Weight Loss Plateau and Set Point- why losing weight can be so tough
Imagine that you have been dealing obesity your whole life. You decide to take better care of yourself and become healthy. After joining a gym and meeting with a dietician, you have an excellent weight loss plan. You are consistent, go to the gym, eat the recommended foods and you start seeing meaningful weight loss. It seems like all the planning and hard work are beginning to payoff. You suddenly reach a plateau and all previous activities resulting in weight loss don’t work anymore. You begin to exercise longer and eat smaller portions but the weight loss becomes unattainable. What’s going on and what can be done about it.
First, let’s see what is happening in the body, brain and intestines that contributes to the plateau. As you lose weight, hormones communicate in the brain causing the metabolic rate to slow down, appetite to increase and you feel hungrier soon after eating a meal. Scientists use the term “Set Point”, your body’s desired weight for ideal function, making it difficult to get significantly below this weight. Your weight is programmed to stay within a range and anything the changes this leads to a strong response from the brain and intestines, potentially causing a plateau. While this may seem unfair, this is the body’s natural way to protect itself from imminent death. For thousands of years, people faced food insecurity. The only way to survive was to store energy effectively in the form of fat. This helped assure that a prolonged period of starvation would not lead to imminent death. Those who didn’t have the ability to store adequate fat, usually died at a young age, stopping transmission of inefficient fat storage capability. Modern science has demonstrated that when a person begins to reduce caloric intake, the body activates a feedback mechanism that increases appetite. Compared to caloric restriction, weight loss medication and surgery provide for greater weight loss due to diminished signals to increase the appetite and slow down metabolism (1). Being aware that any attempts at weight loss will eventually lead to a plateau can decrease the frustration and feelings of failure.
So what can be done about this? Eating smaller portions is not a good option since this will lead to a further decrease in metabolic rate. Instead, pay attention to your portion size and the quality of food. Calorie dense ultra-processed food are the enemy of weight loss maintenance. Many people slip back into previous eating habits, leading to poor food choices and increased caloric intake. Increasing your exercise routine can be beneficial but remember that gaining muscle is crucial, so doing resistance training is very beneficial.
If behavior modification is not enough to get past the plateau, then weight loss medicine can play a crucial role. Medications such Wegovy and Zepbound can improve the signaling between the brain and intestines, contributing to further weight loss. These medications help decrease appetite and desire for calorie dense foods. Food noise, that accompanies weight loss, diminishes and people don’t ruminate about food all day. These findings support the theory that hormones and neurotransmitters play a crucial role in weight loss and maintenance and will power plays a smaller role then is attributed by people.
The next time you experience a weight loss plateau, understand that this is not your fault. Reassess your behaviors including eating habits such as bigger portions and poor food choices. You need to continue your exercise routine, especially resistance exercise so that you minimize muscle loss. If you still need to lose further weight, consider meeting with a weight loss physician. A comprehensive plan that includes a knowledgeable physician, dietician and psychologist can help you get past your set point and overcome the plateau.
Stay Healthy, Stay Strong!
Dr. Leon Katz
This article is strictly for educational purposes. Please talk to a healthcare professional prior to embarking on a weight loss journey.
Sources:
Physiology of the weight-loss plateau in response to diet restriction, GLP-1 receptor agonism, and bariatric surgery. Kevin Hall, PhD. Obesity (Silver Spring). 2024;32:1163–1168. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.24027
Obesity-induced and weight-lossinduced physiological factors
affecting weight regain. Marleen A. van Baak. Nature Reviews Endocrinology | Volume 19 | November 2023 | 655–670.
https://leefstijlinterventies.nl/wp-content/uploads/2024/11/Mariman-van-Baak-2023.pdf
New insights in the mechanisms of weight-loss maintenance:
Summary from a Pennington symposium. Emily W. Flanagan. Obesity (Silver Spring) . 2023 December ; 31(12): 2895–2908.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10915908/pdf/nihms-1968692.pdf
