196. Weight Loss Plateau? What to Check Before You Blame Yourself

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You’re watching what you eat, staying consistent, doing all the things… so why isn’t the scale budging?

If you're putting in the effort and not seeing results, trying harder might not be the answer.

Here, I’m breaking down 3 possible reasons your weight loss has stalled, what might actually be going on behind the scenes, and how to figure out your next step without blaming yourself or jumping into another restrictive diet.

1. An Underlying Medical Issue Could Be Getting in the Way

If you're consistently putting in the effort and your weight isn't changing, one of the first things I'd want to look at is whether there's something medical going on behind the scenes.

Conditions like hypothyroidism (an underactive thyroid) or sleep apnea can affect your energy, metabolism, and ability to manage your weight.

And often, there are other clues that something isn't quite right.

With hypothyroidism, for example, you might notice symptoms like:

• Feeling unusually tired or fatigued
• Hair thinning or hair loss
• Dry skin or brittle nails
• Changes in your menstrual cycle
• Thinning of the outer edges of your eyebrows

Of course, not everyone experiences the same symptoms, and these signs can have several possible causes.

If you've been consistent with your nutrition and activity for months and things still aren't adding up, it's worth having a conversation with your physician.

Ask whether bloodwork or further testing makes sense for your situation. Sometimes there's an underlying issue that needs attention before you can make meaningful progress.

2. Your Muscle Mass Might Be Lower Than You Think

One thing that's easy to overlook when you're trying to lose weight is how much muscle you have, and how that affects your metabolism.

Two people can weigh exactly the same amount and have very different calorie needs depending on how much muscle they carry.

Muscle is metabolically active tissue, meaning your body uses energy to maintain it, even when you're resting. Having less muscle can contribute to a lower basal metabolic rate (BMR), which is the amount of energy your body needs to keep everything running at rest.

And if your muscle mass is particularly low, your daily calorie needs may be lower than you'd expect.

This is one reason I always look beyond the number on the scale.

Body composition measurements can give us more information about what's happening with muscle and fat over time, although these measurements aren't perfect.

It's also why strength training and getting enough protein are such valuable parts of a long-term health strategy.

And don’t forget: if you're gaining muscle while losing fat, the number on the scale might barely change.

You could actually be making fantastic progress without seeing the weight loss you expected.

Often, my patients tell me they've had a terrible month because they didn't lose the pound a week they'd hoped for. Then we look at their numbers and discover their muscle mass has increased and their body composition is improving.

That's still progress worth celebrating!

3. Years of Yo-Yo Dieting May Have Changed Your Metabolism

If you've spent years jumping from one diet to another, eating very little, losing weight, gaining it back, and starting all over again, your body may have adapted along the way.

When you restrict calories for an extended period, your body can respond by reducing how much energy it burns. This is called metabolic adaptation.

It's a normal biological response to changes in energy intake and body weight, but it can make ongoing weight management more challenging.

And let's be honest, diet culture hasn't exactly made things easier.

Think about all the diet trends we've lived through. Atkins, the Zone Diet, low-fat everything, and those supposedly healthy snack bars that were basically candy bars in clever packaging.

I remember eating those bars and thinking I had discovered some magical nutrition cheat code.

We've been sold so many different rules about food over the years that it's hardly surprising when our relationship with eating becomes complicated.

For people with a long history of restrictive dieting, improving metabolic health may involve gradually increasing food intake, rebuilding muscle, and addressing the habits and beliefs they've developed around food.

One approach you may have heard of is reverse dieting, which involves gradually adding calories back into your diet after a period of restriction. For some people, this can help them ease into eating more while monitoring how their body responds.

And this is something I'd strongly recommend working through with a qualified healthcare professional, particularly if you have a history of chronic dieting or other metabolic concerns.

Because there may also be a psychological side to address.

If food has become something you're constantly afraid of, or you feel anxious every time you eat more than a certain amount, that deserves attention too. Working with a registered dietitian or another qualified professional can help you build a healthier relationship with food while supporting your physical health.

Before You Assume Your Metabolism Is the Problem...

Before assuming something else is going on, it’s worth taking a closer look at how consistent you’ve actually been with your habits.

I recently had a conversation with my 19-year-old stepson, who's been learning more about nutrition since starting college.

He was confused about why his weight wasn't changing when he thought he was eating a certain number of calories.

But he was guessing how many calories he was actually eating. And as we talked through what he was actually eating, it became clear that his estimates weren't particularly accurate.

This is incredibly common. Most of us aren't great at estimating portions or calories, especially when we're busy and eating on the go.

That doesn't mean everyone needs to start meticulously tracking every bite. It just means that if you're trying to understand why something isn't working, having accurate information can be helpful.

The same goes for consistency.

If you're following your plan for a few days and then your routine changes dramatically over the weekend, it's possible your overall intake looks different from what you imagine.

Nobody needs to be perfect seven days a week. But it helps to look honestly at your habits over time before concluding that something is medically wrong.

What to Do When Your Weight Loss Has Stalled

If you've been consistently working on your nutrition, movement, sleep, and other health habits for several months and you're still struggling to make progress, I encourage you to get some support.

Start by making an appointment with your physician and explaining what's happening.

You might say something like:

"I've been working consistently on my health for several months, but I'm not seeing the changes I'd expect. Could there be something medical contributing to this? Are there any tests or other things we should look into?"

Depending on your symptoms, medical history, and current health, your physician can help decide whether bloodwork or other investigations are appropriate.

It's also worth looking at your body composition, nutritional intake, strength training, sleep, and dieting history.

Sometimes several smaller factors are working together, which is why having a good clinical team around you can make such a difference.

And remember that weight loss isn't the only measure of success.

Improving your strength, maintaining muscle, sleeping better, feeling more energetic, and developing a healthier relationship with food are all meaningful improvements.

If you've decided that losing exactly one pound every week is your definition of success, you might be overlooking some really positive changes.

You Don't Have to Figure It All Out Alone

I want you to remember this: if weight loss feels harder than it should, there may be a reason worth exploring.

There are so many factors that influence our weight, from hormones and muscle mass to our medical history, lifestyle, and relationship with food.

And sometimes it takes a little detective work to understand what's happening.

You don't need a perfect routine, and you certainly don't need to spend the rest of your life bouncing between restrictive diets.

Start with where you are, get the right support, and take things one step at a time.

Listen to the full podcast episode for more insights into weight loss plateaus and how to figure out what's really going on.

And if you're ready for extra support, my January The Next Chapter program is designed to help you move beyond restrictive dieting and build a healthier, more sustainable approach to weight management with expert guidance. Enrollment closes October 30.

Learn more and join The Next Chapter here.

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.   

 Welcome back to another episode of the podcast. How are you all doing today? I have such a fun story to share with you, and he consented for me to be able to share this story. So my stepson, who has no weight challenge or anything in the world, has started college here recently and, you know, sometimes you're a little bit more sedentary, and so he was just asking about some nutrition and different things with the scale, like body composition. It's actually been such a nice, amazing conversation, and it really makes me realize, he's 19 now, but it really makes me realize how nice it is when people from an early age can just develop a really healthy relationship with food and stuff. But what he tries to tell me is that he had been eating A little bit fewer on the calories. I mean, he said six to eight hundred, but it was 100% not that. It was way higher than that. But he had been guesstimating what he was eating, and I think there was like a pound or two that he wanted to go down, and it wasn't changing, and he was befuddled by this. And I said to him, I was like, "You know, most of the time, guys, you know that I believe you when you say you're eating a certain calorie amount." But with him, I could see what he was taking, and I knew that the numbers were wrong, so he'd been trying to kinda guesstimate things, and I was like, "Mm, we're gonna have to actually measure and weigh if you wanna say numbers like that." But anyway, the bottom line is this doctor side of me kicked in, okay? This is why I'm telling the story. And I said, "Look, if this were really true, it would be one of three things that's going on right now." And this is how I can tell I'm a doctor. I said, "Either, y- number one, you'd have a massive lab problem." So you'd have something like hypothyroid, your thyroid function's low, or you have something else medically going on, like there's sleep apnea. There's something going unchecked 'cause you're doing all this work and you're not seeing results. And I said, "But if that were the case, there'd be other things going on." If you have low thyroid function, people feel really tired and fatigued. They're losing hair. They're getting dry patches on their skin. You can have different arrhythmia, changes. Women, their periods can change. Brittle nails. I could go on and on. Oh, the outside of the eyebrows, that's always an interesting one, that lateral outside gets really thin and gone. So anyway, there's a lot of things that we can notice. "Hey, if you're not feeling different in absolutely any way, likely that type of stuff isn't going on. But that's like number one. If this continues with you, you really feeling like these things don't add up, I would totally get you back to the doctor sooner." Okay, or he would 'cause now he's an adult on his own. Okay, but number two is that, or you've got no muscle mass. You know, who knows? You, you don't know nowadays. Some people have a bunch and some don't. And we have an InBody scale at home, so he pops on it. He's good. He's golden. He's got a bunch of muscle, so that's not it because if your muscle mass is really low, your basal metabolic rate's gonna be in the toilet, and you hardly can eat anything without either gaining or to have to maintain your weight, you're eating a very low calorie number. And that's the body composition that helps you there. Or the third thing is if you've been chronically dieting for super long, and again, this person has no history of any of that. But if you have been dieting for a really long time, you likely have kinda tanked the metabolism a little bit. And I don't mean that you have done it as in it's a bad thing. What I mean is, because of our culture and because of how these things have been run, we've come to learn over time how detrimental it is to metabolism. And so if that's going on, then it makes sense that there would be a lower number that's needed, again, to maintain or not gain. And that with time, what we can do if we suspect that that's the case, is we can slowly do a reverse diet where we slowly add back in calories and nutrition. I highly recommend that all of this, be under the guidance of a physician because 99% of the time when you are dealing with long-term yo-yo dieting, you have other metabolic problems going on that have not been treated. But the larger issue here is you do not have a healthy relationship with food. We're likely gonna have to get some type of nutritionist involved. We're gonna have to think critically about how we go about this with you. You might have some fear of food, maybe not all the way to where you got diagnosed with anorexia, but there is much more going on there than it might seem. I was talking to a friend the other day about, this is unrelated, but you'll get the point. She was having a lot of angst about getting on social media, and in my mind, I know this person, I know how absolutely incredible they are, and I'm thinking, "Well, listen, like XYZ, this is what you gotta do. You just gotta go do it." And basically all this other stuff is kicked up that's coming from other places in their life, and it's has nothing to do with the posting, but it's bringing up all this other stuff, and that's actually what had to get dealt with before they could deal with social media. All right, so when I come to this, that if you've been yo-yo dieting for a long time, yeah, reverse dieting very slowly over time, you potentially can be eating more and more calories and not gaining weight or maintaining the same weight at that point, or maybe even gaining some muscle, things like that. But the point is that there are answers to these things. And so I think that we always think, "Well, I'm uniquely broken and damaged, and I'm the one that all these things are wrong." No, it's just a puzzle that we have to figure out. What for you needs to be true and necessary, and does something need to change, or do we need to unlearn some things? I can't tell you how many of my people, depending on what age my patient is, I can almost predict what propaganda nonsense got into their head about different diets at different times in their life. There were eras to this, right? Like if you mapped diet culture, it was like, all right, there was Atkins, I remember back in the day, I don't remember if it was the Zone Diet or what it was. I just can't remember all these diets at this point. But I remember I was eating... Guys, they were just candy bars, okay? But they were like, "But this is a Zone bar." I don't remember what it was called, and I was like, "Oh, this is good for me." And if I'm really thinking back, it was just a chocolate bar. I mean, it was like, had like Rice Krispie treats in it, right? But the packaging made me think, "Wow, am I doing something great." And of course, because it was a super unsatisfying processed food, I was still eating a bunch of other things. And so it's just kind of funny when we think back to like, wow, like, how did I think at the time that was something that would help me, right? Like, I thought, like, that's the cheat code, that I'm just gonna eat this thing. But anyway, back to the plot. So I was thinking it's just usually one of these things. Now can there be other things? Of course. Of course, there's tons of nuance. I made an electrolyte video the other day, and everyone was like, "Well, it helps me with migraines," and this and that. And I'm like, "Yeah, but that wasn't the point of the video that I was making." It's majority of people don't need random electrolytes all the time. So in this scenario, here's what I wanna come back to. If you are working really hard and you're never making progress, you need to get help because there likely is something else going on there. Now, let's be honest too, if you're like, well, you try for a few days, and then Friday, Saturday, Sunday, Monday is kinda off the rails, and then kinda you get back to things. We don't need perfect, but we do need consistency roughly within the orbit of health for you to get there, but if you're doing that and you're consistently noticing that this is way harder than it should be. That's what I noticed here a while ago. I was like, "Wait a minute. I have cranked this up a lot and things aren't moving." So I went back to my physician. I said, "Can we do XYZ?" We continued the workup. So the point is that you have to sometimes just get away from the being all judgmental to yourself and that it's a me problem and I need to work harder and just turn on the is there anything else medically going on here. Oftentimes there's more at play than we realize, and we got to address that. So I just wanted to bring this case up because I think it's a really nice window into how my brain thinks and... You know, it's interesting, when people present stuff to me, they'll say, "Well, this path- past month went really bad." And I'll say, "You know, let's just like, just tell me the data," and they'll have lost weight, and their muscle will be up, and all these incredible things are happening. But they thought it was a bad month because they'd set their viewing window, their lens of success at, "I'm gonna lose a pound a week." So because that didn't happen, the month was not a success. But friends, that can't be the bar. That can't be the bar that everything's always perfect, that everything's always at this arbitrary number that you set. You just, in your mind, made up a random number, but it might not at all be rooted in reality or what is actually appropriate in that moment. Let's all get the workup that you need to make sure that there's nothing holding you back where it's not your fault. Let's make sure that you not only get lab work done, but the appropriate lab work. You need to have a critical moment of reasoning with the physician or whoever you're working with, and it looks a little something like this: "I've been trying really hard for a bunch of months. It feels like there should be more change. I'm wondering if there's anything happening from a lab standpoint. I pretty much haven't had anything done in the past year. What are all the things that you think we could do, every rock we could turn over to make sure that there's not anything that lab work could reveal? Is there anything else, any other testing?" Things change over time. I bring this up because you are not inherently flawed or there's nothing broken with you. You don't need more motivation. You need a good clinical team around you that's gonna make sure that nothing medically is happening, and you can always get to a better spot with health. It is not gonna require this perfect regimen. It just requires one step at a time, you moving in the direction that you think is right. Okay, friendly reminder, if you are wanting to work with me in 2027, likely one of maybe the only ways that you can do it is in the January, The Next Chapter program, and that is starting in January. But October 30th, enrollment ends. Here's your reminder if you were wanting to do that, to look at the link in either the show notes down below, or you can go to renteaclinic.com/thenextchapter, all one word, and you can get the information. All right, have an amazing rest of the week, and we'll talk soon.