Weight Loss Plateau or Treatment Problem? How to Tell the Difference

The scale has stopped moving, and you're already spiraling: Has my medication stopped working? Should I switch things up? Am I doing something wrong?

Panicking and changing everything is often the worst move you can make. But how do you know when a stall is just your body doing its thing versus a sign that your treatment actually needs adjusting?

In this episode, I'm breaking down the difference between a normal plateau and a true treatment problem. You'll learn the questions to ask beyond the scale, which red flags actually warrant a change, and my golden rule for knowing when the struggle has crossed the line.

References

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All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

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Transcript

0:29

Welcome back to another episode of the podcast. How are you all doing today? I wanna talk today about the thing that everyone always wants to talk about which is gonna be plateaus. Now, I've been thinking a lot about this recently I have the Rentea Metabolic Clinic. I see patients in Indiana or Illinois, and a lot of my patients have been in my clinic for several years. Now, what that ends up meaning is that when you have been losing weight for a significant period of time, there are going to be plateaus, 100%, period, end of story. No one ever wants that, but it's 100% part of the process. And also, if you have 100-plus pounds to lose, that's a lot of the patients that will seek out my help that really need this long-term help, that will be something that they will encounter. But what I've been thinking about recently is that this is a skill that I've really had to develop, is how do you get people past that plateau at a time that's appropriate? So how do you know the difference between this is a natural plateau that is appropriate and we don't need to make big changes versus there's actually a treatment problem? That's what I really want to get at today because you'll hear a lot of people say, "Has my medication stopped working?" Every time the scale slows down, people are assuming that something's wrong. But not every plateau, again, is that treatment problem. The key is really learning the difference. Let's go through a few things today so that you could do some of this reasoning for yourself. And again, if you're in Indiana or Illinois and you want my help, you could always go to RenteaClinic.com and click on Telehealth. First things first, weight loss is not linear Bodies don't lose weight in a straight line, okay? Normal weight loss, it's weeks where nothing's happening, you get some water retention, there's hormonal fluctuations, sleep, stress, all of it affects that. A plateau by itself, it's not evidence that treatment has failed. This is where you can't be pivoting 24/7. Pivots are amazing. Looking once a week, is it working, is it not, is amazing, but you don't wanna haphazardly be changing the plan all the time. There's a lot of reasons that that scale might not be moving down that is totally appropriate and needs time, not a change. I really want you to look beyond the scale when this stuff is happening. The scale's just one data point, right? But I want you to ask things like, "How hungry am I? How much food noise am I experiencing? How often am I thinking about food? How hard does this feel day to day?" If appetite is controlled and your behaviors are consistent, sometimes the answer is just simply patience. You're gonna have to wait, my friend. That's a really good indicator that hunger's not up or just, and cravings are not up. You're actually doing the things that have you actually done that formula, has that been the case for a few months? Majority of you, it'll be a week or two and you're freaking out, and I have compassion and empathy for you. I get it, both from a clinician treating you standpoint and from myself. I so get it. But if you're in that formula, maybe you could say, "All right. I need just a little bit more patience because if I'm truly being honest, it has not been months on end that I've been feeling this way where it's okay and I'm continuing to do all the things, that if you're really being honest, it hasn't looked that way. The other thing that I would really look at is what does a normal plateau look like? I classify it as such: your weight, it's slowed down or it's paused, but your hunger is still reasonably controlled, okay? Your food noise is still manageable. You're able to follow your plan without huge excessive effort most days they feel doable. Of course, there's gonna be hard days. That's called being human, okay? We all have to get on board with this, that you will have days when you struggle. There are gonna be hard times, but it should not exceed 50% of the experience of life. That's just the way in which I think about it. This is often where people are gonna panic unnecessarily, right? You're gonna start changing too many things. But that is reasonable that at times things will slow, they will pause, but food noise is still okay and your effort is not through the roof. What can a treatment problem look like? This is what I want you to lock into, okay? Hunger is increasing significantly. Hunger is not something that you're going to be able to manage long term without a change. It doesn't need to be a medication increase, adding another medication, things like that. It could be nutrition change, it could be exercise change, it could be sleep change, stress change. There's a lot that we can do. But you, for a few days, a few weeks, you can deal with increased hunger. Long term, I'm talking five years plus, you will not be able to manage that. That's when we say, "Okay, this is actually a treatment problem. Something actually needs to change." All right. We went over the hunger has increased significantly. Your food noise is returning. This is classic for my patients that they will have lost, mm 25, 30% of their body weight and they're either at maintenance when anywhere from six to 12 months in, they notice that food noise starting to return, or they're not at their goal yet, but they've lost enough weight that this is starting to happen. And the cravings are really hard to control when this is the case because you're thinking about food all the time. You're starting to want very specific things. You're spending a lot of your mental energy thinking about food. It's like Groundhog Day because it's how it was before you ever started the medicine. And while your weight set point is lower now, you still are struggling. The process feels harder and harder over time. You're having to white-knuckle your way through a lot of things. The issue isn't just the scale, it's the experience. Does everyone get that nuance? Because this is something that's really hard to explain to people because the scale can be looking okay, but you are starting to have the hardest experience in the world to stay there. That's going to be a problem long term. That means we're not effectively treating the overweight or obesity. Sometimes the problem isn't more medication, it's different medication or different tools. So people always assume, "I need to go higher. Oh my gosh, I can't go higher anymore." That's not always needed. So different medications, though, might address different pathways. If your hunger is through the roof, that is a very different treatment compared to your cravings and that reward eating, that emotional eating being higher. A lot of the time I'll throw into that category binge eating tendencies, they are different treatment plans. I'm gonna give an example here. It is More common than not that I'll have a patient with binge eating disorder, and sometimes if it's really significant and we're, we're getting them therapy, we're doing all the things, but it's really still not very well controlled when we have them on a GLP-1. Yes, there's Vyvanse and there's other options, but sometimes it does not make sense to keep going up on the GLP-1. It makes sense to add in something that can be more helpful with the reward-based eating type of tendency that can help them to break that pattern. One of my patients, we had really gotten her to a great place. She's at maintenance. She's just doing amazing. And remember, with binge eating disorder, the goal is not ever to feel out of control with food. It's less, and it's more controlled, and we get some stability in there for you. But she's in a really great spot, so we're transitioning over care to her primary care team, and that doctor says, "Well, you don't need these other oral medications. We can just keep going up on the Zepbound." And the reality is that would be the inappropriate move to do for that patient. We have spent years getting her to a place where she is stable, where she is feeling like she can manage it, it's not perfect, but where she can manage it. I really need you to hear that distinction, by the way, because people have this idea that they're gonna get to a place where everything is perfect and nothing's ever a problem. That's not the nature of a chronic disease. And if we do nothing else on this podcast, I make sure to bring reality to you so that you are not thinking something's gonna happen that won't, but the point is, I really wanted to make sure that doctor understood, please don't change the medications. At least right away don't do it because this person is doing great for these reasons. Again, it's not always more medication. It might be a, an adjustment in bringing one down, bringing another one up. It can also be other changes that you can make. The rule that I think is the golden rule is that more than 50% hard should not exist. You can't keep it up long term. Some struggle is normal, some hunger is normal, some difficult days are normal. You might even have a hard three weeks, but if more than half of your days feel like a battle, that's really useful information. Don't make this a, "I'm then not gonna be successful." No, this is useful information so we can go do something. Long-term treatment should make life feel manageable, not exhausting. You should be able to do this. Yes, it's gonna continue to take effort, but it should feel like you can do it. Everything here really highlights how you need ongoing adjustments with obesity medicine. It's not really just a one-time prescription, a one and done, "Okay, we got you to the dose where you're good." I have seen over the years of working with people that there's... I always say there's this arc to treatment where someone will get on the meds within six to 12 months, they're doing amazing, and then there will be another struggle period, whether it's a year and a half in or two years. There are just these touch points where I know that those people will struggle, and when they're in my clinic long term, we're able to proof against those situations, or they know that they're coming, or they know how to overcome it, right? It's a psychological thing at some point as well. It reminds me, I don't know why I've been thinking about this, but you know how there are different points at which the divorce rate will go up. Someone will get married, and I don't know if I'm butchering this, so again I'm pulling from memory and I might be wrong, but it's... I wanna say like by one year some will have gotten divorced, and then I think it's four years and seven years. There are these little humps where it's like by that point people are like, "I'm out." And I think about, I wonder if I were to pool the data, I've been thinking about this recently with my patients, and just look at, okay it's gonna be a little bit subjective though, right? Because I'm gonna... It's not just based on weight, we're all hearing that today. I wonder if I were to pool that if I could predictively say how those first five years are gonna go once you get on treatment. But I definitely see it's really predictable kinda what happens. So this requires that you do reassessment over time, but I think the right questions to be asking are what's improved, what's still difficult, what symptoms remain, what pathway are we missing, these are the type of questions that we need to care about here. And one thing about ongoing adjustment is that you have to have perspective on where you started from. If you have not listened to the podcast before, or you have not listened to what I've said before, you need to write down how your experience was before you ever got on the medicine. Was it hard to walk around? Was your blood sugar elevated? What was all going on for you? You need to write all that down. You're gonna come so far that you're gonna forget in the two, three weeks when the scale isn't moving, you're gonna forget all of that, and you're so focused in on the pain of what's happening. You need to have some perspective. Don't let the scale be the only judge of whether treatment is working or not. A plateau and a treatment problem are not the same thing, and if your weight is stable but your hunger is controlled, food noise is okay, your quality of life has improved, that may just be a normal plateau. If your weight is stable and you're struggling every day, that's a conversation worth having. But the goal isn't just weight loss, the goal is your metabolic health to improve and for the journey to feel sustainable. It's got to, otherwise you're not gonna keep doing it. If this episode was helpful today, please make sure that you share it with a friend. That's a great way for other people to hear about the podcast. And if you have not left a review in the past, please make sure that you leave a review wherever you are listening, whether it's Apple, Spotify, wherever you are. If you're on YouTube... By the way, I got to 1,000 followers, yay. So thank you, everybody. I'm definitely working on my YouTube. It's a totally different community, and when you say in the comments there, "You know, I love the podcast," and you let me know different things, it really means so much to me. I definitely have oversight on all the comments that are happening on all my different channels, so thank you so much for always messaging me and letting me know what's happening and just for being the absolute most amazing community. I want to just summarize here for you that this is always the hardest part, having faith in something that hasn't occurred yet or having faith that you're doing the right thing before you see the fruits of your labor. But remember that really strong root systems, they take time. You have to have that faith and not kinda go crazy changing a bunch of different things to know if something's gonna work or not. All right, I hope you have an amazing rest of your week, and I'll see you next Monday