This is the 2nd question we are answering in our continuing series of posts to common questions we hear often at the Clinic.
Weight Loss Stalls
The first thing to remember is that weight loss, much like weight gain, never happens in a straight line. We try to look to weight loss averages measured over months, or worse case, in weeks. (Don’t be that twice a day weigh-in person – it’ll just drive your Anxiety through the roof!)
But let’s be honest for a second – we’re all human, it’s built into our DNA and we want to see constant progress.
Unfortunately, that is not how it works. We now have many hundreds of active patients, and have seen amazing results from plenty of them, but nobody sees the same amount of weight come off each month/week. Some weeks are more, some are less. So, part of handling a stall in understanding the weight does not come off in a straight line. There may be days, weeks, or as I shared in one of my blog posts on myself – I had an almost 60 days stall at one point and the scale itself did not move.
Most Common Stall Cause
The most common reason we see patients hit a stall, ironically is because they are not eating enough food on a daily basis. For many this may seem unbelievable – but give us a second to explain.
The appetite suppression in Semaglutide and Tirzepatide are amazingly effective. Some patients find themselves skipping, one or two meals each day as they are simply not hungry. Or when they do eat, the other mechanism of the medicine (feeling full faster) – makes them only eat very small portions for a meal.
These two actions (reduced appetite, and reduced portion sizes) are usually a good thing, especially when compared to how patients were eating before they came to our clinic. But when taken to an extreme, some patients end up getting only 600, 800, or barely even 1000 calories each day.
Getting too few calories can put your body into what some call “Starvation Mode”, or “Survival Mode”. I prefer Survival Mode – because effectively you have reduced your daily calorie intake to the point your body thinks it is in a survival situation – and to keep yourself alive it will work very hard to slow down your metabolism, hold on to every Fat cell you have, and work hard to preserve your current weight.
Survival Mode is AMAZING – if you’re stuck in the middle of the jungle with no access to food on a regular basis. It is not so amazing for when you are actively trying to lose weight.
Anytime you are getting 35% less than your ‘Maintenance’ Calories – you are at risk of your body going into Survival Mode.
Maintenance Calories
What are Maintenance Calories? This is the number of calories, on average, you need to maintain your body weight without gaining or losing. We leverage the TDEE (Total Daily Energy Expenditure) formulas to determine this. You can compute yours easily at TDEECalculator.NET
Let’s look at a real-life example for a recent patient “LG”. She’s in a stall, and we ran her numbers using TDEECalculator. For her age, body fat, height, weight, and daily activity level. She should be getting ~2000 calories a day. We had her provide us her food diary for several days, and on average she is eating about 1050 calories per day.
As you can see, she’s getting 48% less calories than needed, well below the 35% threshold of getting into Survival Mode. Her body is fighting everyday to maintain its weight and not shed fat!!!
Maintenance Calories | Daily Average Calories | Percent below Maint |
2000 | 1050 | 48% |
2000 | 1100 | 45% |
2000 | 1200 | 40% |
2000 | 1300 | 35% |
2000 | 1400 | 30% |
2000 | 1500 | 25% |
For this patient, the adjustment we’ve asked her to make it to add 300 to 400 additional calories each day. YES – her Weight Loss Clinic is directing her to consume more!!!
We know this can be hard for some, especially when you are not hungry or can’t eat as much as you previously did. But ½ of a protein bar in the morning, maybe the 2nd half can add 200 calories. A small bag of peanut butter pretzels snacked over the course of an hour or two can adding another 150 calories.
The goal here is to get the body out of Survival Mode so it feels safe and can shed fat pounds again. It may seem counterintuitive – but there are times we need patients to EAT TO LOSE!!!
Real World Patients
We’ve dealt with this Survival Mode issue with many of our patients here at the clinic, and in almost every case, getting them out of the extreme caloric deficit has resulted in their bodies getting back to normal and shedding fat and overall weight.
If you find yourself in a stall – before thinking that upping your dosage will be the solution – give us a call or sit down with us at your next visit and let’s work through the numbers for you. It helps if you have a multi-day food diary we can work from as well.
Next time we will discuss one of the other reasons people hit Stalls – the dreaded “Set Point”.
Thanks,
Daryl and Jen – Clinic Directors at Pacific Northwest Medical Group