Achieving your desired weight can be challenging, and experiencing a weight loss plateau on the ketogenic diet can be frustrating. A weight loss plateau, or stall, is defined as the inability to lose more weight after experiencing initial success. While weight tends to come off fairly rapidly at first, at some point, it can seem as though your weight won’t budge. Fortunately, there are several strategies that can help you begin to lose weight again. This article explores the causes of weight loss plateaus on the keto diet, as well as strategies to overcome them.
Introduction
Sustained weight loss is known to be challenging. Everywhere one looks, a new diet or exercise strategy promises to be the magic bullet to lose weight. In reality, weight loss is a complex process encompassing changes in diet, physical activity, and other behavioral modifications. Following an initial period of steady weight reduction, individuals attempting to lose weight frequently experience a frustrating plateau where progress halts. Clinicians' understanding of the basis of the weight loss plateau is critical for effective patient management. After an often steady and relatively rapid initial weight reduction, new dieters frequently encounter a weight loss plateau as their bodies adjust to dietary and physical activity changes. This article explores the physiological mechanisms contributing to weight loss plateaus and examines how metabolic adaptations, hormonal variations, and energy expenditure adjustments contribute to this phenomenon. The activity provides evidence-based strategies to help patients overcome weight loss plateaus, including dietary changes, exercise adjustments, behavioral techniques, pharmacotherapy, and bariatric surgery.
What is a Weight Loss Plateau?
A weight loss plateau occurs when weight loss slows or stops despite an individual continuing a diet and exercise regimen. It’s important to distinguish between a true weight loss plateau and a period of weight stability, which is expected after initial weight loss. Weight can vary day to day-as much as several pounds-due to normal fluctuations in how much water your body is holding. So looking at your weight from one day to the next, or even one week to the next, does not always accurately reflect your progress. If you have been weight stable for a period of time and you feel energetic and strong, it may be time to revisit your goals, or at least your timeline. For now, focus on the rediscovered metabolically healthy you, feeling well and functioning well.
Weight loss is not always a linear process. Experiencing plateaus - or periods when you don’t lose weight - is common on any diet, including on the keto diet. Plateaus are a normal, yet frustrating, part of the weight loss process. If you’re stuck in a true weight loss plateau while following a low carb or ketogenic nutritional approach there may be a few reasons why. Experiences of weight loss, including the amount and rate of weight loss vary from person to person and even within an individual's journey. When trying to lose weight, many people experience periods of steady weight loss, followed by periods of stability, and even weight plateaus. The American College of Cardiology (ACC) and the American Heart Association (AHA) indicate individuals generally achieve maximal weight loss at 6 months, followed by weight maintenance or slow regain. According to the American Association of Clinical Endocrinologists and the American College of Endocrinology guidelines, weight loss plateaus with pharmacologic treatment typically occur later than with lifestyle intervention, between 6 and 12 months.
How to Identify a Weight Loss Plateau
Follow these steps to determine whether or not you are stuck in a weight loss plateau:
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- Take a look at your weight loss over time, rather than weight changes within a small window.
- Consider if this ‘plateau’ follows a period of significant weight loss.
- Have you been at the same weight for less than 3 months after a period of significant loss? If the answer is yes, weight loss could pick up again shortly. It might just be that this is your new stable weight for a period of time before you start losing weight again.
- Don’t let the scale be your only measure of progress. Your body composition may be changing while the scale shows no change at all. Notice how clothing fits, and measure your waist circumference.
Causes of Weight Loss Plateaus
There are various reasons for hitting a weight loss plateau. They include overeating, not eating enough protein, not getting enough exercise, and not getting enough sleep.
Weight loss plateaus are complex and determined by physiologic, genetic, environmental, and psychological factors. The body adapts to reduced caloric intake with metabolic adaptations. Weight loss plateaus, characterized by weight loss slowing or stopping despite an individual continuing a diet and exercise regimen, affect approximately 85% of dieters. Adaptive thermogenesis is the primary physiological adaptation that contributes to weight loss plateaus, slowing or halting weight loss as the body's REE decreases to match the lower caloric intake.
Regardless of the type of diet, plateaus occur weeks to months following the initiation of a weight management program. Biological adaptations, a decreased resting metabolic rate, and hormonal changes impede continued weight loss. The body adapts to reduced caloric intake with metabolic adaptations. Weight loss causes loss of adipose tissue and lean mass, and the resulting smaller body mass burns fewer calories during NEAT, further contributing to the plateau. These changes increase hunger and fatigue, often leading to discouragement and diet cessation with resultant weight gain. Weight loss also stimulates appetite by activating the feedback control circuit, and consuming fewer calories requires more effort. Even intermittent lack of adherence to dietary prescriptions can cause weight fluctuations and a plateau.
Physiological Adaptations
Weight loss plateaus are complex and determined by physiologic, genetic, environmental, and psychological factors. The body adapts to reduced caloric intake with metabolic adaptations. From an evolutionary perspective, stored fat is a protective reserve against periods of food scarcity, and the body resists attempts at significant weight reduction.
Individuals lose weight when they achieve a calorie deficit, defined as calories consumed less than calories expended. Popular regimens, such as low-carbohydrate, ketogenic, low-fat, DASH, and Mediterranean diets, offer different macronutrient compositions but share the goal of establishing a caloric deficit to facilitate weight loss.
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Adaptive thermogenesis is the primary physiological adaptation that contributes to weight loss plateaus, slowing or halting weight loss as the body's REE decreases to match the lower caloric intake. REE reduction is greater than the extent predicted by the loss of fat-free mass alone. A lower BMR or REE leads to a lower TDEE. The decrease in BMR may reduce mitochondrial uncoupling protein activity, decrease thermogenesis, and reduce cellular heat production. Consequently, the body becomes more efficient at conserving energy, further contributing to the plateau. Calorie restriction and weight loss also disrupt energy homeostasis, increasing hunger and maintaining fat stores.
Hormonal Changes
Several hormones are critical in regulating energy expenditure and hunger during weight loss. Leptin, produced by adipocytes, promotes satiety and increases energy expenditure. It circulates roughly in proportion to fat stores, signaling to the brain about the body's level of adiposity compared to baseline. Leptin levels decrease during weight loss due to reduced fat mass, while pre-existing leptin receptor resistance developed in response to longtime, obesity-associated elevated leptin levels may persist. These promote more food consumption and less energy expenditure. Ghrelin, known as the "hunger hormone," stimulates appetite, triiodothyronine (T3) influences the metabolic rate, and insulin regulates macronutrient metabolism and inhibits muscle protein breakdown.
A reduction in GLP-1 levels can lead to increased appetite. Peptide YY (PYY), released by the ileum and colon in response to food intake, acts on Y2 brain receptors to promote satiety and reduce food intake. However, PYY levels can decrease during weight loss, reducing the feeling of fullness. Neuropeptide Y, a potent appetite-stimulating neurotransmitter, increases during caloric restriction, promoting food intake, decreasing energy expenditure, and counteracting weight loss efforts.
The Set Point Theory
The set point theory proposes that a predetermined or "set" level maintained by physiological mechanisms regulates body weight. An active feedback system in the hypothalamus monitors and adjusts energy intake and expenditure to maintain body weight around a genetically predetermined set point. Evidence supporting this theory includes the body's resistance to weight changes through altered metabolism and appetite regulation mechanisms.
Strategies to Break a Weight Loss Plateau
There are several strategies that can help break through a weight loss plateau. These include dietary adjustments, exercise modifications, stress management techniques, and other lifestyle changes.
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Dietary Adjustments
1. Cut back on carbs:
Whether carb restriction leads to a “metabolic advantage” that causes your body to burn more calories is a question that continues to be debated among nutrition and obesity experts. That said, there is some evidence that eating a low carb diet may help reduce hunger. This may lead you to subconsciously eat less, making it easier to begin losing weight again without hunger or discomfort. Know your carb tolerance and evaluate your total carb intake to know if you might be going even a bit over that number. Test and monitor your glucose to identify your carb tolerance so that you can be sure to stay below that threshold. Track your portions to identify total carbohydrates. A serving of nuts (1 ounce) with 5 grams of carbs quickly adds up to 10 grams if you consume a second serving.
- Look for Hidden Carbs: If you find that you aren’t losing weight on the keto diet, it’s important to evaluate your carb intake carefully. Even eating just a few extra grams of carbs here and there adds up quickly and may prevent you from entering ketosis. Be sure to account for hidden carbs found in foods like processed meats, condiments, seasonings, and starchy vegetables. Read food labels and look at the ingredients list to make an informed decision. If you’re at a restaurant, ask about the hidden sugars and carbs in sauces and condiments.
2. Don’t skimp on protein:
If your weight loss has stalled, increasing your protein intake may help. Protein boosts metabolic rate more than fat or carbs, due to the thermic effect of food (TEF). Protein digestion boosts calorie burning by 20-30%, which is more than twice as much as fat or carbs. Protein also stimulates the production of hormones that help reduce appetite and make you feel full and satisfied. Patients who experience fatigue and have lost a lot of lean mass may need a "recovery phase" to regain lost muscle and positively impact their metabolism. Helpful dietary changes include a protein intake of 1.2 to 1.5 g/kg/day to preserve lean mass and promote satiety. Eating more fiber-rich foods will lessen hunger by delivering fewer calories per volume of food and slowing gastric emptying time.
3. Adjust Fat Intake
Consuming too much fat can also hinder weight loss. The goal is to add enough fat (butter, oil, cream, etc) to your protein and vegetable sources at meals to ensure you’re not hungry between meals. However, fat is not a ‘free’ food, and calories still matter.
- Beware of MCT Oil: In addition to potentially contributing too many calories, sources of fat like coconut oil (including concentrated supplements) contain medium chain triglycerides (MCT). These cannot be stored in body fat, meaning that whatever is consumed has to be promptly burned for energy. Assess how much fat you’re adding to your meals and beverages. Consider reducing the volume of added fat to test the effect on your weight. Just be sure to notice any changes in hunger as you experiment. If you find yourself hungry, you’ve reduced your fat intake a bit too much.
4. Eat more fiber:
Including more fiber in your diet may help you break through a weight loss plateau. This is especially true for soluble fiber, the type that dissolves in water or liquid. Soluble fiber slows the movement of food through your digestive tract, which can help you feel full and satisfied. Fiber may also aid weight loss by decreasing the number of calories you absorb from other foods.
5. Eat vegetables at every meal:
Vegetables are the ideal food for weight loss, as most are low in calories and carbs, high in fiber, and loaded with beneficial nutrients. Research has found that diets that include lots of vegetables tend to produce the greatest weight loss.
Lifestyle Adjustments
1. Increase exercise frequency or intensity:
Your metabolic rate slows as you lose weight. As weight declines, the progressive reduction in metabolic rate can make continued weight loss difficult. However, exercise has been shown to help counteract this effect. If you’re already exercising, working out an extra 1-2 days per week or increasing the intensity of your workouts may help boost your metabolic rate. In addition, your metabolic rate increases in response to fidgeting, changing posture, and similar types of physical activity. These types of activity are known as non-exercise activity thermogenesis, or NEAT. An easy way to increase your NEAT is by standing up more often, including using a standing desk.
- Switch up your workout routine: Physical activity is an important aspect of any weight loss program. Exercise helps you burn calories to create a calorie deficit, which may increase weight loss. You should aim to get at least 150 minutes of moderate to vigorous exercise per week. You may also want to consider experimenting with new activities to switch up your routine, such as running, cycling, swimming, or strength training.
2. Manage stress:
Stress can often put the brakes on weight loss. In addition to promoting comfort eating and triggering food cravings, it also increases your body’s production of cortisol. Cortisol is known as the “stress hormone.” While it helps your body respond to stress, it can also increase belly fat storage. Producing too much cortisol can make weight loss difficult, but research has shown that learning to manage stress can help promote weight loss. Taking regular breaks, setting a self-care routine, improving your sleep schedule, and incorporating practices like yoga or meditation may decrease your stress levels and help promote weight loss.
3. Get plenty of sleep:
Sleep is extremely important for good mental, emotional, and physical health. Not getting enough sleep can lead to weight gain by lowering your metabolic rate and altering hormone levels to drive appetite and fat storage. To support weight loss and overall health, aim for 7-8 hours of sleep per night.
4. Track everything you eat:
Research suggests people have a tendency to underestimate the amount of food they eat. That’s why tracking your calories and macronutrients - protein, fat, and carbs - can provide concrete information about how much you’re taking in. The AHA and the ACC recommend monitoring dietary intake, physical activity, and weight with food diaries, phys. Ongoing weight loss stimulates appetite by activating the feedback control circuit, and consuming fewer calories requires more effort. Even intermittent lack of adherence to dietary prescriptions can cause weight fluctuations and a plateau. Patients might not be aware that they have gradually begun eating more than they did previously.
Other Strategies
1. Try intermittent fasting:
Intermittent fasting involves going for long periods of time without eating, typically between 16-48 hours. The practice has been credited with promoting the loss of body fat and weight, though additional research may be needed to verify this. When paired with the keto diet, it may speed up your transition into ketosis by switching your body’s primary energy source from sugar to fat. Intermittent fasting may also help boost fat burning by increasing your metabolism. Plus, studies show that it may decrease hunger and calorie intake, both of which may aid weight loss. Although several methods of intermittent fasting exist, 16/8 fasting is one of the easiest and most popular ways to get started. It involves limiting your food intake to an 8-hour window each day.
2. Avoid alcohol:
Although one alcoholic drink contains only around 100 calories, it provides no nutritional value. In addition, you may have more than one drink at a sitting. Another problem is that alcohol loosens inhibitions, which may lead you to overeat or make poor food choices. One study of 283 adults who completed a behavioral weight loss program found that reducing alcohol intake led to a reduction in overeating and greater weight loss among those with high levels of impulsivity. What’s more, research has shown that alcohol can suppress fat burning and may lead to belly fat accumulation. If your weight loss has stalled, it may be best to avoid alcohol or only consume it occasionally in small amounts.
3. Drink water, coffee, or tea:
While sugary beverages lead to weight gain, some beverages may help reverse a weight loss stall. Research has found that plain water can boost metabolism, which may translate into weight loss over time, especially in those who consume water before meals, which may help reduce food intake. Coffee and tea may also help your weight loss efforts. Green tea, in particular, contains an antioxidant known as EGCG (epigallocatechin gallate) that may promote weight loss. Moreover, research suggests that consuming caffeinated beverages can significantly enhance the metabolism-boosting and fat-burning effects of exercise.
4. Reduce your stress levels:
You may want to consider whether other aspects of your lifestyle may be contributing to your weight loss plateau. In particular, some studies link chronic stress to increased weight gain over time .In certain people, maintaining high levels of the stress hormone cortisol may also lead to increased food intake and decreased energy expenditure, which may contribute to weight gain.
5. Consider "Diet Breaks"
Sometimes maintaining a constant calorie deficit is not enough to consistently lose weight. If this sounds like you, then you may benefit from taking a diet break. In one study, the researchers randomized 51 men with obesity into two groups. Each subject was prescribed a 33% calorie deficit, which is pretty severe, but manageable for obese individuals. Both groups lost weight, as expected, but the intermittent energy restriction group lost significantly more weight. The researchers suspect that the substantially better weight loss results experienced by the intermittent energy restriction group were caused by a reduction in compensatory metabolic responses.
According to this study, it may be best to stick with the two weeks on, 2 weeks off energy restriction protocol. Weigh yourself and recalculate your macros for around a 25% calorie deficit. After the first two weeks, weigh yourself and recalculate your macros to figure out what you need to eat to MAINTAIN your NEW weight.
Other Considerations
Non-Scale Victories
Even if the number on the scale isn’t moving, you might still be losing weight or body fat. That’s because many factors cause minor fluctuations in body weight, including what you eat or drink during the day, what you’re wearing, and whether your body is retaining extra water. For this reason, it’s important to look at overall trends in your weight rather than focusing on a single number each day.
There are also plenty of other ways to monitor your progress aside from weighing yourself. These include non-scale victories (NSVs), which are signs that you may be improving your health and achieving weight loss even when the scale doesn’t budge. For example, the fit of your clothes becoming a bit looser is a common NSV.
Potential Underlying Medical Conditions
Endocrine-related conditions like diabetes (or prediabetes), hypertension (or elevated blood pressure), PCOS, and even hypothyroidism can make it difficult to lose weight. They can be at the root of your difficulty with weight loss. In these conditions, your body is predisposed to gain weight. So if you haven’t addressed your underlying medical condition, then you may find weight loss to be a struggle. In these conditions, your body is predisposed to gain weight. So if you haven’t addressed your underlying medical condition, then you may find weight loss to be a struggle. Get an accurate diagnosis (if you haven’t got one already). Discuss your symptoms with your nutritionist and doctor, as they’ll be able to tweak your plan to help manage or reverse the condition.
When to Consult a Healthcare Professional
Keep in mind that although plateaus are common on the keto diet, you may want to consult your healthcare provider if a plateau is accompanied by other persistent adverse symptoms, such as headaches, fatigue, constipation, or nausea. While these symptoms - often called the keto flu - are common when first transitioning to this diet, they should typically resolve within a few days or weeks . If you find that you are struggling to break through a plateau and lose weight despite increased exercise and healthier eating, then you may want to speak to your doctor about alternative solutions. For those who have obesity or are overweight with at least one weight-related medical condition, certain prescription weight loss medications can be effective in combating emotional eating.