Episode #163: Help! I've Hit a Plateau! Now What?

You’ve been doing everything “right.” You’re taking your medication, trying to eat well, moving your body, and suddenly, the scale just stops.

If you’ve hit a weight loss plateau and are wondering What did I do wrong? or Is this medication still working? This episode is for you.

In this episode, Dr. Sarah Stombaugh breaks down why weight loss plateaus are normal, especially when using GLP medications like Wegovy and Zepbound, and what actually helps you move forward without panic, punishment, or drastic changes.

Weight loss is not linear, and plateaus don’t mean your body is broken or that your medication has stopped working. With the right adjustments, and the right support, plateaus are a normal, temporary part of sustainable weight loss.

Ready to get started on your weight loss journey? We’re now enrolling patients for in-person visits in Charlottesville, Virginia and for telemedicine throughout the states of Illinois, Tennessee, and Virginia. Learn more and get started today at https://www.sarahstombaughmd.com

Transcript

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:

In this week's episode, we are talking about plateaus, which can be both one of the most normal and one of the most frustrating parts of the weight loss journey. This is a conversation that I have with patients just about every single day when someone has hit a plateau and we're okay figuring out what happens next from here. So today we're going to talk about how do you know if you're in a plateau? How can you help to reframe and check in about that situation? And then what do you do next? Is it adjusting medications? Is it diet? Is it sleep? Is it exercise? Is it all of the above? And how do you know when you need help in that situation? 

So let's dive in and talk about plateaus. So as I mentioned, plateaus are so, so frustrating. But what I want you to learn today is what is actually a plateau? So often someone will say to me, Hey, Dr. Stombaugh, I am in a plateau. And then we check in on things and actually they're not. They're making progress. It might not be progress on a scale, it might not be progress as fast as they want it to be, but they are still making progress. Excuse me. And so when we think about a plateau, what I'm typically looking at is at the four to six week mark, have there been no changes despite consistent use of medications, despite consistent lifestyle interventions that you've been working on, despite those things, are you seeing no changes? And we're not just talking about changes on a scale. So you might be seeing a consistent weight on the scale, but let's say that one of the changes you've made recently is to engage in more exercise, particularly if you're doing more strength training, or even if you're not. Sometimes it can be really surprising that the number on the scale looks the same, but we see other changes that are happening. So we'll see things like noticing, okay, my body is feeling stronger. My body is smaller. So physically, the size of my body is smaller. I notice that maybe in the way clothes are fitting, or if I'm measuring things like waist circumference, maybe you're doing body composition and you look at body fat percentage compared to muscle mass percentage, you see that maybe your body is uh getting more muscle and that percentage of muscle relative to your body fat is getting higher. So those are changes that we very commonly see. And it's like we're frustrated because we want to see the movement on the scale. But if you are losing fat while your body is gaining muscle, I mean, that's actually one of the best wins that we could possibly anticipate. That's one of the best things that can happen because body recomposition, where we lose fat and gain muscle, is really helpful for our overall metabolic health. And so we're checking in on all of those pieces. Okay, are you taking the medication consistently? Are you maintaining your current form of lifestyle intervention? We might be making adjustments to that, but have you been pretty consistent with that? And is it really actually a plateau, whether it's just the number and the scale or whether it's other pieces as well? When all of those things are consistent, now we're starting to think about a plateau. 

Now, one of the things I do want to point out is I mentioned consistency with medication, which for most of these GLP medications, we're talking about weekly medications. But especially now, as we're talking about the oral Wegovy pill, there are older injections that are once per day, like Saxenda liraglutide, for example. So when we are talking about taking something every day or even every week, the consistency with the medication matters. So especially with the new Wegovy pill, for example, we know that consistency first thing in the morning on an empty stomach is going to be one of the biggest things that impacts absorption. And so if you realize, hey, it's just really hard for me to be able to do that. It is hard for me to stick to this routine. I'm not great at taking a daily medication, that's okay. You just might want to talk to your doctor about is there a weekly option that I'm not thinking about that doesn't depend on food or when I'm timing other medications or anything like that. We each have our areas that our body, you know, that we do well with. And if you're not doing well with that, no big deal. It just might not be the right medication for you. But even for the weekly medications, it can become very common far into our journey that we forget to take our medications. 

Now, sometimes it's outright forgetting. Sometimes it's like the day of the week has changed a little bit over time. So you used to take it on Sundays and now you take it on Tuesdays, and now like you were really into the routine of taking it on Tuesdays, and so Sunday went by and Tuesday went by, and now it's the end of the week, and you're like, oh my gosh, I haven't taken my medication in like 10, 11, 12 days. And so that type of thing does happen. And even if you're not done with the amount of weight that you want to lose, you may just be into such a routine that you forget, and that's absolutely okay. There's other things, of course, that disrupt it. So while it is safe to travel with medications, a lot of patients are like, you know what? I just rather not travel with my medication. I don't want to deal with it. I don't want to forget it. I don't want anyone at the airport or at customs to make any comments. As an aside, they won't, I promise you. But, you know, it's just kind of a pain to travel with medication. And so very commonly people might take it a little bit earlier, a little bit later, even if it was a very intentional thing, that delay in dose of medication can throw things off, especially if we're talking about that happening one or two times over the course of a month. Maybe you had a surgery and you're recommended to stop for one or two weeks before surgery. So sometimes we are hitting a plateau, but it's pretty obvious to us why once we stop and look at things. And a plateau isn't always a bad thing. It just shows us, hey, you know, this is where when my when I do this to my body, whether it's taking these medications, behaving in this way, this is the response that my body has. 

So it's a really nice opportunity. So, like, let me just check in and what's going on. Now, one of the things I always do when we've confirmed, okay, yes, this is actually a plateau. It's been four to six weeks, your body weight is stable, we're not seeing other changes, you've been consistent with your dose of medication. I like to take what I call back to the basics. So we're taking a look at what is happening with diet, what is happening with exercise, what is happening with sleep, you know, what are all of these different pieces looking like? And then how do we work to optimize those things? Because one of the things that you've probably heard me say before is that I like to optimize one thing at a time. Sometimes you go into a weight loss intervention and you go into a program and they're like, okay, you need to eat this many calories and this many macros and do this many minutes of exercise and this much sleep and engage in stress management and engage in, you know, like all of these different things. And it can be really challenging because you're trying to do so many different changes at once, and yet then we like feel sort of overwhelmed and we do none of the changes. So when they said the lifestyle intervention piece before, and like, hey, are you doing those things consistently? I'm not saying perfection here, but wherever you were at in your journey, were you pretty consistent with that piece of it? And if so, maybe it's time that we layer on the next piece. So this can look like a couple of things. So let's talk about from a nutrition standpoint. 

I think one of the biggest mistakes people make is thinking, like, okay, I just need to eat less. And while sometimes that is true, what more frequently we want to do is optimize the nutrition that you're having. When we are simply thinking about the caloric content of things, we are missing what is a signal from that macronutrient of how your body is supposed to use it. So we've got carbohydrates, we've got fats, we've got proteins. We know that each of these things plays a very important role in our body and is metabolized very differently. So I think one of the most damaging things about the calorie counting era is that we got really obsessed with, okay, I'm gonna have this hundred calorie pack of cookies, for example, and that might not be serving you in the way that you want it to, as opposed to if you had a hundred calories of protein, your body is going to do very different things, even though the exact same caloric content. So this is a really good opportunity to look at, okay, are you actually eating? How often are you eating? Are you eating three times per day? So a lot of times I want someone to be eating a minimum of two times per day, but ideally even three times per day. These don't necessarily have to be huge meals, but we want to make sure are you getting a protein source at least two or ideally three times per day? One of the things you may have heard me say about protein before is that our body does not store protein intake particularly well. So we can either use protein for muscle building, for hormone building, for other enzyme and, you know, any different cellular structure building that our body needs. So we can use it for those purposes. Or if we have more protein than our body needs, our body will just use it as an energy source. And so it becomes, I've called it an expensive carbohydrate before, but it comes an expensive carbohydrate if you eat more protein than you need. So you don't want to just have like a hundred grams of protein in one setting. What is much better is to have 20 or 30 grams of protein distributed throughout the day. So we're checking in, are you consistently getting 20 or 30 grams of protein distributed throughout the day? At least three times per day, you want to be getting that. And that can be a really nice thing. Hey, if we're not doing this, let's make sure our body is adequately fueled from a protein standpoint. Are you choosing foods that naturally promote satiety or fullness? 

Now, protein is going to be one of the top things on that list, as well as fiber. So fiber in the forms of especially fruits, vegetables, and grains in their whole form can be really nice at promoting satiety. So it gives us that lasting fullness. When we partner protein and fiber together, especially, that is magic. You know, that allows us to be in a situation where our body gets full relatively quickly and can stay full for longer periods of time and provide us with that lasting satiety. Fats are also helpful for satiety. We do want to be mindful of fats though, because they're just very calorically dense. And so we don't want to have huge servings of fats in and of themselves because they provide this really energy-rich source of nutrition, which is a good thing in some ways, but we want to make sure that we're not overdoing it. So mindlessly eating things like nuts, for example, putting a lot of olive oil in our salad dressing, like these are all fine things to do. You just want to be mindful of, you know, the quantity of those things because fats are very calorically dense. So all that to say, are you getting protein? Is it distributed throughout the day? Are you getting fiber? Also ideally partnered with that protein, especially if you're feeling hunger. Are you getting those two things distributed throughout the day? That can be really important. We also think about the role of carbohydrates. I think carbohydrates sometimes get played up as like the devil when it comes to nutrition. Carbohydrates are incredibly important. When we choose carbohydrates, we ideally want to be choosing really fiber-rich ones. So those fruits, those vegetables, those grains in their whole form. If you're having a lot of simple or processed carbohydrates, that may be an area that you can make some adjustments. But also when you're having those, partnering them with protein, partnering them with fat is going to be helpful in how your body metabolizes them. 

So if you're having a dessert, for example, having it as part of your meal rather than an isolated cookie in the middle of the afternoon will actually have a very different impact on your body too. So sometimes it could be little tweaks like that. Like, hey, if you're going to be having a sweet, just make sure you're having it as part of a meal, that you've partnered it with protein and fat, um, fiber in order to give you that lasting satiety and to blunt the blood glucose response from it. It'll also blunt that crash that can happen as well, that could be really miserable and sometimes drive further process carbohydrate type cravings. So we look at are we optimizing things from a nutrition standpoint? We then want to look at, okay, what does movement look like right now? And we're thinking about cardiovascular movement. So things like walking, running, biking, dancing, rowing, any sort of like you're getting your heart rate up, you're sweating, that type of thing, as well as resistance training. And both of these things will be really important for us. 

When we think about movement on a day-to-day basis, checking in, okay, what are my steps look like right now? Am I getting 2,000, 4,000, 5,000 steps per day? Okay, is there something that I could nudge that up to be getting 6,000, 8,000, 10,000 steps per day? What does this look like on a typical day? And how do I help to nudge myself so that that just basal movement, so that day-to-day movement is nudged up a little bit. There is something to calories in versus calories out. It's not the entire picture, which is so frustrating when people assume that it is, but there is something to, hey, let's help our body to burn a little bit more energy that can be helpful as well. So can we nudge up our daily basal movement is excellent. This can be things like even you hear like parking further out in the parking lot, taking the stairs instead of the elevator. Those things actually make a difference, which is why there's been so much conversation around those in the past. Those things can add up in a really significant way. Getting up and pacing your room while you're thinking about something, doing a couple of squats or a couple of push-ups just to get your blood flowing can also be helpful. So these those things can make a big difference. We also want to be thinking about resistance training. And as we talked about earlier, if you have layered this on, this can make changes where your body is lowering body fat mass, gaining muscle mass, you change that relationship between body fat mass percentage and muscle mass percentage. This is one of the best things you can do for your metabolic health. If you are not resistance training, sometimes a plateau can be a really nice time to bring that in. Now it can be frustrating because you might see that there's pretty good scale stability, but you're looking for those non-scale victories. And so you're looking for change in waist circumference, change in the way clothing is fitting, the way your body feels in terms of strength and energy. But resistance training is a phenomenal tool. Ideally, getting two to three sessions of resistance training per week is going to help you to maintain your muscle, to put on muscle. And this can absolutely be a plateau buster. Now, with both of these things, when we're thinking about movement, we're thinking about nutrition, one of the things that I want you to make sure you're not doing is just like going all out, whether that means all out in terms of restriction, of like, okay, I can't eat anything. I have to like overly restrict myself or I'm not eating any calories, or all out in terms of exercise. Okay, I'm gonna exercise an hour every day or two hours or three hours, or I'm gonna get 15,000, 20,000 steps per day. And you feel like you're beating yourself up. If you feel like you're beating yourself up and you feel physically exhausted, you feel mentally exhausted, you need support in this journey. 

So make sure you are checking in with an accountability doctor, with a coach, with a trainer, with a obesity medicine physician, that you have someone who is going to help you to establish this loving relationship with your body when it comes to both food choices as well as medication choices. So do not be beating yourself up. And if you feel like you're beating yourself up, I want to make sure you get that loving, accountable support that you need without like, hey, I'm attacking myself and I feel like I'm fighting myself. That is absolutely not the goal. So really thinking about that because when we're beating ourselves, it can drive a stress response as well. So it can drive a situation where your body feels stressed, your body feels like it's being fought against and your body can be really revved up in a way that can actually be counterproductive when it comes to weight loss. You know, you hear about cortisol production, you hear about, okay, your body's stressed and it's not releasing energy. You do not want to be the cause of stress in your life. So if you are the cause of stress, just be mindful of that and make sure you're getting that loving and accountable support. Now, there are other stresses in life. You've got a really stressful job, you've got a really stressful family situation. Working through that can sometimes be the plateau buster that you need. I think one of the things that can be really surprising to people is that stressful situations, there are people who lose weight during stressful situations. Like maybe they have no appetite and they don't eat at all. But what is very common is that people gain weight or they just plateau during a stressful season. Their body is like, hey, feels like we're, you know, fight or flight mode right now. We want to conserve energy and their body may not be willing to release weight. I've seen it happen before where when someone's working through a really stressful situation in their personal life, in their professional life, whatever, that it can slow down or even halt their weight loss progress for a period of time. So addressing that, sometimes recognizing that a plateau is actually a huge win in that situation. 

Being able to be in maintenance when life is crazy may be the win that we're looking for. And then when life settles down, that's when it's time to, you know, sort of re-engage or that our body just, even despite doing everything sort of the same, our body just starts letting go of things. Similarly, making sure we're getting plenty of sleep can drive improved metabolic health. So making sure that we're getting both good quantity sleep and quality sleep. If you haven't been evaluated for things like sleep apnea, this is absolutely the time to do it. You're not getting those hours in bed that you need to, getting into a wind-down routine. This is absolutely something to be focused on. So we're thinking about all of these different pieces. Now, I will say a plateau is not always a bad thing. Being in a plateau, we can also think about as maintenance. And maintenance is a good thing. It doesn't mean you have to be at that maintenance point forever, but it can mean like, hey, I'm just letting my body settle out here for a while, feel what this feels like on my body, and things start to move again. We know that people do this. If you look at like professional power builder, like power lifters and bodybuilders, there are people who do this actually very intentionally, where they gain weight and they cut weight. And when they're cutting, they'll get to a maintenance period for a while, sometimes three, six, nine, twelve months. And we see this happen in the weight loss journey as well, where I have seen people be at a plateau for a long period of time, six months, 12 months even, which is like, oh my gosh, they just want to tear their hair out. Sometimes they're feeling crazy about it. And all of a sudden their body just like gets sort of back into routine. So that can absolutely happen as well. And it's not a sign that anything has gone wrong. 

It may be a time, though, to be checking in with your doctor, checking in with a board-certified obesity medicine physician. Do I need to be making adjustments in terms of medication, in terms of nutrition, in terms of exercise, evaluating other health conditions? If you are in Illinois, Tennessee, or Virginia, I would be so happy to support you in your weight journey. If you are in Charlottesville, Virginia, that is where I see patients in person. Outside of those states, find a board certified obesity medicine for physician near you. Thank you so much for joining me for today's episode. We'll see you all next time.