Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 67. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Today we are going to talk about a topic that is the bane of just about nearly everyone's journey at some point in their weight loss process, which is weight loss plateaus. So we are going to talk about how to recognize if you are in a plateau and more importantly what to do about it. So this is something that I talk about every single day, and if you're like, oh my gosh, I'm in a plateau, take a listen. I can imagine that most of us have been there at one point or another, and if you are in one right now, this is a great episode for you. If you are not, you are likely, if you are working to lose weight, going to have a plateau or maybe a perceived plateau, and we'll talk about what that means, but you are likely to have a plateau at some point in the future. So I want you to listen today, remember that this episode exists, and if in the future you are in a plateau and you just are feeling so frustrated and you want to pull your hair out, I want you to come back to this episode and let me talk you down off of that ledge. So the very first thing that I want to say is that weight loss plateaus are normal. They are a normal and a common part of the weight loss process. That doesn't mean that they're any less frustrating. The interesting thing is that I think a lot of times we feel like we're in plateaus pretty frequently, but I actually want to stop and take a minute to address what is the definition of a plateau. There are a lot of different ones out there, so some people say you just sort of know it when you see it, but a more common plateau is when four weeks or longer has gone by without seeing a change in one's weight. Now, four weeks for a lot of people feels like an eternity. It is very common that I will meet with people and they're like, oh my gosh, I'm in a plateau. I haven't lost any weight. And maybe it's been about a month, let's say, since they and I had seen each other more recently, and I'm like, well, tell me what is your weight today? And they share the number and I'm like, Hmm, that doesn't sound like a plateau. You're actually down three pounds since the last time that we met. And they're like, okay, fine. But I've been at the exact same weight for the last 10 days, and I hear you. It is so frustrating when you are working hard and feeling like you're doing everything and you're not seeing the movement on the scale. So one thing that's really important is to actually take a step back and ask yourself, is this actually a plateau? Because we sometimes expect our weight loss to just be this perfectly gradual every day I step on the scale and I see a number that is lower than the day before, and that is not true. That is never, ever, ever going to be true. Our weight loss often is this jagged up and down line that sometimes seems like it's really not moving at all. But then when you start to look at the average, and if you draw what is the average trend over time, and you've checked that over many weeks or many months, all of the sudden you see, even though it sort of feels like nothing is happening in the day to day that over a month or three months or six months or a year, that wow, actually a really meaningful change has happened. So it's interesting because a lot of times people think that they are in a plateau and they are not. So first is to ask yourself, am I in a plateau? Regardless, some of these things will apply, and so if you feel like, okay, it hasn't been four weeks, but really over the last two or three weeks I've seen a stall, I've not been moving as quickly as I was before, you can still apply some of the things that we are going to talk to today. Before we talk about how to handle those plateaus though, let's talk about why do plateaus even happen in the first place. So the most common reason for plateaus is that we actually have this metabolic adaptation that happens. Our bodies are really resistant to losing weight. And when we perceive that we are not getting enough energy, also known as food, when we are not consuming enough food, when our body feels like, oh gosh, is there scarcity? Are we entering a famine? Our body can actually slow down its metabolism in order to make sure that we can get by on less food. When it talks about survival, that is an amazing thing for our bodies to do. But when we are trying to lose weight, it is wildly frustrating because our bodies can become very efficient. And what I mean is if you've ever gotten on a treadmill and you've held onto the heart rate monitors and it said, okay, you burn say 150 calories when you walk a mile. So what can happen is that as our metabolism slows down, maybe it actually only takes your body a hundred calories to walk a mile. Your body becomes a lot more efficient at doing the exact same activities. So things that you've done in the past now have less impact. There is this metabolic adaptation that can happen. We'll talk about some of the strategies to combat that, but just know that it's not you sort of going crazy or losing your mind. Your body, even if you're doing the exact same thing, becomes more efficient so that it needs less energy, less calories in order to move. So if you're eating the same amount, and now even if that's a less amount than way back, but you've been sort of on this stable steady diet doing really well, your body adapts to that such that it starts requiring sort of less and less and less. And we know that that is not a strategy for long-term successful weight loss. We'll talk about how to combat that. Another thing is water retention. So commonly we sort of feel like we're in a plateau, but actually our body is holding onto water, and that can happen for a lot of different reasons. Commonly it may be related to medications that we're taking. Certain blood pressure medications, for example, can cause some fluid retention. The foods that we're eating, so especially if we're eating foods that are higher in salt, our body's going to hold onto more water travel can cause that to happen. Premenstrual syndrome. So when we're getting ready to have our period, there's often bloating that can come with that, and there's a lot of water retention. So it's very common that we see water retention regardless of the cause, as a reason that people may start to see a plateau. The other thing is if we've just had a change in our movement, in our activity, that can create a plateau for us as well. We know that our bodies get sort of used to day in and day out. What are the types of foods we eat? What is the movement that we have and that those two things are matching one another. And so if we change one of those such that maybe we're sick for a period of time or we're not able to exercise because we're traveling or something like that, then when you change that calorie expenditure, if there hasn't been as many calories used up, you may not need to eat as many calories. And so that can be a reason that contributes to these weight loss plateaus as well. The most common though is that metabolic adaptation. So whether you're like, yes, this is definitely a plateau, or maybe this is the plateau, I'm not sure, the most important thing is to take a step back and to assess that with an objective lens. Now that is much easier said than done. Sometimes our emotions are really riding high, we're feeling really frustrated when we have a long history of having dieted tried to attempt to lose weight. There can be so many emotions that come up that really cloud our judgment and make it challenging for us to have that objective opinion that we wish we had. So a couple of things that we can do here is one, either imagine that it was someone else, sort of imagine that you're talking to a friend and a friend is telling you all of these things. Imagine that you're watching your life sort of play out in a movie and you're a movie critic and you're assessing to see what's going on or to actually run everything by another person, whether that is your physician or another trusted person in your life to get a more objective opinion about what's going on. So for one, assessing, okay, is this actually a plateau? How long has this been going on? When I step back over a month, over three months, what is the movement that I'm seeing on the scale? Because you may actually be pretty reassured to see, oh yeah, maybe I haven't seen movement over the last 10 days, but over the last month I've actually lost three pounds, which is moving me closer in the direction of my goals. And that feels sometimes like forever, we want to just snap our fingers and have it over with. But if you imagine losing three pounds per month, at the end of a year, you'd be down 36 pounds, and then at the end of two years, you would be down 72 pounds. And that can add up over time in a really significant way. So even though today when you're sort of in the weeds, it can be really challenging to see, just know that maybe when that has taken out over a longer period of time, you are still seeing that movement in the overall goal direction and it's going to have a really cumulative effect over time. The other thing is looking for non-scale victories. So especially for people who are working on resistance training and really working to build their muscle mass, we know that that is one of the most effective tools that we have for helping to decrease our weight even to overcome or to combat a weight loss plateau. And we'll talk about that. But if you are building muscle mass, you have heard, and you probably know, but I want you to internalize that muscle weighs more than fat. If you look at five pounds of fat, it is this big globular structure where if you look at five pounds of muscle, it is this tight little brick of muscle. And so what that means is that if you've been working to build up your muscle mass, you may step on the scale and see that there hasn't been a lot of movement. But when you measure your waist circumference, when you put on your clothes, you might notice that there's a really big difference in the way that your clothes are fitting you or in the size of your body, because you may be seeing that your body is shrinking even though the number on the scale is not moving. And that is not only okay, but that is actually a really amazing thing when that is happening. So if that is happening where you're replacing some of your fat mass with muscle mass, just know that that is one of the best things that you can do for your overall health and longevity. So remind yourself, if you see a number on this scale that is not decreasing, but you've recently needed to change pants sizes, remind yourself of what an amazing non-scale victory that is, because that's a really, really big deal. The other thing that we should do is stopping to assess with curiosity. What does our food log look like? I encourage all of my patients to keep a food log so that they're aware of the things that they're consuming and to really be mindful of what is actually happening throughout their day. A lot of times we say like, oh, I don't need to do that. I'll just remember. Or I'm generally eating healthy. I'm doing my best, so it doesn't matter what I eat. Now, depending on your history, if you've had a history of disorder eating in a relationship with food and that logging your food is going to create a challenge for you. I'm not saying that that is the right strategy for every single person, but that is generally a tool that I will recommend for people to be able to just be aware what is actually happening here. So start to look at, okay, what is happening? And do there need to be some adjustments here? So a lot of times I ask my patients, oh, let's take a look back at your food log from the last couple of weeks and see what's happening. And their response to me is, oh, actually, I stopped logging over the last couple of weeks. And that is really interesting because a lot of times that also represents this decrease of intentionality or mindfulness about the food choices that are happening. But in that food log, if you are keeping it to start to look at what is the timing of your meals, what are the different types of foods that you're eating, what are the macronutrients that you're consuming, your carbohydrates, your fats, your proteins? Are there calories sneaking in the form of liquids like sodas or sweetened coffees or things like that that may not actually be providing much satiety for you but are providing a lot of calories? Are you snacking at times when you're not even really hungry, picking up a snack here or there? Are you feeling satiety, feeling full after your meals and continuing to feel full for hours later? Paying attention to those starts of those types of things. And then starting to make adjustments such that you are getting plenty of fiber, getting plenty of protein, getting lots of unsaturated healthy fats in order to help our bodies get full and stay full for longer. Start to look at are there adjustments or tweaks that I can make here? Another thing we should be looking at is our exercise. Are we exercising? If not, do we need to make some improvements there? Even if it means just basal exercise or basal movement, like taking the stairs at work, parking on the far end of the parking lot, for example, and walking, trying to get up and moving rather than being as sedentary as we are commonly in our society. If you are not doing exercise, how do we add that in? Are there movements that you enjoy? Are you doing strength training? So we talked about that role of building our muscle mass, decreasing our fat mass strength training. Lifting weights is really one of the best things, like I said, that we can do for overall health and can also be really excellent on those weight loss plateaus. And again, maybe it means that the number on the scale is not shifting in a meaningful way, but when my patients drop two clothing sizes, despite the fact that the number on the scale is the same, you can imagine that that feels really, really good. So you may feel less worried about the number on the scale when you're seeing those non-scale victories. Thinking about what has your stress been like, what has your sleep been like? We know that these things play a major role. I know that you hear that over and over again, but it's really true. And I think about, I had one patient who had been in a really stressful job for a long time, and he had done all of these things in order to support his weight loss and was making some progress, but just not as fast as he had hoped. And he finally left his job. And when I tell you that 10 pounds just fell off overnight, he literally felt like 10 pounds had fallen off overnight. We know that being in stressful situations when we're not managing our stress properly, that that can really wreak a lot of havoc on our system and make it challenging to lose weight. So if there's been a particularly stressful event that's been happening in your life recently, recognizing that maybe giving yourself some grace, and then also looking at what are the tools that you have or what are the tools that you need to establish in order to better support yourself in that way. Similarly, how have your sleep habits been? We know that poor sleep can really make an impact on our ability to lose weight. And then the most important thing is to make a plan and stay consistent with it. If you knew that it was going to work, you would keep going. A lot of times we're in the thick of it, we feel really frustrated. We're like, oh my gosh, I've been working so hard and it's not working. What is the point? And when we're having thoughts like that and feeling really defeated, we are more likely to turn towards foods or towards other behaviors that are not in line with our health goals. And if you're like, oh my gosh, I've been eating so well and it's not working, it doesn't even really matter if I eat this brownie and you eat the brownie, then you end up creating a situation where it hasn't worked. And so if you knew that it was going to work, if you knew that success was inevitable, would you keep going? And so I want you to think about that. How can you stay consistent? Can you think of it as a fun challenge of, oh gosh, what am I going to add next? How can I best support my body in its health goals? That consistency is going to be one of the best things that you can do to lose weight. And the really interesting thing is, again, we expect our weight to just be lower, lower, lower every single time that we weigh ourselves. But it's kind of interesting. I often have patients who are in a plateau and they feel like, oh my gosh, weeks have gone by and nothing happens. And then they quite literally feel like overnight they dropped three or four pounds. And it's wild to me how frequently that happens. Where we're going, we're going, we're going, we're doing the things. We're trying our hardest. We're not seeing a lot of movement, and then bam, the scale drops three or four pounds. It's very common that my patients will tell me stories like that. So just know it is possible. Stay consistent, stay motivated, reach out for help. Whether that is with someone like myself or another trusted friend, an accountability partner, another physician who is board certified in obesity medicine, I would love to support you in your weight loss goals. The best way to get in touch with me and to become a member of my practice is to visit my website, which is www.sarahstombaughmd.com. That's S-A-R-A-H-S-T-O-M-B-A-U-G-H md.com. We'll have that link in the show notes as well. If you are interested in learning how to support your weight, how to support your body so that you can achieve your health goals, I would love to support you in that. Thank you all so much for joining me today. I'll see you all next week. Bye-Bye.