Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

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:
If you have ever had the experience of being in a weight loss journey and realizing that, oh my gosh, I have lost a lot of weight easily at the beginning and then things slow down and it feels like, oh my gosh, why is this not as easy as it used to be? It was just the weight was sort of falling off at the beginning of my weight loss journey and now it feels way more difficult, it’s way more challenging, maybe even feels like I’m fighting with my body to try to lose weight. Today’s episode is just for you. We are going to talk about why the first 20 pounds often comes off pretty easily, but then the further that we get into our journey, things slow down. That’s when frustration can build. It’s when we’re likely to forget about it, just quit the journey altogether.

And it can feel like it’s really hard to get to where our goals are. So let’s talk about today why this happens, how it’s totally normal for things to slow down, and how do it help to work through your mindset while all that is going on. Because like I said, these are the times where sometimes frustration builds, we feel like, oh my gosh, nothing is working and can be really disheartening and make us want to give up on our weight loss journey. So let’s dive in and talk a little bit about what is going on here. So let’s talk about the beginning of the weight loss journey. This is the part that people generally really like. A lot of times, especially with some of the newer GLP medications, for example, people are feeling really empowered in a way that maybe they haven’t felt in a long time.

But even if you’re losing weight without medications, there’s shifts that are happening at the beginning of the weight loss journey that can compound together in a way that weight moves sometimes much more quickly. Now, one of the things that definitely happens at the beginning of the journey is we see a really significant shift in water weight. So people will, whether they start a medication or a very specific dietary plan, people will sometimes notice that they lose huge amounts of weight, especially over the first week or two. And it can be exciting because you get that feedback of, “Hey, I’m doing this journey and I’m seeing that it’s working. I’m seeing really significant movement on the scale.” The truth is that when we see huge fluctuations in weight, it is water weight. And this is so, so funny because at the beginning of the weight loss journey, we see that water shift, that weigh shift down significantly.

We know that it’s a water weight shift. Or logically, maybe if we talk to someone and realize, oh, that was probably a water weight shift, but we’re excited and we take credit for that. We’re like, “Hey, look at all the work that I’m doing.” But later, sometimes we see weight will shift up three pounds overnight and our brain doesn’t give us the same grace. Our brain is like, “Oh my gosh, I’ve failed. Oh my gosh, something’s going wrong.” And you cannot gain or lose three pounds of true fat mass overnight. Those things happen much more slowly, but we absolutely can see really quick shifts in our weight when we are talking about water weight. So especially at the very beginning of our weight loss journey, a lot of times when we look at how energy is stored in our body, we have active glucose, that’s food that we’ve recently eaten that’s active in our bloodstream.

If we have more glucose than our body needs, our body can convert it to glycogen. Glycogen is an intermediate energy storage form found in our muscles, found in our liver. Our body can take that glycogen and rapidly convert it back to glucose for energy. So we have these glycogen energy stores. Those are held, like I said, in our muscle, in our liver. What’s interesting is that when we’re holding onto glycogen, it holds onto water as well. So it’s sort of this sponge effect in our muscles, so it’s holding onto water. This can be a really good thing for endurance athletes that they have more hydration, they have more sugar that’s readily available for their body to use. So those glycogen stores could absolutely be a good thing in. Well, they’re good thing in general, but especially even excess glycogen stores can be a fine thing in the right settings.

And then our body has fat stores, which is more of our long-term energy usage. Now, what’s really interesting is that our body generally needs to deplete at least the excess glycogen stores before it’s going to be dipping into fat for energy. So when we look at the beginning of a weight loss journey, our body’s going to dip into those glycogen stores from the liver, from the muscles. And as you remember, I said that the glycogen stores in the muscle are like a sponge that holds on water with them. So as our body is losing those glycogen stores, what often happens is that we have the significant shift in water weight that happens as well. And so the very rapid movement on the scale that we see over the first week or two of the weight loss journey is often due to this water weight shift that happens.

A lot of times too, even beyond that, even as we talk about true weight loss that’s happening, a lot of times at the beginning of our journey, we’re looking at things that are low-hanging fruit. So maybe there’s things you’re looking at your day-to-day routine and you’re like, “You know what? I recognize that maybe I’m drinking a soda or a couple of sodas every day, or I’m having this sugar sweetened beverage in some sort of other form. I know that I’ve really been eating more fast food than I would typically do.” And so we start out the weight loss journey and we say things like, “Okay, I’m cutting out soda. I’m not going to do that at all. Maybe I’m not eating out at all or I’m going to limit it to once or twice a week, for example.” So we have these sort of easy changes or certainly the low hanging fruit.

We make those changes and we see the results from that. So we see, hey, the effect of having significantly less added sugar, having less of those processed foods that don’t create the feeling of fullness in the same way, or certainly are full of fat and full of salt and fuel of sugar in a way that our body is maybe more swollen after we eat foods like those. So cutting out those things, we see the shift. We see not only those water shifts from the glycogen stores that we were talking about, but our body may feel less swollen. Maybe we’re eating less salt if we’re eating out less and our body can start creating the caloric deficit that’s needed if we’re significantly reducing added sugar, for example. So we have these changes that sometimes at the very beginning of the journey feel, again, easy, big air quotes here because those changes aren’t always easy to make.

But when you’re looking at it, at least from a logical perspective, you sort of step back and look at it, you’re like, “Hey, there’s some very clear, maybe low hanging fruit of things that I could be addressing that you can address very early in the weight loss journey.” And all this is exciting. We get the feedback of we’re excited, we’re motivated, we see those numbers moving on the scale. We’ve talked about before, and I think we’re probably due for another episode of what a relationship with the scale looks like. But a lot of times we step on the scale in the morning and if we see a lower number, then we’re happy and we have a good day. We see a higher number, then we’re angry and we’re frustrated and we have a bad day. So another topic for another day, but we see those lower numbers and it can be really exciting to have that.

So things feel good. People who are starting out medications may feel for the first time that, oh my gosh, my body is responding to this nutrition, to this dietary change in this way that I felt like it never did before, and it’s really, really motivating. Now what happens and what I want you to be very clear on is that weight loss will slow down, and that is actually a good thing. Slow weight loss is good. Our body is not meant to just rapidly drop weight. When our body is dropping three or four pounds a week ongoing for a long period of time, that is a sign of malnutrition. Unless you are living in a body that is 500 pounds or more, it would be inappropriate to be dropping four pounds or more per week. So we will see sometimes really rapid weight shifts at the beginning because of those water weight shifts, and you might be like, “Oh my gosh, I can’t believe I lost 20 pounds in a month.” That should and that will slow down in your weight loss journey.

And not only is that okay, but it’s actually a good thing. So once those initial fluid shifts are happening, we’re now going to get into a rhythm of what our day-to-day routine is looking like. And there may be shifts that we’re making in terms of, “Okay, how am I working to bring in more protein? How am I working to bring in more fiber? I’m optimizing sleep. I’m optimizing my exercise.” But we start to get into this routine where day-to-day feels kind of the same as it did the day before, and the movement on a scale feels much more subtle. It might be one pound a week, maybe even two pounds per week, depending on how much weight that you have to move. Sometimes it’s less than that. Sometimes it’s half of a pound per week, and that can be really hard to see when you’re weighing yourself daily because you see these ups and downs that are happening on the scale.

Now, if you step back and look at it, what happened over the course of a month, we can see, oh, actually there is this downward trajectory that happened, but it can be hard to see that in the day-to-day. And this is where a lot of times that excitement wears off, the motivation wears off. It’s not you’re like, “Oh my gosh, is something wrong? Is my body not responding in the way that it used to?” And this is where I want you to say, “It is okay. Take a deep breath. Do not panic. How is your body feeling?” When I look at day-to-day, the choices that I’m making, if you’re taking medications in your journey, how is that feeling in my body? Sometimes we’re really excited to move up on the dose of your medication, which may absolutely be appropriate based on side effects, based on how it’s feeling in your body.

But if the medication’s feeling okay, if the medication’s allowing you to eat foods in line with your goals, if you’re still seeing movement on the scale, your side effects are well managed, I would recommend generally staying at the same dose of medication. So sometimes we’re trying to drive up to the next dose just because we want to see that shift downward, but you have to ask yourself the question and working together with your healthcare team of does this make sense based on what my goals are based on everything else that’s going on? So we do not want to be just driving up that dose of medication if it’s more than you need. Now that being said, this is hard. This is going to be a very individualized decision and not something that we’re going to go in depth on today’s episode, but choosing the right dose of medication will be a really important part of your journey as well.

We want to make sure that you’re on a dose that supports your goals, it feels good in your body, you’re able to eliminate over hunger and over cravings while managing your side effects. And so work one-on-one with your healthcare team to help to decide what the right dose of medication is for you, but we should not just be driving up the dose of medication in order to see that rapid weight loss as long as things are still shifting, even if it’s slow, that is absolutely okay. But like I said, it gets kind of boring. It gets kind of monotonous. We lose the excitement of it. A lot of times too, now that our body’s lost weight, we’re looking at other things as well. So now we live in a smaller body, so our body has less daily needs. And so if you’re just trying to follow a caloric deficit, for example, you would have to create a further caloric deficit in order for your body to continue to respond with weight loss.

A lot of times too, the body might be panicking a little bit. So your body may be thinking, “Oh my goodness, is there a famine right now? Do I need to be seeking out more food?” This is where we see that the body starts to have these metabolic adaptations and starts to fight back. So your body will work to increase your hunger signals. It will decrease your fullness signals. So your body is going to have this experience of, okay, maybe there’s not food available and your brain is going to protect you, tell you to start seeking out that food. So you might notice that you’re feeling more hungry, that you’re feeling less full, and that can also be challenging because that can slow down the weight loss journey if now you’re going to be eating a lot more. We can do things like medications or making sure we’re choosing foods that help to really promote satiety, foods that are fiber rich, foods that are protein rich.

This can be really helpful, but your body, as you get into a weight loss journey, may start to resist weight loss and that can feel really challenging. So a lot of times we’re looking at the comprehensive picture to see are there other changes that I could be making, whether that’s medication or other pieces of nutrition or exercise or something like that. But it can be hard because your body starts fighting back. And so this too is sometimes where people have in the past seen yo-yo diets happen where they’ve lost some weight really rapidly, but then their body starts to send those hunger signals, for example, and they’ve seen their weight come back. This is where it’s really important that having support, whether it’s with an obesity medicine physician, with a nutritionist, someone who’s experienced in this can be a really, really important thing. Even just psychologically, a lot of times we start to panic at this stage and it’s like, “You know what? Just forget it.” And this is where sometimes motivation is at the lowest. We’re like, “I’m doing all this work. I’m working so hard. I’m not seeing movement in the way that I want it to.” And this is the point where sometimes people give up in their weight loss journey. So what I would like you to know is that it’s okay. The weight loss journey is going to take what it is going to take. A lot of times we want things to happen quickly. We want to see movement on the scale and we want to see it now. We want to lose all that weight in three months or six months or 12 months. But a lot of times when we look back, we realize that we’ve gained weight over a period of five years or 10 years or 20 years or 50 years even, and it is okay for the weight loss journey to be slow.

It is okay for it to take one year or two years or five years, depending where you’re at, and it’s not always going to be linear. We will have plateaus. We will have times that feel challenging. We will have times that the body regains weight, and that does not mean that you have to go back to your baseline. This is where you can work together with someone like myself who is board certified in obesity medicine to help support of, okay, what are the adjustments that we make from here? This is the time that we’re looking at non-scale victories. We have a great episode a couple weeks ago looking at non-scale victories. How do you decide what your goal weight is? We have a couple of really great recent episodes that can help put this in context as well because are we even targeting the best goal weight for our body?

Knowing that and checking in with that regularly makes a big difference. But I just want to encourage you that if you’re in your weight loss journey, you’re feeling stuck, you’re feeling frustrated, that just keep going. You’ve absolutely got this. And having support is going to be one of the best things you can do. I would love to support you in your journey. I see patients in person in Charlottesville, Virginia and by telemedicine throughout the states of Illinois, Tennessee, and Virginia. If you’re looking for more support, please reach out. I would love to support you. If you were outside of those states, definitely make sure to check out the GLP guide. This is an online program that walks you through the answers to all the most frequently asked questions for people taking GLP medications. You’ll get in-depth video explanations to help support you on your journey so that you don’t feel so alone.

I would love to help you in that way. Thank you all for joining us for this week’s episode. I’ll see you all next time.