbles from a dining companion’s or a child’s plate. I like to review my early chart notes to remind us both what exactly are the steps the patient took to lose weight. One by one, we revisit them to see if the patient is still diligent about these behavior changes. I typically discuss the following:

  • Getting back to the basics: food records, measuring portions, planning ahead
  • Alcohol intake
  • Boosting intake of non-starchy vegetables
  • Adding time and/or intensity to workouts

Additionally, this is a good time to re-assess the patient’s weight loss goals. It may just be that this is the individual’s healthy or reasonable weight or perhaps it’s a good time to work on weight maintenance only to attempt weight loss some weeks down the road.

By Jill Weisenberger, MS, RD, CDE

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