Augusta University Health
Stuck at a certain number on the scale? And even with good dieting and frequent exercise, that number just won’t go down?
Guess what? It’s called a weight loss plateau and it’s a frustrating part of the weight loss journey.
“Anyone can plateau,” said Dr. Renee Hilton, Director of Bariatric Surgery at the Augusta University Health Center for Obesity & Metabolism. “The fact is, the body gets comfortable at a certain weight. So you can work out intensely and eat little to nothing, and you might lose some weight, but the minute you go back to a realistic lifestyle, you regain.”
This is how you lose weight
Losing weight boils down to this: The total amount of exercise you do every day—including walking, taking the stairs, carrying groceries as well as more formal exercise—has to use up more energy than what you’re taking in through food.
So if your exercise isn’t enough to burn off the calories you’re eating, you’ll plateau. Every time.
For some people, though, it gets more complicated. Diabetes and insulin resistance, for example, can make it harder to lose weight.
Here’s where it gets even more unfair: If you have obesity, you can hit a point where your body just doesn’t want you to lose any more weight. “Why the body does that, no one entirely knows,” said Hilton. “It’s multifactorial and affected by genetics, hormones, insulin resistance, inflammation and likely other things that we have not even discovered yet.”
While television shows like “The Biggest Loser” make it seem like anyone could lose massive weight with crazy hectic exercise and a really low-calorie diet, Hilton points out that the show never has a reunion episode. “That’s because the vast majority of contestants have regained the weight,” she said.
One reason is that very low-calorie dieting and short-term, heavy exercise actually lowers the body’s resting metabolic rate, once you stop the dieting and heavy exercise. In other words, while that hard work and fasting can seem great, the result is that the body can’t burn off calories as efficiently once we go back to normal eating and exercise.
What’s ideal?
The first step is to find out what your ideal body size actually is. For anyone, the answer is to take a look at your body mass index or BMI.
BMI compares your height and weight and assigns a number. Online calculators are widely available, including one at the National Heart, Lung, and Blood Institute’s website.
BMI categories are:
- Underweight = Less than 18.5
- Normal or ideal weight = 18.5 to 24.9
- Overweight = 25 to 29.9
- Obese = 30 or more
Once you know your BMI, your health care provider can help you figure out the weight you need to lose to get to your ideal size.
Breaking through the plateau
If you’re stuck at a certain weight, the first step is to take a hard look at what you’re eating and how much you’re exercising.
It can help to write everything down in a food journal or log it into an app. And be vigilant about your log: It’s easy to say, “Oh, that was just a little coffee,” but you might be surprised at how many calories that iced coffee really is. An exercise log can also help you see clearly how many calories you’re burning based on the time you spend and how intense your workout is.
If you’re eating more than you thought—or aren’t exercising as much as you believed—you can adjust your diet and fitness plans and see if that helps you break through your plateau.
At the Augusta University Health Center for Obesity & Metabolism, surgery is not the only option. Patients can benefit from medical weight loss too, which includes counseling from registered dietitians who take them back to the basics to look at the different types of food, how much food we should be eating and how to evaluate food in order to make smart food choices.
Hilton says that for patients who get help at center, one thing she has found is that they often don’t understand food macronutrients. “Three hundred calories of food that also contains 25 grams of protein is very different than 300 calories with no protein and lots of carbohydrates,” she explained. “Some types of food will keep you satisfied for longer, so you are able to eat less. We teach patients how to consume a balanced diet.”
Since patients can also plateau because their bodies get used to the exercise they’re doing, the center also reviews exercise plans and the benefits of different types of exercise, including both cardiac and strength training. “If you get on an elliptical and do the same thing over and over, your brain, body and muscles get bored,” said Hilton. “We encourage patients to vary their exercise routine and include strength training, especially women as they get older to help prevent osteoporosis.”
Need more help?
Still, for anyone with a BMI over 35, weight loss surgery is also an option. “For people with obesity, hormonal influences and genetic predisposition can make it so that they can’t lose weight with just diet and exercise alone,” said Hilton.
She compares it to resetting the body’s internal thermostat. A patient’s body may be happy at a certain weight, say 300 pounds, even though his or her ideal weight is 150 pounds. Surgery, said Hilton, resets that thermostat to remind the body that this is what it should weigh to help patients break that plateau.
Many people don’t realize that weight loss surgery is really metabolic surgery, which is why patients who leave the hospital after bariatric surgery oftentimes no longer require medication for diabetes or high blood pressure. “It treats the metabolic effects of obesity too,” said Hilton.
And here’s a fact: Less than 10 percent of patients with a BMI greater than 35 are ever able to lose the weight and keep it off with just diet and exercise, but they can with surgery. “It’s very hard to maintain successful weight loss once you reach a certain BMI,” said Hilton. “So surgery really can make a big difference in breaking that plateau for patients diagnosed with obesity. The many non-scale victories such as feeling better, having more energy and resolving many life-threatening medical conditions for most patients far outweigh the benefit of weight loss.”
Lindsey Morris
