Episode #144: How to Maintain Your Weight Loss

In this week's episode of the Conquer Your Weight podcast, Dr. Sarah Stombaugh talks about maintaining weight loss. And even if you're still in the middle of your weight loss journey, this episode will be helpful for you too! This episode will discuss how we lose weight. You'll learn why building a weight loss plan will be highly individualized. We'll focus on concepts like protein, fiber, and learning to choose foods that create satiety. You'll learn how to intentionally incorporate sweets and alcohol, so that you're practicing building habits you can stick with for the long haul. 

We'll also discuss the role of monitoring yourself, whether it's regular weigh-ins or utilizing tools like food logging to keep yourself on track. 

Ready to lose weight or need help transitioning to a weight maintenance plan? We'd love to help you. We're enrolling patients for in-person visits in Charlottesville, Virginia and for telemedicine visits throughout the states of Illinois, Tennessee, and Virginia. Visit www.sarahstombaughmd.com to learn more and get started today. 

Are you taking a GLP medication? We are thrilled to share we are offering an online course, The GLP Guide, to answer the most common questions people have while taking GLP medications.

To sign up, please visit: www.sarahstombaughmd.com/glp

Transcript

Dr. Sarah Stombaugh:
This is Dr. Sarah Stambaugh, 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 Stambaugh.

Dr. Sarah Stombaugh:
Hello, everyone, and welcome to this week's episode of the Conquer Your Weight podcast. We are going to be talking about weight maintenance, which if you are still losing weight and you're like, okay, let me just skip this episode, listen up because I think this is a great episode. Actually, regardless of where you're at in the weight loss journey, being able to think about both what you're doing now as well as, okay, what does this look like me for the long term? Now, of course, we don't have a crystal ball and we can't always say a exactly what it looks like from a future standpoint, but making plans right now, if you are still on your weight loss journey for what the future will look like is really important. And then certainly if you are getting to that point or you're in that point of weight maintenance, let's talk about how do you maintain weight after weight loss? Now, one of the most important principles that I will share with people is how you lose weight is how you maintain your weight, which a lot of times doesn't happen. 

You know, a lot of times we think about really intense dietary interventions or exercise programs. You do a six-week program, a three-month program, and you're all in really restrictive, maybe exercising really intensely and lose weight rapidly over that period of time. And then the program ends, you kind of go back to what you were doing and you see a significant weight regain, sometimes all of, if not even more weight than you had lost. And this weight cycling can be incredibly, incredibly frustrating. So one of the core messages that I have for people is when we're thinking about implementing a nutrition plan, we're thinking about exercise, we're thinking about all of these different components, what are the things that you could do long-term? Now your plan can change. It doesn't mean that you have to choose something today and you're not going to make any variations to that. for the rest of your life. But when you think of what are the changes that I'm going to make, you want to be thinking of changes that feel very doable. And again, that may evolve over time. You might sort of layer on or build on things together, but you don't want to go into a program and you sort of review it and you're like, oh yeah, no way is that something that I would keep up on. If you are starting out a program, you're reviewing it and you're that in the long term, that I will recommend stepping away from that program. That is likely not going to be the breast program for you. 

So when I think about how are we going to both lose weight, how are we going to maintain our weight, thinking about principles that you can start adapting and then layering on top of each other. One of the things that I think drives some people totally crazy is that in my weight loss program, I don't give a calorie count recommendation. I will give some macro crowd recommendations. A lot of times talking about minimums on things like protein or talking about fiber goals, for example, but a lot of times I will not give very specific amounts of macros, especially as we're diving into the carbohydrates and we're diving into fats because the reality is, is there are different programs or different amounts of things that will work for different people. And we need to lean into what do you like? You know, what are your food preferences? What are the things you're going to be able to implement in your day-to-day routine, both because you like them as well as in terms of just logistically, do you have time to purchase that food, prepare that food, eat that food that will look very different for different people? 

And so when we think about a meal plan, we want to be thinking about layering on tools over time. This might look like emphasizing protein in the diet, emphasizing fiber in the diet. As I said, those are the two things that I will focus on most. It may look like paying attention to what is your body saying in terms of hunger or satiety? You know, are there reasons that I'm eating for reasons beyond hunger? Or are there times that I'm eating for reasons beyond hunger, recognizing that I'm eating in response to maybe challenging emotions that are coming up, or even emotions like boredom, for example, it's very common that eating is an activity and we may be eating for reasons beyond just hunger. And so being really keenly aware of these things, and then And over time, starting to shift our patterns in the direction of, okay, when is my body feeling hungry? I can't tell you how many people I've talked to who their entire life, they think back to childhood, they've woken up in the morning, they haven't been super hungry, but they were forced to eat breakfast as a child. Even as an adult, they are forcing themselves to eat breakfast. And they're like, you know what? If left to my own devices, I would probably actually start eating mid-morning or midday. And that's okay. So starting to re connect with what is it that you like to do? What is it that your body is asking for? That'll be in terms of the time of days that you eat. What are the foods that feel really good in your body? I think one of the things that's really powerful in our weight loss journey is that if we're logging our food, we're logging other symptoms, we're maybe logging emotions, we're logging hunger and satiety, it can be really powerful to start to see that different foods fuel our body in different ways. 

And so there can be really extraordinary variations of this where you eat a muffin or a cookie or a candy bar on an empty stomach and an hour later, you feel just crashing energy. You feel low blood sugar, dizzy, headachy, nauseated, just feeling miserable because your body has processed that simple carbohydrate super quickly and you're hungry and feeling low blood sugar very quickly thereafter versus how do you feel on the day that you had a omelet with lots of vegetables loaded up on it, maybe some fats in the form of cheese or meats, and you've got this protein and fat and fiber that is sticking with you for hours later and recognizing that, okay, if I had something like that, I'm feeling satiated for three, four, five hours and beyond sometimes. So really starting to pay attention to what are the foods that I already like that are feeling really good in my body when I eat certain How does that feel immediately afterwards? How does that feel hours afterwards? Are there times where I'm more likely to overeat, for example? So are there times where maybe I got overly hungry? And so when I'm eating, I'm eating really rapidly and finding that I'm more likely to overeat. Or if I'm at a certain friend's house or if I'm in company with other people and just not really paying attention to what is being served to me or what I'm serving to myself, I'm more likely to overeat. There may be times where you're likely to overeat, for example. 

So starting to pay attention and be aware of those things is super, super powerful. Are there days where maybe you do wake up in the morning and you are hungry, but you have to kind of rush out the door before you have an opportunity to eat? And then by the time that you do have an opportunity to eat, you're just ravenous. Is there something that we could do a grab and go and figure out, okay, maybe you would love to eat an omelet for breakfast every morning, but if you're sprinting out the door, you are not going to be eating an omelet for breakfast every morning. So is there something frozen? Is there something in the refrigerator that's like a grab and go type thing, or even a shelf stable thing that you keep at home or in the office, for example? Are there ways that you can set yourself up for success? And learning and experimenting with all of these tools is one of the most important ways that then we start to design, you know, you hear that cliche of, it's not a diet, it's a lifestyle. But you start to design what works for you? What do you enjoy? I also love people are always very intimidated in their weight loss journey when their first vacation comes up. Maybe they have a cruise or they're traveling with their family. Or even sometimes just an eating out experience with certain people in their life can be really scary because they've not had this experience during their weight loss journey. They're worried about seeing a setback. Planning around those times is so powerful. And so you might look at... How am I going to help set a goal for, let's say it's a dinner. You're going out to dinner. You might look at the menu in advance. You might decide, I'm going to focus on a protein and a vegetable. I'm going to only have one glass of wine with dinner. I'm going to make sure that regardless of how delicious the food is, I'm stopping when my body feels appropriate satiety. We can make some of those type of choices. Even if you end up eating something that's not as in line with your goals, you can still have certain goals guardrails in place to help yourself stay on track. Practicing, okay, how do I do this over the course of a week? You know, let's say you're going on a week-long cruise and it's all you can eat and all you can drink and you may have had experiences in the past where doing something like that, you would see a five pound or a 10 pound weight gain, for example. How can you decide that maybe this cruise you're going to be in weight maintenance or in this cruise, I want to try to lose weight, setting certain goals of what is the number of desserts I'm going to have? What is the number of alcoholic beverages that I'm going to have? And how do you allow yourself to choose an amount that feels in line with your goals, but also feels enjoyable? Like you can choose to intentionally consume these things. 

And so practicing doing that is really, really important. I think sometimes we have this idea that during our weight loss journey, if we could not work and we had nobody else in our life and all we could do with focus on our weight loss, then we would be able to lose weight and we'd be able to keep it off. And sure, that may absolutely be true. And it's not going to happen. And so if we're not going to find ourselves in that type of position, pining over it and being upset that we don't get to be in that situation isn't helping you. It's only hurting you and keeping you from your goals. And so how do we learn to live life? How do we learn to go about our daily a day routine to go on vacations and go out to dinner and making and practicing these things, especially in conjunction with a trusted accountability partner in a medical weight loss practice like my own with a health psychologist, with someone who can help work through the challenges that they come up during this time, you start to create a situation where your weight loss journey becomes very doable. I think one of the favorite things that people will say to me at times is, wow, I didn't expect this to be so simple. Now, they sometimes use the word easy when they say that, but sometimes it's simple. And I think the simplicity is the message that I want to get across. It may not always feel totally easy. There may be times where you're frustrated and where there's challenges that come up, but that weight loss can be simple when it's done in a comprehensive way and with additional support. The additional support may be people, it may be medication And I think that too is a really important conversation here of how you lose weight is how you keep weight off. 

Now, broadly, it's hard to give a recommendation on a podcast of what would happen for you if you're taking a medication, like let's say one of the GLPs, you've got Wegovy or Zepbound or Ozempic or whatever it is, and thinking about, okay, what does this mean for me in the long term? Do I need to keep taking this medication at this dose? Do I need to take this forever? Hard to say, I guess. can't give a specific individual or yes, a specific and individualized recommendation. But what I can say is that we'll take the dosing in a very individualized way. How are you responding? Are we, you know, if we're utilizing medications to help support your weight loss journey, what does that look like when you get to weight maintenance? I think one of the biggest challenges that I see come up is that sometimes people are told, okay, it's time to stop your medication because you're, you know, you've lost the weight. So just stop the medication. These medications can be stopped cold turkey. I mean, there's no disastrous side effect that will happen. It's not like you need to wean off of the medications, but these medications are not designed to be stopped. These medications are designed to be continued in a long-term fashion in order to continue supporting someone's weight goals. 

And when we do the whole thing together with diet changes, with movement changes, with addressing sleep and stress, and we layer on the medical piece, I have seen patients who have completely change the trajectory of their entire life and taking the medication piece out of that, you know, why, why would we do that to someone? You know, we think about other medical conditions. We think about blood pressure. We think about depression. We think about asthma. If someone is stable in a regimen, we continue them on the regimen. And so when someone has hit their weight loss goals with a question that we ask is, okay, you know, is this worth it where we want to stay? Maybe someone's losing more weight than they had intended. Even sometimes when people have significant weight loss goals, we still can find that weight loss is going beyond what we would expect it to. And it may make sense for us to dial back on the dosing, for example. Very commonly, we might take a step back on whichever dose that someone was on and see how are things feeling at a lower dose, because you can over-medicate someone. I've seen plenty of people for whom they're taking too high of a dose of especially some of the GLP medications, and they feel miserable. They feel like they're not able to eat at all. They feel really run down. They feel fatigued. The goal of the medication is not that. The goal of the medication is that it allows you to have regulated hunger signals such that you're able to eat foods that nourish your body without having some of those significant thoughts about food, cravings for sugar, eating frequently, feeling like when you do eat that you need to eat larger amounts. 

These medications are helping to regulate that. They are not designed to suppress the appetite completely because I have seen patients who feel just totally run down because they just almost can't eat anything when they're on these medications. And so the titration moving up based on how you're responding, but then also you may hold at that number. You know, if you're on a whatever dose of medication that we're talking about here, you may stay at that number and find that at that amount of medication, it continues to adequately suppress you in your goals. Now, if it's, like I said, if you're finding that you have not enough energy, if you're feeling like you're losing or you are losing more weight than what would be needed or what would be desired, those are absolutely reasons for us to scale back. And, you know, we, we certainly do that. And so we take this response of what does your body need and then how do we match that to medication? But I think one of the most dangerous things that I see happening is that patients are abruptly stopped on this medication and then they'll see weight rebound really quickly. And it can be awful because we're just setting, you know, as medical professionals, we are setting people up for that same yo-yo diet that they have done in the past. 

Now, just in the context of a medication. And so continuing medication, it may mean switching medications. Like I said, it may mean decreasing dose of medications, but generally we are thinking about how do we continue to support that in that way. The same will ring true for exercise. We know, especially for weight maintenance, that exercise can be really valuable. And this can look like getting in step count. So walking or jogging or swimming or elliptical or bike, just general day-to-day activity, as well as things like resistance training can be really helpful for weight maintenance. And having adequate muscle mass is one of the best things we can do in order to support our long-term metabolism. I think we have all these principles in place, but one of the most important, if not the most important thing is that we are actually keeping track of things and monitoring things. Now, I certainly recognize that there are people for whom their relationship with a scale does not lend itself to tracking regularly. And I think if you find that stepping on the scale creates a lot of emotional turmoil for you, absolutely, that's a conversation to have with your physician. Is there another way? There are scales like a blind weight scale, for example, where you can step on and get an alpha code that can be translated into a numerical weight that your physician or somebody else could track. But being really aware and checking in regularly with yourself, you know, what is my weight? How are my clothes fitting? Sometimes I think we have this expectation that we'll get to a goal weight and we'll stay exactly there. The reality is you are a human being. with human physiology and there are natural fluctuations that occur in our weight. 

You may be on your period, you may have eaten salty foods, you may have just traveled, maybe you just had a GI bug and you're seeing things on the lower end of the scale. We may see some variation in our weight and that is normal. Typically, I'm thinking about, you know, like a five to six pound range. So if you think about getting your weight down, let's say your goal weight becomes 150 pounds, just picking an 147 and 153. Recognizing that we do see these fluctuations and it's not like every single day you step on the scale and see 150, 150, 150. You're going to see some movement up and some movement down. And that's completely normal. It'd be weird to see the exact same number day in and day out. But I do think that checking in, whether that is daily, whether that is weekly, whether that is monthly, but having that check in so that you are able to recognize, okay, I am seeing some weight regain. How am I going to work towards supporting that piece? Very commonly, I do have patients for whom food logging, they may do it every day for the rest of their life. But generally, the way we think about food logging is a tool that you can bring on and bring off if you need to. I encourage all of my patients to do that in the beginning of their journey, where they're logging their food, they're paying attention, they're logging physical symptoms, how they feel after eating, how they feel before eating, especially if there's any of emotions that are coming up, paying attention to things like hunger and satiety, and using that as a tool to really pay attention to what are the food choices I'm making? When am I eating? Why am I eating? And over time, we make that adjustment. What happens over time is a lot of times we get into routines where things are going very well, our weight's been stable. We haven't been logging our food. If we're doing something like hunger and satiety, it's just built into our brain. And so we're sort of naturally starting when we're hungry, we're ending when we're full. 

We feel like we get into really good routines. But what I want to offer to you is that could be a tool that you bring on and off as you need to. And so if you recognize, okay, I stepped on the scale and okay, the scale's up eight, 10 pounds, and let's work on this. Let's fix this now before I start seeing a more significant weight gain. That can be a really valuable time in order to bring back on some of those tools. Like, okay, I'm going to start food logging. I'm going to pay a little closer attention to protein or vegetables or movement. You may, when you take a step back from a place of curiosity, be able to see fairly clearly, okay, what's going on here? Was there a medication added? Is there a new stressor in my life? Has there been a change in my day-to-day activity level? Maybe you used to have a really active job and now you're retired and so you get 10,000 less steps per day. Was there something that happened at the time where you started seeing weight or is it just that weight creep that can happen? And either way, there may be solutions to that. But the checking in of it regularly, like I said, whether it is the number on the scale, whether it is the way that your clothing fits, whether it is a trusted relationship with a primary care physician or an obesity medicine physician, someone for whom you are checking in and having these conversations regularly, so that you're able to see, okay, there is this weight regain that's starting to happen. 

Let's tackle that now because knowing the problem is there is absolutely one of the first steps I think this is where sometimes a lot of shame can come up because there's been a successful weight loss journey you're celebrating it people in your life are noticing and then you start to see weight regain and it can feel like oh gosh not again you know is this going to be like every other experience that I've had before and I will say it does not have to be you know having loving yourself build that relationship where you can look at it from curiosity with kindness with compassion and then make shifts back in the direction of your goal that is a huge you know easier said than done best done with support but that is absolutely something that I would wish for you and for everybody on their journey so we're thinking about how do we pay attention bring a mindfulness to it how do we make sure that we have things when we're making decisions for a weight loss plan How do I, could I stick with this thing for the rest of my life? Am I planning? Am I choosing these things with intentionality? Those are going to be some of the most effective tools for both losing weight as well as maintaining your weight in the long-term. If you have been looking for a doctor to support you in your weight loss goals, I would love to help you. I see patients in person in Charlottesville, Virginia. I also see patients by telemedicine throughout the states of Illinois, Tennessee, and Virginia Thank you so much for joining us for today's episode. We'll see you all next time. Bye-bye.