If you’ve ever wondered about why the last few pounds are the most stubborn, or asked “how do I break a weight loss plateau?”, rest assured—you’re not the only one!
The concept of metabolic set points refers to the idea that your body has a natural weight range it tries to maintain. This range is influenced by factors like genetics, hormones, lifestyle, and previous weight history.
When you lose weight, your body often resists further weight loss because it perceives this as a threat to survival. This resistance can manifest as a weight plateau, which I encourage our team to think of as an “abnormal vital sign” signaling the need for intervention and reassessment.
Key Mechanisms Behind Metabolic Set Points
1. Hormonal Changes:
Hormones like leptin (which regulates hunger) and ghrelin (which stimulates appetite) adjust to promote weight regain or maintenance.
GLP-1 medications help regulate these hormones and can be effective tools for managing plateaus. Bariatric surgery also modifies GLP-1 responses, demonstrating its impact on weight regulation.
For men and women, Testosterone Replacement Therapy (TRT) can assist with maintaining lean muscle mass, which is essential for breaking plateaus. Our program emphasizes TRT in our office in combination with our wellness program for better outcomes during acute weight loss and maintenance. TRT can be especially beneficial for patients post-bariatric surgery. Learn more about how hormone therapy can help you break a weight loss plateau here.
2. Increased Hunger and Cravings:
Weight loss often triggers increased hunger and cravings, making it challenging to stick to a calorie deficit. This is why we emphasize eating the “right amount” and may need to periodically refeed patients.
3. Reduced Resting Metabolic Rate (RMR):
As you lose weight, your body burns fewer calories at rest due to a smaller body size and metabolic adaptations. Maintaining the right caloric balance—not too much and not too little—is crucial.
How to Break a Weight Plateau
1. Reassess Caloric Intake:
Recheck your RMR (resting metabolic rate, ie medgem breathing test) to ensure your caloric intake aligns with current weight and goals.
I encourage accurate food journaling to avoid unintentional “calorie creep.”
2. Incorporate Strength Training and Change Exercise Routine:
Building muscle increases BMR, especially when combined with hormone replacement therapy (HRT).
Since 90% of insulin receptors are located in lean muscle, improving your muscle mass directly enhances insulin sensitivity and fuel utilization, this allows you to better manage calories, even take on more calories; especially good ones!
Therefore, if you’ve hit a plateau with your weight loss progress, we recommend beginning resistance training exercises targeting multiple muscle groups at least 2-3 times per week.
If your workout has become too boring, repetitive, or unchallenging, I suggest increasing intensity, duration, or variety (e.g., adding HIIT, swimming, or yoga).
I highly encourage additional daily activity, like walking or standing more, to boost overall calorie burn.
3. Cycle Caloric Intake (Reverse Dieting or Refeeds):
As our bodies approach their new “set point”, it gets harder and harder to push past it and continue to lose weight with dieting. Interestingly, the way to overcome this physiological plateau is a tactic known as reverse dieting, or “refeeding”.
Essentially, we will recommend an increase caloric intake for a week and reassess with our coaching team to reset hormonal and metabolic responses, preventing the slowdown associated with prolonged calorie restriction.
4. Adjust Macronutrient Ratios:
If weight loss progress slows down midway through a diet or program, there are some ways to further optimize our macronutrient ratios. First and foremost, we’ll want to prioritize protein to preserve muscle mass and promote satiety.
We can also balance carbohydrates and fats to support energy needs without excess storage.
These very basic changes to macronutrient ratios usually make a big difference.
5. Prioritize Sleep and Stress Management:
Unfortunately, it doesn’t matter how great your diet is or how hard you work out if you’re not getting adequate sleep. Poor sleep and chronic stress elevate cortisol levels, promoting fat storage, particularly around the abdomen.
I prescribe a minimum of 7 hours of quality sleep and stress-relief practices like meditation or mindfulness. If you’re still not getting at least 7 hours, you should think about how you can make it your top priority.
6. Be Patient and Consistent:
Weight plateaus are normal, and the body often needs time to adapt. I encourage you to stay consistent with healthy habits and focus on non-scale victories such as increased energy, improved fitness, or better sleep.
Moving Forward Together
At Blue Sky MD, we approach weight management with a comprehensive understanding of the metabolic challenges our patients face. Overcoming a weight plateau is not just about adjusting calories or increasing exercise; it’s about addressing the underlying metabolic mechanisms and customizing care for each patient.
As we refine our protocols on a regular basis, I encourage our clinicians and team members to continue utilizing innovative tools like GLP-1s, TRT, and personalized exercise and nutrition plans. Together, we can empower you to break through plateaus and achieve sustainable health.
