Medical Edge Newspaper Column

When Weight Loss Stalls, Reevaluate Your Plan and Focus on Health

January 2, 2009
Dear Mayo Clinic:
I've lost 15 pounds and want to lose 10 more. But I'm stuck. The healthy diet and daily exercise plan I used for the first 15 pounds isn't working any more. Why is this? What can I do to lose the next 10 pounds?

Answer:
First of all, congratulations. Losing 15 pounds is a major accomplishment, particularly if you consider that one pound of fat contains 3,500 calories!

Being stuck at a plateau — meaning you're continuing with your exercise and healthy eating habits but no longer seeing results on the scale — eventually happens to everyone who is trying to lose weight. Often, that plateau causes people to get frustrated, resume old habits and gain back the weight they have lost. Understanding what causes the plateau can help you to better deal with it, either by implementing changes in your weight-loss program or, at least for a time, being content with your current weight loss.

A plateau occurs because your metabolism — the process of burning calories for energy — slows as you lose lean tissue (muscle). When you lose weight, you lose both fat and lean tissue. (The notion that overweight people have a slower metabolism is a myth. In general, the higher a person's weight, the higher the body's metabolic rate.)

At some point, your weight-loss approach — calories burned and calories consumed — is going to result in a new equilibrium with your now slower metabolism. This means that in order to lose more weight, you'll need to increase activity or decrease the calories you eat. Using the same approach that worked for the first 15 pounds will maintain your weight loss, but, as you are experiencing, it's not enough to lose more weight.

Assess your approach. Chances are there's still room for eating less or burning more calories. In general, we see that people tend to underestimate the calories they consume by at least 20 percent, perhaps because of snacking or oversized portions. And, you guessed it, people tend to overestimate their activity levels.

To find out what it will take to move beyond your weight-loss plateau, you'll need to do some creative problem solving and ask some tough questions. Can you add another exercise session, exercise longer or increase the intensity of your workouts? Are there other ways you can increase physical activity, for example, by doing yard work or walking more throughout the day.

When it comes to food, can you change your diet with new food choices? If you started your weight-loss journey taking in 1,400 calories a day, could you cut back to 1,200 calories a day? Just be aware that less than 1,200 calories may cause you to feel hungrier, increasing the risk of snacking or binge eating.

Making one or more of these changes — and sticking to them — could be the answer to going beyond your weight-loss plateau. But if these changes are too difficult or impossible, relook at your weight-loss goals. Often, people have unrealistic expectations on how much weight they want to lose. If they lose 5 pounds, they want to lose 10. If they lose 20 pounds, they want to lose 40. I can recall one patient, in tears in my office, who had lost 80 pounds and was not happy with her success, because she felt it wasn't enough.

Focus on the positive — the weight you have lost — and don't grab for the cookies when pounds don't come off quickly. If you've improved your diet and increased exercise, you've already improved your health even without weight loss. For those who are overweight or obese, even modest weight loss can improve chronic health conditions related to being overweight.

—Donald Hensrud, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.