"The current epidemic of obesity is the result of a mismatch between our ancient genes and the realities of modern life."

So you're still doing the same things that peeled off the first 5, 10 or 50 pounds. You've kept up the daily walks, and you're a role-model for low fat eating. So why does it seem that your scale weights are stuck is neutral? Well, you're on a plateau. Join the club. It happens to people losing weight all the time. Plateaus can and will happen during weight loss even when you're doing the same thing as you always were. Even when you have eaten exactly the same thing as you always were. Even when you have eaten exactly the same thing and done the same amount of exercise. So what has changed? What's the problem.

What's changed is you. The smaller you are, the fewer calories you require. So the diet and exercise program that helped you get from 190 pounds down to 160 may not be creating enough of a calorie deficit to get you to your goal of 145. Remember, we calculated your diet based on your initial weight. You weigh less than that now. Your initial 2200 calorie diet that created, with exercise, the energy deficit needed to lose a pound per week may not be appropriate for you weight now.

For example. If you were 190 pounds and sedentary when you started, you burned about 2280 calories a day to maintain that weight. If you cut back to 2000 calories of food and walked one hour a day (about 300-350 calories burned), you lost weight. But, now, you have lost 30 pounds and weight 160 pounds. Maintenance of this weight only requires 1920 calories. Also, since you weigh less, your one hour walk only burns up around 290-300 calories. Your nice energy deficit at 190 pounds is now a slight energy excess at 160 pounds. Can you see where your weight-loss express has jumped off the tracks?

This doesn't mean you have to swear off satisfying meals or walk to the other side of the state and back to get rid of more pounds. You just need to reevaluate, adapt. And overcome!

Keep a Positive Attitude

Stop and think about how far you have come. All the positive changes you have made in your life are quite enough to be proud of. If you never lose another pound of weight. I really mean that. You have started down a path toward health that is worthy of your praise and pride. Keeping the right perspective on these things is very important.

Don't get down on yourself. It's the process that's the problem, not your efforts. You have been working hard and you deserve to be rewarded. That's an important distinction for you to make. You are just fine. Remember that a plateau is actually a positive sign. What it means is that your body is accepting the new reduced weight you have achieved by all your hard work. The body is adjusting your metabolism and several hormones, not the least of which is your thyroid, insulin, and leptin hormone levels. When it completes the regulation of your metabolism, it will allow further weight loss. Until that time, you are just witnessing the wonderful machinery of the human body. Remember, it has adjusted to times of feast and famine for hundreds and thousands of years. When famine strikes, your genetics are the protection your body has developed to keep your ancestors from dying. It is very efficient and very protective. Much more protective and adaptive than when things are good and food availability is sufficient - the "feast" times. (1) It will allow additional weight loss but only after it has had time to adjust and accommodate your new, healthier weight. Don't be discouraged; be proud of God's handiwork. (2)

Ask your self this question: is it really a plateau or are you at your ideal weight? If you are still 50 pounds from your target weight, chances are you have hit a plateau. If you are 10 pounds from your target, then perhaps you should just take a break and accept your new weight for a few months and let your body get adjusted - mentally and physically. But let's concentrate on the real plateau case.

Get Your Energy Equation Back Under Control

It doesn't really matter how you got to this plateau. The important question is: how are you going to blast through this temporary - and don't ever forget that is what it is - roadblock and continue down your new path? If I may use a baseball analogy, you've been throwing the batter fastballs all these weeks and months. The answer to breaking through the plateau is to change things up a bit. You need to throw a curveball now and then and even a changeup. You need to kick-start your metabolism again. It's gotten lazy and complacent.

You remember how things went so well when you first started changing your diet and being more active? You changed the "energy in-energy out" equation and began losing weight. Now, your body has readjusted, protecting the organism, and has stopped your weight loss. Just as at the beginning, you need to start burning more calories than you're taking in. And you can make it back to that wonderful "negative energy balance" state again. It's not as hard as it may seem. Here's how to get started:

Energy in (Ei) - Supply Side

• Strictly measure your portions. Arm your kitchen with measuring devices like scales or cups, so you don't have to rely on your eyes (or your stomach). American ideas of portions are extremely skewed and, culturally, we have no idea what a single portion of any given food is. Once you get familiar with what your portion sizes should be, you need only measure from time to time to make sure you're eyes are still on believable. Keep portion sizes reasonable. But here's something you will like: Never put limits on plain vegetables - raw or cooked. And try for three to five servings of fruit a day.

• Shortcut you part of the portion control equation. Stock up on prepackaged low-fat meals. I heartily recommend the "Healthy Choice" forzen entrees. Food labels make it easy to know exactly what you're getting - and you save yourself the job of measuring portions. But always - always - read how many servings are offered in each package. Food companies tend to cheat. I know that is a harsh word, but they do. They have these wonderfully attractive food labeling that prominently displays how few grams of fat their food has. And, then, they package 6 servings in a container. We otherwise intelligent Americans, brainwashed as we are, don't read the FDA label and assume that the enticing ad on the front of the package that says, in large letter "Only 6 grams of fat!" is true. Our eyes have learned to skip over the very small print underneath the banner that states "grams per serving."

• Try a liquid meal substitute. Slim-Fast and other liquid meals can be helpful, especially when you're on the run. I have found them to particularly helpful for the morning meal, which is the most often skipped in a rush. While these liquid substitutes shouldn't become a long-term strategy, but it can help breach a plateau.

• Fill up on whole, uncooked, fresh foods. Apples, bananas, baby carrots, celery and air-popped popcorn pack more fiber and fewer calories than fat-free cakes, muffins or cookies. Result: You feel satisfyingly full on less calories of food.

• Change-up your evening schedule. While scheduled eating can be an allie early in your changed lifestyle, they - like your menus - need to be changed up. Eating half an hour or even an hour later than usual may be just what you need to take the edge off late-night sneak eating. While I would ideally like all eating (at least all calorie intake; free foods like celery and pickles are exceptions) to stop a minimum of 3 hours before you go to sleep, sometimes you have to get creative and break patterns. If you go to sleep at 10:00PM, eating your evening meal at 6:00 leaves you susceptible in the next four hours to spontaneous eating. You can safely have supper at 7:00 and, rarely, 8:00 at least for a few weeks.

• Drink more liquids. Put a quart bottle of water on your desk, and make sure you drink one before lunch and another before you head for home at the end of the day. Filling up on water - or even calorie-free sodas - during the day can help make portion control easier at meals.

• Limit mealtimes. So you stuck to your portion, but then you ate your child's leftovers, and before you knew it, you were eating a 2 hour supper. It's important to do things that signal the end of the meal, like brushing your teeth. Explain to your family that you need a little help getting past your hurdle. They will understand. Then, set a timer when you sit down to dinner, and when it goes off, you're out of the kitchen or dining room. Ask someone else to clean up the dishes after supper.

Energy-out (Eo) - Demand Side

• Add a minute. Gradually lengthen your exercise sessions. On good days, adding 5-10 minutes here and there can go along way toward producing real results.

• Add resistance training to your exercise regimen. This is my personal favorite, one that I practice and have seen work, and - in my opinion - most effective new "pitch" to throw that stubborn batter called "metabolism." As your body loses weight, genetics starts to assert itself more and more. Your metabolism, as we have mentioned goes into "starvation mode." Your metabolism decreases. In order to combat this, you have to change your body composition more dramatically. Specifically, you need to increase your muscle mass. Muscles burn more calories than fat, even when you're sleeping. A pound of muscle burns at least 35 calories every day just staying alive; a pound of fat burns a sluggish 3 calories per day. Aerobic exercise has carried you this far; now you need to start toning up. Now, initially, your actual weight loss will slow as you add muscle. But, as you remain persistent, your metabolism will once again kick into gear. You will find yourself paradoxically losing inches faster than you lose weight. And, since muscle takes up less space, so you will look slimmer. It's a "win-win" situation - you get your exercise plus you improve your metabolism for the rest of your life.

• Be innovative and try something new. You're not the only one who gets bored on the stationary bike - your muscles do too. Your wonderfully adaptive human machinery compensates beautifully to repetitive work. Someone who has been laying brick for 20 years burns far less calories than an office worker who suddenly starts laying brick. Take me out of my clinic and ask me to lay brick, roof a house, or dig a ditch and that will get some calories burned up in a hurry! If you work the same muscles in the same way, they become trained and very efficient and then won't burn as many calories as when you first started doing the activity. If you want to shake up your metabolism, work your muscles in new ways by cross-training. If you're walking, try swimming. If you're running, try boxing. If you are cycling, try resistance training. No one activity should ever get to be too easy.

• Add some interval training techniques. Like the world-class athletes, shake up your routine with short bursts of very intense exercise. Try not to amble along at the same pace throughout your entire workout session. Walk 5 minutes and jog for 2 minutes or even 60 seconds. If you're already running, sprint for 30 seconds after every 5 minute jogging interval. Get off your cycle seat and sprint pedal for 30 or 60 seconds once every mile. Intervals not only break up the boredom of a workout, they make each session more exciting and challenging. And they help burn more calories by calling on your muscles and your metabolism to change up..

• Take the long way. You don't need to have gym clothes, sneakers and a sweat band on to get exercise. Use the second-floor bathroom or the copier down the hall. Think of exercise as a bank account, your "calorie bank." The calorie bank is always open. You can make deposits into your account anytime and they don't have to be a 500 calories every time. You can deposit a 100 calories, or 25 calories, whenever the occasion permits. Accumulating physical activity throughout the day, such as walking more and taking the stairs, adds up. Just like "a penny saved is a penny earned," an extra 100 steps five or ten times a day adds up.

Remembers this advice from a veteran: The important thing is to realize how far you've come and to remind yourself every day of your short- and long-term goals. And that's exactly what you should do. Celebrated your victories, didn't dwell on what you think are defeats.

1. Keys A, Brozek J, Kenschel A, Mickelsen O, Taylor HL. The biology of human starvation. Vol 1, Minneapolis: University of Minnesota Press, 1950.
2. Prentice AM, Goldberg GR, Jebb SA, Black AE, Murgatroyd PR. Physiological responses to slimming. Proc Nutr Soc 1991;50:441-58.

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Albright Bariatric Clinic