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Whether you're shedding pounds after weight loss surgery with the help of effective new medications or cutting calories and increasing exercise, the day will come when the numbers on the scale will stop going down and you'll hit the dreaded weight loss plateau. .
In a recent study, National Institutes of Health researcher Kevin Hall, who specializes in measuring metabolism and weight change, found that weight loss stalled depending on the method people used. Drop the pounds. He breaks down the weight loss plateau into mathematical models using high-quality clinical trials to understand why people stop losing when they do. The study was published on Monday in the journal Obesity.
What he found is that one of the reasons gastric bypass surgery and new weight loss drugs like Wegovy and Zepbound are so effective is that they double the time it takes to hit one spot. People can lose weight longer than cutting calories.
Our bodies control weight by trying to maintain a balance between the calories we eat and the calories we burn. When we cut or cut calories and begin to burn our stored energy, appetite kicks in, telling us to eat more. Hall's research shows that the more weight a person loses, the more intense their appetite becomes, and sometimes even completely reversed, to lose all the hard work they did in the first place.
This feedback mechanism was useful to our hunter-gatherer ancestors, but it doesn't work so well for modern humans, who have easy access to energy-dense, highly processed foods.
To study the trajectory of weight loss using only calorie restriction, Hall modeled weight loss in the CALERIE study, which randomly assigned 238 adults to follow a 25% calorie restriction diet or eat as usual for two years. The study was conducted from 2007 to 2010 and was sponsored by the NIH. Adults in the group who reduced calories lost an average of 16 pounds. The group that followed their normal diet gained about 2 kg.
Although the people who participated in the CALERIE study continued their efforts for two years, the weight loss stopped somewhere in the 12 months, because their appetite increased to cope with it.
Hall explained that their study looked at averages. Weight loss plateau times may vary for individuals.
Hall's model to achieve the weight loss reported in the study; People whose diets started at 2,500 calories a day had to cut just over 800 calories a day. They responded by asking them to add an estimated 83 calories to their daily caloric intake for every kilogram of weight they gained.
One kilogram is about 2.2 pounds. For every 2.2 pounds of weight gain, participants responded by requiring 83 more calories per day. The average weight loss reported in the study was 7.5 kg, or 16 kg, which means they were feeling the need to eat 622 more calories a day before they started losing weight.
But they weren't actually eating the 622 extra calories a day—instead, it was the extra appetite they felt, even though they were making the same effort as they did to cut 800 calories a day in the beginning.
At the end of the study, participants were working just as hard as they did when they started, but were only able to cut 200 calories a day instead of the 800 they were shooting for. That made their weight stand off.
Dr. Christopher Gardner, director of nutrition research at Stanford's Center for Defense Research, previously told that this feedback loop gets stronger the longer the weight loss is lost.
Because people's bodies respond to that and they become more metabolically efficient. And so the same calorie deficit won't do for you. That's why people's weight loss starts to plateau,” Gardner told Chief Medical Correspondent Dr. Sanjay Gupta in “Chasing Life” Podcast.
In Hall's model, as people in the CALERIE study gained weight, their appetites regressed, and they stopped losing weight around the 12-month mark.
The drugs semaglutide and tirzepatide mimic gut hormones and induce greater caloric restriction to help people lose weight. For semaglutide, the active ingredient in Wegovy, Hall's model In the study, people went from eating 600 fewer calories per day to 1,300 fewer calories per day as they gradually increased their intake. For tirzepatide, the active ingredient in Zepbond, the number of calories people cut from their meals each day increased from 830 at the lowest dose to 1,560 in the study.
But crucially, the drugs didn't just affect the number of calories people cut from their diets. They also reduce the number of calories their body forces them to eat when they lose weight – which suppresses their appetite. For Wegovy people only need to eat 49 calories per day for every kilogram of body weight. For Zepbound, it was number 48. By cutting their appetite in half, they were able to lose an average of one more year of weight compared to calorie restriction. People who take weight loss drugs generally stop losing weight around the two-year mark.
Weight loss surgery had the strongest effect of all, causing people to cut down to 3,600 calories Eat only 58 calories from your daily diet and for every pound you lose each day. People who had weight loss surgery had another year before their plateaus reached, suggesting that the surgery significantly reduced their appetite.
Hall says there are several important insights from this study. The first is that drugs like Wegovy and Zepbound and interventions like weight loss surgery will prolong the time it takes to hit a plateau, but they won't stop it from happening completely.
“What's happening is they're still gaining weight because their appetite is increasing,” Hall said.
“If they didn't have an appetite cycle, in other words, the drug would just kick in and their intake would stay at this very low level. It took them many, many years to plateau and you know, they lose an inordinate amount of weight,” Hall said.
Dietitians may be stymie, but appetite feedback is really a good thing, he said. A drug or treatment is dangerous if it completely eliminates the appetite. If that happens, a person may stop eating completely until they die.
Hall said the study helps clarify some ideas about why people stop losing weight.
For example, one theory suggests that weight loss impairs metabolism, so people burn fewer calories than when they started off and gain weight more easily.
Hall says metabolism slows after weight loss, “but nowhere near the amount needed to explain the timing or extent of weight loss.”
Hall said the study appears to disprove the notion that the drugs eventually stop working. “I don't think that's right either,” Hall said.
“Our modeling suggests that the cause of the plateau is the point at which the drug's effect is balanced by increased appetite,” he said.
Sometimes people hit their goals well before they reach their weight, which is very frustrating.
In such cases, Hall said, people may need to add interventions to increase their results.
“Another very common thing is that people who haven't lost as much weight from bariatric surgery as you might think are going on one of the GLP-1 receptor agonists, so they're adding to each other,” he said. .
Regardless of the route you choose, “maintaining weight loss requires consistent results,” says Hall. Therefore, it is good to consider whether you can continue what you are doing for a long time.
People who reach a plateau after cutting calories can fall back by restricting calories even more or adding exercise to their daily routine.
“The whole point here is that whatever you do, you have to do it. And so you have to be happy with that lifestyle intervention for the rest of your life. Otherwise, it's not going to add value,” Hall said.