Weight loss plateaus…

When pursuing any goal, including weight loss, hitting a stubborn roadblock can be frustrating, especially when what you have been doing, and what has been working, suddenly stops.

Even more frustrating is when you try new interventions, such as increasing your activity levels, trying to eat more servings of vegetables, drinking more water, and still, you see no results.  

And…nearly everyone experiences plateaus at some point in their weight loss journey, including the most successful clients who have achieved incredible results.

Why do weight loss plateaus occur?  What can you do about them when they do occur?  

Why do weight loss plateaus occur? 

Weight loss plateaus are incredibly common.  In fact, without medical intervention, sustaining continuous weight loss beyond 6 months is successful in only 10-20% of individuals (Sarwan et al., 2024).  

With medical interventions, weight loss tends to plateau at 6 to 12 months (Sarwan et al., 2024).

Weight loss plateaus affect 85% of those attempting to lose weight at some point (Sarwan et al., 2024).  

Weight loss plateaus make sense as the body works to protect itself from times of food scarcity, a problem still prevalent in certain parts of the world, and highly prevalent throughout all cultures up till recent times.

Multiple factors contribute to weight loss plateaus, such as (Sarwan et al., 2024): 

• Hormonal adaptations that promote hunger and fat storage, such as decreases in leptin as fat storage decreases, and increases in ghrelin which drives increased hunger 
• Behavioral fatigue that leads to decreased activity and increased food intake 
• Metabolic adaptations, such as lower cellular heat production and adaptations of the mitochondria to reduce energy expenditure at the cellular level–thus decreasing daily calories burned 
• Leptin resistance in the brain secondary to long term high leptin exposure rates during time spent as overweight / obese may persist even as leptin levels drop during weight loss, further contributing to hunger drive 
• Other hormonal factors include increased neuropeptide Y which promotes increased hunger and decreased energy expenditure, and drops in peptide YY leading to increased hunger.  Thyroid hormone drops (T3) can also impact metabolic rate.

It is estimated that for every 1 kg (or 2.2 pounds) lost, energy expenditure goes down by 20-30 calories per day, whereas appetite increases by about 100 calories over baseline (Hall & Kahan, 2018).  

How can you blast through a weight loss plateau? 

Blasting through a plateau can be challenging and even a bit counter intuitive at times.  

Current research recommendations include the following (Department of Health & Human Services, 2018; Physicians Committee for Responsible Medicine, n.d.; Sarwan et al., 2024; Turicchi et al., 2020):

• • Boosting LEAN protein:
    • Aim for 1.2 to 1.5 g/ kg (or 0.54 g/ lb to 0.68 g/ lb of current body weight) and/ or 
    • Ensuring 25% of calories come from protein as this helps with satiety
  • Increasing natural fiber-rich whole foods as they boost satiety by providing large amounts of volume for a relatively small amount of calories, they also slow stomach emptying: 
    • Aim for 40 grams of fiber per day from whole food sources (beans, whole grains, fruits, vegetables, nuts/ seeds)
  • Monitoring:  Per the American College of Cardiology and American Heart Association:
    • Routine weights
    • Nutrition / meal tracking (could be a simple journal or a detailed calorie tracker)
    • Fitness trackers/ movement trackers
    • Engagement with a health care provider-based weight loss support team regularly
  • Consistency of healthy dietary patterns across weekdays and weekends
    • Research repeatedly demonstrates that people tend to gain weight over the weekends, and, despite eating in a calorie deficit during the week, still end up in a weight surplus leading to a small weekly weight gain that adds up week after week over the course of the year, year after year.
    • NOTE:  this is MUCH MORE LIKELY to be the case than not for most people…careful attention to weekend nutrition choices all meals, beverages, and snacks is KEY!

• Increasing frequency, duration, intensity of exercise:

• At least 300 minutes per week (5 hours) of moderate intensity cardio (brisk walking) or equivalent activity

• NOTE: 1 minute of jogging, hiking, biking–vigorous activity–counts as 2 minutes of moderate activity
• Strength training can boost basal metabolic rate, and promotes insulin sensitivity.  
  • 2 days per week are recommended for every major muscle group
    • Total body programs are an excellent way to meet this need efficiently.
• Boost Non-excercise activity thermogenesis (NEAT):  standing desks, taking the stairs, tracking step counts, dancing with your kids or grandkids, parking further away, finding ways to move throughout the day–sounds cliche but it does add up and it is one of multiple tools that are evidence-based to work together. 

In truth, most people experiencing plateaus are not doing one or more of the above interventions, and for very stubborn plateaus, all of these interventions may be needed.  

Food tracking can be used as a measure temporarily to help identify protein or fiber insufficiencies and correct such, and then used periodically if progress stalls.   

I have heard that “re-feeds” can “boost my metabolism…,” do re-feeds work? 

There is a growing interest in the concept of “re-feeds” to help break plateaus or prevent plateaus.  There is some research that supports the concept of using planned, closely structured re-feed protocols intermittently to reduce some of the frustrating metabolic adaptations.

5 days at a deficit, 2 days of “re-feeding,” repeat….

In one study, resistance-trained adults performing 4 day strength training protocols had an intervention group that used a calorie deficit of 25% reduction from maintenance calorie levels 5 days a week, while for 2 days a week they increased carbohydrate consumption so that calories reached maintenance levels (Campbell et al., 2020). 

The control group also trained 4 days a week following the same strength protocol and remained in a caloric deficit all 7 days of the week (Campbell et al., 2020). 

The study ran for 7 weeks.  

The intervention group that consumed a MAINTENANCE level of calories two days a week lost slightly more fat than did the control group who maintained a consistent calorie deficit.

 

The study also shows slightly more lean mass retention during the weight loss intervention (Campbell et al., 2020).  

The study was a short period of time and involved a small sample size of just 27 participants.  

However, it is suggestive of greater fat loss and muscle retention using a 2-day increased carbohydrate intake re-feed period, taking calories out of a deficit and to a maintenance level each week during a weight loss intervention (Campbell et al., 2020).  

It is important to note subjects did not eat freely on the weekends, rather, they closely tracked intake so as to avoid going into a weight gain promoting caloric overage.  

This intervention may be worth considering for persons who are willing to closely track their caloric intake.

2 weeks on a calorie deficit, 2 weeks at baseline maintenance calories

Another study looked at 51 obese males who were randomized into a control group doing continuous calorie restriction for 16 weeks versus an intervention group doing 2 week cycles of caloric restriction alternating with intake at a maintenance calorie amount (Byrne et al., 2017). 

The caloric restriction involved a 33% reduction of calories from participants’ maintenance level of calories.  

During the 2 week refeeding phases for the intervention group, calories were taken up to maintenance levels.  Weights were tracked at least weekly or more frequently.

During the 2 week maintenance phase, if a participant gained or lost weight consistently over a 3 day period, calories were adjusted up or down to provide weight stability (Byrne et al., 2018). 

Caloric needs were updated every 4 weeks as participants lost weight and required less and less baseline calories. 

Macro distribution in the study was 25-30% calories from fat, 15-20% protein, and 50-60% carbohydrates (Byrne et al., 2018).  

Weight loss was 58% superior in the intervention group who completed the intervention successfully doing 2 week breaks from weight loss alternating with active weight loss for 2 weeks.

At a 6 month follow up, the weight loss was 80% greater in the intervention group versus the control group!

Fat mass reduction was also significantly greater in the intervention group while lean body mass changes between groups were insignificant (Byrne et al., 2018).  

This means that the superior weight loss in the intervention group compared to the control group came predominantly from fat and not lean body mass.

Even more fascinating, the reduction in resting energy expenditure (measured in a vented hood system) was reduced LESS in the intervention group compared to the control group.

Also, at the 6 month follow up, the control group gained their fat mass back, while the intervention group maintained substantially lower fat mass despite gaining some weight back.

In summary, compared to study participants who did continuous caloric restriction, those that did 2 week caloric restriction periods alternating with 2 week maintenance caloric intake periods:

• Lost substantially more weight
• Lost substantially more fat mass
• Preserved lean body mass
• Experienced less of a metabolism slow down
• At a 6 month follow up the difference in weight loss was 80% greater than the control group!!
• Similarly, the control group regained their lost fat at 6 months whereas fat mass remained much lower in the intervention group

Some caveats to consider with the study and its applicability to the general population:

a.) meals were provided to participants so calories were tightly managed 

b.) weights were frequently and closely monitored to ensure that participants did not gain or lose weight during the 2 week maintenance phases

c.) maintenance calorie needs were updated every 4 weeks to reflect changes in body weight

For those that want to use this approach, close monitoring of both weights and calories/ meal intake are required ongoing for a prolonged period of time.

There are additional studies with similar findings using refeed periods at maintenance levels to preserve muscle maintenance and reverse metabolic changes that occur with weight loss (Gripeteg et al., 2010).  

Are re-feed strategies right for me?  

The re-feed strategy to periodically break up caloric restriction periods appears to be effective in addressing the downsides of prolonged caloric restriction, such as diet fatigue, lean body mass losses, and metabolic slowdowns beyond what is explained by a lighter, smaller body.

However, re-feed periods are not periods of indulgence, but rather, carefully planned maintenance of prior lost weight, avoiding weight loss or weight gain.

To make the refeeds work for you to the extent seen in the studies above, you must be willing to:

• Closely and consistently track your calorie intake, best accomplished using an app such as cronometer.com or myfitnesspal.com or using other reputable nutrition tracking software.  
• Weigh yourself several times per week, or even daily to ensure you do not gain weight or lose weight (beyond 3 lbs was the protocol in the above study) during maintenance periods.
• Calculate your maintenance calorie needs every 4 weeks, this can be done using a tool such as the NIH body weight planning tool located here:  https://www.niddk.nih.gov/bwp 
  • Caloric need calculators and tracking always have a margin of error, that is why routine weights with food adjustments up or down based on weight responses  are necessary.

What is the most simple approach to busting through plateaus? 

The most simple approach to busting through plateaus is to achieve the basics, make sure you are hitting the protein targets of 0.54 g/ lb to 0.68 g/ lb of current body weight, hitting fiber intake goals of 40 grams per day or more from real food (not supplemental fiber), and get 5 hours per week of brisk walking plus 2 strength training sessions per week.  

Additionally, weigh yourself daily or at least weekly.  Take the stairs, park further away, get a standing desk, find simple ways to build more energy-burn into your daily routine.  

Most people who plateau are in truth not following all of these basic strategies.

If for some reason you are consistently following these strategies and still plateaued, calorie tracking and refeed strategies may be useful..

Or…you could just go 90% to 100% plant-based, but that is an entirely different article!  (see here!).  

How Lancaster Wellness can help!

At Lancaster Wellness, we have meal-plans that we can fine-tune to match your caloric needs and weight goals.  These meal plans contain recipes and can support you as you transition from a traditional western omnivore diet to a more high fiber, plant-strong diet.

With the following plant-based meal plans, we are able to support your health and nutrition goals using:

• Mediterranean diet meal plans
• Flexitarian diet meal plans
• Vegetarian diet meal plans 
• Vegan diet meal plans 

If your goal is weight management and weight loss, we can help you with our comprehensive weight loss program which includes

• Coaching with weekly check-in’s and high accessibility throughout the week
• Meal plans customized to suit your needs and goals
• Fitness programming customized according to your abilities and fitness levels
• Medical management including FDA-approved medications, hormone assessments when appropriate, and oversight by a physician-led medical team
• A focus on LONG-TERM interventions that enhance both short-term and long-term success
• A track record of successfully weaning many clients off of weight loss medications after achieving their final goals

Clients frequently lose 20-40 lbs in the first 3 months of care (10-15% or more of their bodyweight in just 3 months!) and many go on to hit their ultimate goals of 50, 60, 70…100+ lbs off with Lancaster Wellness.

We also offer a maintenance program for those that need / desire ongoing support after hitting their goals.

Reach out today to learn more about how we can help you optimize your health and nutrition!!!  Live well!

Written by Donovan Carper MSN RN CPT CHC

References

Byrne, N. M., Sainsbury, A., King, N. A., Hills, A. P., & Wood, R. E. (2018). Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study. International journal of obesity (2005), 42(2), 129–138. https://doi.org/10.1038/ijo.2017.206   

Campbell, B. I., Aguilar, D., Colenso-Semple, L. M., Hartke, K., Fleming, A. R., Fox, C. D., Longstrom, J. M., Rogers, G. E., Mathas, D. B., Wong, V., Ford, S., & Gorman, J. (2020). Intermittent Energy Restriction Attenuates the Loss of Fat Free Mass in Resistance Trained Individuals. A Randomized Controlled Trial. Journal of functional morphology and kinesiology, 5(1), 19. https://doi.org/10.3390/jfmk5010019  

Department of Health & Human Services. (2018). Physical Activity Guidelines for Americans, 2nd Ed. Retrieved from https://odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf 

Gripeteg, L., Torgerson, J., Karlsson, J., & Lindroos, A. K. (2010). Prolonged refeeding improves weight maintenance after weight loss with very-low-energy diets. The British journal of nutrition, 103(1), 141–148. https://doi.org/10.1017/S0007114509991474 

Hall, K. D., & Kahan, S. (2018). Maintenance of Lost Weight and Long-Term Management of Obesity. The Medical clinics of North America, 102(1), 183–197. https://doi.org/10.1016/j.mcna.2017.08.012 

Sarwan, G., Daley, S. F., & Rehman, A. (2024). Management of Weight Loss Plateau. In StatPearls. StatPearls Publishing.  Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK576400/ 

Turicchi, J., O’Driscoll, R., Horgan, G., Duarte, C., Palmeira, A. L., Larsen, S. C., Heitmann, B. L., & Stubbs, J. (2020). Weekly, seasonal and holiday body weight fluctuation patterns among individuals engaged in a European multi-centre behavioural weight loss maintenance intervention. PloS one, 15(4), e0232152. https://doi.org/10.1371/journal.pone.0232152