Science-backed weight-loss tips to conquer 'the plateau'

By Naveed Saleh, MD, MS
Published August 13, 2020

Key Takeaways

Losing weight is hard, but keeping the weight off is even harder. Long-term maintenance of weight loss is the primary challenge in obesity treatment, according to the authors of a review published in Medical Clinics of North America. 

“Obesity interventions typically result in early rapid weight loss followed by a weight plateau and progressive regain,” they wrote. “Biological, behavioral, and environmental factors conspire to resist weight loss and promote regain,” they added.

Fortunately, there are research-backed, interventional strategies that are designed to combat the plateau—to help lose the weight and keep it off.

More protein and fiber

One possible approach to reducing the incidence of obesity at a young age is to change energy intake patterns to boost feelings of fullness, per the authors of a study published in the Journal of Nutrition.

The team examined whether a high-protein breakfast, a high-fiber breakfast, or a combination of both boosted feelings of fullness in preschoolers before and after breakfast and before lunch. They also assessed diet quality.

They found that although feelings of fullness did not differ between experimental and control groups, children in the experimental groups ate an average of 65 calories less when compared with the caloric intake in children in the control group. Furthermore, high-protein and high-fiber breakfasts led to improved diet quality. Of note, the combined high-protein/high-fiber breakfast failed to affect diet quality. 

“Serving [high-protein] or [high-fiber] breakfasts may be valuable in improving diet quality without lowering feelings of satiation or satiety,” the authors concluded.

Less television

Physicians spend a lot of time in the hospital and clinic, so it may be hard to fathom that the average adult watches nearly 5 hours of television a day. Although various efforts in obesity prevention have looked at diet and physical activity, simply decreasing sedentary behaviors—such as time in front of the boob tube—may do the trick.  In addition to boosting active behaviors, less television time may mitigate sleep deprivation, which is also linked to obesity.

In a small randomized-controlled study published in the Archives of Internal Medicine, researchers enrolled adults with BMIs ranging from 25-50 who watched at least 3 hours of television per day. The participants were equipped with a device that automatically shut off their televisions when they reached at most 50% of their routine view times. They found that these adults burned 119 more calories per day during a 3-week period compared with members of a control group who consumed 95 more calories. These differences led to a net-negative energy balance in the experimental group compared with a net-positive energy balance in the control group.

Walking speed

Unless they’re on a treadmill, most people don’t walk at a constant rate of speed. While walking, the average person typically starts, stops, and adjusts speeds, thus burning up to 20% more calories vs walking at a constant pace. Moreover, up to 8% of energy expended could be due to the mechanics of stopping and starting walking.

“Most of the existing literature has been on constant-speed walking. This study is a big missing piece,” said author Manoj Srinivasan, PhD, in an interview. “Measuring the metabolic cost of changing speeds is very important because people don't live their lives on treadmills and do not walk at constant speeds. We found that changing speeds can increase the cost of walking substantially.”

Daily weigh-ins

Even losing as little as 5% of body mass may enhance health. In a randomized-controlled trial (n = 162) published in the Journal of Obesity, researchers found that “the use of frequent weighing accompanied by visual feedback of weight, without a prescribed diet or exercise plan, was effective in producing a small but sustainable weight loss in overweight males.” 

In an interview, study author David A. Levitsky, PhD, said, “It used to be taught that you shouldn't weigh yourself daily, and this is just the reverse.”  

He added: “You just need a bathroom scale and an Excel spreadsheet or even a piece of graph paper.” This approach appears to be more effective in men.

Dr. Levitsky hypothesized that daily weighing compels an awareness of the relationship between eating and weight.

Slow your roll

To lose weight, it may be a good idea to simply slow the pace of eating—possibly by placing the fork down between bites—according to the results of a small study published in the Journal of the American Dietetic Association.

In a randomized trial, researchers tested the effects of slow vs quick eating rates in healthy women during two visits. Satiation was measured using objective measures of energy intake during ad libitum meals. In addition, participants rated their hunger, desire to eat, satiety, thirst, and meal palatability using visual analog scales.

The researchers found that slow rates of food intake resulted in less energy and more water intake. On the other hand, faster rates of consumption led to higher energy intake and lower satiety. Although not reaching the level of significance, eating more slowly was also linked to a more pleasant experience.

“Although more study is needed, these data suggest that eating slowly may help to maximize satiation and reduce energy intake within meals,” the authors wrote.

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