Tag: Obesity Treatment Strategies

Why Weight Loss Plateaus Happen and How to Break One

On By Dr. Scott RennieIn Weight Loss & Metabolic HealthLeave a comment

Most people losing weight eventually hit a plateau. The number on the scale stops moving, sometimes for weeks, and it can feel like something has gone wrong. Nothing has. Plateaus happen because of biology: at a lower body weight the body burns fewer calories than it used to, and hormones like leptin shift in ways that increase hunger, slow resting metabolism, and make the next five pounds harder to lose than the first fifty.

Handling a plateau matters more than trying to prevent one. In my practice, we look at the medication plan, nutrition, and activity together. Sometimes the answer is moving to a higher dose of semaglutide (Wegovy) or tirzepatide (Zepbound), switching between the two, or starting orforglipron (Foundayo) if a patient hasn’t tried it yet. In my experience two patterns show up most. An early one within the first month, when patients think the medication has stopped working but it’s actually just been started low to help the body adjust rather than to drive weight loss yet. And a later one once someone’s at the highest dose they can tolerate, when exercise drops off and food choices drift back to where they started. Other times the prescription isn’t the issue at all. Small changes in nutrition, like adding more protein, cutting liquid calories, or tightening portions, can make the difference.

Physical activity plays a role too. The National Weight Control Registry has shown that people who keep weight off long term usually exercise about an hour a day. That doesn’t mean a treadmill. Brisk walking, biking, swimming, anything that raises the heart rate consistently, counts, and strength training helps by preserving lean muscle and keeping metabolism steady.

Daily habits matter. People who maintain weight loss tend to eat breakfast every day and weigh themselves regularly. They also tend to watch less television, generally under ten hours a week. None of this is a rigid rulebook. It’s structure, and structure makes it harder to drift back into old patterns.

If you hit a plateau, don’t get discouraged. Treat it as a signal to check in and adjust, not to quit. My first move is usually education, making sure the patient understands what the medication is actually doing and why the scale has stalled. If food noise is still loud after that conversation, I’ll increase the dose or add another medication, but not before we’ve gone back through lifestyle and food choices together. Whatever the starting point, there are proven strategies to get moving again.

Reference: National Weight Control Registry. www.nwcr.ws

Scott Rennie, D.O.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Does Chronic Stress Cause Weight Gain? A Doctor Explains

On By Dr. Scott RennieIn Weight Loss & Metabolic HealthLeave a comment

Obesity gets described as a balance of diet and exercise, and stress plays a far larger role in it than most people are told. I have seen patients who eat well and stay active and still lose ground the moment their stress rises. Research from Dr. Rajita Sinha at Yale explains a good deal of why. Chronic stress produces measurable biological change, well past anything you would call a mood.

Stress acts on the brain circuits governing emotion, motivation, and self-control. Those circuits overlap with the ones handling food reward and craving, particularly for calorie-dense processed food (Sinha et al., 2022). Cortisol climbs under chronic stress. Ghrelin rises with it while leptin falls. What you end up with is a body primed to eat more, in an environment where high-calorie food is always within reach.

Calling that emotional eating undersells it. In Sinha’s lab work, people exposed to stress through guided imagery ate more snack food afterward, and participants who were already overweight were the most affected. Their cravings and calorie intake tracked with measured increases in cortisol and ghrelin. The stress reached past how they felt and changed how their brains and bodies handled food.

The pandemic ran this experiment at national scale. Nearly half of U.S. adults gained weight over that period, with worse effects among people who already had higher BMIs (Khubchandani et al., 2022). Children were not spared; CDC data showed the rate of BMI increase doubling against pre-pandemic years (Lange et al., 2021). The predictors of gain were emotional distress, having children at home, and how long it had been since someone last weighed themselves.

Work outside the pandemic points the same way. In one community study, people with higher baseline cortisol and greater insulin resistance were more likely to gain weight over the following six months (Chao et al., 2017). Those markers did more than correlate with obesity. They predicted it.

That has pushed researchers past the eat-less-move-more framing toward treatments aimed at the stress itself. Mindfulness-based stress reduction lowers food cravings, perceived stress, and blood pressure in people with obesity (Tuit et al., 2011). There is even evidence in parenting: a small study of low-income mothers found mindful parenting reduced parental stress and was associated with healthier BMI outcomes in their children (Jastreboff et al., 2018).

Medical and surgical treatment still matter, and the evidence suggests they perform best alongside strategies that reduce stress reactivity and support executive function. Stress management belongs in the treatment plan rather than tacked onto the end of it.

I have seen patients who feel defeated because they are certain the weight they gained under stress was a personal failure. The science says otherwise. Stress reshapes brain pathways, moves hormone levels, and changes eating behavior in ways we can measure. None of that makes change impossible. It does mean compassion is not optional in this conversation, and that treating stress as part of the disease moves the discussion off blame and onto something we can actually act on.

Scott Rennie, D.O.

References

Sinha R. Chronic Stress and Obesity. Yale School of Medicine, Columbia Obesity ABOM Virtual Course, 2022.

Chao A et al. High Cortisol and Insulin Resistance Predict Weight Gain. Obesity. 2017.

Khubchandani J et al. Depression and Anxiety Predict Weight Gain During the COVID-19 Pandemic. Diabetes & Metabolic Syndrome. 2022.

Lange SJ et al. Body Mass Index Increase in Children During COVID-19. MMWR Morb Mortal Wkly Rep. 2021.

Tuit K et al. Mindfulness and Stress Reduction in Obesity. Appetite. 2011.

Jastreboff AM et al. Mindful Parenting and Childhood Obesity Prevention. Journal of Pediatrics. 2018.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.